Ins 3.39(30)(k)1.1. The grievance procedure shall be described in the policy and certificate and in the outline of coverage.
Ins 3.39(30)(k)2.2. At the time the policy or certificate is issued, the issuer shall provide detailed information to the policyholder describing how a grievance may be registered with the issuer.
Ins 3.39(30)(k)3.3. Grievances shall be considered in a timely manner and shall be transmitted to appropriate decision-makers who have authority to fully investigate the issue and take corrective action.
Ins 3.39(30)(k)4.4. If a grievance is found to be valid, corrective action shall be taken promptly.
Ins 3.39(30)(k)5.5. All concerned parties shall be notified about the results of a grievance.
Ins 3.39(30)(k)6.6. The issuer shall report no later than each March 31st to the commissioner regarding its grievance procedure. The report shall be in a format prescribed by the commissioner and shall contain the number of grievances filed in the past year and a summary of the subject, nature and resolution of such grievances.
Ins 3.39(30)(L)(L) At the time of initial purchase, a Medicare select issuer shall make available to each applicant for a Medicare select policy or certificate the opportunity to purchase any Medicare supplement policy or certificate otherwise offered by the issuer.
Ins 3.39(30)(m)(m)
Ins 3.39(30)(m)1.1. At the request of an individual insured under a Medicare select policy or certificate, a Medicare select issuer shall make available to the individual insured the opportunity to purchase a Medicare supplement policy or certificate offered by the issuer, which has comparable or lesser benefits and which does not contain a restricted network provision. The issuer shall make such policies or certificates available without requiring evidence of insurability after the Medicare select policy or certificate has been in force for 6 months.
Ins 3.39(30)(m)2.2. For the purposes of subd. 1., a Medicare supplement policy or certificate shall be considered to have comparable or lesser benefits unless it contains one or more significant benefits not included in the Medicare select policy or certificate being replaced. For the purposes of this paragraph, a significant benefit means coverage for the Medicare Part A deductible, coverage for at-home recovery services or coverage for Medicare Part B excess charges.
Ins 3.39(30)(n)(n) Medicare select policies and certificates shall provide for continuation of coverage in the event the secretary determines that Medicare select policies and certificates issued pursuant to this section should be discontinued due to either the failure of the Medicare select federal program to be reauthorized under law or its substantial amendment.
Ins 3.39(30)(n)1.1. Each Medicare select issuer shall make available to each individual insured under a Medicare select policy or certificate the opportunity to purchase any Medicare supplement policy or certificate offered by the issuer, which has comparable or lesser benefits and which does not contain a restricted network provision. The issuer shall make such policies and certificates available without requiring evidence of insurability.
Ins 3.39(30)(n)2.2. For the purposes of subd. 1., a Medicare supplement policy or certificate shall be considered to have comparable or lesser benefits unless it contains one or more significant benefits not included in the Medicare select policy or certificate being replaced. For the purposes of this paragraph, a significant benefit means coverage for the Medicare Part A deductible, coverage for at–home recovery services or coverage for Medicare Part B excess charges.
Ins 3.39(30)(o)(o) A Medicare select issuer shall comply with reasonable requests for data made by state or federal agencies, including the CMS, for the purpose of evaluating the Medicare select program.
Ins 3.39(30)(p)(p) Except as provided in par. (q) or (r), a Medicare select policy shall contain the following benefits:
Ins 3.39(30)(p)1.1. The “basic Medicare supplement coverage” as described in sub. (5) (c).
Ins 3.39(30)(p)2.2. Coverage for the Medicare Part A hospital deductible as described in sub. (5) (i) 1.
Ins 3.39(30)(p)3.3. Coverage for home health care for an aggregate of 365 visits per policy year as described in sub. (5) (i) 2.
Ins 3.39(30)(p)4.4. Coverage for the Medicare Part B medical deductible as described in sub. (5) (i) 3.
Ins 3.39(30)(p)5.5. Coverage for the difference between Medicare Part B eligible charges and the actual charges for authorized referral services. This coverage shall not be described with words or terms that would lead insureds to believe the coverage is for Medicare part B Excess Charges as described in sub. (5) (i) 4.
Ins 3.39(30)(p)6.6. Coverage for benefits obtained outside of the United States as described in sub. (5) (i) 5.
Ins 3.39(30)(p)7.7. Coverage for preventive health care services as described in sub. (5) (c) 14.
Ins 3.39(30)(p)8.8. Coverage for at least 80% of the charges for outpatient prescription drugs after a drug deductible of no more than $6,250 per calendar year. This coverage may only be included in a Medicare select policy issued before January 1, 2006.
Ins 3.39(30)(q)(q) The Medicare Select 50% Cost-Sharing plans shall only contain the following:
Ins 3.39(30)(q)1.1. The designation: MEDICARE SELECT 50% COST-SHARING PLAN;
Ins 3.39(30)(q)2.2. Coverage of 100% of the Medicare Part A hospital coinsurance amount for each day used from the 61st through the 90th day in any Medicare benefit period;
Ins 3.39(30)(q)3.3. Coverage for 100% of the Medicare Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period;
Ins 3.39(30)(q)4.4. Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of 100% of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system rate, or other appropriate Medicare standard of payment, subject to a lifetime limitation benefit of an additional 365 days;
Ins 3.39(30)(q)5.5. Medicare Part A Deductible: Coverage for 50% of the Medicare Part A inpatient hospital deductible amount per benefit period until the out-of-pocket limitation is met as described in subd. 12.;