Cal. Ins. Code § 10192.6

Current through the 2024 Legislative Session.
Section 10192.6 - Limitations or exclusions; use of waivers; duplicate benefits; outpatient prescription drugs
(a) Except for permitted preexisting condition clauses as described in Sections 10192.7, 10192.8, and 10192.81, a policy or certificate shall not be advertised, solicited, or issued for delivery as a Medicare supplement policy if the policy or certificate contains limitations or exclusions on coverage that are more restrictive than those of Medicare.
(b) A Medicare supplement policy or certificate shall not use waivers to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions.
(c) A Medicare supplement policy or certificate in force shall not contain benefits that duplicate benefits provided by Medicare.
(d)
(1) Subject to paragraphs (4) and (5) of subdivision (a) of Section 10192.8, a Medicare supplement policy with benefits for outpatient prescription drugs that was issued prior to January 1, 2006, shall be renewed for current policyholders, at the option of the policyholder, who do not enroll in Medicare Part D.
(2) A Medicare supplement policy with benefits for outpatient prescription drugs shall not be issued on and after January 1, 2006.
(3) On and after January 1, 2006, a Medicare supplement policy with benefits for outpatient prescription drugs shall not be renewed after the policyholder enrolls in Medicare Part D unless both of the following conditions exist:
(A) The policy is modified to eliminate outpatient prescription drug coverage for outpatient prescription drug expenses incurred after the effective date of the individual's coverage under a Medicare Part D plan.
(B) The premium is adjusted to reflect the elimination of outpatient prescription drug coverage at the time of enrollment in Medicare Part D, accounting for any claims paid if applicable.

Ca. Ins. Code § 10192.6

Amended by Stats 2009 ch 10 (AB 1543),s 16, eff. 7/2/2009.
Amended by Stats 2005 ch 206 (SB 375),s 19, eff. 1/1/2006
Added by Stats 2000 ch 706 (SB 764), s 4, eff. 1/1/2001.