The national guide covers Medicare (Parts A, B, C and D), Medigap plan letters, Medicaid and the basics of long-term care. Indiana regulates these products in three places:

• Medicare supplement: IC 27-8-13 and 760 IAC 3.
• Long-term care: IC 27-8-12 and 760 IAC 2.
• Indiana Long Term Care Insurance Program (Partnership): IC 12-15-39.6.

These notes cover the Indiana rules.

National concepts in brief

• Part A covers hospital care, Part B covers medical care, Part C is Medicare Advantage, and Part D covers drugs.
• Medigap fills gaps in Original Medicare. Its open enrollment is the six months starting the first month a person is 65 and in Part B.
• Long-term care pays for custodial care when a person can't perform activities of daily living or is cognitively impaired.

Medicare supplement in Indiana

Enrollment:

• Open enrollment: no denial, conditions or health-based pricing for applications made during the six months starting the first month a person is 65 and enrolled in Part B (760 IAC 3-9-1).
• Medicare Advantage: a Medigap policy can't be issued to a Part C enrollee unless it takes effect after Part C ends (760 IAC 3-18-1).

Policy rules:

• Preexisting conditions: the look-back is six months, and no exclusion may apply after the first six months of coverage (IC 27-8-13-9).
• No duplication: benefits may not duplicate Medicare.
• One policy per person: selling someone more than one Medicare supplement policy is prohibited, except a properly handled replacement (760 IAC 3-18-1).
• Free look: 30 days from delivery. The insurer refunds the premium directly (IC 27-8-13-17).
• Medicaid suspension: benefits and premiums can be suspended for up to 24 months while the person is on Medicaid, if requested within 90 days of becoming eligible.

Paperwork:

• Outline of coverage: delivered when the application is made (IC 27-8-13-14).
• Application: the agent lists other health policies sold to the applicant that are still in force, or were in force in the past five years (760 IAC 3-15-1).
• Replacement: the replacement notice is signed by the applicant and agent before issue.

Long-term care in Indiana

Definition: coverage for at least 12 consecutive months, in a setting other than an acute care hospital unit (IC 27-8-12-5).

Policy rules:

• Renewability: individual policies must be guaranteed renewable or noncancellable, and tax-qualified policies must be guaranteed renewable (760 IAC 2-3-1).
  • Guaranteed renewable: rates can change by class.
  • Noncancellable: nothing can change, including the premium.
• Preexisting conditions: six-month look-back, and an exclusion may apply only to losses that begin within six months of coverage (IC 27-8-12-10.5).
• Free look: 30 days (IC 27-8-12-12).
• Lapse protection (760 IAC 2-3-8):
  • The applicant names a person to receive lapse notices, or signs a waiver.
  • Lapse notice comes at least 30 days before lapse, and no sooner than 30 days after the premium was due.
  • Reinstatement is available within five months if cognitive impairment or loss of functional capacity is shown.
• Replacement: the new insurer waives preexisting condition and probationary periods already satisfied under the old policy (760 IAC 2-16-2).

Commissions (IC 27-8-12-18):

• Paid annually for at least six years.
• A replacement earns only a renewal-level commission unless its benefits are clearly and substantially better.

Sales:

• The outline of coverage comes before the application is presented (IC 27-8-12-14).
• At solicitation, the buyer gets written notice of SHIIP and the Indiana Long Term Care Insurance Program (760 IAC 2-15-1).
• Cold-lead advertising and high-pressure tactics are prohibited.
• Producers must make reasonable efforts to decide whether a purchase or replacement is appropriate (760 IAC 2-16-1).

Who may sell:

• License: producers need an Accident & Health or Life, Accident & Health license.
• Training: a one-time 8-hour basic LTC course before selling, then at least 5 hours of LTC CE every renewal period. Missing the 5 hours means retaking the 8-hour course.
• Partnership sales: also require a one-time 7-hour Indiana Partnership course. It can't be replaced by another state's course or the NAIC 4-hour course, and it isn't available as self-study.

The Partnership (IC 12-15-39.6):

• Asset disregard: $1 of assets is protected for each $1 of benefits paid. Qualifying larger policies get total asset protection.
• Administration: the program is run by the Office of Medicaid Policy and Planning and the Department of Insurance.

Viatical settlements (IC 27-8-19.8)

• Brokers must be licensed producers with a life qualification. They represent only the viator and owe a fiduciary duty.
• Rescission: the viator may rescind for the longer of 15 days after receiving the proceeds or 30 days after signing.
• Commissions: a producer may not be paid on a settlement of a policy the producer sold less than two years earlier.
• STOLI is an unfair and deceptive act (IC 27-8-19.8-20.1).

Common exam traps

• Medigap and LTC free looks are 30 days.
• Indiana LTC training: 8 hours up front, then 5 hours every renewal period. Partnership sales add a 7-hour Indiana course.
• LTC must be guaranteed renewable or noncancellable.
• Medigap can be suspended for up to 24 months while the person is on Medicaid.
• The viatical rescission period is the longer of 15 days after proceeds or 30 days after signing.