MEDICARE SUPPLEMENTS
CHECKLIST FOR CODE 42
IDENTIFY
POLICY & CERT
PAGE #, OR
LOCATION, OF
BENEFIT WITHIN
FORM
SUBMISSION
October 24, 2005
LH42CHK
Prior versions – July 30, 2004, October 7, 2003,
PAGE 1 OF 10
♦DENOTES A MANDATE FOR WHICH A SPECIFIC CONTRACTUAL REFERENCE IS REQUIRED.
REGARDING COMPLIANCE WITH REQUIREMENTS FOR MEDICARE
PART D
• Amendments that drop coverage for outpatient prescription drugs from
existing or in‐force Medicare Supplement Plans must be submitted for
review and approval.
• Filings of such amendments must include a signed and dated Actuarial
Memorandum supporting a corresponding reduction in the premium rate.
• All such amendments, while appropriate for use with in‐force plans, will be
confusing when attached to new Medicare supplement policies and will not
be approved for use with newly issued Medicare Supplement policies issued
after January 1, 2006. If the filed amendment is not intended to be used with
newly issued supplement plans, the filing should specify that this is the case.
60A.06
Kinds of Insurance Permitted
Subd 3
Limitation on Combination Policies
♦60A.08
Contracts of Insurance
Subd 5
Signatures Required
The signatures may be facsimile signatures and may be placed in brackets
[] designating a "variable" item.
♦62A.02
Policy Forms
♦62A.021
Health Care Policy Rates
For health, we require proof of a reasonable loss ratio. Insurers must
forward a signed actuarial memorandum for review.
♦62A.03
General Provisions of Policy
MEDICARE SUPPLEMENTS
CHECKLIST FOR CODE 42
IDENTIFY
POLICY & CERT
PAGE #, OR
LOCATION, OF
BENEFIT WITHIN
FORM
SUBMISSION
October 24, 2005
LH42CHK
Prior versions – July 30, 2004, October 7, 2003,
PAGE 2 OF 10
♦DENOTES A MANDATE FOR WHICH A SPECIFIC CONTRACTUAL REFERENCE IS REQUIRED.
♦62A.04
Standard Provisions (All Accident & Sickness Contracts)
Subd 2
Required Provisions
(4) Reinstatement
For health plans described in section 62A.011, subdivision 3, clause (10),
an insurer must acce