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Home » US Law » 2019 US Virgin Islands Code » Title 22 - Insurance » Chapter 56 - Medicare Supplemental Insurance

§ 1451. Definitions

(a) “Applicant” means: (1) In the case of an individual Medicare Supplement policy the person who seeks to contract for insurance benefits; and (2) In the case of a group Medicare Supplement policy the proposed certificate holder. (b) “Certificate” means any certificate delivered or issued for delivery in the Territory under a group Medicare Supplement […]

§ 1452. Applicability and scope

(a) Except as otherwise specifically provided, this chapter shall apply to: (1) All Medicare supplement policies delivered or issued for delivery in this Territory on or after the effective date hereof; and (2) All certificates issued under group Medicare supplement policies, which certificates have been delivered or issued for delivery in this Territory. (b) This […]

§ 1453. Standards for policy provisions and authority to promulgate regulations

(a) No Medicare supplement insurance policy, contract or certificate in force in the Territory shall contain benefits that duplicate benefits provided by Medicare. (b) The Commissioner shall adopt reasonable regulations to establish specific standards for policy provisions of Medicare supplement policies, and certificates, which shall be in addition to and in accordance with applicable laws […]

§ 1454. Prohibited policy provisions

The Commissioner may adopt regulations that specify prohibited policy provisions not otherwise specifically authorized by statute which, in the opinion of the Commissioner, are unjust, unfair or unfairly discriminatory to any person insured or proposed to be insured under a Medicare supplement policy or certificate.

§ 1455. Preexisting condition: denial of claim for losses

Notwithstanding any other provision of law to the contrary, a Medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than six months from the effective date of coverage because it involved a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than a condition […]

§ 1457. Loss ratio standards.

Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The Commissioner shall issue reasonable regulations to establish minimum standards for loss ratios of Medicare supplement policies on the basis of incurred claims experience, or incurred health care expenses where coverage is provided by a health maintenance organization […]

§ 1458. Disclosure standards: outline of coverage

(a) In order to provide for full and fair disclosure of Medicare supplement policies, no Medicare supplement policy shall be delivered or issued for delivery in the Territory, and no certificate shall be delivered pursuant to a group Medicare supplement policy delivered or issued for delivery in the Territory unless an outline of coverage is […]

§ 1459. Notice of free examination

Medicare supplement policies, certificates, shall have a notice prominently printed on the first page of the policy or certificate, or attached thereto, stating in substance that the applicant shall have the right to return the policy or certificate within thirty days of its delivery and to have the premium refunded if, after examination of the […]

§ 1460. Filing requirements for advertising

Every issuer of Medicare supplement insurance, policies or certificates in the Territory shall provide a copy of any Medicare supplement advertisement intended for use in the Territory, whether through written, radio or television medium, to the Commissioner for review or approval by the Commissioner.

§ 1461. Penalties

In addition to any other applicable penalties for violations of this title, the Commissioner may require issuers violating any provision of this chapter, or regulations promulgated pursuant to this chapter, to cease marketing any Medicare supplement policy or certificate in the Territory which is related directly or indirectly to a violation or may require such […]