Written comments on the proposed rule received at the above address no later than Wednesday, November 13, 2002, will be given the same consideration as testimony presented at the hearing.
Fiscal Estimate
The rule will not result in additional workload. Therefore, there is no cost to the state resulting from these rule changes.
Initial Regulatory Flexibility Analysis
The rule changes will not affect small businesses as “small business" is defined in s.
227.114 (1) (a), Stats.
Notice of Hearing
Notice is hereby given that pursuant to the authority granted under s.
601.41 (3), Stats., and the procedure set forth in under s.
227.18, Stats., OCI will hold a public hearing to consider the adoption of the attached proposed rulemaking order affecting s.
Ins 3.39, Wis. Adm. Code, relating to Medicare supplement insurance.
Hearing Information
Date: November 7, 2002
Time: 10:30 a.m.
or as soon thereafter as the matter may be reached
Place: Room 23, OCI,
121 East Wilson St.
Madison, WI
Written comments on the proposed rule will be accepted into the record and receive the same consideration as testimony presented at the hearing if they are received at OCI within 14 days following the date of the hearing. Written comments should be addressed to: Julie E. Walsh, OCI, PO Box 7873, Madison WI 53707
Summary of Fiscal Estimate
There will be no state or local government fiscal effect.
Analysis Prepared by the Office of the Commissioner of Insurance
Due to changes in federal law as a result of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act (“BIPA"), amendments are necessary in order that Wisconsin Medicare supplement insurance regulation is in compliance with the national association of insurance commissioners (“NAIC") Medicare supplement insurance minimum standards model act modifications.
Under the previous federal law and model act a potential timing gap was created such that persons who were provided notice of cessation or termination of employee welfare benefit plans in excess of 63 days were put in an untenable position of withdrawing early from the employee welfare benefit plan that may have attractive insurance features (such as more comprehensive coverage) and switch to the Medigap policy so not to risk losing their guaranteed issue rights as they are unable to simultaneously keep a Medigap application current or delay the effective date of the policy beyond the 63 day window. The modifications to BIPA and the NAIC model act, and regulation and as reflected in the changes made to s. INS 3.39, altered time periods to provide the broadest application of when and how the guaranteed issue period is triggered and calculated for eligible persons as defined within s.
Ins 3.39 (34) (b) to alleviate most of the potential problems.
Specifically, s.
Ins 3.39 (34) (c), as newly created, provides that the guaranteed issue period for persons enrolled in an employee welfare benefit plan begins on the later of two dates; the date the individual receives a notice of termination or cessation of all supplemental health benefits and ends 63 days after the date of termination of the coverage. Or, if the individual was not directly notified, the date the individual received notice that a claim has been denied because the plan terminated or ceased offering insurance and ends 63 days after the date of the actual notice of the denied claim.
Section Ins 3.39 (34) (b), describes several additional distinct groups of persons who may be eligible for guaranteed issue of Medicare supplement or Medigap coverage. Several subsections within s. Ins 3.39 (34) (b) were modified slightly without significant changes. Modifications made to s. Ins 3.39 (34) (c) reference the different groups of eligible persons and specific situations that then trigger guaranteed issue rights and provides time periods specific to each situation.
Modifications were also made for extended Medicare supplement insurance guaranteed issue as a result of interrupted trial periods. Section Ins 3.39 (34) (d), describes the circumstances of how and when such an extension is applicable for eligible persons who had a Medicare supplement policy and subsequently enrolled, for the first time, in a Medicare + Choice or other described plan under s. Ins 3.39 (34) (b) 5. and 6., the manner in which the guaranteed issue period of time will be treated.
Other modifications made in this proposed rule include clarification of eligible expenses that are to include outpatient services paid under the prospective payment system and correcting references to Medicare supplement insurance and federal provisions.
Initial Regulatory Flexibility Analysis
This rule does not impose any additional requirements on small businesses.
Contact Person
Inger Williams, Services Section
Office of the Commissioner of Insurance
(608) 264-8110
or at
121 East Wilson Street
PO Box 7873
Madison WI 53707-7873
