State RegulationsPA specificDifficulty 2/5
A Medicare beneficiary in Pennsylvania loses other health coverage and applies for a Medicare supplement policy outside the open enrollment period, in one of the circumstances that trigger a guaranteed issue right. Under 31 Pa. Code 89.790, what must the insurer do?
Select an option to reveal the answer and the full 3-part explanation — free, no signup.
Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under 31 Pa. Code 89.790, when a guaranteed issue circumstance applies, the insurer must issue the Medicare supplement policy without health screening, medical underwriting, or denial for pre-existing conditions. Pennsylvania layers these guaranteed issue rights on top of the open enrollment guarantee of 31 Pa. Code 89.778 so that beneficiaries who lose specified coverage keep a path to standardized Med-supp protection. The Pennsylvania Insurance Department treats an underwriting refusal in a guaranteed issue situation as a violation of the regulation.
Why the other options are wrong
- A) A guaranteed issue right removes health-based underwriting in the specified circumstances; conditioning issuance on a completed medical review defeats the right.
- C) The right is not a conditional pass with a health test attached; in these circumstances the policy must be issued regardless of health history or pre-existing conditions.
- D) Guaranteed issue protects the issuance of coverage; it does not authorize a claims-history surcharge as a substitute for the issuance obligation.
Memory hook
Guaranteed issue = guaranteed yes: no health check when the trigger applies.