Rhode Island's senior-market rules come from the Medicare supplement statute (chapter 27-18.2) and rule (230-RICR-20-30-7), and from the Long-Term Care Insurance Act (chapter 27-34.2) and rule (230-RICR-20-35-1). Expect questions on free looks, outlines of coverage, preexisting-condition limits, commissions, LTC protections, inflation offers and producer training. How Medicare works (Parts A-D, enrollment, standardized plans, Medicaid, LTC benefit triggers) is in the national Senior and Special Needs guide.

Medicare supplement

Free look, outline and preexisting conditions

• Free look: 30 days from delivery (27-18.2-7).
• Outline of coverage: delivered at the time of application (27-18.2-6).
• Preexisting conditions: no exclusion for losses incurred more than 6 months after the effective date (27-18.2-3).

Open enrollment (230-RICR-20-30-7.14)

• A 6-month period beginning with the first day of the first month the person is 65 or older and enrolled in Part B.
• An applicant with 6 months of prior creditable coverage can't be subject to a preexisting-condition exclusion.

Commissions (7.19)

• First-year commission may not exceed 200% of the second-year commission.
• Renewal commissions must equal the second-year commission and be paid for at least 5 renewal years.

Prohibited practices

• Duplicate coverage: a sale that would give a person more than one Medicare supplement policy (7.24).
• Medicare Advantage enrollees: a supplement may be issued to someone in Part C only if it takes effect after the Part C coverage ends.
• High pressure tactics such as force, fright or threats (7.23).

Required documents

• The first page of the policy says it may not cover all of the buyer's medical expenses.
• Applicants receive the Guide to Health Insurance for People with Medicare (7.20).

Long-term care insurance

Policy standards (27-34.2-6)

• No cancellation for age or health: a policy can't be canceled or nonrenewed because of the insured's age or deteriorating physical or mental health.
• Not skilled care only: an individual policy may not cover skilled nursing care only.
• Home health care benefits must be at least 50% of the nursing facility coverage.
• Preexisting conditions: the definition can reach back no more than 6 months before coverage.

Contestability (27-34.2-7.1)

• Before 2 years: rescission only for a misrepresentation that is material to acceptance and pertains to the condition for which benefits are sought.
• After 2 years: the insurer must show the insured knowingly and intentionally misrepresented relevant health facts.

Benefit triggers (230-RICR-20-35-1.29)

• Eligibility can be no more restrictive than a deficiency in three activities of daily living, or a cognitive impairment.

Lapse protection (27-34.2-12)

• Before issuing a policy, the insurer gets a third-party designee for lapse notices, or a written waiver.
• A policy can't lapse until premium is 30 days overdue, and only after 30 days' notice to the insured and the designee.
• A lapse caused by cognitive impairment must allow reinstatement if requested within 5 months.

Inflation protection and nonforfeiture

• Insurers must offer inflation protection at least as favorable as 5% compounded annually (27-34.2-13).
• If the applicant declines nonforfeiture benefits, a contingent benefit upon lapse still applies after a substantial premium increase (27-34.2-19).

Partnership (230-RICR-20-35-1.34)

• A Partnership policy sold to someone under 61 must include automatic compound annual inflation protection.

Marketing

• In a producer solicitation, the Shopper's Guide comes before the application is presented (27-34.2-15).
• The outline and the policy say on the first page that the policy may not cover all LTC costs.
• Cold lead advertising is prohibited (27-34.2-14).

Producer training (27-34.2-21)

• A one-time 8-hour course, then 4 hours every 24 months.

Penalties

• $500 to $50,000 for LTC law violations (27-34.2-10).

Guaranty protection

• The Rhode Island Life and Health Insurance Guaranty Association protects LTC and other health benefits within its limits (chapter 27-34.3). See the Rhode Island Insurance Regulation guide.

Common exam traps

• Free looks: Medigap 30 days. The individual life and annuity free look is 20 days.
• Medigap open enrollment: 6 months from being 65 and enrolled in Part B. Renewal commissions run at least 5 years.
• LTC home health must be at least 50% of the nursing home benefit.
• LTC lapse: 30 days overdue plus 30 days' notice, with a 5-month reinstatement window for cognitive impairment.
• LTC training: 8 hours once, then 4 hours every 24 months. The inflation offer is 5% compound.