| (A) Plan A, B, C, F (including F with a High Deductible),
K, or L, and that is offered and is available for issuance to new
enrollees by the same issuer that issued the individual's Medicare
supplement policy with outpatient prescription drug coverage, for
an individual who first became eligible for Medicare before January
1, 2020; or
(B) Plan A, B, D, G (including G with a High Deductible),
K, or L, and that is offered and is available for issuance to new
enrollees by the same issuer that issued the individual's Medicare
supplement policy with outpatient prescription drug coverage, for
a 2020 newly eligible individual.
(d) Guaranteed issue time period.
(1) In the case of an individual described in subsection
(b)(1) of this section:
(A) for a plan that supplements the benefits under
Medicare, the guaranteed issue period begins on the later of:
(i) the date the individual receives a notice of termination
or cessation of all supplemental health benefits (or, if a notice
is not received, the date the individual receives notice that a claim
has been denied because of the termination or cessation); or
(ii) the date the applicable coverage terminates or
ceases; and ends 63 days later; or
(B) for a plan that is primary to the benefits under
Medicare, the guaranteed issue period begins on the later of:
(i) the date the individual receives a notice of termination
or cessation of all health benefits (or if a notice is not received,
the date the individual receives notice that a claim has been denied
because of the termination or cessation); or
(ii) the date the applicable coverage terminates or
ceases; and ends 63 days later.
(2) In the case of an individual described in subsection
(b)(2), (3), (5), or (6) of this section whose enrollment is terminated
involuntarily, the guaranteed issue period begins on the date that
the individual receives a notice of termination and ends 63 days after
the date the applicable coverage is terminated.
(3) In the case of an individual described in subsection
(b)(4)(A) of this section, the guaranteed issue period begins on the
earlier of the date that the individual receives a notice of termination,
a notice of the issuer's bankruptcy or insolvency, or other such similar
notice, if any, and the date that the applicable coverage is terminated,
and ends on the date that is 63 days after the date the coverage is
terminated.
(4) In the case of an individual described in subsection
(b)(2), (4)(B) and (C), (5), or (6) of this section, who disenrolls
voluntarily, the guaranteed issue period begins on the date that is
60 days before the effective date of the disenrollment and ends on
the date that is 63 days after the effective date of disenrollment.
(5) In the case of an individual described in subsection
(b)(7) of this section, the guaranteed issue period begins on the
date the individual receives notice under §1882(v)(2)(B) of the
Social Security Act from the Medicare supplement issuer during the
60-day period immediately preceding the initial Part D enrollment
period and ends on the date that is 63 days after the effective date
of the individual's coverage under Medicare Part D.
(6) In the case of an individual described in subsection
(b) of this section, but not described in paragraphs (1) - (5) of
this subsection, the guaranteed issue period begins on the effective
date of disenrollment and ends on the date that is 63 days after the
effective date of disenrollment.
(7) In the case of an individual described in subsection
(b)(9) of this section, the guaranteed issue period begins on the
date that the individual's coverage in the Texas Health Insurance
Pool terminates and ends 63 days later.
(e) Extended Medicare supplement access for interrupted
trial periods.
(1) In the case of an individual described in subsection
(b)(5) of this section (or deemed to be so described under this paragraph),
whose enrollment with an organization or provider described in subsection
(b)(5) of this section is involuntarily terminated within the first
12 months of enrollment, and who, without an intervening enrollment,
enrolls with another organization or provider, the subsequent enrollment
will be deemed to be an initial enrollment as described in subsection
(b)(5) of this section.
(2) In the case of an individual described in subsection
(b)(6) of this section (or deemed to be so described under this paragraph),
whose enrollment with a plan or in a program described in subsection
(b)(6) of this section is involuntarily terminated within the first
12 months of enrollment, and who, without an intervening enrollment,
enrolls with another plan or program, the subsequent enrollment will
be deemed to be an initial enrollment as described in subsection (b)(6)
of this section.
(3) For purposes of subsection (b)(5) and (6) of this
section, no enrollment of an individual with an organization or provider
described in subsection (b)(5) of this section, or with a plan or
in a program described in subsection (b)(6) of this section, may be
deemed to be an initial enrollment under this paragraph after the
2-year period beginning on the date on which the individual first
enrolled with the organization, provider, plan, or program.
|
| Source Note: The provisions of this §3.3312 adopted to be effective April 14, 1999, 24 TexReg 3353; amended to be effective February 19, 2001 26 TexReg 1544; amended to be effective April 4, 2002, 27 TexReg 2498; amended to be effective May 10, 2005, 30 TexReg 2669; amended to be effective March 4, 2014, 39 TexReg 1396; amended to be effective June 13, 2018, 43 TexReg 3787 |
