Guaranteed issuance of Medicare supplement policies for enrollees of a Medicare supplement policy that is involuntarily terminated or issued by an insolvent issuer expanded.

A bill for an act

relating to health insurance; expanding guaranteed issuance of Medicare supplement

policies for enrollees of a Medicare supplement policy that is involuntarily

terminated or issued by an insolvent issuer; amending Minnesota Statutes 2025

Supplement, section 62A.31, subdivision 1u.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2025 Supplement, section 62A.31, subdivision 1u, is

amended to read:

Subd. 1u.

Guaranteed issue for eligible persons.

(a)(1) Eligible persons are those

individuals described in paragraph (b) who seek to enroll under the policy during the period

specified in paragraph (c) and who submit evidence of the date of termination or

disenrollment described in paragraph (b), or of the date of Medicare Part D enrollment, with

the application for a Medicare supplement policy.

(2) With respect to eligible persons, an issuer shall not: deny or condition the issuance

or effectiveness of a Medicare supplement policy described in paragraph (c) that is offered

and is available for issuance to new enrollees by the issuer; discriminate in the pricing of

such a Medicare supplement policy because of health status, claims experience, receipt of

health care, medical condition, or age; or impose an exclusion of benefits based upon a

preexisting condition under such a Medicare supplement policy.

(b) An eligible person is an individual described in any of the following:

(1) 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 such supplemental health benefits to the individual;

(2) the individual is enrolled with a Medicare Advantage organization under a Medicare

Advantage plan under Medicare Part C, and any of the following circumstances apply, or

the individual is 65 years of age or older and is enrolled with a Program of All-Inclusive

Care for the Elderly (PACE) provider under section 1894 of the federal Social Security Act,

and there are circumstances similar to those described in this clause that would permit

discontinuance of the individual's enrollment with the provider if the individual were enrolled

in a Medicare Advantage plan:

(i) the organization's or plan's certification under Medicare Part C has been terminated

or the organization has terminated or otherwise discontinued providing the plan in the area

in which the individual resides;

(ii) the individual is no longer eligible to elect the plan because of a change in the

individual's place of residence or other change in circumstances specified by the secretary,

but not including termination of the individual's enrollment on the basis described in section

1851(g)(3)(B) of the federal Social Security Act, United States Code, title 42, section

1395w-21(g)(3)(b) (where the individual has not paid premiums on a timely basis or has

engaged in disruptive behavior as specified in standards under section 1856 of the federal

Social Security Act, United States Code, title 42, section 1395w-26), or the plan is terminated

for all individuals within a residence area;

(iii) the individual demonstrates, in accordance with guidelines established by the

Secretary, that:

(A) the organization offering the plan substantially violated a material provision of the

organization's contract 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 such covered care in accordance with applicable quality

standards; or

(B) 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

(iv) the individual meets such other exceptional conditions as the secretary may provide;

(3)(i) the individual is enrolled with:

(A) an eligible organization under a contract under section 1876 of the federal Social

Security Act, United States Code, title 42, section 1395mm (Medicare cost);

(B) a similar organization operating under demonstration project authority, effective for

periods before April 1, 1999;

(C) an organization under an agreement under section 1833(a)(1)(A) of the federal Social

Security Act, United States Code, title 42, section 1395l(a)(1)(A) (health care prepayment

plan); or

(D) an organization under a Medicare Select policy under section
62A.318
or the similar

law of another state; and

(ii) the enrollment ceases under the same circumstances that would permit discontinuance

of an individual's election of coverage under clause (2);

(4) the individual is enrolled under a Medicare supplement policy, and the enrollment

ceases because:

(i)(A) of the insolvency of the issuer or bankruptcy of the nonissuer organization; or

(B) of other involuntary termination of coverage or enrollment under the policy;

(ii) the issuer of the policy substantially violated a material provision of the policy; or

(iii) 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;

(5)(i) the individual was enrolled under a Medicare supplement policy and terminates

that enrollment and subsequently enrolls, for the first time, with any Medicare Advantage

organization under a Medicare Advantage plan under Medicare Part C; any eligible

organization under a contract under section 1876 of the federal Social Security Act, United

States Code, title 42, section 1395mm (Medicare cost); any similar organization operating

under demonstration project authority; any PACE provider under section 1894 of the federal

Social Security Act, or a Medicare Select policy under section
62A.318
or the similar law

of another state; and

(ii) the subsequent enrollment under item (i) is terminated by the enrollee during any

period within the first 12 months of the subsequent enrollment during which the enrollee

is permitted to terminate the subsequent enrollment under section 1851(e) of the federal

Social Security Act;

(6) the individual, upon first enrolling for benefits under Medicare Part B, enrolls in a

Medicare Advantage plan under Medicare Part C, or with a PACE provider under section

1894 of the federal Social Security Act, and disenrolls from the plan by not later than 12

months after the effective date of enrollment;

(7) the individual enrolls in a Medicare Part D plan during the initial Part D enrollment

period, as defined under United States Code, title 42, section 1395ss(v)(6)(D), and, at the

time of enrollment in Part D, was enrolled under a Medicare supplement policy that covers

outpatient prescription drugs and the individual terminates enrollment in the Medicare

supplement policy and submits evidence of enrollment in Medicare Part D along with the

application for a policy described in paragraph (e), clause (4);

(8) the individual was enrolled in a state public program and is losing coverage due to

the unwinding of the Medicaid continuous enrollment conditions, as provided by Code of

Federal Regulations, title 45, section 155.420 (d)(9) and (d)(1), and Public Law 117-328,

section 5131 (2022); or

(9) the individual meets the requirements under subdivision 1r, paragraph (c), and enrolls

during the open enrollment period.

(c)(1) In the case of an individual described in paragraph (b), clause (1), the guaranteed

issue period begins on the later of: (i) the date the individual receives a notice of termination

or cessation of all supplemental health benefits or, if a notice is not received, notice that a

claim has been denied because of a termination or cessation; or (ii) the date that the applicable

coverage terminates or ceases; and ends 63 days after the later of those two dates.

(2) In the case of an individual described in paragraph (b), clause (2), (3), (5), or (6),

whose enrollment is terminated involuntarily, the guaranteed issue period begins on the

date that the individual receives a notice of termination and ends 63 days after the date the

applicable coverage is terminated.

(3) In the case of an individual described in paragraph (b), clause (4), item (i), the

guaranteed issue period begins on the earlier of: (i) the date that the individual receives a

notice of termination, a notice of the issuer's bankruptcy or insolvency, or other such similar

notice if any; and (ii) the date that the applicable coverage is terminated, and ends on the

date that is 63 days after the date the coverage is terminated.

(4) In the case of an individual described in paragraph (b), clause (2), (4), (5), or (6),

who disenrolls voluntarily, the guaranteed issue period begins on the date that is 60 days

before the effective date of the disenrollment and ends on the date that is 63 days after the

effective date.

(5) In the case of an individual described in paragraph (b), clause (7), the guaranteed

issue period begins on the date the individual receives notice pursuant to section

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 ends on the

date that is 63 days after the effective date of the individual's coverage under Medicare Part

D.

(6) In the case of an individual described in paragraph (b) but not described in this

paragraph, the guaranteed issue period begins on the effective date of disenrollment and

ends on the date that is 63 days after the effective date.

(7) For an individual described in paragraph (b), clause (9), the guarantee issue period

is the open enrollment period.

(d)(1) In the case of an individual described in paragraph (b), clause (5), or deemed to

be so described, pursuant to this paragraph, whose enrollment with an organization or

provider described in paragraph (b), clause (5), item (i), is involuntarily terminated within

the first 12 months of enrollment, and who, without an intervening enrollment, enrolls with

another such organization or provider, the subsequent enrollment is deemed to be an initial

enrollment described in paragraph (b), clause (5).

(2) In the case of an individual described in paragraph (b), clause (6), or deemed to be

so described, pursuant to this paragraph, whose enrollment with a plan or in a program

described in paragraph (b), clause (6), is involuntarily terminated within the first 12 months

of enrollment, and who, without an intervening enrollment, enrolls in another such plan or

program, the subsequent enrollment is deemed to be an initial enrollment described in

paragraph (b), clause (6).

(3) For purposes of paragraph (b), clauses (5) and (6), no enrollment of an individual

with an organization or provider described in paragraph (b), clause (5), item (i), or with a

plan or in a program described in paragraph (b), clause (6), may be deemed to be an initial

enrollment under this paragraph after the two-year period beginning on the date on which

the individual first enrolled with the organization, provider, plan, or program.

(e) The Medicare supplement policy to which eligible persons are entitled under:

(1) paragraph (b), clauses (1) to
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(4)
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(3)
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, is any Medicare supplement policy that has a

benefit package consisting of the basic Medicare supplement plan described in section

62A.316, paragraph (a)
, plus any combination of the three optional riders described in

section
62A.316, paragraph (b)
, clauses (1) to (3), offered by any issuer;

(2) paragraph (b), clause (5), 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, any policy described in clause (1) offered by any issuer, except that 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 to which

the individual is entitled under paragraph (b), clause (5), is:

(i) the policy available from the same issuer but modified to remove outpatient

prescription drug coverage; or

(ii) at the election of the policyholder, a policy described in clause (4), except that the

policy may be one that is offered and available for issuance to new enrollees that is offered

by any issuer;

(3) paragraph (b),
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clause
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clauses (4) and
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(6), is any Medicare supplement policy offered

by any issuer;

(4) paragraph (b), clause (7), is a Medicare supplement policy that has a benefit package

classified as a basic plan under section
62A.316
if the enrollee's existing Medicare

supplement policy is a basic plan or, if the enrollee's existing Medicare supplement policy

is an extended basic plan under section
62A.315
, a basic or extended basic plan at the option

of the enrollee, provided that the policy 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. The issuer must permit the enrollee to retain all

optional benefits contained in the enrollee's existing coverage, other than outpatient

prescription drugs, subject to the provision that the coverage be offered and available for

issuance to new enrollees by the same issuer.

(f)(1) At the time of an event described in paragraph (b), 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 subdivision, and of the obligations of issuers of Medicare

supplement policies under paragraph (a). The notice must be communicated

contemporaneously with the notification of termination.

(2) At the time of an event described in paragraph (b), 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 subdivision, and of the obligations of issuers of Medicare

supplement policies under paragraph (a). The notice must be communicated within ten

working days of the issuer receiving notification of disenrollment.

(g) Reference in this subdivision to a situation in which, or to a basis upon which, an

individual's coverage has been terminated does not provide authority under the laws of this

state for the termination in that situation or upon that basis.

(h) An individual's rights under this subdivision are in addition to, and do not modify

or limit, the individual's rights under subdivision 1h.

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EFFECTIVE DATE.

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This section is effective January 1, 2027.

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