<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".09-1" citation="COMAR 31.10.06.09-1" title_num="31" subtitle_num="10" chapter_num="06" heading="Guaranteed Issue for Eligible Individuals.">
  <paragraph num="A.">
    <text>Guaranteed Issue.</text>
    <paragraph num="(1)">
      <text>Eligible individuals are those individuals described in §B of this regulation who:</text>
      <paragraph num="(a)">
        <text>Seek to enroll under the policy during the period specified in §C of this regulation; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Submit evidence of the date of termination, disenrollment, or Medicare Part D enrollment with the application for a Medicare supplement policy.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>With respect to eligible individuals, an issuer may not:</text>
      <paragraph num="(a)">
        <text>Deny or condition the issuance or effectiveness of a Medicare supplement policy described in §E of this regulation that is offered and is available for issuance to new enrollees by the issuer;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Discriminate in the pricing of a Medicare supplement policy described in §E of this regulation because of health status, claims experience, receipt of health care, or medical condition; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Impose an exclusion of benefits based on a preexisting condition under a Medicare supplement policy described in §E of this regulation.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>An eligible individual is an individual described in any of the following:</text>
    <paragraph num="(1)">
      <text>The individual is enrolled under an employee welfare benefit plan that provides health benefits that supplement the benefits under Medicare, and the plan terminates or the plan ceases to provide all supplemental health benefits to the individual;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The individual is enrolled with a Medicare Advantage organization under a Medicare Advantage plan under Part C of Medicare, and any of the following circumstances apply:</text>
      <paragraph num="(a)">
        <text>The certification of the organization or plan under the federal Social Security Act has been terminated;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The organization has terminated or otherwise discontinued providing the plan in the area in which the individual resides;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The individual is no longer eligible to elect the plan because:</text>
        <paragraph num="(i)">
          <text>Of a change in the individual's place of residence,</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Of another change in circumstances specified by the Secretary, but not including termination of the individual's enrollment on the basis described in §1851(g)(3)(B) of the federal Social Security Act (when the individual has not paid premiums on a timely basis or has engaged in disruptive behavior as specified in standards under §1856 of the federal Social Security Act), or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>The plan is terminated for all individuals within a residence area;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(d)">
        <text>The individual demonstrates, in accordance with guidelines established by the Secretary, that:</text>
        <paragraph num="(i)">
          <text>The organization offering the plan substantially violated a material provision of the organization's contract under Part C of Medicare in relation to the individual, including the failure to provide an enrollee on a timely basis medically necessary care for which benefits are available under the plan or the failure to provide medically necessary covered care in accordance with applicable quality standards, or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The organization, or agent or other entity acting on the organization's behalf, materially misrepresented the plan's provisions in marketing the plan to the individual; or</text>
        </paragraph>
      </paragraph>
      <paragraph num="(e)">
        <text>The individual meets any other exceptional conditions as the Secretary may provide;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The individual is 65 years old or older and is enrolled with a Program of All-Inclusive Care for the Elderly (PACE) provider under §1894 of the Social Security Act, and there are circumstances similar to those described in §B(2) of this regulation that would permit discontinuance of the individual's enrollment with the PACE provider if the individual were enrolled in a Medicare Advantage plan;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The individual:</text>
      <paragraph num="(a)">
        <text>Is enrolled with:</text>
        <paragraph num="(i)">
          <text>An eligible organization under a contract under §1876 of the federal Social Security Act (Medicare cost),</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A similar organization to the organization described in §B(4)(a)(i) of this regulation operating under demonstration project authority, effective for periods before April 1, 1999,</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>An organization under an agreement under §1833(a)(1)(A) of the federal Social Security Act (health care prepayment plan), or</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>An organization under a Medicare Select policy; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Ceases to be enrolled under the same circumstances that would permit discontinuance of an individual's election of coverage under §B(2) of this regulation;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>The individual is enrolled under a Medicare supplement policy and the enrollment ceases because of:</text>
      <paragraph num="(a)">
        <text>The insolvency of the issuer or bankruptcy of the nonissuer organization or other involuntary termination of coverage or enrollment under the policy;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The issuer of the policy substantially violated a material provision of the policy; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The issuer, or an agent or other entity acting on the issuer's behalf, materially misrepresented the policy's provisions in marketing the policy to the individual;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>The individual:</text>
      <paragraph num="(a)">
        <text>Was enrolled under a Medicare supplement policy and terminates enrollment and subsequently enrolls, for the first time with:</text>
        <paragraph num="(i)">
          <text>Any Medicare Advantage organization under a Medicare Advantage plan under Part C of Medicare,</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Any eligible organization under a contract under §1876 of the federal Social Security Act (Medicare cost),</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Any similar organization operating under demonstration project authority,</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>A Medicare Select policy, or</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Any Program of All-Inclusive Care for the Elderly (PACE) provider under §1894 of the Social Security Act; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Terminates the subsequent enrollment under §B(6)(a) of this regulation during any period within the first 12 months of the subsequent enrollment (during which the enrollee is permitted to terminate the subsequent enrollment under §1851(e) of the federal Social Security Act);</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>The individual, upon first becoming enrolled in Part B of Medicare at 65 years old or older, enrolls in a Medicare Advantage plan under Part C of Medicare, or with a PACE provider under §1894 of the Social Security Act, and disenrolls from the plan or program by not later than 12 months after the effective date of enrollment; or</text>
    </paragraph>
    <paragraph num="(8)">
      <text>The individual:</text>
      <paragraph num="(a)">
        <text>Enrolls in a Medicare Part D plan during the initial enrollment period;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>At the time of enrollment in Part D:</text>
        <paragraph num="(i)">
          <text>Was enrolled under a Medicare supplement policy that covers outpatient prescription drugs; and</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Terminates enrollment in the Medicare supplement policy described in §B(8)(b)(i) of this regulation; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Submits evidence of enrollment in Medicare Part D with the application for a policy described in §E(5) of this regulation.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Guaranteed Issue Time Periods.</text>
    <paragraph num="(1)">
      <text>The guaranteed issue period for an individual described in §B(1) of this regulation:</text>
      <paragraph num="(a)">
        <text>Begins on the later of the date:</text>
        <paragraph num="(i)">
          <text>The individual receives a notice of termination or cessation of all supplemental health benefits, or, if the individual does not receive the notice, the date the individual receives notice that a claim has been denied because of a termination or cessation of all supplemental health benefits; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The applicable coverage terminates or ceases; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Ends 63 days after the beginning of the period described in §C(1)(a) of this regulation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The guaranteed issue period for an individual described in §B(2)—(4), (6), or (7) of this regulation whose enrollment is terminated involuntarily:</text>
      <paragraph num="(a)">
        <text>Begins on the date that the individual receives a notice of termination; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Ends 63 days after the date the applicable coverage is terminated.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>The guaranteed issue period for an individual described in §B(5)(a) of this regulation:</text>
      <paragraph num="(a)">
        <text>Begins on the earlier of:</text>
        <paragraph num="(i)">
          <text>The date that the individual receives a notice of termination, a notice of the issuer's bankruptcy or insolvency, or other similar notice, if any; or</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The date that the applicable coverage is terminated; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Ends on the date that is 63 days after the date the coverage is terminated.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>The guaranteed issue period for an individual described in §B(2), (3), (5)(b), (5)(c), (6), or (7) of this regulation, who disenrolls voluntarily:</text>
      <paragraph num="(a)">
        <text>Begins on the date that is 60 days before the effective date of the disenrollment; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Ends on the date that is 63 days after the effective date.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>The guaranteed issue period for an individual described in §B(8) of this regulation:</text>
      <paragraph num="(a)">
        <text>Begins on the date the individual receives notice pursuant to §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</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Ends on the date that is 63 days after the effective date of the individual's coverage under Medicare Part D.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>The guaranteed issue period for an individual described in §B of this regulation but not described in §C(1)—(5) of this regulation:</text>
      <paragraph num="(a)">
        <text>Begins on the effective date of disenrollment; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Ends on the date that is 63 days after the effective date of disenrollment.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Extended Medigap Access for Interrupted Trial Periods.</text>
    <paragraph num="(1)">
      <text>A subsequent enrollment of an individual described in §B(6) of this regulation shall be deemed to be a first time enrollment described in §B(6) of this regulation if both of the following are satisfied:</text>
      <paragraph num="(a)">
        <text>The individual's enrollment with an organization or provider described in §B(6)(a) of this regulation is involuntarily terminated within the first 12 months of enrollment; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The individual enrolls with another organization or provider described in §B(6)(a) of this regulation without an intervening enrollment.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A subsequent enrollment of an individual described in §B(7) of this regulation shall be deemed to be a first time enrollment described in §B(7) of this regulation if both of the following are satisfied:</text>
      <paragraph num="(a)">
        <text>The individual's enrollment with a plan or in a program described in §B(7) of this regulation is involuntarily terminated within the first 12 months of enrollment; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The individual enrolls in another plan or program described in §B(7) of this regulation, without an intervening enrollment.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>For purposes of §B(6) and (7) of this regulation, an enrollment of an individual with an organization or provider described in §B(6)(a) of this regulation, or with a plan or in a program described in §B(7) of this regulation, may not be deemed to be a first time enrollment under this section after the 2-year period beginning on the date on which the individual first enrolled with the organization, provider, plan, or program.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>Products to Which Eligible Individuals Are Entitled. The Medicare supplement policy to which eligible individuals are entitled under:</text>
    <paragraph num="(1)">
      <text>§B(1)—(5) of this regulation is a Medicare supplement policy which has a benefit package classified as plan A, B, C, F, including F with a high deductible, K, or L offered by any issuer;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Subject to §E(3) of this regulation, §B(6) of this regulation is the same Medicare supplement policy in which the individual was most recently previously enrolled, if available from the same issuer, or, if not so available, a policy described in §E(1) of this regulation;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>§B(6) of this regulation after December 31, 2005, if the individual was most recently enrolled in a Medicare supplement policy with an outpatient prescription drug benefit, a Medicare supplement policy described in this subsection is:</text>
      <paragraph num="(a)">
        <text>The policy available from the same issuer but modified to remove outpatient prescription drug coverage; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>At the election of the policyholder, an A, B, C, F, including F with a high deductible, K, or L policy that is offered by any issuer;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>§B(7) of this regulation shall include any Medicare supplement policy offered by any issuer; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>§B(8) of this regulation is a Medicare supplement policy that has a benefit package classified as 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.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Notification Provisions.</text>
    <paragraph num="(1)">
      <text>At the time of an event described in §B of this regulation because of which an individual loses coverage or benefits due to the termination of a contract or agreement, policy, or plan, the organization that terminates the contract or agreement, the issuer terminating the policy, or the administrator of the plan being terminated, respectively, shall notify the individual of the individual's rights under this section, and of the obligations of issuers of Medicare supplement policies under §A of this regulation.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The notice required by §F(1) of this regulation shall be communicated contemporaneously with the notification of termination.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>At the time of an event described in §B of this regulation because of which an individual ceases enrollment under a contract or agreement, policy, or plan, the organization that offers the contract or agreement, regardless of the basis for the cessation of enrollment, the issuer offering the policy, or the administrator of the plan, respectively, shall notify the individual of the individual's rights under this section, and of the obligations of issuers of Medicare supplement policies under §A of this regulation.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The notice required by §F(3) of this regulation shall be communicated within 10 working days of the issuer receiving notification of disenrollment.</text>
    </paragraph>
  </paragraph>
</regulation>