State RegulationsIL specificDifficulty 2/5
A 65-year-old applicant with managed diabetes applies for a Medicare supplement policy during her initial open enrollment period. Under Illinois rules, what may the insurer do regarding her health status?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
During the Medicare supplement initial open enrollment period, Illinois rules bar the insurer from denying the application, conditioning coverage, or pricing the policy based on health status. Under the 215 ILCS 5/363a framework and the standards administered by the Illinois Department of Insurance, an applicant in the 6-month open enrollment window is entitled to a Medicare supplement policy without medical underwriting.
Why the other options are wrong
- B) Health-based premium rating is not permitted during the initial open enrollment period; neither denial nor rating up on health status is allowed.
- C) Exclusion riders based on preexisting health conditions cannot be imposed during the initial open enrollment period.
- D) Requiring a medical examination to make the underwriting decision defeats the open enrollment guarantee and is not permitted.
Memory hook
In the OEP, your health history stays out of the deal.