Medicare's parts, Medicaid and long-term care basics are covered in the national Senior and Special Needs guide. This guide covers Utah's Medicare supplement rule (R590-146), its long-term care statute and rule (31A-22-1401 and following; R590-148), and the senior-sales protections that go with them.

Medicare supplement (R590-146)

Open enrollment and guaranteed issue

• Open enrollment: the 6 months starting when a person is 65 or older and enrolled in Part B. The issuer can't deny, condition or price coverage based on health (R590-146-11).
• Employer plan ends: when an employer plan that supplements Medicare ends, the guaranteed issue period runs 63 days from the later of the termination notice or the end of coverage (R590-146-12).

Policy terms

• Preexisting conditions: no exclusion for losses more than 6 months after the effective date (R590-146-7).
• Plan G covers the core benefits, the Part A deductible, skilled nursing coinsurance, 80% of Part B excess charges, foreign travel emergencies and at-home recovery. It doesn't cover the Part B deductible (R590-146-9).

Selling rules

• Free look: 30 days from delivery (R590-146-17).
• Issuers give the Guide to Health Insurance for People with Medicare (R590-146-17).
• No duplicate policies: a sale that would give someone more than one Medigap policy is prohibited (R590-146-21).
• A Medicare Advantage enrollee may buy Medigap only if it takes effect after the Advantage coverage ends.
• Replacement (R590-146-23):
  • The new issuer must credit time served under the old policy's waiting and preexisting periods.
  • If the old policy was in force at least 6 months, no new periods apply for similar benefits.
• Commissions: first-year pay is capped at 200% of second-year pay. Renewal pay equals the second year's for at least 5 renewal years (R590-146-16).

Other senior protections

• Self-conferred senior designations are an unfair practice (R590-252).
• A limited A&H policy sold to a Medicare-eligible person has a 30-day free look (31A-22-605).

Long-term care

Policy protections

• Free look: 30 days from delivery (31A-22-1408).
• An insurer can't cancel or nonrenew because of age or declining health (31A-22-1405).
• No prior hospitalization may be required. A policy may not require a prior institutional stay of more than 30 days for noninstitutional benefits (31A-22-1407).
• Preexisting conditions (31A-22-1406):
  • the look-back is 6 months
  • the exclusion applies only to losses that begin within 6 months after the effective date
• Rescission (31A-22-1411):
  • During the first 6 months, any material misrepresentation can support rescission.
  • From 6 months to 2 years, the misrepresentation must also relate to the condition the claim is for.

Inflation and nonforfeiture

• Insurers must offer inflation protection at least as good as 5% annual compounding (R590-148-13).
• They must offer nonforfeiture. If it's declined, the contingent benefit upon lapse applies after a substantial rate increase (31A-22-1412).

Lapse protection (R590-148-11)

• Lapse notice goes out at least 30 days ahead, by first-class mail, to the insured and each designee.
• Reinstatement within 5 months is required when the lapse was caused by a cognitive or functional impairment.

Selling rules

• The shopper's guide is delivered before an application is presented (R590-148-16).
• The personal worksheet must be returned before the insurer considers the applicant (R590-148-17).

Guaranty protection

The Utah Life and Health Insurance Guaranty Association covers health benefit plans up to $500,000 (31A-28-103).

Common exam traps

• Medigap and LTC free looks are both 30 days. A limited A&H policy sold to a Medicare-eligible person also gets 30 days.
• Guaranteed issue after an employer plan ends: 63 days.
• Plan G doesn't cover the Part B deductible.
• LTC: shopper's guide before the application. Inflation offer at least 5% compound. Reinstatement within 5 months.