Department of Insurance

This regulation shall become effective thirty (30) days after its adoption and filing with the Mississippi Secretary of State's Office, as required by law. PROMULGATED AND ADOPTED, this the 13th day of August, 1984. Notes 19 Miss. Code. R. 2-9.12 Miss. Code Ann. § 25-43-3.113 (Re…

TO ALL COMPANIES WRITING HEALTH, ACCIDENT & HOSPITALIZATION INSURANCE IN MISSISSIPPI. It has come to the attention of the State Insurance Department that certain agents in the State make a practice of having the insured's check made to the agent personally rather than to the comp…

The purpose of this regulation is to provide for the reasonable standardization of coverage and simplification of terms and benefits of Medicare supplement policies; to facilitate public understanding and comparison of such policies; to eliminate provisions contained in such poli…

This regulation is issued pursuant to the authority vested in the commissioner under Miss. Code Ann. § 83-9-103 and § 83-9-105. Notes 19 Miss. Code. R. 3-10.02 Miss Code Ann §§ 83-9-103; 83-9-105 (Rev. 2011) Amended 1/1/2020 Wherever the term "commissioner" appears, the title of …

A. Except as otherwise specifically provided in Rules 10.07, 10.13, 10.14, 10.17 and 10.22, this regulation shall apply to: 1. All Medicare supplement policies delivered or issued for delivery in this state on or after the effective date of this regulation; and 2. All certificate…

For purposes of this regulation: 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. "Bankruptcy" m…

No policy or certificate may be advertised, solicited or issued for delivery in this state as a Medicare supplement policy or certificate unless the policy or certificate contains definitions or terms which conform to the requirements of this section. A. "Accident," "accidental i…

A. Except for permitted preexisting condition clauses as described in Rules 10.07 A(1), 10.08A(1), and 10.08.1A(1) of this regulation, no policy or certificate may be advertised, solicited or issued for delivery in this state as a Medicare supplement policy if the policy or certi…

Minimum Benefit Standards for Pre-Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued For Delivery Prior To July 1, 1992 No policy or certificate may be advertised, solicited or issued for delivery in this state as a Medicare supplement policy or certifi…

Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued For Delivery After July 1, 1992 With An Effective Date For Coverage Prior To June 1, 2010 The following standards are applicable to all Medicare supplement policies or certifi…

Benefit Standards For 2010 Standardized Medicare Supplement Benefit Plan Policies Or Certificates Issued For Delivery With An Effective Date For Coverage On Or After June 1, 2010 The following standards are applicable to all Medicare supplement policies or certificates delivered …

Standard Medicare Benefit Plans For 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery after July 1, 1992 and with an Effective Date for Coverage Prior to June 1, 2010 A. An issuer shall make available to each prospective policyholder …

Standard Medicare Supplement Benefit Plans for 2010 Standardized Supplement Benefit Plan Policies or Certificates Issued for Delivery Effective Date for Coverage on or After June 10, 2010 The following standards are applicable to all Medicare supplement policies or certificates d…

Standard Medicare Supplement Benefit Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery to Individuals Newly Eligible for Medicare on or After January 1, 2020. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) …

A. 1. This section shall apply to Medicare Select policies and certificates, as defined in this section. 2. No policy or certificate may be advertised as a Medicare Select policy or certificate unless it meets the requirements of this section. B. For the purposes of this section:…

A. An issuer shall not deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in this state, nor discriminate in the pricing of a policy or certificate because of the health status, claims experience, receipt of health …

A. Guaranteed Issue. 1. Eligible persons are those individuals described in Subsection B who seek to enroll under the policy during the period specified in Subsection C, and who submit evidence of the date of termination, disenrollment, or Medicare Part D enrollment with the appl…

A. An issuer shall comply with Section 1882(c)(3) of the Social Security Act (as enacted by section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987 (OBRA) 1987, Pub. L. No. 100-203) by:1. Accepting a notice from a Medicare carrier on dually assigned claims submitte…

A. Loss Ratio Standards. 1. a. A Medicare Supplement policy form or certificate form shall not be delivered or issued for delivery unless the policy form or certificate form can be expected, as estimated for the entire period for which rates are computed to provide coverage, to r…

A. An issuer shall not deliver or issue for delivery a policy or certificate to a resident of this state unless the policy form or certificate form has been filed with and approved by the commissioner in accordance with filing requirements and procedures prescribed by the commiss…

A. An issuer or other entity may provide commission or other compensation to an agent or other representative for the sale of a Medicare supplement policy or certificate only if the first year commission or other first year compensation is no more than 200 percent of the commissi…

A. General Rules. 1. Medicare supplement policies and certificates shall include a renewal or continuation provision. The language or specifications of the provision shall be consistent with the type of contract issued. The provision shall be appropriately captioned and shall app…

A. Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant currently has Medicare supplement, Medicare Advantage, Medicaid coverage, or another health insurance policy or certificate in…

An issuer shall provide a copy of any Medicare supplement advertisement intended for use in this state whether through written, radio or television medium to the Commissioner of Insurance of this state for review or approval by the commissioner to the extent it may be required un…

A. An issuer, directly or through its producers, shall: 1. Establish marketing procedures to assure that any comparison of policies by its agents or other producers will be fair and accurate. 2. Establish marketing procedures to assure excessive insurance is not sold or issued. 3…

A. In recommending the purchase or replacement of any Medicare supplement policy or certificate an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement. B. Any sale of a Medicare supplement policy or certificate that will p…

A. On or before March 1 of each year, an issuer shall report the following information for every individual resident of this state for which the issuer has in force more than one Medicare supplement policy or certificate: 1. Policy and certificate number; and 2. Date of issuance.…

A. If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate, the replacing issuer shall waive any time periods applicable to preexisting conditions, waiting periods, elimination periods and probationary periods in the new Medicare …

This Section applies to all policies with policy years beginning on or after May 21, 2009. A. An issuer of a Medicare supplement policy or certificate; 1. Shall not deny or condition the issuance or effectiveness of the policy or certificate (including the imposition of any exclu…

If any provision of this regulation or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the regulation and the application of such provision to other persons or circumstances shall not be affected thereby Notes 19 Miss. …

This regulation and its amendments shall be effective on and after January 1, 2020. Notes 19 Miss. Code. R. 3-10.26 Miss Code Ann § 25-43-3.113(Rev. 2010) Amended 1/1/2020

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Click Here To View Image Notes 19 Miss. Code. R. 3-10.28 Miss Code Ann §839-103(Rev. 2011) Amended 1/1/2020

DISCLOSURE STATEMENTS Instructions for Use of the Disclosure Statements for Health Insurance Policies Sold to Medicare Beneficiaries that Duplicate Medicare 1. Section 1882 (d) of the federal Social Security Act [ 42 U.S.C. 1395 ss] prohibits the sale of a health insurance policy…

This Regulation is promulgated pursuant to the authority vested in the Commissioner of Insurance under Article 7 and Article 9 of Chapter 41 of Title 83 of the Mississippi Code of 1972, Annotated, and is promulgated in accordance with Mississippi Insurance Department Regulation N…

This Regulation requires a managed care entity to establish a comprehensive health care professional credentialing verification program to ensure that its participating health care professionals meet specific minimum standards of professional qualification. The standards set out …

For purposes of this Regulation: A. "Commissioner" means the Commissioner of Insurance. B. "Credentialing verification" is the process of obtaining and verifying information about a health care professional, and evaluating the professional credentials of that health care professi…

This Regulation shall apply to managed care entities that offer, operate or participate in managed care plans. Notes 19 Miss. Code. R. 3-11.04 Miss Code Ann §§ 83-5-1; 83-41-413 (Rev. 2011)

A. A managed care entity shall: 1. Establish written policies and procedures for credentialing verification of all health care professionals with whom the managed care entity contracts and apply these standards consistently; 2. Verify the credentials of a health care professional…

A managed care entity shall: A. Obtain primary verification of at least the following information about the applicant: 1. Current license or certification to practice in this and all other states and history of licensure or certification; 2. Status of primary admitting hospital p…

A. In order to simplify the application process for physicians who are applying to multiple managed care entities, the Commissioner hereby adopts a basic uniform credentialing application which shall be used by all managed care entities performing physician credentialing and recr…

Subject to the provisions of Subsections A., B., C., and D. of this Section, a managed care entity shall provide a health care professional with the sources from which credentialing information is received, notification of any information that varies substantially from the inform…

Whenever a managed care entity delegates the credentialing functions required by this Regulation to another entity, the commissioner shall hold the managed care entity responsible for monitoring the activities of the delegatee entity in order to ensure that the requirements of th…

If any provision of the Regulation, or the application of the provision to any person or circumstance, shall be held invalid, the remainder of the Regulation, and the application of the provision to persons or circumstances other than those to which it is held invalid, shall not …

This Regulation shall become effective thirty (30) days after filing with the Office of the Secretary of State of the State of Mississippi. Notes 19 Miss. Code. R. 3-11.11 Miss Code Ann § 25-43-3.113(Rev. 2010)

To effectively use the Application, the following is suggested: Type or legibly complete the Application in black ink. A. Complete all of the Application except for line 1, "This application is submitted to,___". Do not sign and date the original. Keep the completed original on f…

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