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INSURANCE COMMISSIONER APPROVES SENIOR HEALTH INSURANCE REFORMS

    INSURANCE COMMISSIONER APPROVES SENIOR HEALTH INSURANCE REFORMS
    DOVER, Del., Nov. 10 /PRNewswire/ -- Delaware Insurance Commissioner David N. Levinson today issued new regulations governing the sale of Medicare supplement insurance, the primary health insurance sold to Delaware's senior citizens.
    The new regulations, which take effect Jan. 1, 1992, include requirements that insurers sell only six standard Medicare supplement insurance plans in the state of Delaware; and, that all insurers offer an open enrollment period, during which time newly eligible Medicare beneficiaries cannot be denied Medicare supplement health insurance because they have pre-existing medical conditions.
    In addition, insurance agents must ask consumers direct questions about their eligibility for the state-sponsored Medicaid program and whether or not they already have existing Medicare supplement insurance policies.
    "Senior citizens who qualify for Medicaid benefits," stated Levinson, "may not need Medicare supplement insurance.  And, no one should purchase more than one Medicare supplement insurance policy."
    To discourage the improper sale and replacement of existing policies, Levinson has leveled for seven years the commissions companies pay their agents and brokers.  Additionally, insurance companies must begin to pay policyholder benefits after a waiting period of no more than six months, regardless of the policyholder's health history. Waiting periods do not apply to replacement policies.
    The new regulations mandate that insurance companies which miscalculate premium rates must return those excess premium dollars directly to their policyholders in the form of premium credits for existing policyholders, and cash refunds for former policyholders.
    Levinson promulgated today's reform regulation after meeting with representatives from the department's SOAR (Senior Outreach Advisory Resource) Program to hear their ideas on the proposed changes, and after holding a formal hearing at which comments were made by Delaware's senior citizens and insurance industry representatives.
    All of the consumer protection amendments in the new regulations, such as premium refunds, lifetime coverage, and simplified standards for claims payment, will be extended to current policyholders.
    Of greatest interest to first-time purchasers is the regulation's provision that limits the sales to six standardized Medicare supplement insurance plans.  Insurance companies selling Medicare supplement insurance must offer the basic plan of benefits that covers policyholders for their co-insurance expenses, that portion of the Medicare-approved amount of their medical charges not paid by Medicare. These basic benefits must be included in all other policies sold in Delaware.  Additional plans approved for sale by Levinson have benefits to reimburse for policyholder deductibles, the amount Medicare beneficiaries must pay before Medicare begins to pay medical charges.
    Benefits available in some of the other standard plans are: coverage for the copayment amounts charged when policyholders are receiving treatment in skilled nursing facilities, reimbursement for claims made for treatment received while policyholders are travelling abroad, and the payment of charges submitted by physicians that are more than the Medicare-approved amounts for medical procedures.
    There are three new benefits that will be in some of the plans available for sale.  The first is a preventive medical care benefit that will reimburse policyholders for an annual visit with their doctor to discuss health promotion and receive preventive medicine counseling, flu shots and tests to detect hearing loss, cancer, diabetes and other potential health problems.
    An at-home recovery benefit is included in four of the new standard plans.  This benefit will pay some of the costs not covered by Medicare for short-term, at-home assistance with activities of daily living for those recovering from an illness, injury or sickness.  Services include assistance with bathing, dressing, walking and taking medicine and will be provided by licensed home health care nurses, aides or homemakers.
    The most comprehensive plan includes a prescription drug benefit that will reimburse policyholders up to $3,000 a year after they have met established deductibles and co-insurance payments.
    For more information on how this revised regulation will affect the marketing of Medicare supplement insurance in Delaware, contact a SOAR counselor in your community or call the Insurance Department.  The phone number for area SOAR counselors and the Delaware Insurance Department is 800-282-8611.
    -0-                             11/10/91
    /CONTACT:  David N. Levinson, Delaware Insurance commissioner, 302-739-4251/ CO:  Department of Insurance ST:  Delaware IN:  INS SU: KA-CC -- PHSU001 -- 2825 11/10/91 10:00 EST
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Publication:PR Newswire
Date:Nov 10, 1991
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