*State variations apply. Discount not available in HI, ID, MN, and VT. For residents of WA, the discount is referred to as Spousal Premium Discount, and only applies to spouses. Discount percentage varies by state. 1 After the Part B Deductible has been met. 2 Insured by Cigna Health and Life Insurance Company, American Retirement Life Insurance Company, Loyal American Life Insurance Company or Cigna National Health Insurance Company. In Kansas, insured by Cigna National Life Insurance Company, Cigna Health and Life Insurance Company and Loyal American Life Insurance Company. American Retirement Life Insurance Company is not available to residents of Kansas. In Pennsylvania, Maryland North Carolina and Utah, insured by Cigna National Health Insurance Company domiciled in Ohio. In New Mexico, Idaho and Ohio, insured by Cigna Health and Life Insurance Company View State Disclosures, Exclusions, and Limitations View Kansas disclosures, exclusions, and limitations Notice for persons eligible for Medicare because of disability: In the following states, all Medicare Supplement plans are available to persons eligible for Medicare because of disability: California, Colorado, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Kansas, Kentucky, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, New Hampshire, Oregon, Pennsylvania, South Dakota, Tennessee, Vermont, and Wisconsin. Tennessee Medicare Supplement Policy Forms Plan A: CNHIC-MS-AA-A-TN; Plan F: CNHIC-MS-AA-F-TN; Plan G: CNHIC-MS-AA-G-TN; Plan N: CNHIC-MS-AA-N-TN. 2007—Subsec. (r)(5). Pub. L. 110–161 substituted “The Secretary may” for “(A) The Comptroller General shall periodically, not less often than once every 3 years,” and struck out “and to the Secretary” after “State involved” and subpar. (B) which read as follows: “The Secretary may independently perform such compliance audits.” 2003—Subsec. (d)(3)(A)(i)(II). Pub. L. 108–173, § 736(e)(1), substituted “plan, a medicare supplemental policy” for “plan a medicare supplemental policy”. Subsec. (d)(3)(B)(iii)(II). Pub. L. 108–173, § 736(e)(2), substituted “to the best of the issuer’s or seller’s knowledge” for “to the best of the issuer or seller’s knowledge”. Subsec. (g)(1). Pub. L. 108–173, § 104(b)(2)(A), inserted “a prescription drug plan under part D or” after “but does not include”. Subsec. (g)(2)(A). Pub. L. 108–173, § 736(e)(3), substituted “medicare supplemental policies” for “medicare supplement policies”. Subsec. (o)(1). Pub. L. 108–173, § 104(b)(2)(B), substituted “subsections (p), (v), and (w)” for “subsection (p)”. Subsec. (p)(2)(B). Pub. L. 108–173, § 736(e)(4), substituted “; and” for “, and” at end. Subsec. (s)(3)(A)(iii). Pub. L. 108–173, § 736(e)(5), substituted “preexisting” for “pre-existing”. Subsec. (s)(3)(C)(ii). Pub. L. 108–173, § 104(a)(2)(A), designated existing provisions as subcl. (I), substituted “Subject to subclause (II), only” for “Only”, and added subcl. (II). Subsec. (s)(3)(C)(iii). Pub. L. 108–173, § 104(a)(2)(B), inserted “and subject to subsection (v)(1)” after “subparagraph (B)(vi)”. Subsec. (v). Pub. L. 108–173, § 104(a)(1), added subsec. (v). Subsec. (w). Pub. L. 108–173, § 104(b)(1), added subsec. (w). 2000—Subsec. (s)(3)(A). Pub. L. 106–554, § 1(a)(6) [title VI, § 618(a)(1)], in concluding provisions, substituted “seeks to enroll under the policy during the period specified in subparagraph (E)” for “, subject to subparagraph (E), seeks to enroll under the policy not later than 63 days after the date of the termination of enrollment described in such subparagraph”. Subsec. (s)(3)(E). Pub. L. 106–554, § 1(a)(6) [title VI, § 618(a)(2)], added subpar. (E) and struck out former subpar. (E) which read as follows: “(E)(i) An individual described in subparagraph (B)(ii) may elect to apply subparagraph (A) by substituting, for the date of termination of enrollment, the date on which the individual was notified by the Medicare+Choice organization of the impending termination or discontinuance of the Medicare+Choice plan it offers in the area in which the individual resides, but only if the individual disenrolls from the plan as a result of such notification. “(ii) In the case of an individual making such an election, the issuer involved shall accept the application of the individual submitted before the date of termination of enrollment, but the coverage under subparagraph (A) shall only become effective upon termination of coverage under the Medicare+Choice plan involved.” Subsec. (s)(3)(F). Pub. L. 106–554, § 1(a)(6) [title VI, § 618(b)], added subpar. (F). 1999—Subsec. (g)(1). Pub. L. 106–113, § 1000(a)(6) [title III, § 321(k)(13)], struck out “or” after “; but does not include”. Subsec. (q)(5)(C). Pub. L. 106–170, § 205(a)(1), inserted “or paragraph (6)” after “this paragraph”. Subsec. (q)(6). Pub. L. 106–170, § 205(a)(2), added par. (6). Subsec. (s)(2)(D). Pub. L. 106–113, § 1000(a)(6) [title III, § 321(k)(14)], inserted “section” after “(as defined in” in introductory provisions. Subsec. (s)(3)(A). Pub. L. 106–113, § 1000(a)(6) [title V, § 501(a)(2)(A)], inserted “, subject to subparagraph (E),” after “in the case of an individual described in subparagraph (B) who” in concluding provisions. Subsec. (s)(3)(B)(ii). Pub. L. 106–113, § 1000(a)(6) [title V, § 536(a)(1)], inserted before period at end “or the individual is 65 years of age or older and is enrolled with a PACE provider under section 1395eee of this title, and there are circumstances that would permit the discontinuance of the individual’s enrollment with such provider under circumstances that are similar to the circumstances that would permit discontinuance of the individual’s election under the first sentence of such section if such individual were enrolled in a Medicare+Choice plan”. Subsec. (s)(3)(B)(v)(II). Pub. L. 106–113, § 1000(a)(6) [title V, § 536(a)(2)], inserted “any PACE provider under section 1395eee of this title,” after “demonstration project authority,”. Subsec. (s)(3)(B)(vi). Pub. L. 106–113, § 1000(a)(6) [title V, § 536(a)(3)], inserted “or in a PACE program under section 1395eee of this title” after “part C” and substituted “such plan or such program” for “such plan”. Subsec. (s)(3)(E). Pub. L. 106–113, § 1000(a)(6) [title V, § 501(a)(2)(B)], added subpar. (E). 1998—Subsec. (l)(6). Pub. L. 105–362 struck out par. (6) which read as follows: “The Secretary shall report to the Congress in March 1989 and in July 1990 on actions States have taken in adopting standards equal to or more stringent than the NAIC Model Transition Regulation or the amended NAIC Model Regulation (or Federal model standards).” 1997—Subsec. (d)(3)(A)(i). Pub. L. 105–33, § 4003(a)(1)(A), inserted “(including an individual electing a Medicare+Choice plan under section 1395w–21 of this title)” after “part B of this subchapter” in introductory provisions. Subsec. (d)(3)(A)(i)(II). Pub. L. 105–33, § 4003(a)(1)(B), inserted “in the case of an individual not electing a Medicare+Choice plan” after “(II)” and inserted “or in the case of an individual electing a Medicare+Choice plan, a medicare supplemental policy with knowledge that the policy duplicates health benefits to which the individual is otherwise entitled under the Medicare+ÐChoice plan or under another medicare supplemental policy” before comma at end. Subsec. (d)(3)(A)(vi)(III). Pub. L. 105–33, § 4031(c), inserted “, a policy described in clause (v),” after “Medicare supplemental policy”. Subsec. (d)(3)(B)(i)(I). Pub. L. 105–33, § 4003(a)(2), inserted “(including any Medicare+Choice plan)” after “health insurance policies”. Subsec. (g)(1). Pub. L. 105–33, § 4003(a)(3), inserted “or a Medicare+Choice plan or” after “does not include” the first place appearing. Subsec. (p)(2)(C). Pub. L. 105–33, § 4032(a)(1), inserted before period at end “plus the 2 plans described in paragraph (11)(A)”. Subsec. (p)(11). Pub. L. 105–33, § 4032(a)(2), added par. (11). Subsec. (s)(2)(B). Pub. L. 105–33, § 4031(b)(1), substituted “subparagraphs (C) and (D)” for “subparagraph (C)”. Subsec. (s)(2)(D). Pub. L. 105–33, § 4031(b)(2), added subpar. (D). Subsec. (s)(3). Pub. L. 105–33, § 4031(a)(3), added par. (3). Former par. (3) redesignated (4). Pub. L. 105–33, § 4031(a)(1), (2), substituted “requirements of this subsection” for “requirements of paragraphs (1) and (2)” and redesignated par. (3) as (4). Subsec. (s)(4). Pub. L. 105–33, § 4031(a)(2), redesignated par. (3) as (4). Subsec. (u). Pub. L. 105–33, § 4003(b), added subsec. (u). 1996—Subsec. (d)(3)(A)(iii). Pub. L. 104–191, § 271(a)(1), substituted “clause (i)(II)” for “clause (i)”. Subsec. (d)(3)(A)(iv) to (viii). Pub. L. 104–191, § 271(a)(2), added cls. (iv) to (viii). Subsec. (d)(3)(C). Pub. L. 104–191, § 271(b)(1), substituted “with respect to” for “with respect to (i)” and struck out before period at end “, (ii) the sale or issuance of a policy or plan described in subparagraph (A)(i)(I) (other than a medicare supplemental policy to an individual entitled to any medical assistance under subchapter XIX of this chapter) under which all the benefits are fully payable directly to or on behalf of the individual without regard to other health benefit coverage of the individual but only if (for policies sold or issued more than 60 days after the date the statements are published or promulgated under subparagraph (D)) there is disclosed in a prominent manner as part of (or together with) the application the applicable statement (specified under subparagraph (D)) of the extent to which benefits payable under the policy or plan duplicate benefits under this subchapter, or (iii) the sale or issuance of a policy or plan described in subparagraph (A)(i)(III) under which all the benefits are fully payable directly to or on behalf of the individual without regard to other health benefit coverage of the individual”. Subsec. (d)(3)(D). Pub. L. 104–191, § 271(b)(2), struck out subpar. (D) which provided for development of statements for various types of health insurance policies sold or issued to persons entitled to health benefits under this subchapter regarding extent to which benefits payable under those policies duplicate benefits under this subchapter. 1994—Subsec. (a)(2). Pub. L. 103–432, § 171(c)(1)(B), in closing provisions substituted “on and after the effective date specified in subsection (p)(1)(C)” for “after the effective date of the NAIC or Federal standards with respect to the policy”. Subsec. (a)(2)(A). Pub. L. 103–432, § 171(c)(1)(A), substituted “1991 NAIC Model Regulation or 1991 Federal Regulation” for “NAIC standards or the Federal standards”. Subsec. (b)(1). Pub. L. 103–432, § 171(e)(2), substituted “subparagraph (F)” for “subsection (F)” in last sentence. Pub. L. 103–432, § 171(c)(4), substituted “the Secretary determines” for “the the Secretary determines” in introductory provisions. Pub. L. 103–432, § 171(c)(2), in last sentence substituted “Each report” for “The report”, “fail to meet the standards and requirements” for “fail to meet the standards”, “compliance, information regarding” for “compliance, and information regarding”, and “Commissioners may specify” for “Commissioners, may specify”. Subsecs. (b)(1)(B), (c)(5). Pub. L. 103–432, § 171(a)(1), made technical amendment to Pub. L. 101–508, § 4351. See 1990 Amendment notes below. Subsec. (d)(3)(A). Pub. L. 103–432, § 171(d)(1)(D), struck out at end “This subsection shall not apply to such a seller until such date as the Secretary publishes a list of the standardized benefit packages that may be offered consistent with subsection (p) of this section.” Pub. L. 103–432, § 171(d)(1)(C), designated third sentence as cl. (iii), substituted “clause (i) with respect to the sale of a medicare supplemental policy” for “the previous sentence”, and struck out “and the statement under such subparagraph indicates on its face that the sale of the policy will not duplicate health benefits to which the individual is otherwise entitled” after “compliance with subparagraph (B)”. Pub. L. 103–432, § 171(d)(1)(B), designated second sentence as cl. (ii) and substituted “Whoever violates clause (i)” for “Whoever violates the previous sentence”. Pub. L. 103–432, § 171(d)(1)(A), designated first sentence as cl. (i) and amended it generally. Prior to amendment, first sentence read as follows: “It is unlawful for a person to sell or issue a health insurance policy to an individual entitled to benefits under part A of this subchapter or enrolled under part B of this subchapter, with knowledge that such policy duplicates health benefits to which such individual is otherwise entitled, other than benefits to which he is entitled under a requirement of State or Federal law (other than this subchapter or subchapter XIX of this chapter).” Subsec. (d)(3)(B)(ii)(II). Pub. L. 103–432, § 171(d)(2)(A), struck out “65 years of age or older” before “may be eligible”. Subsec. (d)(3)(B)(iii)(I). Pub. L. 103–432, § 171(d)(2)(B), (C), substituted “has a medicare supplemental policy” for “has another medicare supplemental policy” and “sale of a medicare supplemental policy” for “sale of such a policy”. Subsec. (d)(3)(B)(iii)(II). Pub. L. 103–432, § 171(d)(2)(D), substituted “has a medicare supplemental policy” for “has another policy”. Subsec. (d)(3)(B)(iii)(III). Pub. L. 103–432, § 171(d)(2)(E), amended subcl. (III) generally. Prior to amendment, subcl. (III) read as follows: “Subclause (I) also shall not apply if a State medicaid plan under subchapter XIX of this chapter pays the premiums for the policy, or pays less than an individual’s (who is described in ) full liability for medicare cost sharing as defined in .” Subsec. (d)(3)(C). Pub. L. 103–432, § 171(d)(3)(A), substituted “(i) the sale or issuance of a group policy” for “the selling of a group policy” and added cls. (ii) and (iii). Subsec. (d)(3)(D). Pub. L. 103–432, § 171(d)(3)(B), added subpar. (D). Subsec. (d)(4)(D). Pub. L. 103–432, § 171(k)(1), struck out before period at end “, if such policy expires not more than 12 months after the date on which the duplicate copy is mailed”. Subsec. (d)(4)(E). Pub. L. 103–432, § 171(k)(2), added subpar. (E). Subsec. (f)(3). Pub. L. 103–432, § 171(j)(2), added par. (3). Subsec. (g)(2)(B). Pub. L. 103–432, § 171(c)(3), substituted “Secretary” for “Panel”. Subsec. (o). Pub. L. 103–432, § 171(a)(1), made technical amendment to Pub. L. 101–508, § 4351. See 1990 Amendment note below. Subsec. (p). Pub. L. 103–432, § 171(a)(1), made technical amendment to Pub. L. 101–508, § 4351. See 1990 Amendment note below. Subsec. (p)(1)(A). Pub. L. 103–432, § 171(a)(2)(A), in introductory provisions, substituted “changes the revised NAIC Model Regulation (described in subsection (m)) to incorporate” for “promulgates”, and in closing provisions, struck out “(such limitations, language, definitions, format, and standards referred to collectively in this subsection as ‘NAIC standards’),” before “subsection (g)(2)(A)” and substituted “were a reference to the revised NAIC Model Regulation as changed under this subparagraph (such changed regulation referred to in this section as the ‘1991 NAIC Model Regulation’)” for “included a reference to the NAIC standards”. Subsec. (p)(1)(B). Pub. L. 103–432, § 171(a)(2)(B), substituted “make the changes in the revised NAIC Model Regulation” for “promulgate NAIC standards”, “a regulation” for “limitations, language, definitions, format, and standards described in clauses (i) through (iv) of such subparagraph (in this subsection referred to collectively as ‘Federal standards’)”, and “were a reference to the revised NAIC Model Regulation as changed by the Secretary under this subparagraph (such changed regulation referred to in this section as the ‘1991 Federal Regulation’)” for “included a reference to the Federal standards”. Subsec. (p)(1)(C)(i). Pub. L. 103–432, § 171(a)(2)(C), substituted “1991 NAIC Model Regulation or 1991 Federal Regulation” for “NAIC standards or the Federal standards”. Subsec. (p)(1)(C)(ii)(I), (E). Pub. L. 103–432, § 171(a)(2)(D), substituted “1991 NAIC Model Regulation or 1991 Federal Regulation” for “NAIC or Federal standards”. Subsec. (p)(2). Pub. L. 103–432, § 171(a)(2)(D), substituted “1991 NAIC Model Regulation or 1991 Federal Regulation” for “NAIC or Federal standards” in introductory provisions. Subsec. (p)(2)(C). Pub. L. 103–432, § 171(a)(2)(E), substituted “paragraph (4)(B)” for “paragraph (5)(B)”. Subsec. (p)(4). Pub. L. 103–432, § 171(a)(2)(G), substituted “applicable 1991 NAIC Model Regulation or 1991 Federal Regulation” for “applicable standards” wherever appearing. Subsec. (p)(4)(A)(i). Pub. L. 103–432, § 171(a)(2)(F), inserted “or paragraph (6)” after “subparagraph (B)”. Subsec. (p)(6). Pub. L. 103–432, § 171(a)(2)(H), substituted “described in clauses (i) through (iii) of paragraph (1)(A)” for “in regard to the limitation of benefits described in paragraph (4)”. Subsec. (p)(7). Pub. L. 103–432, § 171(a)(2)(I), substituted “policyholders” for “policyholder”. Subsec. (p)(8). Pub. L. 103–432, § 171(a)(2)(J), substituted “on and after the effective date specified in paragraph (1)(C) (but subject to paragraph (10)), in violation of the applicable 1991 NAIC Model Regulation or 1991 Federal Regulation insofar as such regulation relates to the requirements of subsection (o) or (q) or clause (i), (ii), or (iii) of paragraph (1)(A)” for “after the effective date of the NAIC or Federal standards with respect to the policy, in violation of the previous requirements of this subsection”. Subsec. (p)(9)(B). Pub. L. 103–432, § 171(a)(2)(D), substituted “1991 NAIC Model Regulation or 1991 Federal Regulation” for “NAIC or Federal standards”. Subsec. (p)(9)(D). Pub. L. 103–432, § 171(a)(2)(K), added subpar. (D). Subsec. (p)(10). Pub. L. 103–432, § 171(a)(2)(L), substituted “consistent with paragraph (1)(A)(i)” for “consistent with this subsection”. Subsec. (q)(2). Pub. L. 103–432, § 171(b)(1), substituted “paragraph (4)” for “paragraph (2)”. Subsec. (q)(4). Pub. L. 103–432, § 171(b)(2), substituted “issuer of the replacement policy” for “the succeeding issuer”. Subsec. (q)(5)(A), (B). Pub. L. 103–432, § 171(d)(4), made technical amendment to the reference to subchapter XIX of this chapter to correct reference to corresponding provision of original act. Subsec. (r)(1). Pub. L. 103–432, § 171(e)(1)(A), (E), in introductory provisions substituted “or renewed (or otherwise provide coverage after the date described in subsection (p)(1)(C))” for “or sold” and inserted at end of closing provisions “For the purpose of calculating the refund or credit required under paragraph (1)(B) for a policy issued before the date specified in subsection (p)(1)(C), the refund or credit calculation shall be based on the aggregate benefits provided and premiums collected under all such policies issued by an insurer in a State (separated as to individual and group policies) and shall be based only on aggregate benefits provided and premiums collected under such policies after the date specified in section 171(m)(4) of the Social Security Act Amendments of 1994.” Subsec. (r)(1)(A). Pub. L. 103–432, § 171(e)(1)(C), substituted “Commissioners)” for “Commissioners,”. Pub. L. 103–432, § 171(e)(1)(B), inserted “for periods after the effective date of these provisions” after “the policy can be expected”. Subsec. (r)(1)(B). Pub. L. 103–432, § 171(e)(1)(D), inserted before period at end “, treating policies of the same type as a single policy for each standard package”. Subsec. (r)(2)(A). Pub. L. 103–432, § 171(e)(1)(F)–(I), substituted “by standard package” for “by policy number” in first sentence and “until 12 months following issue” for “with respect to the first 2 years in which it is in effect” in second sentence, struck out “in order to apply paragraph (1)(B) to the first 2 years in which policies are effective” after “may be appropriate” in third sentence, and inserted at end “In the case of a policy issued before the date specified in subsection (p)(1)(C), paragraph (1)(B) shall not apply until 1 year after the date specified in section 171(m)(4) of the Social Security Act Amendments of 1994.” Subsec. (r)(2)(C), (D). Pub. L. 103–432, § 171(e)(1)(J), substituted “calendar year” for “policy year” wherever appearing. Subsec. (r)(4). Pub. L. 103–432, § 171(e)(1)(K), substituted “October” for “February”, “disallowance” for “disllowance”, “loss ratios” for “loss-ratios” in two places, and “loss ratio” for “loss-ratio”. Subsec. (r)(6)(A). Pub. L. 103–432, § 171(e)(1)(L), substituted “fails to provide refunds or credits as required in paragraph (1)(B)” for “issues a policy in violation of the loss ratio requirements of this subsection” and “policy issued for which such failure occurred” for “such violation”. Subsec. (r)(6)(B). Pub. L. 103–432, § 171(e)(1)(M), substituted “to the policyholder or, in the case of a group policy, to the certificate holder” for “to policyholders”. Subsec. (s)(2)(A). Pub. L. 103–432, § 171(g)(1), (2), substituted “in the case of an individual for whom an application is submitted prior to or” for “for which an application is submitted” and “as of the first day on which the individual is 65 years of age or older and is enrolled for benefits under part B” for “in which the individual (who is 65 years of age or older) first is enrolled for benefits under part B”. Subsec. (s)(2)(B). Pub. L. 103–432, § 171(g)(3), substituted “before the policy became effective” for “before it became effective”. Subsec. (t)(1). Pub. L. 103–432, § 171(h)(1)(A), (B), substituted “If a medicare supplemental policy meets the 1991 NAIC Model Regulation or 1991 Federal Regulation” for “If a policy meets the NAIC Model Standards”. Subsec. (t)(1)(A). Pub. L. 103–432, § 171(h)(1)(C), inserted “or agreements” after “contracts”. Subsec. (t)(1)(E)(i), (F). Pub. L. 103–432, § 171(h)(1)(D), substituted “standards in the 1991 NAIC Model Regulation or 1991 Federal Regulation” for “NAIC standards”. Subsec. (t)(2). Pub. L. 103–432, § 171(h)(1)(E), inserted “the issuer” before “is subject to a civil money penalty” in concluding provisions. 1990—Pub. L. 101–508, § 4353(a)(1), struck out “Voluntary” at beginning of section catchline. Subsec. (a). Pub. L. 101–508, § 4353(a)(2), designated existing provisions as par. (1) and added par. (2). Pub. L. 101–508, § 4207(k)(1), formerly § 4027(k)(1), as renumbered by Pub. L. 103–432, § 160(d)(4), struck out “(k)(4),” after “subsections (k)(3),” in third sentence. Subsec. (b)(1). Pub. L. 101–508, § 4353(c)(5), inserted at end “The report required under subsection (F) shall include information on loss ratios of policies sold in the State, frequency and types of instances in which policies approved by the State fail to meet the standards of this paragraph, actions taken by the State to bring such policies into compliance, and information regarding State programs implementing consumer protection provisions, and such further information as the Secretary in consultation with the National Association of Insurance Commissioners, may specify.” Pub. L. 101–508, § 4353(b)(1), (2), substituted “the Secretary” for “Supplemental Health Insurance Panel (established under paragraph (2))” in introductory provisions and for “the Panel” in concluding provisions. Pub. L. 101–508, § 4207(k)(1), formerly § 4027(k)(1), as renumbered by Pub. L. 103–432, § 160(d)(4), which directed the amendment of third sentence of par. (1) by striking out “(k)(4),” was executed by making the deletion after “subsections (k)(3),” in concluding provisions to reflect the probable intent of Congress. Subsec. (b)(1)(A). Pub. L. 101–508, § 4358(b)(2)(A), inserted before semicolon at end “, except as otherwise provided by subparagraph (H)”. Pub. L. 101–508, § 4353(b)(3), inserted “and enforcement” after “application”. Subsec. (b)(1)(B). Pub. L. 101–508, § 4351(1), formerly § 4351(a)(1), as renumbered and amended by Pub. L. 103–432, § 171(a)(1), substituted “through (5)” for “through (4)”. Subsec. (b)(1)(C). Pub. L. 101–508, § 4355(b), substituted for semicolon at end “, and that a copy of each such policy, the most recent premium for each such policy, and a listing of the ratio of benefits provided to premiums collected for the most recent 3-year period for each such policy issued or sold in the State is maintained and made available to interested persons;”. Subsec. (b)(1)(D). Pub. L. 101–508, § 4353(b)(3), inserted “and enforcement” after “application”. Subsec. (b)(1)(F). Pub. L. 101–508, § 4353(c)(1)–(3), added subpar. (F). Subsec. (b)(1)(G). Pub. L. 101–508, § 4355(c), which directed amendment of par. (1) by adding at the end thereof a new subpar. (G), was executed by adding the new subpar. (G) immediately after subpar. (F) to reflect the probable intent of Congress. Subsec. (b)(1)(H). Pub. L. 101–508, § 4358(b)(2)(B)–(D), added subpar. (H). Subsec. (b)(2). Pub. L. 101–508, § 4353(b)(4), amended par. (2) generally. Prior to amendment, par. (2) read as follows: “(B) A majority of the members of the Panel shall constitute a quorum, but a lesser number may conduct hearings. “(C) The Secretary shall provide such technical, secretarial, clerical, and other assistance as the Panel may require. “(D) There are authorized to be appropriated such sums as may be necessary to carry out this paragraph. “(E) Members of the Panel shall be allowed, while away from their homes or regular places of business in the performance of services for the Panel, travel expenses (including per diem in lieu of subsistence) in the same manner as persons employed intermittently in the Government service are allowed expenses under section 5703 of title 5.” Subsec. (c). Pub. L. 101–508, § 4357(a)(1), inserted “or the requirement described in subsection (s)” after “paragraph (3)” in introductory provisions. Pub. L. 101–508, § 4355(a)(2), struck out at end “For purposes of paragraph (2), policies issued as a result of solicitations of individuals through the mails or by mass media advertising (including both print and broadcast advertising) shall be deemed to be individual policies.” Subsec. (c)(1). Pub. L. 101–508, § 4358(b)(1), inserted before semicolon at end “(except as otherwise provided by subsection (t))”. Subsec. (c)(2). Pub. L. 101–508, § 4355(a)(1), amended par. (2) generally. Prior to amendment, par. (2) read as follows: “can be expected (as estimated for the entire period for which rates are computed to provide coverage, on the basis of incurred claims experience and earned premiums for such period and in accordance with accepted actuarial principles and practices) to return to policyholders in the form of aggregate benefits provided under the policy, at least 75 percent of the aggregate amount of premiums collected in the case of group policies and at least 60 percent of the aggregate amount of premiums collected in the case of individual policies;”. Subsec. (c)(5). Pub. L. 101–508, § 4351(2), formerly § 4351(a)(2), as renumbered and amended by Pub. L. 103–432, § 171(a)(1), added par. (5). Subsec. (d)(3)(A). Pub. L. 101–508, § 4354(a)(1), substituted “It is unlawful for a person to sell or issue” for “Whoever knowingly sells”, “duplicates health benefits” for “substantially duplicates health benefits”, “. Whoever violates the previous sentence shall be fined” for “, shall be fined”, “(other than this subchapter or subchapter XIX of this chapter)” for “(other than this subchapter)”, and “$25,000 (or $15,000 in the case of a person other than the issuer of the policy)” for “$5,000” and inserted at end “A seller (who is not the issuer of a health insurance policy) shall not be considered to violate the previous sentence if the policy is sold in compliance with subparagraph (B) and the statement under such subparagraph indicates on its face that the sale of the policy will not duplicate health benefits to which the individual is otherwise entitled. This subsection shall not apply to such a seller until such date as the Secretary publishes a list of the standardized benefit packages that may be offered consistent with subsection (p) of this section.” Subsec. (d)(3)(B). Pub. L. 101–508, § 4354(a)(2), amended subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: “For purposes of this paragraph, benefits which are payable to or on behalf of an individual without regard to other health benefit coverage of such individual, shall not be considered as duplicative.” Subsec. (d)(4)(B). Pub. L. 101–508, § 4353(d)(1), struck out at end “For purposes of this paragraph, a medicare supplemental policy shall be deemed to be approved by the commissioner or superintendent of insurance of a State if— “(i) the policy has been certified by the Secretary pursuant to subsection (c) of this section or was issued in a State with an approved regulatory program (as defined in subsection (g)(2)(B) of this section); “(ii) the policy has been approved by the commissioners or superintendents of insurance in States in which more than 30 percent of such policies are sold; or “(iii) the State has in effect a law which the commissioner or superintendent of insurance of the State has determined gives him the authority to review, and to approve, or effectively bar from sale in the State, such policy; except that such a policy shall not be deemed to be approved by a State commissioner or superintendent of insurance if the State notifies the Secretary that such policy has been submitted for approval to the State and has been specifically disapproved by such State after providing appropriate notice and opportunity for hearing pursuant to the procedures (if any) of the State.” Subsec. (g)(1). Pub. L. 101–508, § 4356(a), inserted before period at end of first sentence “and does not include a policy or plan of a health maintenance organization or other direct service organization which offers benefits under this subchapter, including such services under a contract under under section 1395mm of this title or an agreement under section 1395l of this title”. Subsecs. (o), (p). Pub. L. 101–508, § 4351(3), formerly § 4351(a)(3), as renumbered and amended by Pub. L. 103–432, § 171(a)(1), added subsecs. (o) and (p). Subsec. (q). Pub. L. 101–508, § 4352, added subsec. (q). Subsec. (q)(5). Pub. L. 101–508, § 4354(b), added par. (5). Subsec. (r). Pub. L. 101–508, § 4355(a)(3), added subsec. (r). Subsec. (s). Pub. L. 101–508, § 4357(a)(2), added subsec. (s). Subsec. (t). Pub. L. 101–508, § 4358(a), added subsec. (t). 1989—Subsecs. (a), (b)(1). Pub. L. 101–234, § 203(a)(1)(A), substituted “subsections (k)(3), (k)(4), (m), and (n)” for “subsection (k)(3)”. Subsec. (k)(1)(A). Pub. L. 101–234, § 203(a)(1)(B)(i), inserted “except as provided in subsection (m),” before “subsection (g)(2)(A)”. Subsec. (k)(3). Pub. L. 101–234, § 203(a)(1)(B)(ii), substituted “subsections (l), (m), and (n)” for “subsection (l)”. Subsecs. (m), (n). Pub. L. 101–234, § 203(a)(1)(C), added subsecs. (m) and (n). 1988—Subsec. (a). Pub. L. 100–360, § 221(d)(1), substituted “Subject to subsection (k)(3), such” for “Such”. Subsec. (b)(1). Pub. L. 100–360, § 221(d)(2), substituted “(subject to subsection (k)(3), for so long as” for “(for so long as” in concluding provisions. Subsec. (b)(1)(B). Pub. L. 100–360, § 221(a)(1), substituted “through (4)” for “and (3)”. Subsec. (b)(1)(C). Pub. L. 100–360, § 221(b)(2), (3), added subpar. (C). Former subpar. (C) redesignated (D). Pub. L. 100–360, § 221(b)(1), substituted “(A), (B), and (C)” for “(A) and (B)”. Subsec. (b)(1)(D), (E). Pub. L. 100–360, § 221(b)(2), redesignated former subpars. (C) and (D) as (D) and (E), respectively. Subsec. (b)(2)(A). Pub. L. 100–360, § 221(f), substituted “appointed by the Secretary” for “appointed by the President”. Subsec. (b)(3). Pub. L. 100–360, § 221(e), added par. (3). Subsec. (c). Pub. L. 100–360, § 411(i)(1)(B), added Pub. L. 100–203, § 4081(b)(2)(A), see 1987 Amendment note below. Subsec. (c)(3). Pub. L. 100–360, § 411(i)(1)(B), redesignated Pub. L. 100–203, § 4081(b)(2)(B)–(D), see 1987 Amendment note below. Subsec. (c)(3)(A). Pub. L. 100–360, § 411(i)(1)(C)(i), substituted “claim form” for “claims form” in two places and “such notice” for “such claims form”. Subsec. (c)(3)(B)(i). Pub. L. 100–360, § 411(i)(1)(C)(ii), inserted “under the policy” after “payment determination”. Subsec. (c)(3)(B)(ii). Pub. L. 100–360, § 411(i)(1)(C)(iii), substituted “payment covered by such policy” for “appropriate payment”. Subsec. (c)(4). Pub. L. 100–360, § 221(a)(2), added par. (4). Subsec. (d). Pub. L. 100–360, § 428(b)(1), substituted “shall be fined under title 18 or imprisoned not more than 5 years, or both, and, in addition to or in lieu of such a criminal penalty, is subject to a civil money penalty of not to exceed $5,000 for each such prohibited act” for “shall be guilty of a felony and upon conviction thereof shall be fined not more than $25,000 or imprisoned for not more than 5 years, or both” in pars. (1), (2), (3)(A), and (4)(A). Subsec. (d)(5). Pub. L. 100–360, § 428(b)(2), added par. (5). Subsec. (e). Pub. L. 100–360, § 221(c), designated existing provision as par. (1) and added pars. (2) and (3). Subsecs. (k), (l). Pub. L. 100–360, § 221(d)(3), added subsecs. (k) and (l). 1987—Subsec. (b)(1)(B). Pub. L. 100–203, § 4081(b)(1)(A), amended subpar. (B) generally. Prior to amendment, subpar. (B) read as follows: “includes a requirement equal to or more stringent than the requirement described in subsection (c)(2) of this section; and”. Subsec. (b)(1)(D). Pub. L. 100–203, § 4081(b)(1)(B), (C), added subpar. (D). Subsec. (c). Pub. L. 100–203, § 4081(b)(2)(A), as added by Pub. L. 100–360, § 411(i)(1)(B), inserted “(or, with respect to paragraph (3), the issuer of the policy)” in introductory provisions. Subsec. (c)(3). Pub. L. 100–203, § 4081(b)(2)(B)–(D), formerly § 4081(b)(2), as redesignated by Pub. L. 100–360, § 411(i)(1)(B), added par. (3). Subsec. (d)(1). Pub. L. 100–93 substituted “knowingly and willfully” for “knowingly or willfully”. Effective Date of 2008 Amendment Effective Date of 1997 Amendment “(2) Limit on preexisting condition exclusions.— “(2) Transition.— The provisions of [set out as a note below] shall apply with respect to this section in the same manner as they apply to section 4031 [amending this section and enacting provisions set out as notes below].” Effective Date of 1996 Amendment “(2) (A) Clause (vi) of section 1882(d)(3)(A) of the Social Security Act [42 U.S.C. 1395ss(d)(3)(A)(vi)], as added by subsection (a), shall only apply to individuals applying for— “(ii) another health insurance policy after the end of the 30-day period beginning on the date of the enactment of this Act. “(B) A seller or issuer of a health insurance policy may substitute, for the disclosure statement described in clause (vii) of such section, the statement specified under section 1882(d)(3)(D) of the Social Security Act (as in effect before the date of the enactment of this Act), without the revision specified in such clause.” Effective Date of 1994 Amendment “The amendments made by this section [amending this section and sections 1320c–3, 1395b–2, and 1395b–4 of this title, repealing section 1395zz of this title, and enacting and amending provisions set out as notes below] shall be effective as if included in the enactment of OBRA–1990 [Pub. L. 101–508]; except that— “(2) the amendments made by subsection (d)(2)(A) [amending this section] and by subparagraphs (A), (B), and (E) of subsection (e)(1) [amending this section] shall be effective on the date specified in subsection (m)(4) [set out as a note below]; and Effective Date of 1989 Amendment Effective Date of 1987 Amendment “(B) In the case of a State which the Secretary of Health and Human Services identifies as— “(i) requiring State legislation (other than legislation appropriating funds) in order for medicare supplemental policies to be changed to meet the requirements of section 1882(c)(3) of the Social Security Act [42 U.S.C. 1395ss(c)(3)], and Implementation of NAIC Recommendations “(2) Implementation dates.— “(B) Extension of effective date for state law amendment.— Study of Medigap Policies “(1) In general.— The Comptroller General of the United States (in this section referred to as the ‘Comptroller General’) shall conduct a study of the issues described in paragraph (2) regarding medicare supplemental policies described in section 1882(g)(1) of the Social Security Act (42 U.S.C. 1395ss(g)(1)). “(2) Issues to be studied.—The issues described in this paragraph are the following: “(A) The level of coverage provided by each type of medicare supplemental policy. “(B) The current enrollment levels in each type of medicare supplemental policy. “(C) The availability of each type of medicare supplemental policy to medicare beneficiaries over age 65½. “(D) The number and type of medicare supplemental policies offered in each State. “(E) The average out-of-pocket costs (including premiums) per beneficiary under each type of medicare supplemental policy. Conforming Benefits to Changes in Terminology for Hospital Outpatient Department Cost Sharing “For purposes of apply [sic] section 1882 of the Social Security Act (42 U.S.C. 1395ss) and regulations referred to in subsection (e) [set out as a note above], copayment amounts provided under section 1833(t)(5) of such Act [42 U.S.C. 1395l(t)(5)] with respect to hospital outpatient department services shall be treated under medicare supplemental policies in the same manner as coinsurance with respect to such services.” Transition Provisions “(1) In general.— If the Secretary of Health and Human Services identifies a State as requiring a change to its statutes or regulations to conform its regulatory program to the changes made by this section [amending this section], the State regulatory program shall not be considered to be out of compliance with the requirements of section 1882 of the Social Security Act [42 U.S.C. 1395ss] due solely to failure to make such change until the date specified in paragraph (4). “(3) Secretary standards.— “(4) Date specified.— “(A) In general.—Subject to subparagraph (B), the date specified in this paragraph for a State is the earlier of— “(i) the date the State changes its statutes or regulations to conform its regulatory program to the changes made by this section, or “(B) Additional legislative action required.—In the case of a State which the Secretary identifies as— “(i) requiring State legislation (other than legislation appropriating funds) to conform its regulatory program to the changes made in this section, but “(1) In general.— If the Secretary of Health and Human Services identifies a State as requiring a change to its statutes or regulations to conform its regulatory program to the changes made by this section [amending this section], the State regulatory program shall not be considered to be out of compliance with the requirements of section 1882 of the Social Security Act [42 U.S.C. 1395ss] due solely to failure to make such change until the date specified in paragraph (4). “(3) Secretary standards.— If the NAIC does not make the modifications described in paragraph (2) within the period specified in such paragraph, the Secretary of Health and Human Services shall make the modifications described in such paragraph and such revised regulation incorporating the modifications shall be considered to be the appropriate Regulation for the purposes of such section. “(4) Date specified.— “(A) In general.—Subject to subparagraph (B), the date specified in this paragraph for a State is the earlier of— “(i) the date the State changes its statutes or regulations to conform its regulatory program to the changes made by this section, or “(ii) 1 year after the date the NAIC or the Secretary first makes the modifications under paragraph (2) or (3), respectively. “(B) Additional legislative action required.—In the case of a State which the Secretary identifies as— “(i) requiring State legislation (other than legislation appropriating funds) to conform its regulatory program to the changes made in this section, but “(ii) having a legislature which is not scheduled to meet in 1996 in a legislative session in which such legislation may be considered, |
