Medicare Program; Recognition of Revised NAIC Model Standards for Regulation of Medicare Supplemental Insurance, 41684-41823 [2017-18605]
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Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–4177–N]
Medicare Program; Recognition of
Revised NAIC Model Standards for
Regulation of Medicare Supplemental
Insurance
Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION: Notice.
AGENCY:
This notice announces the
changes made by the Medicare Access
and CHIP Reauthorization of 2015
(MACRA) to section 1882 of the Social
Security Act (the Act), which governs
Medicare supplemental insurance. This
notice also recognizes that the Model
Regulation adopted by the National
Association of Insurance Commissioners
(NAIC) on August 29, 2016, is
considered to be the applicable NAIC
Model Regulation for purposes of
section 1882 of the Act, subject to our
clarifications that are set forth in this
notice.
DATES: Amendments made by section
401 of MACRA apply to issuers of
Medigap policies for policies issued on
or after January 1, 2020.
FOR FURTHER INFORMATION CONTACT:
Derrick Claggett, (410) 786–2113.
SUPPLEMENTARY INFORMATION:
SUMMARY:
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I. Background
A. The Medicare Program
The Medicare program was
established by Congress in 1965 with
the enactment of title XVIII of the Social
Security Act (the Act). The program
provides payment for certain medical
expenses for persons 65 years of age or
older, certain disabled individuals,
persons with end-stage renal disease
(ESRD), and certain individuals exposed
to environmental health hazards.
Medicare has three types of benefits.
The Hospital Insurance Program (Part A)
covers inpatient care. The
Supplementary Medical Insurance
Program (Part B) covers a wide range of
medical services, including physicians’
services and outpatient hospital
services, as well as equipment and
supplies, such as prosthetic devices.
The Voluntary Prescription Drug Benefit
Program (Part D) covers outpatient
prescription drugs not otherwise
covered by Part B.
Beneficiaries can get their Part A and
Part B benefits in two ways. Under
Original Medicare, beneficiaries get
their Part A and Part B benefits directly
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from the Federal government.
Beneficiaries can also choose to get their
Part A and Part B benefits through
private health plans that contract with
Medicare. Most of these contracts are
under Part C of Medicare, the Medicare
Advantage (MA) Program.
While Medicare provides extensive
benefits, it is not designed to cover the
total cost of medical care for Medicare
beneficiaries. Under Original Medicare,
even if the items or services are covered
by Medicare, most beneficiaries are
responsible for various deductibles,
coinsurance, and in some cases
copayment amounts.
1. Deductibles
Under Original Medicare, a
beneficiary with Part A is generally
responsible for the Part A inpatient
hospital deductible for each benefit
period. A benefit period is the period
beginning on the first day of
hospitalization and extending until the
beneficiary has not been an inpatient of
a hospital or skilled nursing facility for
60 consecutive days. The inpatient
hospital deductible is updated annually
in accordance with a statutory formula.
The inpatient hospital deductible for
calendar year (CY) 2016 was $1,288.00
and for CY 2017 it is $1,316.00.
A beneficiary with Part B is
responsible for the Part B deductible for
each calendar year. The deductible is
indexed to increase with the average
cost of Part B services for aged
beneficiaries. The Part B deductible for
CY 2016 was $166.00 and for CY 2017
it is $183.00.
2. Coinsurance
As previously stated, beneficiaries are
generally responsible for paying
coinsurance for covered items and
services. For example, the coinsurance
applicable to physicians’ services under
Part B is generally 20 percent of the
Medicare-approved amount for the
service(s). If a physician or certain other
suppliers accept assignment, the
beneficiary is only responsible for the
coinsurance amount. When
beneficiaries receive covered services
from physicians or other suppliers who
do not accept assignment of their
Medicare claims, beneficiaries may also
be responsible for some amounts in
excess of the Medicare approved
amount (excess charges).
3. Non-Covered Services
Some items and services are not
covered under either Part A or Part B;
for example, custodial nursing home
care, most dental care, eyeglasses, and
items or services furnished outside the
United States. Original Medicare covers
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many health care services and supplies,
but beneficiaries are responsible for the
out-of-pocket expenses described
previously. As such, most beneficiaries
choose to obtain some type of additional
coverage to pay some of the costs not
covered by Original Medicare. For
people who do not have coverage from
a current or previous employer that
performs this function, or who do not
qualify for Medicaid, the most common
coverage is Medicare supplemental
insurance (also called Medigap). Some
beneficiaries may also try to defray
some expenses with hospital indemnity
insurance, nursing home or long-term
care insurance, or specified disease (for
example, cancer) insurance.
B. Medicare Supplemental Insurance
A Medicare supplemental (Medigap)
policy is a health insurance policy sold
by private insurance companies
specifically to fill ‘‘gaps’’ in Original
Medicare coverage. A Medigap policy
typically provides coverage for some or
all of the deductible and coinsurance
amounts applicable to Medicare-covered
services, and sometimes covers items
and services that are not covered by
Medicare. Section 1882(d)(3)(A)(i) of the
Act specifies that a party may not sell
a Medigap policy with knowledge that
the policy duplicates health benefits
which the applicant is otherwise
entitled to, including from Medicaid
programs that cover Medicare costsharing (for example, the Qualified
Medicare Beneficiary Program), MA
plans, and individual market plans.
Section 1882 of the Act sets forth
requirements and standards that govern
the sale of Medigap policies. It
incorporates by reference, as part of the
statutory requirements, certain
minimum standards established by the
National Association of Insurance
Commissioners (NAIC). These minimum
standards, known as the NAIC Model
Standards are found in the ‘‘Model
Regulation to Implement the NAIC
Medicare Supplement Insurance
Minimum Standards Act’’ (NAIC
Model), initially adopted by the NAIC
on June 6, 1979, and revised
periodically to reflect subsequent
Federal legislative changes. (For
additional information, see section
1882(g)(2)(A) of the Act.)
Under section 1882 of the Act,
Medigap policies generally may not be
sold unless they conform to the
standardized benefit packages that have
been defined and designated by the
NAIC. The 10 original standardized
plans were created in accordance with
the Omnibus Budget Reconciliation Act
of 1990 (OBRA ’90), and designated A
through J. The Balanced Budget Act of
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1997 (BBA) authorized plans F and J to
have high deductible options that are
counted as separate plans. The Medicare
Modernization Act of 2003 (MMA)
created new plans K and L, and the
Medicare Improvements for Patients and
Providers Act of 2008 (MIPPA)
authorized the creation of new plans M
and N. Medigap plans E, H, I, and J are
no longer available for sale. Three states
(Massachusetts, Minnesota, and
Wisconsin) are permitted by statute to
have different standardized Medigap
plans and are sometimes referred to in
this context as the ‘‘waiver’’ States.
There are also policies issued before the
OBRA ’90 requirements became
applicable in 1992 (pre-standardized
policies) that are still in effect.
Effective January 1, 2006, Medigap
policies could no longer be sold with a
prescription drug benefit. Three of the
original standardized Medigap plans, H,
I and J, as well as some Medigap
policies in the waiver States, may still
contain coverage for outpatient
prescription drugs if the policies were
sold before January 1, 2006. In addition,
some pre-standardized plans cover
drugs. If a beneficiary holding one of
these policies enrolls in Medicare Part
D prescription drug coverage, the
prescription drug coverage is removed
from the individual’s Medigap policy.
Section 1882(b)(1) of the Act provides
that Medigap policies issued in a State
are deemed to meet the Federal
requirements if the State’s program
regulating Medigap policies provides for
the application of standards is at least
as stringent as those contained in the
NAIC Model Regulation, and if the State
requirements are equal to or more
stringent than those set forth in section
1882 of the Act.
States must amend their regulatory
programs to implement all new Federal
statutory requirements and applicable
changes to the NAIC Model Standards.
Thus, States will now be required to
implement the statutory changes made
by the Medicare Access and CHIP
Reauthorization Act of 2015 the
(MACRA), and the changes to the NAIC
Model Standards made to comport with
the requirements of MACRA. The
revised NAIC Model is attached to this
notice. States generally cannot modify
the standardized benefit packages set
out in the NAIC Model. However, with
respect to other provisions, States retain
the authority to enact provisions that are
more stringent than those that are
incorporated in the NAIC Model
Standards or in the Federal statutory
requirements. (See section 1882(b)(1)(B)
of the Act.) States that have received a
waiver under section 1882(p)(6) of the
Act may continue to authorize the sale
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of policies that contain different benefits
than the standardized benefit packages.
However, those States are also required
to amend their regulatory programs to
implement the new Federal statutory
requirements and changes to the NAIC
Model Standards as a result of MACRA.
(See section 1882(z)(3) of the Act.)
II. Legislative Changes Affecting
Medigap Policies and Clarification
A. Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA)
Some standardized Medigap plans
currently sold on the market provide
first-dollar coverage for beneficiaries,
which means the plan pays the
Medicare deductibles, coinsurance, and
copayments so that the beneficiary has
no out-of-pocket costs for Medicare
covered services. MACRA was enacted
on April 16, 2015 (Pub. L. 114–10), and
beginning on January 1, 2020, it
prohibits the sale of Medigap plans with
first-dollar coverage to an individual
who is a ‘‘newly eligible Medicare
beneficiary,’’ which is further defined in
section II.C.1. of this notice. The effect
of this provision is that as of this date,
a ‘‘newly eligible Medicare beneficiary’’
will be required to pay out-of-pocket for
the Medicare Part B deductible. The Part
B deductible for CY 2016 was $166.00
and for CY 2017 it is $183.00.
B. Changes to the NAIC Model #651
(Model Regulation To Implement the
NAIC Medicare Supplement Insurance
Minimum Standards Model Act)
Approved by the NAIC on August 29,
2016
Consistent with the process
authorized in section 1882(p)(1) of the
Act, the NAIC formulated a task force
consisting of State regulators, consumer
advocates, industry representatives, and
staff from the Centers for Medicare &
Medicaid Services (CMS) to draft
changes to the Medigap standardized
plan structure and the NAIC Model
Standards to align with section 401 of
MACRA. The draft changes were
approved by the NAIC task force on
April 4, 2016. The revised NAIC Model
(with the approved changes) was
adopted by the NAIC on August 29,
2016. The changes apply to Medigap
policies or certificates issued on or after
January 1, 2020.
The following are the changes,
effective January 1, 2020, to the
standardized Medigap plans:
• A new Plan G With High Deductible
is created, which is identical to the Plan
F With High Deductible except there is
no coverage for the Part B deductible.
• For a ‘‘newly eligible Medicare
beneficiary’’—
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++ Plan C is redesignated as Plan D,
which does not provide coverage for the
Part B deductible;
++ Plan F is redesignated as Plan G,
which does not provide coverage for the
Part B deductible; and
++ Plan F With High Deductible is
redesignated as Plan G With High
Deductible, which does not provide
coverage for the Part B deductible.
As a result of these changes, the
revised NAIC Model contains the
following three sets of standardized
plans:
• Sections 8 and 9 of the NAIC Model
outline the benefits for standardized
plans with an effective date of coverage
prior to June 1, 2010 (the 1990
standardized plans).
• Sections 8.1 and 9.1 of the NAIC
Model spell out the benefits for the
standardized plans with an effective
date for coverage on or after June 1,
2010 (the ‘‘2010 standardized plans’’).
• Section 9.2 of the NAIC Model
contains the benefits for the
standardized plans for an individual
who is a ‘‘newly eligible Medicare
beneficiary’’ with an effective date for
coverage on or after January 1, 2020 (the
2020 standardized plans for Newly
Eligible Medicare Beneficiaries).
C. Clarifications
1. Definition of Newly Eligible Medicare
Beneficiary
Section 401 of MACRA defines a
newly eligible Medicare beneficiary’’ as
an individual who is neither of the
following:
• An individual who has attained age
65 before January 1, 2020.
• An individual who was entitled to
benefits under Medicare Part A
pursuant to section 226(b) or 226A of
the Act, or deemed eligible for benefits
under 226(a) of the Act, before January
1, 2020.
Section 9.2.B. of the NAIC Model
captures this definition. An individual
who is not a newly eligible Medicare
beneficiary can continue to purchase
Medigap policies that provide coverage
of the Medicare Part B deductible.
Individuals retroactively entitled to
Medicare Part A after January 1, 2020,
with an effective date for Medicare
coverage before January 1, 2020 would
not fall under the definition of a ‘‘newly
eligible Medicare beneficiary’’ because
their Part A benefits would begin before
January 1, 2020. In addition, an
individual who has attained age 65
before January 1, 2020, but who was not
entitled to Medicare Part A until after
January 1, 2020, would also not be a
‘‘newly eligible Medicare beneficiary.’’
Similarly, environmental exposure
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affected individuals deemed eligible for
Medicare before January 1, 2020 would
not be a ‘‘newly eligible Medicare
beneficiary.’’
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2. Upon Exhaustion Benefit
Section 8.B. of the NAIC Model
describes the standards for basic
benefits common to the 1990
standardized Plans A through J. Section
8.D.(1) of the NAIC Model describes the
standards for benefits common to the
1990 standardized Plans K and L.
Section 8.1.B. of the NAIC Model
describes the basic benefits common for
the 2010 standardized plans A through
D, F, F with High Deductible, G, M and
N. Section 9.1.E.(8) of the NAIC Model
describes the standards for benefits
common to the 2010 standardized plans
K and L. Section 9.2.A. of the NAIC
Model describes the standards for
benefits common to the 2020
standardized plans for a ‘‘newly eligible
Medicare beneficiary’’. Sections 8.B.(3).,
8.D.(1)(c)., 8.1.B.(3)., and 9.1.E.(8)(c). of
the NAIC Model describe what is
commonly referred to as the ‘‘upon
exhaustion’’ benefit. Medicare provides
inpatient hospital benefits for up to 90
days in a benefit period, plus any of the
60 lifetime reserve days that have not
already been used. After a beneficiary
exhausts this coverage, including the
lifetime reserve days, all Medigap
policies cover 100 percent of Medicare
Part A eligible expenses for
hospitalization paid at the applicable
prospective payment system (PPS) rate
or other appropriate Medicare standard
of payment, subject to a lifetime
maximum benefit of 365 days.
We note that the last sentence of
sections 8.B.(3)., 8.D.(1)(c)., 8.1.B.(3).,
and 9.1.E.(8)(c). of the NAIC Model is
not part of the benefit description of the
‘‘upon exhaustion’’ benefit. Therefore, a
State’s failure to include this language
in its regulatory program does not affect
the State’s compliance with Federal
Medigap standards and requirements.
Similarly, section 17.D.(4). of the NAIC
Model sets forth the outlines of coverage
for Plans A through D, F or High
Deductible F, G or High Deductible G,
K through N. Each outline contains, at
the bottom of the chart on Part A
benefits, a ‘‘NOTICE’’ to prospective
purchasers about the ‘‘upon exhaustion’’
benefit. The final sentence of this notice
is also not part of the benefit
description, and therefore, a State’s
failure to include this language in the
outlines of coverage does not affect the
State’s compliance with Federal
Medigap standards and requirements.
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3. Guaranteed Issue Opportunities
Consistent with the December 4, 1998
(63 FR 67078) Federal Register notice
published in recognizing the BBA
changes to the NAIC Model, we reiterate
that, in contrast to both the general open
enrollment provision of section
1882(s)(2)(A) of the Act and the
guaranteed issue provision in section
1882(s)(3)(B)(vi) of the Act, which
specifically state that the protected
individual must be at least at age 65, the
guaranteed issue provisions in section
1882(s)(3)(B)(i) through (v) of the Act do
not contain an age restriction. Therefore,
the latter provisions apply by their
terms both to individuals eligible for
Medicare based on age, and those whose
eligibility is based on disability, end
stage renal disease (ESRD) or exposure
to an environmental hazard. All
individuals who meet the criteria set
forth in section 1882(s)(3)(B)(i) through
(v) of the Act qualify for the Federal
guaranteed issue protections. (In some
situations policies may not be available
to beneficiaries under 65. In other
situations, a policy designated B, C, or
F may not be available in a particular
State.) Furthermore, we note that in
some states, individuals under age 65
with Medicare have additional rights
under State law to purchase Medigap
coverage on a guaranteed issue basis.
Section 1882(z)(4) of the Act, as
added by section 401 of MACRA,
generally provides that for a ‘‘newly
eligible Medicare beneficiary’’ any
reference in section 1882 of the Act to
Plans C and F shall be deemed, as of
January 1, 2020, to be a reference to
Plans D and G, respectively. As a result,
the references to Plans C and F as plans
that must be offered by issuers on a
guaranteed issue basis under section
1882(o)(5), (s)(3)(C)(i), and (v)(3)(A)(i) of
the Act are replaced with references to
Plans D and G, respectively, for a
‘‘newly eligible Medicare beneficiary.’’
Further, State laws that currently
provide additional guaranteed issue
rights for Plans C and F may need to be
changed for coverage with an effective
date on or after January 1, 2020, to align
with MACRA prohibition on the sale of
first-dollar Medigap coverage to a
‘‘newly eligible Medicare beneficiary.’’
4. Definition of Medicare-Eligible
Expenses
Payment of Medigap benefits is, in
many cases, based on whether a service
is one that is generally covered by
Medicare. The NAIC Model accordingly
contains a definition of ‘‘Medicare
eligible expenses.’’ This definition
provides that ‘‘Medicare eligible
expenses’’ means only those expenses of
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the kinds covered by Medicare Parts A
and B, to the extent recognized as
reasonable and necessary by Medicare.
As outlined in the March 25, 2005
Federal Register (70 FR 15394), this
definition clarifies that a Medigap
policy does not pay cost-sharing for
expenses under Medicare Part D and
also clearly states the position of the
NAIC and CMS that Medigap policies
do not pay cost sharing incurred under
Part C.
5. New Standardized Plan G With High
Deductible
Consistent with section 1882(z)(4) of
the Act, section 9.2A.(4) of the revised
NAIC Model redesignates Plan F With
High Deductible as a new Plan G With
High Deductible for an individual who
is a ‘‘newly eligible Medicare
beneficiary,’’ as defined by section 401
of MACRA. As a result, the references
to Plan F With High Deductible under
section 1882(p)(11)(A)(i) of the Act is
replaced with a reference to Plan G With
High Deductible for a ‘‘newly eligible
Medicare beneficiary.’’ Plan G With
High Deductible does not provide
coverage for any portion of the Part B
deductible and will be available
beginning on January 1, 2020.
Section 9.1.E.(7). of the NAIC Model
provides that states may permit the sale
of Plan ‘‘G’’ With High Deductible to an
individual who is not a ‘‘newly eligible
Medicare beneficiary.’’ While states are
permitted to provide additional rights
and protections beyond the Federal
minimum standards, we note that this
option and the last sentence of section
9.1.E.(7). of the NAIC are not part of the
Federal standards. Therefore, a state’s
failure to include this language in its
regulatory program does not affect the
state’s compliance with Federal
Medigap standards and requirements.
III. Standardized Benefit Packages
The following tables list the
standardized Medigap benefit packages
(by standardized plan year and effective
date of coverage), with a cross-reference
to the sections of the attached NAIC
Model where the packages are described
in detail. The revised NAIC Model,
adopted by the NAIC on August 29,
2016, is reprinted at the end of this
notice. The NAIC has granted
permission for the NAIC Model to be
published and reproduced. Under 1 CFR
2.6, there is no restriction on the
republication of material as it appears in
the Federal Register.
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NAIC model
section number
Plan
Plan A (Core Benefit
Plan).
Plan B ...........................
Plan C ..........................
Plan D ..........................
Plan E ...........................
Plan F ...........................
Plan F High Deductible
Plan G ..........................
Plan H ..........................
Plan I ............................
Plan J ...........................
Plan J High Deductible
Plan K ...........................
Plan L ...........................
Section 9.E.(1).
Section
Section
Section
Section
Section
Section
Section
Section
Section
Section
Section
Section
Section
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Section
Section
Section
Section
Section
Section
Section
Section
9.1.E.(2).
9.1.E.(4).
9.1.E.(7).
9.1.E.(7).
9.1.E.(8).
9.1.E.(9).
9.1.E.(10).
9.1.E.(11).
NAIC model
section number
Plan
9.1.E.(2).
9.1.E.(3).
9.1.E.(4).
9.1.E.(5).
9.1.E.(6).
9.1.E.(7).
9.1.E.(8).
9.1.E.(9).
9.1.E.(10).
9.1.E.(11).
Section 9.1.E.(1).
Plan L ...........................
Plan M ..........................
Plan N ..........................
NAIC model
section number
Section 9.1.E.(9).
Section 9.1.E.(10).
Section 9.1.E.(11).
1 Consistent with the last sentence of section 9.1.E.(7) of the NAIC Model, states may
permit the sale of Plan G With High Deductible to an individual who is not a ‘‘newly eligible Medicare beneficiary.’’ However, a State’s
failure to adopt this sentence and provide this
option does not affect the State’s compliance
TABLE 4—2020 STANDARDIZED PLANS with Federal Medigap standards and
WITH AN EFFECTIVE DATE OF COV- requirements.
ERAGE ON OR AFTER JANUARY 1, IV. Collection of Information
2020 FOR AN INDIVIDUAL WHO IS Requirements
NOT A ‘‘NEWLY ELIGIBLE MEDICARE
This document does not impose
BENEFICIARY,’’ AS DEFINED BY SEC- information collection requirements,
TION 401 OF MACRA
Section 9.1.E.(1).
Section
Section
Section
Section
Section
Section
Section
Section
Section
Section
TABLE 4—2020 STANDARDIZED PLANS
WITH AN EFFECTIVE DATE OF COVERAGE ON OR AFTER JANUARY 1,
2020 FOR AN INDIVIDUAL WHO IS
NOT A ‘‘NEWLY ELIGIBLE MEDICARE
BENEFICIARY,’’ AS DEFINED BY SECTION 401 OF MACRA—Continued
Plan
Plan A (Core Benefit
Plan).
Plan B ...........................
Plan D ..........................
Plan G ..........................
Plan G High Deductible
Plan K ...........................
Plan L ...........................
Plan M ..........................
Plan N ..........................
NAIC model
section number
Plan A (Core Benefit
Plan).
Plan B ...........................
Plan C ..........................
Plan D ..........................
Plan F ...........................
Plan F High Deductible
Plan G ..........................
Plan K ...........................
Plan L ...........................
Plan M ..........................
Plan N ..........................
NAIC model
section number
Plan
9.E.(2).
9.E.(3).
9.E.(4).
9.E.(5).
9.E.(6).
9.E.(7).
9.E.(8).
9.E.(9).
9.E.(10).
9.E.(11).
9.E.(12).
9.F.(1).
9.F.(2).
TABLE 2—2010 STANDARDIZED PLANS
WITH AN EFFECTIVE DATE OF COVERAGE ON OR AFTER JUNE 1, 2010
BUT PRIOR TO JANUARY 1, 2020:
Plan
TABLE 3—2020 STANDARDIZED PLANS
WITH AN EFFECTIVE DATE OF COVERAGE ON OR AFTER JANUARY 1,
2020 FOR A ‘‘NEWLY ELIGIBLE MEDICARE BENEFICIARY,’’ AS DEFINED BY
SECTION 401 OF MACRA
Plan A (Core Benefit
Plan).
Plan B ...........................
Plan C ..........................
Plan C ..........................
Plan F ...........................
Plan F High Deductible
Plan G ..........................
Plan G High Deductible
Plan K ...........................
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Section 9.1.E.(1).
Section
Section
Section
Section
Section
Section
Section
Section
Sfmt 4725
9.1.E.(2).
9.1.E.(3).
9.1.E.(4).
9.1.E.(5).
9.1.E.(6).
9.1.E.(7).
9.1.E.(7).1
9.1.E.(8).
that is, reporting, recordkeeping or
third-party disclosure requirements.
Consequently, there is no need for
review by the Office of Management and
Budget under the authority of the
Paperwork Reduction Act of 1995 (44
U.S.C. 3501 et seq.).
Dated: August 24, 2017.
Seema Verma,
Administrator, Centers for Medicare &
Medicaid Services.
BILLING CODE 4120–01–P
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TABLE 1—1990 STANDARDIZED PLANS
WITH AN EFFECTIVE DATE OF COVERAGE PRIOR TO JUNE 1, 2010
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Table of Contents
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Sccti<m 1.
Authority
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Definition>~
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Other similar insurance
under which benefits for
(3)
"Creditable coverage" shall not
provided under a separate
following benefits
they are
contract of insurance or are
(a)
(b)
Benefits for long-term care, numing home care, home health care,
con1munity-based care) or any con1binaticm thereof; and
(c)
(4)
Limited scope dental or vision benefits;
Such
similar, limited benefits
regulations.
specified in federal
"Creditable coverage' shall not include the !(>!lowing benefits if offered as
independent, non-coordinated benefits:
(a)
Coverage only for a specified disease or illness; and
(b)
Hospital indemnity or other fixed indemnity insurance.
(5)
shall not inclnde the following if it is
ceJ"til:ic,Jte or contract of insurance:
as a
as defined under Section
(b)
to the coverage provided under chapter 55 of
and
(c)
Similar supplemental coverage provided to coverage under a group
health plan.
coverage has been
in an interin1 final rule (62 Fed. Reg.
p1rrsuant to HIP~A.A, and may he adrlres:::ed in s11hsequent regulations
by the Secretary
benefits
G.
H.
it with a finding of
state of domicile.
Drafting Note: If the state law definition of insolvency differs from the above definition, please insert the state law
definition.
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"Issuer'' includes insurance companies, fraternal benefit societies, health care
plans, health maintenance organizations, and any other
delivering or issuing
for delivery in this state Medicare supplement policies or
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7~
l\'linimum Benefit Stand11rd~ (or Pt·ec-Standardized Met:lic:are S~ml~l<lmen,t
Benefit Plan Poliuies or Certifioatcs Issued for Delivory Prior
effe<:Jtive date adopted b~· 1:1tatej
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St::!etion
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Benefit Stamhu·d" for 1990 Sta1u:lardizad Madit"l!lre StltpJ>lem•~nt Uunel:lt Pbm
Polide!!
Certil:loatt'!! I~'!ued or Delivered on or Afte1·
(~ffe<:th'f:! d11te
adoptl!d by statej1md Ptior to ,June 1, 20Ul
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(Vll
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Bmmtit Standurds lbr 20HI Smndardb:nd :\indiearn.S••PlPic!lltfm:t !lent!fif Pbu1
Polici<!S or C<n'tifi•"'llt~'-" I"sued fol' Helh'ei'J' ou or At'ttn'
2010
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8t;ction9.
41711
Standard Medical~
Benefit Plan~ for 1990 Standardized
Medit1are Supplement
.Piau f>olieies or Certificates l~su;s'<d for
Oelhoery oil or After [iu!'l.:n·t effeetive date adoptoo by state! and Pri,~r to
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,hme 1, l!OHI
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Standard M<.'ili<mre
Benefit Plans for 2010 Standardized
Medioare Suppl~·mont
Plan Polloi""" or C<!rtifieates ls'!lued for
t::l<!Uvt!ry on or After ,June 1, 2010
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Sentiott 9.2.
Meclieare
neliV!H'Y
to
llll1l'l·'i(lUlU!I
41719
Benefit Plans for 21120 Stanclardiz~od
Plan Polides (>r Cm·tific;at~;s lsl"tt<"d for
Newly ll:litlible tbr llilediQlH'e Oll 01' After ,January 1,
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Standards fot" GlainiS Paynlent
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Benefit Chart ofMedieam Supplement Plans Sold on or After ,June 1, 20Hl
Basic Ben<;fit!'l:
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•
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RIGHT TO RETURN POUCY
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COMPLETE ANSWEI(S AR.F: VERY IM.POI~TANT {!3oldf~~t!<l
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J>f.,AN A
(PAR'r A)-l:f{),'SPI'l'AI, SE;RVIC~~-Pt~l~ BE:NE;J<Tl' Pli:RIOD
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l'LAN PAYS
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PL.AN A
1\U';niCARF2 (PART A)--HOSPlTi\L Sl~RVIC.!';s-J>l':R Hr:NE:FIT
MEDlCARfilJ>AYS
PLA:"l PAYS
Pl~:JUOIJ (cont.)
YOU PAY
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41745
J>f.,AN A
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l\ft;mcARr; (PART B)-MI:ilHCAL Sl'il'i:VlCI~B--PlsR CALf;NJ)AR YtlAR
41746
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
PL.AN A
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PAR'fS A&B
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41747
PLANH
1\'U;J)ICARl': (l'ART A)---HOSPITAl, Sl':RVICI:~S--Pf;R
Bl'~Ng!''l'l'
Pf;RIOU
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YOU PAY
41748
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
PLANU
MJ':DtCt\Ri'~
(PART A}-H08l'lTAl, SE:RVICI<:S-PE:R HFiNi':fTr Pi':RJOD (cont.)
PLAN PAYS
YOU PAY
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18:06 Aug 31, 2017
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BJ,OOD
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41749
PLANH
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Ml'il}ICARt; (I'Ait'l' il)~l\H~JI)JCAL tU~:rtVICI<:S-PI'~R c,U,l':Nl>AR Yf'lAR
41750
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
PLANU
P,<\Ft'rS A & U
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18:06 Aug 31, 2017
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EN01SE17.064</GPH>
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YOU PAY
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41751
f'l,AN
Ml'mlCARJ<; (l~ART A)-HOSl~lTt\1, sgRVICI~S-PI:';R
Bl'~NI::l''IT Pl'~RIOU
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18:06 Aug 31, 2017
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EN01SE17.065</GPH>
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41752
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
PLANC
1\U:mCAR~:
(PART A)-UOSPJ'l'At, SI<:RVICl<:S-Pr:R Bf~Nr:nT
Pl<~RIOD (o<ntt.)
YOU i>AY
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18:06 Aug 31, 2017
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BLOOD
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41753
f'l,AN
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Mf<:nJCAIU<: (I'AltT B)-IVU;OICAL SI':ItVlC~~B--PJI;I~. CAL~;Nl)AR YE:AR
41754
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
PLANC
PAR'rSA&H
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18:06 Aug 31, 2017
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01SEN2
EN01SE17.068</GPH>
sradovich on DSK3GMQ082PROD with NOTICES2
I'I.AN PAYS
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41755
f'l,AN
Bl'~Nl~FI'l'S-NO't'
COVI<:IU'}I) BY Ml~;meARI'i
sradovich on DSK3GMQ082PROD with NOTICES2
SERVICES
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OTHF;R
41756
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
PI,AND
MI<:mCAIU; (PART A)-fU)SPITAL Sl!:RVJCF':S-Pt:I~ Bt:NKfl'l' P'b:RIOD
VerDate Sep<11>2014
18:06 Aug 31, 2017
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01SEN2
EN01SE17.070</GPH>
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Plu\N PAYS
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41757
Pl,AN 0
i\U;mCAlU: (PAR'l' A.!--HOSt'ITi\L SF:RVICl':S-l'I'~R m;Ngl-'IT Pl':IUOD (eont.)
YOU .PAY
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BLOOD
41758
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PI,AND
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(PART 13)-MI•JnlCAL SF;l'tVlCFJS-!'l':R CAl,F:NDAR n:AR
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1\U~lHCARF;
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41759
Pl,AN 0
l'l\HTS ,>\ & B
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MEDICARI~
Frm 00077
I'AYS
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EN01SE17.073</GPH>
sradovich on DSK3GMQ082PROD with NOTICES2
SERVICES
41760
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
PI,AND
!Vl E:DI CARl;;
PLAN PAYS
Y()U l'AY
PAYS
FOREION TRAVEL-NOT
UY J\mDICARI•;
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COVf~RED
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
MEDlCARl<~
(PART A)-
liC~'lPI'fAl,
41761
SERVICES- PER Bl~NEr'IT PERIOD
(IN ADIWI'ION
TO$f2180i
SERVICES
MI~DICARE
PAYS
DtmUt"fiBLI':,**I
YOU PAY
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HOS Pl'l'Al,lZA'!'IO N"'
41762
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
MEDICARE (PART A)- HOSPI'f.<\L SERVICES-
PF~R
I.AF'I'l~R
BENFlFI'r PERIOD (oont.)
YOU PAY
$[:mml
SERVICES
DF:OUC~l'IBLt;.-1
PLAN PAYS
!lN ADDITION
$(2HIOI
OF;I)UC'I'I Bl,l~. **I
Y(JU PAY
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81:\ll,l,Efl NURSING
J<'AGJU'l'Y CAR~;*
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41763
UN AUDl'l'lON TO
$(1!1801
DE.OUC"fiBLE,**)
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sradovich on DSK3GMQ082PROD with NOTICES2
PLAN PAYS
41764
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
(AFTER YOU PAY
$f2H>Ol
!\fEDICt\REJ I'AYS
IJ1tlDUCTIBL~1.*1
fl'lu\N PAYS
!IN ADDITION TO
${21801
mmUC'I'lllU:,*"'I
YOU PAY
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HLOOO
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41765
PAR'I'SA&B
YOU PI\Y
1!1:[2l8tll
sradovich on DSK3GMQ082PROD with NOTICES2
~U:O.ICARE: PA'fS
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11 N ADill'rtON TO
${2180!
DEIJUCTlBLE,*"'l
Plu\N PAYS
DEDUC'I'IBI.,E,"""I
YOU J>,\Y
Sfmt 4725
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EN01SE17.079</GPH>
(AI"TI~R
41766
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
PLAN F or HIGH DEDUCTIBLli: PLAN F
!AI"l'ER YOU PAY
$(21<'101
SRRVICii:S
MEIJICAIUi: PAYS
DEDUC'l'IBl,E,-1
!'LAN PAYS
liN AI!OlTION
T0$!2180}
DEDUCTIBLE:,**!
YOU PAY
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l''OfH~:tGN 'I'RAVl•:I,- NO'r
COVER!';O BY MEI)ICAR!':
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41767
YOU PAY
$(21801
jAf'~I'E;R
sradovich on DSK3GMQ082PROD with NOTICES2
PAYS
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PI"\~ PA\'S
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EN01SE17.081</GPH>
ME:DI.CARI<:
41768
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
PI.u\i"< G or mcm
mmUCTIBL:E: Pk\N G
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M'i'".:DICARE (PAirr A)- HOSPITAL SERVICt::S- l'Eit BENEFIT PI'~RIOD (<Jont.)
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41769
PLAN Got· HIOH DEDUCTIBLE Plh4.N G
$(21801
MI':D!Cl\RI<: PAYS
DIGDUCTlBU!~,*"'I
sradovich on DSK3GMQ082PROD with NOTICES2
PLAN PAYS
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18:06 Aug 31, 2017
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${21801
Oi':UU<'TI BU<:,**t
YOU PAY
E:\FR\FM\01SEN2.SGM
01SEN2
EN01SE17.083</GPH>
ll\F'TER YOU PAY
41770
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
Pl.:\N G or HIGH DEDUG'fiBLrs PLAN G
IAFTI!:~t
[IN ADIHTION '1'0
$f2ISOI
DEDU t~IBLE:, **I
Plu\N PAYS
UEDUl:'J'IBLI~**]
YOU PAY
$J2Hl0J
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18:06 Aug 31, 2017
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All
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41771
PARTS A& B
sradovich on DSK3GMQ082PROD with NOTICES2
Ml:li.HCA!Ui: PA'fS
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PLAN PAYS
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UN ADDI'I'ION 'I'O
1!!!2ll'IOI
t:n•:DUC'I'IUl,I<:,J**
YOU PAY
E:\FR\FM\01SEN2.SGM
01SEN2
EN01SE17.085</GPH>
YOU PA\'
$(218{11
41772
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
{AF'rER YOU PAY
$(21861
l\IU;mcARE PAYS
[IN AD[)f'l'toN 'I'O
m!~DUC'l'IBUi,j**
PI4AN PAYS
YOU PAY
I<'OfmiON TI1AVI~:L
NOT COVI<::tmD BY
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sradovich on DSK3GMQ082PROD with NOTICES2
Ml~DICAIU~
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41773
l'LAN 1\
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PERIOD
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EN01SE17.087</GPH>
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MEDICARE (PAI~T AJ--HO.''!P!TAL S.E:RVICES-PER
41774
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
PLA.l\l I\
i\U:DICARl•: (PART A)--HOSPIT."\L St~I{V!Cl'S-P~;R a~:N~;;J;'l'l' Pl'iRIOD (cont.)
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YOU l'.A\'*
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41775
l'LAN 1\
VerDate Sep<11>2014
18:06 Aug 31, 2017
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(PAR'!' 13}--Ml'JIHCAl, SE:RVICI!::8-P~iR
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n:.<\R
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EN01SE17.089</GPH>
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Mf;l)ICARF~
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41776
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41777
l'LAN 1\
!\o\R1'S ,, & B
Sli:RVICES
ME.DIC'AIU,;
PAYS
PLAN PAYS
YO\J PAY*
HOME HEALTH CARE
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to
41778
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
PLAN L
''EX<l<'~s
dta~+d
Howevar,
ci<l()"'
provider tbttt eX(I(o'<!d MooiC~Ir-pproved atnomtt!ll (the!lle
Clu1rge;,~")
~'(HI will be l'll!llpousibl<! for
thil> diff<lreuce in th(! ;mwultt
by your pr<wid(!l' >tnci tit<! ''mount paid hy
tit<!! it<i!n> m· >><•l"vie<!.
MEDICARE (PAR'l' A)--HOSPI'I'AL SERVICES-PER BENEI"I'r PI~RIOD
VerDate Sep<11>2014
18:06 Aug 31, 2017
Jkt 241001
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YOU PAY"
01SEN2
EN01SE17.092</GPH>
sradovich on DSK3GMQ082PROD with NOTICES2
PLAN PAYS
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41779
Pt.AN L
(PART A:I--HOSPI'l'At. Sf;J:NJCI<lS-PflR 13$Nk~f'IT !>!';moo (cont.)
sradovich on DSK3GMQ082PROD with NOTICES2
l\-fgmcARE PAYS
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18:06 Aug 31, 2017
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01SEN2
EN01SE17.093</GPH>
1\UmtCAI~I'l
41780
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
PLAN L
MEDICARE PAYS
PLAN PAYS
YOU PAY*
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18:06 Aug 31, 2017
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EN01SE17.094</GPH>
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MEDICAL EXPENSI<;S--
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41781
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18:06 Aug 31, 2017
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EN01SE17.095</GPH>
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amounts (dl(l!le are called
and you will be
this differem~ in the amount charged by ymu· provider and the
illll<:lll<!ltl'e for the item or servioe.
41782
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
PLAN L
J>A.RTS A&B
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18:06 Aug 31, 2017
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EN01SE17.096</GPH>
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Ml~IHCARI!i
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41783
PI,ANl\ll
i\n:mCARl3: (l'AR'l' A)-HC~'>PITAl, Sf<:RViCI'JS-Pl~R m•:Nt•;t''IT J>I'JtUOD
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EN01SE17.097</GPH>
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YOU I'AY
41784
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
Plu\N !\If
PLAN PAYS
YOU PAY
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18:06 Aug 31, 2017
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Sl\IU,ED NURSING
FACU,lT\' CARl~*
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41785
PI,ANl\ll
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CAL~~NDAR
YEAR
E:\FR\FM\01SEN2.SGM
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EN01SE17.099</GPH>
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1\'U:lllCAR!<; (PART B)-Ml~IJlGAl, Sl'1RVlC1'::8-Pl~R
41786
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
Plu\N !\If
PAR'rSA&B
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YOU J>AY
AR!i; PAYS
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41787
PI,ANl\ll
Bt::NF;FIT&-NO'r (X)Vl':Rlm HY Mt<;DICAlU;
YOU PAY
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PAYS
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OTln~R
41788
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PLANN
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~mDIC.ARf~
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MF:DlCAtU; (PART A)--HOSPITAL SE:t~VJC~l~S-Pl'~R
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41789
Pl,AN N
M!'::OICAR!<: (PAR'l' A)--HOSPITAL Sf:llVlCl':S-Pr)R m~;Nr:J:'IT PF;RlOt) ((:ont.)
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YOU PAY
41790
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
PLANN
2\'U:DH'ARF: (PAR'f 8)-Ml'~IJICAL Sl':RV.ICF:S-Pl':R CAU~NOAR YF~AR
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f>LAN PAYS
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41791
Pl,AN N
l\H~:OICARt1
(PAln' B)--M8l)lCAL SPJRVlCf~S-l>I'JR
CAl..~;NnAR
Yl:'1c\.R
{oont.)
YOU PAY
SE.RVWES
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HLOOD
41792
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PLANN
PAR't'S A. & B
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t>LAN PAYS
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41793
Pl,AN N
OTIU:R I:U:';Ni'1l"t'I'5-NO'l' COVI<:RI':t.J .BY l\U';I.JICAIU:
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PLAN PAYS
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(Questions]
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41796
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41797
NO'rtcE 1'<) APPUCi>.N'l' lt!':flARDI.NG REPI,ACl\<U:NT
OJ<' l\HCDlCAIU~ SUJ>PJ,gi\!H;NT INSUlt&\NCE;
OR M!':l)ICARJ!: AIJVANTAG~;
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THIS NOTlCE!
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rr MAY :B!'; IMPORTANT 'rO YOU IN 'I'H !'; r'UTURK
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SAVf~
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20.
Standards lhr Marketing
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SL'<Jtion
41799
41800
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
(2)
pressure tactics. En1ployimg
tending to induce the
threat,
whether
or implied, or undue pressm'e to purchase or recommend thE'
purchase
(3)
use directly or indirectly of any method of
to
in a conspicuous 1nannei"'" that a purpose of
of marketmg is solicitation of insurance and that contact will be
made by an insurance agent or insurance company.
"1\lleclic'"re Wrap-il.round" and words
policy is issued in compliance with tbis
Drafting Note: Remember that the Unfair Trade Practice
Section 21.
in your state
applie~
to Medicare supplement insurance
Appropriateness of Reeommended Purchase and Excessive Insurance
B.
an
c.
an individual
is
Section 22.
A.
Reporting of :Multiple Policies
On or before Mfll'ch 1 of each
an issuer shall report the following information
for
state for which the issuer has in force more than
lVi•uu_tc"n' supplement policy or certi!lcate:
(1)
(2)
B.
Policy and certificate number; and
Date of issuance.
The items set forth above must be grouped by individual policyholder.
:Editor'!!i Note: Appendix B contains a reporting form for complimce \vith this
Section 23.
Prohibition Against Preexisting Conditions, Waiting Periods, Elimina.tion
Periods and Probationary Periods in Replacement Policies or Certificates
A.
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Prohihiti<>n Agnlnst Uso or
n~meti<:
lnr<wntati<m and !?<>quests fot'
41801
Cl<~n;,ti<'
'restin~
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L
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41802
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41803
Separability
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Seetion 26.
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41804
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41805
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1\U:mcARJ:: SU Pl'UJl\U:N'l' RE:I"UN!) CAl,CUl,A'l'lON FORM
F'Oil CAl,FlNDAR YF1AR
41806
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SUPPI,EMENT Rl~FUND CAI,CULATION FORM
l''OR Ci\LI':NJ)AR Y~',;AR
sradovich on DSK3GMQ082PROD with NOTICES2
MEDlCARl~
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liURM l''O.R RfiJPORTtNG
Ml')ntCAIU': SUPPLl~ll\U3:N'l' l'()l,!CifilS
41812
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APPENI!IXC
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lmi!t:ructlon;;; for Ul'!<:> of the Dis.cllostu-e Statements for
Hoolth Insttr<Utee Policies Sold to :Viedi<m.rc J~neficinries;;
tllnt Duplk\lilt<l Medkl<H"e
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41813
•
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t"ti\gardlnss of tho
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M1!dieat-e pays ·~xtem;:ive h••nollts for
n~e~~sou yon neod tht!m. 'l'be,.;:e ilmlnde:
41814
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
lVIedieat·n pays extensive bnn!!l'its for medienlly
re.as<ut you need them. Th('Se include:
neees~uy servi(~
rognrdles;.;; of the
•
•
•
•
M<:!di<'.at"e pa~'~'~ extensive benefits rm·
reason you m0ed them. TbeRe i.rwlud<"
mcdicnll~· IU>ee!IS!II':I'
•
•
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.
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
1'his insm-.moe dupli<:-.ttos
M<!dk~U'<c>
benefits
b~"(,.HIS<)
Medlem:e generally
J:»l~'s
41815
for most of
the <~xpense~s for tim diagnosis and tre.. tment of the spedfie eonditions or dingnos<Js
mnnfld in tbe poiiey,
Mfldicaro pa~"S extensive benefits for
t•easmt you need them, Thes<' ineh1de:
111edic~dl~' IUl<J<,>,<;,<Mry
serviees t-egnrdle&" of the
•
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•
•
•
41816
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
'l'hi:s is not Medk11u'e Supplement lu!:mt1lllce
Medi<'Jll'e pays extensive benefits for medienlly nEK'eSsary
l'eason yott need them. These iuclude:
seni~Jes
regnrdless of the
•
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•
..
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
Medi!Jll!l:"e pa~?> extensivn bem~fits f'ot•
r!l~l!lOII ym,t tle~~ them. 'rbese inelud~l:
medk·~tlly
neeesl!mry serviees
t'1lg~trdl~"
41817
of the
•
DJ
Medi<:'~n·e geuendiy P''J"" for nmst or nU of these""~'"''"'''"'·
Mfldieaxe P."~Y"' o::l'tem<ivo b(lJu;fits for IU<ldi<'•ali~· IHlQe;;;sat·y seni<"llll n::gat·dless of tb€!
reu!lou you need them. TIH~e includE,:
•
•
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•
•
41818
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
Soutti' h<?~ltb (!Ut>e sot•vices paid. 1'01· hy Medicat·e tuay also trig-ger the
from this poli<~.
payu:u~nt
of benefits
Mooi<JJU'O pays <>::<tlmsiv<' h<ntelits for m•~di<:~~dly n'''~''"'"''li'Y s<li"Vi<l<!s l:'<C!garditlss of tht•
r<'IISOll you nc<l'd tbcm. 'l'b<l'Se indude:
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•
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
Sonte he.o1lth <~are servi<X~s paid for by
under this poli<'Y·
Medi<l>U"<~
41819
maJ' also trigger the payment. of benefits
Medlnal'l1 pays e:~~te11si·ve benefits for· medi<:;dlJ' ne<W.l't.'lni"Y services I"Oglll'dleslil of tb1'
rP~sott you 110ed them. These hlclude:
•
Smn~'
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health oore serVt(l(lS paid for by Medkare may all!lo trigg<!r the J:Miyment of benefit;;
fl"<>nt this poliey. MediMl'e
pay'" for mo"'t ()I' all of: tltese oxpol>se:;::.
41820
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
Medi<liU'<! ~-enm"£~Uy J!)l'tl'S for most or all oftlu"'e expenses.
$Medioare pays •~xt:ensive benefits fur nu:>dieully neeessary scet·••ioos
rt'-ason you tU!OO th<1Ul. These inelude:
n-;~u:-dle&s
uf the
•
•
•
'l'bis
benefits witbt>ut
under 1\'tedioare t)l'
Some be;altb eare services p.'tid forb!' M.edkare may also
trig~r
the p.lyment of benefits
fn">m tlli~< poll<'}'.
Medif':at-e pays <lll:tensive beuellts for
n111son you m"ed them. These include:
modif'~llly
nooossaw•y set•vioe'< l"eglll'dloss of the
•
•
VerDate Sep<11>2014
18:06 Aug 31, 2017
benefits without
under l\·hlditlllr<~ or
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~l'his
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
Soute health care ~;rvices pnid fol·l1y Mediau:e may also
rmm this policy.
Medi('IU<l! pnys es.ttmsive benefits fot medi('l\lly
l'<m,.on you noo£1 ttuuu. 'Fh;~se ilull•uh;:
tri~r
n<K~lSstu·y
41821
the pnyment of benefits
S<!l'Vioos regardi<!!!'S of tbo
.
•
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•
41822
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
Some health t1111'1c servi<:es paid fo:u· by Medimre :nu1y also trigger the pa)'ment. of benefits
!'rom tbis poliey,
~Itldi<?.;~ro pays o:ttensive benefits for medi<'.;~lly ueooss£u·~·
!"ellson ~·ou I:Uled them. Th('SC irwlud(;:
servit?es t'<!$lrdless of the
•
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18:06 Aug 31, 2017
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also
t1·igger
the puynumt of benefits
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Some b ...aldl (l.'tN: serviees paid fm· by Mmliea re
r.·om t.his poliey.
Federal Register / Vol. 82, No. 169 / Friday, September 1, 2017 / Notices
41823
[FR Doc. 2017–18605 Filed 8–31–17; 8:45 am]
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BILLING CODE 4120–01–C
]]>Agencies
[Federal Register Volume 82, Number 169 (Friday, September 1, 2017)]
[Notices]
[Pages 41684-41823]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-18605]
[[Page 41683]]
Vol. 82
Friday,
No. 169
September 1, 2017
Part II
Department of Health and Human Services
-----------------------------------------------------------------------
Centers for Medicare & Medicaid Services
-----------------------------------------------------------------------
Medicare Program; Recognition of Revised NAIC Model Standards for
Regulation of Medicare Supplemental Insurance; Notice
Federal Register / Vol. 82 , No. 169 / Friday, September 1, 2017 /
Notices
[[Page 41684]]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-4177-N]
Medicare Program; Recognition of Revised NAIC Model Standards for
Regulation of Medicare Supplemental Insurance
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice announces the changes made by the Medicare Access
and CHIP Reauthorization of 2015 (MACRA) to section 1882 of the Social
Security Act (the Act), which governs Medicare supplemental insurance.
This notice also recognizes that the Model Regulation adopted by the
National Association of Insurance Commissioners (NAIC) on August 29,
2016, is considered to be the applicable NAIC Model Regulation for
purposes of section 1882 of the Act, subject to our clarifications that
are set forth in this notice.
DATES: Amendments made by section 401 of MACRA apply to issuers of
Medigap policies for policies issued on or after January 1, 2020.
FOR FURTHER INFORMATION CONTACT: Derrick Claggett, (410) 786-2113.
SUPPLEMENTARY INFORMATION:
I. Background
A. The Medicare Program
The Medicare program was established by Congress in 1965 with the
enactment of title XVIII of the Social Security Act (the Act). The
program provides payment for certain medical expenses for persons 65
years of age or older, certain disabled individuals, persons with end-
stage renal disease (ESRD), and certain individuals exposed to
environmental health hazards.
Medicare has three types of benefits. The Hospital Insurance
Program (Part A) covers inpatient care. The Supplementary Medical
Insurance Program (Part B) covers a wide range of medical services,
including physicians' services and outpatient hospital services, as
well as equipment and supplies, such as prosthetic devices. The
Voluntary Prescription Drug Benefit Program (Part D) covers outpatient
prescription drugs not otherwise covered by Part B.
Beneficiaries can get their Part A and Part B benefits in two ways.
Under Original Medicare, beneficiaries get their Part A and Part B
benefits directly from the Federal government. Beneficiaries can also
choose to get their Part A and Part B benefits through private health
plans that contract with Medicare. Most of these contracts are under
Part C of Medicare, the Medicare Advantage (MA) Program.
While Medicare provides extensive benefits, it is not designed to
cover the total cost of medical care for Medicare beneficiaries. Under
Original Medicare, even if the items or services are covered by
Medicare, most beneficiaries are responsible for various deductibles,
coinsurance, and in some cases copayment amounts.
1. Deductibles
Under Original Medicare, a beneficiary with Part A is generally
responsible for the Part A inpatient hospital deductible for each
benefit period. A benefit period is the period beginning on the first
day of hospitalization and extending until the beneficiary has not been
an inpatient of a hospital or skilled nursing facility for 60
consecutive days. The inpatient hospital deductible is updated annually
in accordance with a statutory formula. The inpatient hospital
deductible for calendar year (CY) 2016 was $1,288.00 and for CY 2017 it
is $1,316.00.
A beneficiary with Part B is responsible for the Part B deductible
for each calendar year. The deductible is indexed to increase with the
average cost of Part B services for aged beneficiaries. The Part B
deductible for CY 2016 was $166.00 and for CY 2017 it is $183.00.
2. Coinsurance
As previously stated, beneficiaries are generally responsible for
paying coinsurance for covered items and services. For example, the
coinsurance applicable to physicians' services under Part B is
generally 20 percent of the Medicare-approved amount for the
service(s). If a physician or certain other suppliers accept
assignment, the beneficiary is only responsible for the coinsurance
amount. When beneficiaries receive covered services from physicians or
other suppliers who do not accept assignment of their Medicare claims,
beneficiaries may also be responsible for some amounts in excess of the
Medicare approved amount (excess charges).
3. Non-Covered Services
Some items and services are not covered under either Part A or Part
B; for example, custodial nursing home care, most dental care,
eyeglasses, and items or services furnished outside the United States.
Original Medicare covers many health care services and supplies, but
beneficiaries are responsible for the out-of-pocket expenses described
previously. As such, most beneficiaries choose to obtain some type of
additional coverage to pay some of the costs not covered by Original
Medicare. For people who do not have coverage from a current or
previous employer that performs this function, or who do not qualify
for Medicaid, the most common coverage is Medicare supplemental
insurance (also called Medigap). Some beneficiaries may also try to
defray some expenses with hospital indemnity insurance, nursing home or
long-term care insurance, or specified disease (for example, cancer)
insurance.
B. Medicare Supplemental Insurance
A Medicare supplemental (Medigap) policy is a health insurance
policy sold by private insurance companies specifically to fill
``gaps'' in Original Medicare coverage. A Medigap policy typically
provides coverage for some or all of the deductible and coinsurance
amounts applicable to Medicare-covered services, and sometimes covers
items and services that are not covered by Medicare. Section
1882(d)(3)(A)(i) of the Act specifies that a party may not sell a
Medigap policy with knowledge that the policy duplicates health
benefits which the applicant is otherwise entitled to, including from
Medicaid programs that cover Medicare cost-sharing (for example, the
Qualified Medicare Beneficiary Program), MA plans, and individual
market plans.
Section 1882 of the Act sets forth requirements and standards that
govern the sale of Medigap policies. It incorporates by reference, as
part of the statutory requirements, certain minimum standards
established by the National Association of Insurance Commissioners
(NAIC). These minimum standards, known as the NAIC Model Standards are
found in the ``Model Regulation to Implement the NAIC Medicare
Supplement Insurance Minimum Standards Act'' (NAIC Model), initially
adopted by the NAIC on June 6, 1979, and revised periodically to
reflect subsequent Federal legislative changes. (For additional
information, see section 1882(g)(2)(A) of the Act.)
Under section 1882 of the Act, Medigap policies generally may not
be sold unless they conform to the standardized benefit packages that
have been defined and designated by the NAIC. The 10 original
standardized plans were created in accordance with the Omnibus Budget
Reconciliation Act of 1990 (OBRA '90), and designated A through J. The
Balanced Budget Act of
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1997 (BBA) authorized plans F and J to have high deductible options
that are counted as separate plans. The Medicare Modernization Act of
2003 (MMA) created new plans K and L, and the Medicare Improvements for
Patients and Providers Act of 2008 (MIPPA) authorized the creation of
new plans M and N. Medigap plans E, H, I, and J are no longer available
for sale. Three states (Massachusetts, Minnesota, and Wisconsin) are
permitted by statute to have different standardized Medigap plans and
are sometimes referred to in this context as the ``waiver'' States.
There are also policies issued before the OBRA '90 requirements became
applicable in 1992 (pre-standardized policies) that are still in
effect.
Effective January 1, 2006, Medigap policies could no longer be sold
with a prescription drug benefit. Three of the original standardized
Medigap plans, H, I and J, as well as some Medigap policies in the
waiver States, may still contain coverage for outpatient prescription
drugs if the policies were sold before January 1, 2006. In addition,
some pre-standardized plans cover drugs. If a beneficiary holding one
of these policies enrolls in Medicare Part D prescription drug
coverage, the prescription drug coverage is removed from the
individual's Medigap policy.
Section 1882(b)(1) of the Act provides that Medigap policies issued
in a State are deemed to meet the Federal requirements if the State's
program regulating Medigap policies provides for the application of
standards is at least as stringent as those contained in the NAIC Model
Regulation, and if the State requirements are equal to or more
stringent than those set forth in section 1882 of the Act.
States must amend their regulatory programs to implement all new
Federal statutory requirements and applicable changes to the NAIC Model
Standards. Thus, States will now be required to implement the statutory
changes made by the Medicare Access and CHIP Reauthorization Act of
2015 the (MACRA), and the changes to the NAIC Model Standards made to
comport with the requirements of MACRA. The revised NAIC Model is
attached to this notice. States generally cannot modify the
standardized benefit packages set out in the NAIC Model. However, with
respect to other provisions, States retain the authority to enact
provisions that are more stringent than those that are incorporated in
the NAIC Model Standards or in the Federal statutory requirements. (See
section 1882(b)(1)(B) of the Act.) States that have received a waiver
under section 1882(p)(6) of the Act may continue to authorize the sale
of policies that contain different benefits than the standardized
benefit packages. However, those States are also required to amend
their regulatory programs to implement the new Federal statutory
requirements and changes to the NAIC Model Standards as a result of
MACRA. (See section 1882(z)(3) of the Act.)
II. Legislative Changes Affecting Medigap Policies and Clarification
A. Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
Some standardized Medigap plans currently sold on the market
provide first-dollar coverage for beneficiaries, which means the plan
pays the Medicare deductibles, coinsurance, and copayments so that the
beneficiary has no out-of-pocket costs for Medicare covered services.
MACRA was enacted on April 16, 2015 (Pub. L. 114-10), and beginning on
January 1, 2020, it prohibits the sale of Medigap plans with first-
dollar coverage to an individual who is a ``newly eligible Medicare
beneficiary,'' which is further defined in section II.C.1. of this
notice. The effect of this provision is that as of this date, a ``newly
eligible Medicare beneficiary'' will be required to pay out-of-pocket
for the Medicare Part B deductible. The Part B deductible for CY 2016
was $166.00 and for CY 2017 it is $183.00.
B. Changes to the NAIC Model #651 (Model Regulation To Implement the
NAIC Medicare Supplement Insurance Minimum Standards Model Act)
Approved by the NAIC on August 29, 2016
Consistent with the process authorized in section 1882(p)(1) of the
Act, the NAIC formulated a task force consisting of State regulators,
consumer advocates, industry representatives, and staff from the
Centers for Medicare & Medicaid Services (CMS) to draft changes to the
Medigap standardized plan structure and the NAIC Model Standards to
align with section 401 of MACRA. The draft changes were approved by the
NAIC task force on April 4, 2016. The revised NAIC Model (with the
approved changes) was adopted by the NAIC on August 29, 2016. The
changes apply to Medigap policies or certificates issued on or after
January 1, 2020.
The following are the changes, effective January 1, 2020, to the
standardized Medigap plans:
A new Plan G With High Deductible is created, which is
identical to the Plan F With High Deductible except there is no
coverage for the Part B deductible.
For a ``newly eligible Medicare beneficiary''--
++ Plan C is redesignated as Plan D, which does not provide
coverage for the Part B deductible;
++ Plan F is redesignated as Plan G, which does not provide
coverage for the Part B deductible; and
++ Plan F With High Deductible is redesignated as Plan G With High
Deductible, which does not provide coverage for the Part B deductible.
As a result of these changes, the revised NAIC Model contains the
following three sets of standardized plans:
Sections 8 and 9 of the NAIC Model outline the benefits
for standardized plans with an effective date of coverage prior to June
1, 2010 (the 1990 standardized plans).
Sections 8.1 and 9.1 of the NAIC Model spell out the
benefits for the standardized plans with an effective date for coverage
on or after June 1, 2010 (the ``2010 standardized plans'').
Section 9.2 of the NAIC Model contains the benefits for
the standardized plans for an individual who is a ``newly eligible
Medicare beneficiary'' with an effective date for coverage on or after
January 1, 2020 (the 2020 standardized plans for Newly Eligible
Medicare Beneficiaries).
C. Clarifications
1. Definition of Newly Eligible Medicare Beneficiary
Section 401 of MACRA defines a newly eligible Medicare
beneficiary'' as an individual who is neither of the following:
An individual who has attained age 65 before January 1,
2020.
An individual who was entitled to benefits under Medicare
Part A pursuant to section 226(b) or 226A of the Act, or deemed
eligible for benefits under 226(a) of the Act, before January 1, 2020.
Section 9.2.B. of the NAIC Model captures this definition. An
individual who is not a newly eligible Medicare beneficiary can
continue to purchase Medigap policies that provide coverage of the
Medicare Part B deductible.
Individuals retroactively entitled to Medicare Part A after January
1, 2020, with an effective date for Medicare coverage before January 1,
2020 would not fall under the definition of a ``newly eligible Medicare
beneficiary'' because their Part A benefits would begin before January
1, 2020. In addition, an individual who has attained age 65 before
January 1, 2020, but who was not entitled to Medicare Part A until
after January 1, 2020, would also not be a ``newly eligible Medicare
beneficiary.'' Similarly, environmental exposure
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affected individuals deemed eligible for Medicare before January 1,
2020 would not be a ``newly eligible Medicare beneficiary.''
2. Upon Exhaustion Benefit
Section 8.B. of the NAIC Model describes the standards for basic
benefits common to the 1990 standardized Plans A through J. Section
8.D.(1) of the NAIC Model describes the standards for benefits common
to the 1990 standardized Plans K and L. Section 8.1.B. of the NAIC
Model describes the basic benefits common for the 2010 standardized
plans A through D, F, F with High Deductible, G, M and N. Section
9.1.E.(8) of the NAIC Model describes the standards for benefits common
to the 2010 standardized plans K and L. Section 9.2.A. of the NAIC
Model describes the standards for benefits common to the 2020
standardized plans for a ``newly eligible Medicare beneficiary''.
Sections 8.B.(3)., 8.D.(1)(c)., 8.1.B.(3)., and 9.1.E.(8)(c). of the
NAIC Model describe what is commonly referred to as the ``upon
exhaustion'' benefit. Medicare provides inpatient hospital benefits for
up to 90 days in a benefit period, plus any of the 60 lifetime reserve
days that have not already been used. After a beneficiary exhausts this
coverage, including the lifetime reserve days, all Medigap policies
cover 100 percent of Medicare Part A eligible expenses for
hospitalization paid at the applicable prospective payment system (PPS)
rate or other appropriate Medicare standard of payment, subject to a
lifetime maximum benefit of 365 days.
We note that the last sentence of sections 8.B.(3)., 8.D.(1)(c).,
8.1.B.(3)., and 9.1.E.(8)(c). of the NAIC Model is not part of the
benefit description of the ``upon exhaustion'' benefit. Therefore, a
State's failure to include this language in its regulatory program does
not affect the State's compliance with Federal Medigap standards and
requirements. Similarly, section 17.D.(4). of the NAIC Model sets forth
the outlines of coverage for Plans A through D, F or High Deductible F,
G or High Deductible G, K through N. Each outline contains, at the
bottom of the chart on Part A benefits, a ``NOTICE'' to prospective
purchasers about the ``upon exhaustion'' benefit. The final sentence of
this notice is also not part of the benefit description, and therefore,
a State's failure to include this language in the outlines of coverage
does not affect the State's compliance with Federal Medigap standards
and requirements.
3. Guaranteed Issue Opportunities
Consistent with the December 4, 1998 (63 FR 67078) Federal Register
notice published in recognizing the BBA changes to the NAIC Model, we
reiterate that, in contrast to both the general open enrollment
provision of section 1882(s)(2)(A) of the Act and the guaranteed issue
provision in section 1882(s)(3)(B)(vi) of the Act, which specifically
state that the protected individual must be at least at age 65, the
guaranteed issue provisions in section 1882(s)(3)(B)(i) through (v) of
the Act do not contain an age restriction. Therefore, the latter
provisions apply by their terms both to individuals eligible for
Medicare based on age, and those whose eligibility is based on
disability, end stage renal disease (ESRD) or exposure to an
environmental hazard. All individuals who meet the criteria set forth
in section 1882(s)(3)(B)(i) through (v) of the Act qualify for the
Federal guaranteed issue protections. (In some situations policies may
not be available to beneficiaries under 65. In other situations, a
policy designated B, C, or F may not be available in a particular
State.) Furthermore, we note that in some states, individuals under age
65 with Medicare have additional rights under State law to purchase
Medigap coverage on a guaranteed issue basis.
Section 1882(z)(4) of the Act, as added by section 401 of MACRA,
generally provides that for a ``newly eligible Medicare beneficiary''
any reference in section 1882 of the Act to Plans C and F shall be
deemed, as of January 1, 2020, to be a reference to Plans D and G,
respectively. As a result, the references to Plans C and F as plans
that must be offered by issuers on a guaranteed issue basis under
section 1882(o)(5), (s)(3)(C)(i), and (v)(3)(A)(i) of the Act are
replaced with references to Plans D and G, respectively, for a ``newly
eligible Medicare beneficiary.'' Further, State laws that currently
provide additional guaranteed issue rights for Plans C and F may need
to be changed for coverage with an effective date on or after January
1, 2020, to align with MACRA prohibition on the sale of first-dollar
Medigap coverage to a ``newly eligible Medicare beneficiary.''
4. Definition of Medicare-Eligible Expenses
Payment of Medigap benefits is, in many cases, based on whether a
service is one that is generally covered by Medicare. The NAIC Model
accordingly contains a definition of ``Medicare eligible expenses.''
This definition provides that ``Medicare eligible expenses'' means only
those expenses of the kinds covered by Medicare Parts A and B, to the
extent recognized as reasonable and necessary by Medicare. As outlined
in the March 25, 2005 Federal Register (70 FR 15394), this definition
clarifies that a Medigap policy does not pay cost-sharing for expenses
under Medicare Part D and also clearly states the position of the NAIC
and CMS that Medigap policies do not pay cost sharing incurred under
Part C.
5. New Standardized Plan G With High Deductible
Consistent with section 1882(z)(4) of the Act, section 9.2A.(4) of
the revised NAIC Model redesignates Plan F With High Deductible as a
new Plan G With High Deductible for an individual who is a ``newly
eligible Medicare beneficiary,'' as defined by section 401 of MACRA. As
a result, the references to Plan F With High Deductible under section
1882(p)(11)(A)(i) of the Act is replaced with a reference to Plan G
With High Deductible for a ``newly eligible Medicare beneficiary.''
Plan G With High Deductible does not provide coverage for any portion
of the Part B deductible and will be available beginning on January 1,
2020.
Section 9.1.E.(7). of the NAIC Model provides that states may
permit the sale of Plan ``G'' With High Deductible to an individual who
is not a ``newly eligible Medicare beneficiary.'' While states are
permitted to provide additional rights and protections beyond the
Federal minimum standards, we note that this option and the last
sentence of section 9.1.E.(7). of the NAIC are not part of the Federal
standards. Therefore, a state's failure to include this language in its
regulatory program does not affect the state's compliance with Federal
Medigap standards and requirements.
III. Standardized Benefit Packages
The following tables list the standardized Medigap benefit packages
(by standardized plan year and effective date of coverage), with a
cross-reference to the sections of the attached NAIC Model where the
packages are described in detail. The revised NAIC Model, adopted by
the NAIC on August 29, 2016, is reprinted at the end of this notice.
The NAIC has granted permission for the NAIC Model to be published and
reproduced. Under 1 CFR 2.6, there is no restriction on the
republication of material as it appears in the Federal Register.
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Table 1--1990 Standardized Plans With an Effective Date of Coverage
Prior to June 1, 2010
------------------------------------------------------------------------
Plan NAIC model section number
------------------------------------------------------------------------
Plan A (Core Benefit Plan)................ Section 9.E.(1).
Plan B.................................... Section 9.E.(2).
Plan C.................................... Section 9.E.(3).
Plan D.................................... Section 9.E.(4).
Plan E.................................... Section 9.E.(5).
Plan F.................................... Section 9.E.(6).
Plan F High Deductible.................... Section 9.E.(7).
Plan G.................................... Section 9.E.(8).
Plan H.................................... Section 9.E.(9).
Plan I.................................... Section 9.E.(10).
Plan J.................................... Section 9.E.(11).
Plan J High Deductible.................... Section 9.E.(12).
Plan K.................................... Section 9.F.(1).
Plan L.................................... Section 9.F.(2).
------------------------------------------------------------------------
Table 2--2010 Standardized Plans With an Effective Date of Coverage On
or After June 1, 2010 But Prior to January 1, 2020:
------------------------------------------------------------------------
Plan NAIC model section number
------------------------------------------------------------------------
Plan A (Core Benefit Plan)................ Section 9.1.E.(1).
Plan B.................................... Section 9.1.E.(2).
Plan C.................................... Section 9.1.E.(3).
Plan D.................................... Section 9.1.E.(4).
Plan F.................................... Section 9.1.E.(5).
Plan F High Deductible.................... Section 9.1.E.(6).
Plan G.................................... Section 9.1.E.(7).
Plan K.................................... Section 9.1.E.(8).
Plan L.................................... Section 9.1.E.(9).
Plan M.................................... Section 9.1.E.(10).
Plan N.................................... Section 9.1.E.(11).
------------------------------------------------------------------------
Table 3--2020 Standardized Plans With an Effective Date of Coverage On
or After January 1, 2020 for a ``Newly Eligible Medicare Beneficiary,''
as Defined by Section 401 of MACRA
------------------------------------------------------------------------
Plan NAIC model section number
------------------------------------------------------------------------
Plan A (Core Benefit Plan)................ Section 9.1.E.(1).
Plan B.................................... Section 9.1.E.(2).
Plan D.................................... Section 9.1.E.(4).
Plan G.................................... Section 9.1.E.(7).
Plan G High Deductible.................... Section 9.1.E.(7).
Plan K.................................... Section 9.1.E.(8).
Plan L.................................... Section 9.1.E.(9).
Plan M.................................... Section 9.1.E.(10).
Plan N.................................... Section 9.1.E.(11).
------------------------------------------------------------------------
Table 4--2020 Standardized Plans With an Effective Date of Coverage On
or After January 1, 2020 for an Individual Who Is Not A ``Newly Eligible
Medicare Beneficiary,'' as Defined by Section 401 of MACRA
------------------------------------------------------------------------
Plan NAIC model section number
------------------------------------------------------------------------
Plan A (Core Benefit Plan)................ Section 9.1.E.(1).
Plan B.................................... Section 9.1.E.(2).
Plan C.................................... Section 9.1.E.(3).
Plan C.................................... Section 9.1.E.(4).
Plan F.................................... Section 9.1.E.(5).
Plan F High Deductible.................... Section 9.1.E.(6).
Plan G.................................... Section 9.1.E.(7).
Plan G High Deductible.................... Section 9.1.E.(7).\1\
Plan K.................................... Section 9.1.E.(8).
Plan L.................................... Section 9.1.E.(9).
Plan M.................................... Section 9.1.E.(10).
Plan N.................................... Section 9.1.E.(11).
------------------------------------------------------------------------
\1\ Consistent with the last sentence of section 9.1.E.(7) of the NAIC
Model, states may permit the sale of Plan G With High Deductible to an
individual who is not a ``newly eligible Medicare beneficiary.''
However, a State's failure to adopt this sentence and provide this
option does not affect the State's compliance with Federal Medigap
standards and requirements.
IV. Collection of Information Requirements
This document does not impose information collection requirements,
that is, reporting, recordkeeping or third-party disclosure
requirements. Consequently, there is no need for review by the Office
of Management and Budget under the authority of the Paperwork Reduction
Act of 1995 (44 U.S.C. 3501 et seq.).
Dated: August 24, 2017.
Seema Verma,
Administrator, Centers for Medicare & Medicaid Services.
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[FR Doc. 2017-18605 Filed 8-31-17; 8:45 am]
BILLING CODE 4120-01-C
