Ch. 35

1997 LAWS OF MARYLAND

REASONABLE COST IN A CALENDAR YEAR OF THE FIRST 3 PINTS OF BLOOD OR, AS
DEFINED BY FEDERAL REGULATIONS, EQUIVALENT QUANTITIES OF PACKED RED
BLOOD CELLS,

(B) CHANGES IN DEDUCTIBLE AND COPAYMENT PROVISIONS.

(1) FOR BENEFITS DESIGNED TO COVER DEDUCTIBLES OR
COINSURANCE AMOUNTS UNDER MEDICARE, A MEDICARE SUPPLEMENT POLICY
SHALL PROVIDE FOR AN AUTOMATIC CHANGE IN THOSE BENEFITS TO COINCIDE
WITH CHANGES IN APPLICABLE MEDICARE DEDUCTIBLE AND COPAYMENT
PROVISIONS.

(2) SUBJECT TO APPROVAL BY THE COMMISSIONER, A CARRIER MAY
RESERVE THE RIGHT IN A MEDICARE SUPPLEMENT POLICY TO CHANGE PREMIUMS
TO CORRESPOND WITH CHANGES IN BENEFITS UNDER PARAGRAPH (1) OF THIS
SUBSECTION.

(C) CONDITIONS OF PAYMENT.

PAYMENT OF A BENEFIT FOR A MEDICARE ELIGIBLE EXPENSE UNDER A
MEDICARE SUPPLEMENT POLICY MAY BE CONDITIONED ON THE SAME OR LESS
RESTRICTIVE PAYMENT CONDITIONS THAT APPLY TO A MEDICARE CLAIM,
INCLUDING THE DETERMINATION OF MEDICAL NECESSITY.

(D) POLICY EXCLUSIONS, LIMITATIONS, OR REDUCTIONS.

(1) UNLESS OTHERWISE EXPRESSLY AUTHORIZED UNDER THIS
ARTICLE OR A REGULATION ADOPTED BY THE COMMISSIONER UNDER THIS
ARTICLE, COVERAGE UNDER A MEDICARE SUPPLEMENT POLICY MAY NOT BE
SUBJECT TO ANY EXCLUSION, LIMITATION, OR REDUCTION THAT IS INCONSISTENT
WITH THE EXCLUSIONS, LIMITATIONS, OR REDUCTIONS UNDER MEDICARE.

(2) TO THE EXTENT A BENEFIT IS AVAILABLE TO THE INSURED UNDER
MEDICARE, A MEDICARE SUPPLEMENT POLICY SHALL PROVIDE THAT COVERAGE
FOR THE BENEFIT IS NOT DUPLICATED.

(E) MEDICAL ASSISTANCE UNDER MEDICAID.

IF THE INSURED IS RECEIVING MEDICAL ASSISTANCE UNDER MEDICAID, A
MEDICARE SUPPLEMENT POLICY SHALL PROVIDE FOR THE SUSPENSION OF POLICY
BENEFITS AND PREMIUMS FOR A MAXIMUM OF 24 MONTHS.

(F) PROHIBITIONS.

(1) A MEDICARE SUPPLEMENT POLICY, CONTRACT, OR CERTIFICATE IN
FORCE IN THE STATE MAY NOT PROVIDE BENEFITS THAT DUPLICATE BENEFITS
PROVIDED BY MEDICARE.

(2) UNLESS APPROVED BY THE COMMISSIONER, A MEDICARE
SUPPLEMENT POLICY MAY NOT BE OFFERED AT AN INTRODUCTORY PREMIUM
RATE.

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