The national Senior and Special Needs guide covers Medicare Parts A to D, the standardized Medigap plans, Medicaid and how long-term care insurance works. This guide covers the Wyoming rules: Medicare supplement standards (Rule Ch. 35; Wyo. Stat. 26-38-207), long-term care law (Wyo. Stat. 26-38; Rule Ch. 37), and the guaranty limits for these coverages.

Medicare supplement

Policy standards:

• Free look: 30 days from delivery, with a full refund (26-38-207).
• Preexisting conditions: Wyoming is stricter than the six months in the NAIC model. A policy may exclude only losses within 90 days of the effective date, and the look-back can't exceed 90 days (Ch. 35 Sec. 8.1).
• Renewability: policies are guaranteed renewable. The issuer may cancel or nonrenew only for nonpayment or material misrepresentation.
• Medicaid suspension: benefits and premiums may be suspended for up to 24 months if the policyholder notifies the issuer within 90 days of becoming entitled to Medicaid.

Sales rules:

• The outline of coverage is given when the application is presented, with an acknowledgment except for direct-response sales. The Guide to Health Insurance for People with Medicare is given with an acknowledgment.
• The first page says: "This policy may not cover all of your medical expenses."
• The agent lists the applicant's policies still in force and those sold in the past five years that are no longer in force.
• A replacement notice is given before the policy is issued. The applicant gets a signed copy, and the issuer keeps one.
• Commissions: first-year pay is at most 200% of second-year pay. Renewal pay stays level for at least five renewal years.
• Cold lead advertising, which hides that an agent will make contact, is prohibited.

Long-term care

Free look and delivery:

• Free look: 30 days from delivery. The refund is due within 10 days, not counting weekends and holidays, or it earns interest (26-38-105(j)).
• In an agent sale, the outline of coverage and the shopper's guide are given before the application is presented.
• A replacement notice gives the buyer 30 days to decide without cost and warns that preexisting conditions may not be covered right away.

Coverage standards:

• No cancellation or nonrenewal because of age or declining health (26-38-105(b)).
• No requirement of a prior hospital stay (26-38-105(g)).
• A preexisting condition can be excluded only for losses starting within six months of the effective date.
• Benefit triggers can't require more than three ADL deficiencies, or cognitive impairment (Ch. 37 Sec. 17). The ADLs are bathing, continence, dressing, eating, toileting and transferring. Managing finances isn't one.
• Alzheimer's disease can't be excluded, even under a mental or nervous disorder exclusion. Permitted exclusions include preexisting conditions, other mental and nervous disorders, alcoholism and drug addiction, and war.
• Inflation protection must be offered at purchase (Ch. 37 Sec. 10).
• A nonforfeiture benefit must be offered as an option (26-38-109).

Lapse protection:

• The applicant names someone to receive lapse notices, or signs a waiver.
• A policy can't lapse without 30 days' notice, which can't be sent until 30 days after the premium is due.
• A policy that lapsed because of cognitive impairment or loss of function is reinstated if requested within five months (26-38-108).

Other rules:

• Rate increases must rest on accepted actuarial principles and need the Commissioner's approval.
• Within 60 days of a written request, the insurer explains a claim denial.

Guaranty protection

The Wyoming Life and Health Insurance Guaranty Association covers disability, disability income and LTC up to $300,000, and other health coverage up to $100,000 (26-42-103).

Common exam traps

• The Medigap preexisting-condition limit in Wyoming is 90 days, not six months.
• The Medigap and LTC free look is 30 days. An LTC refund is due within 10 business days.
• LTC triggers can't require more than 3 ADLs. Alzheimer's can't be excluded.
• An LTC lapse needs 30 days' notice, and reinstatement can be requested within 5 months for cognitive impairment.
• Medigap first-year commission is capped at 200% of the second year's.