,i #aafth ,,congress #ast ,session ,h4 ,r4 #acid ,,in ,,the ,,house ,,of ,,representatives ,february #bg1 #bjai,mr4 ,doggett introduced the following bill2 which was referred to the ,committee on ,ways and ,means1 and in addition to the ,committee on ,energy and ,commerce1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to provide for certain reforms with respect to medicare supplemental health insurance policies4 #a4 ,short title ,this ,act may be cited as the ,medigap ,consumer ,protection ,act of #bjai4 #b4 ,guaranteed issue 7a7 ,guaranteed issue of ,medigap policies to all ,medigap-,eligible ,medicare beneficiaries 7#a7 ,in general ,section #ahhb7s7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77 is amended-- 7,a7 in paragraph 7#b77;,a71 by striking #fe years of age or older and is enrolled for benefits under part ,b and inserting entitled to1 or enrolled for1 benefits under part ,a and enrolled for benefits under part ,b2 7,b7 in paragraph 7#b77;,d71 by striking who is #fe years of age or older as of the date of issuance and2 7,c7 in paragraph 7#c77;,b77ii71 by striking is #fe years of age or older and2 and 7,d7 in paragraph 7#c77;,b77vi71 by striking at age #fe4 7#b7 ,effective date2 phase-,in authority 7,a7 ,effective date ,subject to subparagraph 7,b71 the amendments made by paragraph 7#a7 shall apply to medicare supplemental policies effective on or after ,january #a1 #bjbb4 7,b7 ,phase-,in authority 7i7 ,in general ,subject to clause 7ii71 the ,secretary of ,health and ,human ,services may phase in the implementation of the amendments made under paragraph 7#a7 7with such phase-in beginning on or after ,january #a1 #bjbb7 in such manner as the ,secretary determines appropriate in order to minimize any adverse impact on individuals enrolled under a medicare supplemental policy4 7ii7 ,phase-,in period may not exceed #e years ,the ,secretary of ,health and ,human ,services shall ensure that the amendments made by paragraph 7#a7 are fully implemented by not later than ,january #a1 #bjbg4 7#c7 ,additional enrollment period for certain individuals 7,a7 ,one-time enrollment period 7i7 ,in general ,in the case of an individual described in subparagraph 7,b71 the ,secretary shall establish a one-time enrollment period during which such an individual may enroll in any medicare supplemental policy of the individual's choosing4 7ii7 ,period ,the enrollment period established under clause 7i7 shall begin on the date on which the phase-in period under paragraph 7#b7 is completed and end #f months after such date4 7,b7 ,individual described ,an individual described in this paragraph is an individual who-- 7i7 is entitled to hospital insurance benefits under part ,a under section #bbf7;b7 or section #bbf;,a of the ,social ,security ,act 7#db ,u4,s4,c4 #dbf7;b72 #dbf-a72 7ii7 is enrolled for benefits under part ,b of such ,act 7#db ,u4,s4,c4 #acie;j et seq472 and 7iii7 would not1 but for the provisions of and amendments made by paragraphs 7#a7 and 7#b71 be eligible for the guaranteed issue of a medicare supplemental policy under paragraph 7#b7 or 7#c7 of section #ahhb7s7 of such ,act 7#db ,u4,s4,c4 #aciess7s774 7,c7 ,outreach plan 7i7 ,in general ,the ,secretary shall develop an outreach plan to notify individuals described in subparagraph 7,b7 of the one-time enrollment period established under subparagraph 7,a74 7ii7 ,consultation ,in implementing the outreach plan developed under clause 7i71 the ,secretary shall consult with consumer advocates1 brokers1 insurers1 the ,national ,association of ,insurance ,commissioners1 and ,state ,health ,insurance ,assistance ,programs4 7b7 ,guaranteed issue of ,medigap policies for ,medicare ,advantage and ,medicaid enrollees2 ,treatment of individuals with ,,cobra 7#a7 ,in general ,section #ahhb7s77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77#c771 as amended by subsection 7a71 is further amended-- 7,a7 in subparagraph 7,b71 by adding at the end the following new clauses3 7vii7 ,the individual was enrolled in a ,medicare ,advantage plan under part ,c for not less than #ab months and subsequently disenrolled from such plan and elects to receive benefits under this title through the original ,medicare fee-for-service program under parts ,a and ,b4 7viii7 ,the individual-- 7,i7 is entitled to1 or enrolled for1 benefits under part ,a and enrolled for benefits under part ,b2 and 7,,ii7 either-- 7aa7 is eligible for medical assistance under a ,state plan or waiver under title ,,xix based on a reduction of income of the individual based on costs incurred for medical or other remedial care and was enrolled in such plan or waiver2 or 7bb7 was otherwise eligible for medical assistance under a ,state plan or waiver under title ,,xix and subsequently lost eligibility for such medical assistance4 2 7,b7 by striking subparagraph 7,c77iii7 and inserting the following3 7iii7 ,subject to subsection 7v77#a71 for purposes of an individual described in clause 7vi71 7vii71 or 7viii7 of subparagraph 7,b71 a medicare supplemental policy described in this subparagraph shall include any medicare supplemental policy4 2 and 7,c7 in subparagraph 7,e7-- 7i7 in clause 7iv71 by striking and at the end2 7ii7 in clause 7v71 by striking the period at the end and inserting a semicolon2 and 7iii7 by adding at the end the following new clauses-- 7vi7 in the case of an individual described in subparagraph 7,b77vii71 the annual1 coordinated election period 7as defined in section #ahea7;e77#c77;,b77 or a continuous open enrollment period 7as defined in section #ahea7;e77#b77 during which the individual disenrolls from a ,medicare ,advantage plan under part ,c2 7vii7 in the case of an individual described in subparagraph 7,b77viii7 who is eligible for medical assistance under a ,state plan or waiver under title ,,xix for a reason described in item 7aa71 such period as is specified by the ,secretary2 7viii7 in the case of an individual described in subparagraph 7,b77viii7 who is eligible for medical assistance under a ,state plan or waiver under title ,,xix for a reason described in item 7bb71 the period beginning on the date that the individual receives a notice of cessation of such individual's eligibility for medical assistance under the ,state plan or waiver under title ,,xix and ending on the date that is four months after the individual receives such notice2 and 4 7#b7 ,treatment of individuals with ,,cobra 7,a7 ,in general ,section #ahhb7s77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77#c771 as amended by subsection 7a7 and paragraph 7#a71 is further amended-- 7i7 in subparagraph 7,b77i7 by inserting or1 in the case of an individual enrolled in such an employee welfare benefit plan pursuant to a ,,cobra continuation provision 7as defined in section #bgia7;d77#d7 of the ,public ,health ,service ,act71 that the individual disenrolls from such plan and enrolls under part ,b before the period at the end2 and 7ii7 in subparagraph 7,e71 as amended by paragraph 7#a71 by adding at the end the following new clause3 7ix7 in the case of an individual described in subparagraph 7,b77i7 who enrolled in an employee welfare benefit plan described in such subparagraph pursuant to a ,,cobra continuation provision 7as defined in section #bgia7;d77#d7 of the ,public ,health ,service ,act7 and who disenrolls from such plan and enrolls under part ,b1 the period beginning on #fj days before the effective date of such disenrollment and ending on the date that is #fc days after such effective date4 4 7,b7 ,technical correction ,section #ahhb7s77#b77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7s77#b77;,d77 is amended-- 7i7 by striking #bgja7;c7 and inserting #bgjd7;c72 and 7ii7 by striking #bgja7;a77#c7 and inserting #bgjd7;a77#c74 7#c7 ,effective date ,the amendments made by paragraphs 7#a7 and 7#b77;,a7 shall apply to medicare supplemental policies effective on or after ,january #a1 #bjbb4 #c4 ,medical loss ratio ,section #ahhb7r77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7r77#a77;,a77 is amended-- 7#a7 by inserting and periodically reviewed after developed2 and 7#b7 by striking policy1 at least #ge percent of the aggregate amount of premiums collected in the case of group policies and at least #fe percent in the case of individual policies2 and and inserting the following3 policy-- 7i7 with respect to periods beginning before ,january #a1 #bjbb1 at least #ge percent of the aggregate amount of premiums collected in the case of group policies and at least #fe percent in the case of individual policies2 and 7ii7 with respect to periods beginning on or after ,january #a1 #bjbb1 a percent of the aggregate amount of premiums collected that1 in the case of group policies or individual policies1 as applicable1 is equal to or greater than both-- 7,i7 the applicable percent specified in clause 7i7 with respect to such policies2 and 7,,ii7 such percent as the ,national ,association of ,insurance ,commissioners may recommend to the ,secretary with respect to such policies for purposes of this paragraph2 and 4 #d4 ,limitations on pricing discrimination 7a7 ,in general ,section #ahhb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess71 as amended by section #f1 is further amended by adding at the end the following new subsection3 7aa7 ,development of new standards relating to pricing discrimination 7#a7 ,in general ,the ,secretary shall request the ,national ,association of ,insurance ,commissioners to review and revise the standards for all benefit packages under subsection 7p77#a71 including the core benefit package1 in order to provide coverage consistent with paragraph 7#b74 ,such revisions shall be made consistent with the rules applicable under subsection 7p77#a77;,e7 7with the reference to the #aiia ,,naic ,model ,regulation deemed a reference to the ,,naic ,model ,regulation as most recently updated by the ,national ,association of ,insurance ,commissioners to reflect previous changes in law and the reference to date of enactment of this subsection deemed a reference to the date of enactment of this subsection74 7#b7 ,changes in cost-sharing described ,under the revised standards1 coverage shall not be available under a ,medicare supplemental insurance policy unless the issuer of the policy1 in addition to conforming to the other applicable requirements of this section-- 7,a7 does not discriminate in the pricing of the policy because of the age of the individual to whom the policy is issued2 7,b7 does not1 to an extent that jeopardizes the access to such policy for individuals who are eligible to participate in the program under this title because the individuals are individuals described in paragraph 7#b7 or 7#c7 of section #ahaa1 discriminate in the pricing of the policy because the individual to whom the policy is issued is so eligible to participate in such program because the individual is an individual so described in such a paragraph2 and 7,c7 does not establish premiums applicable under such policy on a basis that would apply to a portion of1 but not the entirety of1 a county or equivalent area specified by the ,secretary4 7#c7 ,application date ,the revised standards shall apply to benefit packages sold1 issued1 or renewed under this section to individuals who first become entitled to benefits under part ,a or first enrolls in part ,b on or after ,january #a1 #bjbb4 4 7b7 ,conforming amendment ,section #ahhb7o77#a7 of such ,act 7#db ,u4,s4,c4 #aciess7o77#a77 is amended by striking 1 and 7y7 and inserting 7y71 and 7aa74 #e4 ,clarifying beneficiary options on the ,medicare plan finder website ,section #ahjd of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#b7 is amended by adding at the end the following new subsections3 7d7 ,in the case that the ,secretary provides for a ,medicare plan finder internet website of the ,centers for ,medicare ,medicaid ,services 7or a successor website71 the ,secretary shall1 with respect to such website and in accordance with subsection 7f7-- 7#a7 make available on such website-- 7,a7 access to provider networks in order to provide to individuals entitled to benefits under part ,a or enrolled under part ,b information to assist such individuals in understanding the restrictions on providers and potential costs entailed by their decisions regarding enrollment under parts ,a and ,b1 under part ,c1 and in medicare supplemental policies under section #ahhb2 7,b7 a review of out-of-pocket expenditures1 including deductibles1 copayments1 coinsurance1 monthly premiums1 and estimated annual out-of-pocket costs1 displayed overall and by components1 based on the best available information as determined by the ,secretary2 and 7,c7 during the period prior to ,january #a1 #bjbe1 information regarding the rules that1 in each ,state1 pertain to guaranteed issue of medicare supplemental health insurance policies prior to implementation of the provisions of the ,medigap ,consumer ,protection ,act of #bjai and1 in the case that a ,state has no such rules pertaining to guaranteed issue of such policies1 clear language explaining the implications of such lack of rules for individuals with pre-existing conditions2 7#b7 not later than ,january #a1 #bjbj1 and periodically thereafter1 perform a review of such website in order to ensure that such website makes available to individuals entitled to benefits under part ,a or enrolled under part ,b the information that the ,secretary determines is necessary for such individuals to make informed choices regarding their options under the program under this title2 and 7#c7 not later than #ab months after the last day of each period for the request for information under subsection 7e71 update such website1 taking into consideration the information collected pursuant to such subsection1 to clarify the presentation of consumer options for medicare supplemental health insurance policy options1 including by presenting such information in a manner calculated to be understood by the average consumer and in a manner that-- 7,a7 improves consumer access to information regarding the applicable premiums under such policy options as of the date on which such website is so updated2 7,b7 facilitates consumers' ability to compare and sort policy options and premium information across plan offerings in a given location2 7,c7 clarifies and explains differences in policy value2 7,d7 rates and explains the financial stability of issuers of such policies2 7,e7 provides data on the inflation rate of different policies2 7,f7 provides information regarding the guaranteed issue requirements that apply to medicare supplemental health insurance policies under section #ahhb7s77#c72 and 7,g7 includes such general information as is determined by the ,secretary to be necessary for individuals entitled to benefits under part ,a or enrolled under part ,b to understand costs under ,,ma plans available pursuant to part ,c and prescription drug plans available pursuant to part ,d4 7e7 ,not later than #f months after the date of the enactment of this subsection and beginning on ,december #g of each year thereafter1 the ,secretary of ,health and ,human ,services shall provide an opportunity for public comment during which the ,secretary requests information1 including recommendations1 from stakeholders regarding potential improvements to the presentation of medicare supplemental health insurance policy options under section #ahhb on the ,medicare plan finder internet website of the ,centers for ,medicare ,medicaid ,services 7or a successor website74 7f7 ,with respect to any information that the ,secretary makes available on the ,medicare plan finder internet website of the ,centers for ,medicare ,medicaid ,services 7or a successor website7 pursuant to subsection 7d71 the ,secretary shall1 prior to making such information available-- 7#a7 provide1 in consultation with the ,national ,association of ,insurance ,commissioners1 an opportunity for consumer testing of such information2 7#b7 share the results of such consumer testing of such information with interested stakeholders2 and 7#c7 provide a #fj-;day public comment period with respect to such information4 4 #f4 ,restoring access to first-dollar ,medigap coverage ,section #ahhb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciess7 is amended by striking subsection 7z74 #g4 ,broker transparency ,section #aabh;,g of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;a-#g;h7 is amended-- 7#a7 in subsection 7c77#a77;,a71 by striking #bjaa1 and inserting #bjaa 7or1 with respect to information required to be submitted under subsection 7f77#a71 not later than six months after the date of the enactment of such subsection712 and 7#b7 by adding at the end the following new subsection3 7f7 ,application to ,medigap insurance brokers 7#a7 ,in general ,beginning not later than #ab months after the date of enactment of this subsection1 each issuer of a medicare supplemental health insurance policy shall annually submit to the ,secretary a report regarding payments or other transfers of value made during the previous year to agents1 brokers1 and other third parties representing such policy4 ,each such report shall include the following information1 with respect to such a payment or other transfer of value3 7,a7 ,the name of the recipient of the payment or other transfer of value4 7,b7 ,the business address of the recipient4 7,c7 ,the amount of the payment or other transfer of value4 7,d7 ,the dates on which the payment or transfer of value was provided4 7,e7 ,a description of the form of the payment or transfer of value4 7,f7 ,any other categories of information the ,secretary determines appropriate4 7#b7 ,application of transparency system ,the provisions of subsections 7b7 through 7d7 shall apply to an issuer described in paragraph 7#a71 information required to be reported under such paragraph1 and agents1 brokers1 and other third parties described in such paragraph in the same manner and to the same extent as such provisions apply to an applicable manufacturer1 information required to be reported under subsection 7a71 and a covered recipient4 4