Current through Register Vol. 42, No. 5, February 29, 2024
C. Benefit plans shall be uniform in
structure, language, designation and format to the standard benefit plans "A"
through "L" listed in this subsection and conform to the definitions in Rule
482-1-071-.04. Each
benefit shall be structured in accordance with the format provided in
Subsections B and C or D of Rule
482-1-071-.08
and list the benefits in the order shown in this subsection. For purposes of
this rule, "structure, language, and format" means style, arrangement and
overall content of a benefit.
E. Make-up of benefit plans:
(1) Standardized Medicare supplement benefit
plan "A" shall be limited to the basic (core) benefits common to all benefit
plans, as defined in Rule
482-1-071-.08
B.
(2) Standardized Medicare
supplement benefit plan "B" shall include only the following: The core benefit
as defined in Rule
482-1-071-.08
B, plus the Medicare Part A deductible as defined in Rule
482-1-071-.08
C(1).
(3) Standardized Medicare
supplement benefit plan "C" shall include only the following: The core benefit
as defined in Rule
482-1-071-.08
B, plus the Medicare Part A deductible, skilled nursing facility care, Medicare
Part B deductible and medically necessary emergency care in a foreign country
as defined in Rules
482-1-071-.08
C(1), (2), (3) and (8) respectively.
(4) Standardized Medicare supplement benefit
plan "D" shall include only the following: The core benefit (as defined in Rule
482-1-071-.08
B), plus the Medicare Part A deductible, skilled nursing facility care,
medically necessary emergency care in an foreign country and the at-home
recovery benefit as defined in Rules
482-1-071-.08
C(1), (2), (8) and (10) respectively.
(5) Standardized Medicare supplement benefit
plan "E" shall include only the following: The core benefit as defined in Rule
482-1-071-.08
B, plus the Medicare Part A deductible, skilled nursing facility care,
medically necessary emergency care in a foreign country and preventive medical
care as defined in Rules
482-1-071-.08
C(1), (2), (8) and (9) respectively.
(6) Standardized Medicare supplement benefit
plan "F" shall include only the following: The core benefit as defined in Rule
482-1-071-.08
B, plus the Medicare Part A deductible, the skilled nursing facility care, the
Part B deductible, one hundred percent (100%) of the Medicare Part B excess
charges, and medically necessary emergency care in a foreign country as defined
in Rules
482-1-071-.08
C(1), (2), (3), (5) and (8) respectively.
(7) Standardized Medicare supplement benefit
high deductible plan "F" shall include only the following: 100% of covered
expenses following the payment of the annual high deductible plan "F"
deductible. The covered expenses include the core benefit as defined in Rule
482-1-071-.08
B, plus the Medicare Part A deductible, skilled nursing facility care, the
Medicare Part B deductible, one hundred percent (100%) of the Medicare Part B
excess charges, and medically necessary emergency care in a foreign country as
defined in Rules
482-1-071-.08
C(1), (2), (3), (5) and (8) respectively. The annual high deductible plan "F"
deductible shall consist of out-of-pocket expenses, other than premiums, for
services covered by the Medicare supplement plan "F" policy, and shall be in
addition to any other specific benefit deductibles. The annual high deductible
Plan "F" deductible shall be $1500 for 1998 and 1999, and shall be based on the
calendar year. It shall be adjusted annually thereafter by the Secretary to
reflect the change in the Consumer Price Index for all urban consumers for the
twelve-month period ending with August of the preceding year, and rounded to
the nearest multiple of $10.
(8)
Standardized Medicare supplement benefit plan "G" shall include only the
following: The core benefit as defined in Rule
482-1-071-.08
B, plus the Medicare Part A deductible, skilled nursing facility care, eighty
percent (80%) of the Medicare Part B excess charges, medically necessary
emergency care in a foreign country, and the at-home recovery benefit as
defined in Rules
482-1-071-.08
C(1), (2), (4), (8) and (10) respectively.
(9) Standardized Medicare supplement benefit
plan "H" shall consist of only the following: The core benefit as defined in
Rule
482-1-071-.08
B, plus the Medicare Part A deductible, skilled nursing facility care, basic
prescription drug benefit and medically necessary emergency care in a foreign
country as defined in Rules
482-1-071-.08
C(1), (2), (6) and (8) respectively. The outpatient prescription drug benefit
shall not be included in a Medicare supplement policy sold after December 31,
2005.
(10) Standardized Medicare
supplement benefit plan "I" shall consist of only the following: The core
benefit as defined in Rule
482-1-071-.08
B, plus the Medicare Part A deductible, skilled nursing facility care, one
hundred percent (100%) of the Medicare Part B excess charges, basic
prescription drug benefit, medically necessary emergency care in a foreign
country and at-home recovery benefit as defined in Rules
482-1-071-.08
C(1), (2), (5), (6), (8) and (10) respectively. The outpatient prescription
drug benefit shall not be included in a Medicare supplement policy sold after
December 31, 2005.
(11)
Standardized Medicare supplement benefit plan "J" shall consist of only the
following: The core benefit as defined in Rule
482-1-071-.08
B, plus the Medicare Part A deductible, skilled nursing facility care, Medicare
Part B deductible, one hundred percent (100%) of the Medicare Part B excess
charges, extended prescription drug benefit, medically necessary emergency care
in a foreign country, preventive medical care and at-home recovery benefit as
defined in Rules
482-1-071-.08
C(1), (2), (3), (5), (7), (8), (9) and (10) respectively. The outpatient
prescription drug benefit shall not be included in a Medicare supplement policy
sold after December 31, 2005.
(12)
Standardized Medicare supplement benefit high deductible plan "J" shall consist
of only the following: 100% of covered expenses following the payment of the
annual high deductible plan "J" deductible. The covered expenses include the
core benefit as defined in Rule
482-1-071-.08
B, plus the Medicare Part A deductible, skilled nursing facility care, Medicare
Part B deductible, one hundred percent (100%) of the Medicare Part B excess
charges, extended outpatient prescription drug benefit, medically necessary
emergency care in a foreign country, preventive medical care benefit and
at-home recovery benefit as defined in Rules
482-1-071-.08
C(1), (2), (3), (5), (7), (8), (9) and (10) respectively. The annual high
deductible plan "J" deductible shall consist of out-of-pocket expenses, other
than premiums, for services covered by the Medicare supplement plan "J" policy,
and shall be in addition to any other specific benefit deductibles. The annual
deductible shall be $1500 for 1998 and 1999, and shall be based on a calendar
year. It shall be adjusted annually thereafter by the Secretary to reflect the
change in the Consumer Price Index for all urban consumers for the twelve-month
period ending with August of the preceding year, and rounded to the nearest
multiple of $10. The outpatient prescription drug benefit shall not be included
in a Medicare supplement policy sold after December 31, 2005.
F. Make-up of two Medicare
supplement plans mandated by The Medicare Prescription Drug, Improvement and
Modernization Act of 2003 (MMA);
(1)
Standardized Medicare supplement benefit plan "K" shall consist of only those
benefits described in Rule
482-1-071-.08
D(1).
(2) Standardized Medicare
supplement benefit plan "L" shall consist of only those benefits described in
Rule
482-1-071-.08
D(2).
G. New or
Innovative Benefits: An issuer may, with the prior approval of the
commissioner, offer policies or certificates with new or innovative benefits in
addition to the benefits provided in a policy or certificate that otherwise
complies with the applicable standards. The new or innovative benefits may
include benefits that are appropriate to Medicare supplement insurance, new or
innovative, not otherwise available, cost-effective, and offered in a manner
that is consistent with the goal of simplification of Medicare supplement
policies. After December 31, 2005, the innovative benefit shall not include an
outpatient prescription drug benefit.
