(a) A Medicare
supplement policy or certificate delivered or issued for delivery with an
effective date of coverage on or after January 1, 2020 may not be advertised,
solicited, delivered, or issued for delivery in this state as a Medicare
supplement policy or certificate unless it complies with the benefit
requirements of this section.
(b)
An issuer shall make available to each prospective policyholder and certificate
holder a policy form or certificate form containing only the basic core
benefits, as set out in
3
AAC 28.459(m).
(c) If an issuer makes available any of the
additional benefits as set out in
3
AAC 28.459(n), or offers standardized
benefit plans "K" or "L" as set out in (g)(9) and(lO) of this section, the
issuer shall make available to each prospective policyholder and certificate
holder, in addition to a policy form or certificate form with only the basic
core benefits as set out in
3
AAC 28.459(m), a policy form or
certificate form containing either standardized benefit plan "D" as set out in
(g)(4) of this section or standardized benefit plan "G" as set out in (g)(7) of
this section.
(d) An issuer may not
offer for sale in this state a group, package, or combination of Medicare
supplement benefits other than those listed in this section, except as may be
permitted under (h) of this section.
(e) Medicare supplement benefit plans must be
uniform in structure, language, designation, and format to the standardized
benefit plans listed in (g) of this section and conform to the definitions
under 3 AAC 28.430 and
3
AAC 28.510. Each benefit must be structured in
accordance with the format provided in
3
AAC 28.454(m) and (n), or, in the
case of plans "K" or "L," in (g)(9) or (10) of this section, and list the
benefits in the order shown. For purposes of this section, "structure,
language, and format" means style, arrangement, and overall content of a
benefit.
(f) An issuer may use, in
addition to the benefit plan designations required in (e) of this section,
other designations to the extent permitted by law.
(g) The 2020 standardized Medicare supplement
benefit plans must adhere to the following requirements:
(1) standardized Medicare supplement benefit
plan "A" must be limited to the basic core benefits, as set out in
3
AAC 28.459(m);
(2) standardized Medicare supplement benefit
plan "B" must consist of the core benefit as set out in
3
AAC 28.459(m), plus the Medicare Part
A deductible as set out in
3
AAC 28.459(n)(l);
(3) standardized Medicare supplement benefit
plan "C" must consist of the core benefit as set out in
3
AAC 28.459(m), plus the Medicare Part
A deductible, skilled nursing facility care. Medicare Part B deductible, and
medically necessary emergency care provided in a foreign country as set out in
3
AAC 28.459(n)(l), (3), (4), and
(6);
(4) standardized Medicare supplement benefit
plan "D" must consist of the core benefit as set out in
3
AAC 28.459(m), plus the Medicare Part
A deductible, skilled nursing facility care, and medically necessary emergency
care provided in an foreign country as set out in
3
AAC 28.459(n)(l), (3), and
(6);
(5) standardized Medicare supplement plan "F"
must consist of the core benefit as set out in
3
AAC 28.459(m), plus the Medicare Part
A deductible, skilled nursing facility care, the Medicare Part B deductible,
100 percent of the Medicare Part B excess charges, and medically necessary
emergency care provided in a foreign country as set out in
3
AAC 28.459(n)(l) and (3) -
(6);
(6) standardized Medicare
supplement high deductible plan "F" must consist of all of the covered expenses
following the payment of the annual high deductible plan "F" deductible subject
to the following:
(A) the covered expenses
include the basic core benefit as set out in
3
AAC 28.459(m), plus the Medicare Part
A deductible, skilled nursing facility care, the Medicare Part B deductible,
100 percent of the Medicare Part B excess charges, and medically necessary
emergency care provided in a foreign country as set out in
3
AAC 28.459(n)(l) and (3) - (6);
(B) the annual high deductible
plan "F" deductible must consist of out-of-pocket expenses, other than
premiums, for services covered by the Medicare supplement plan "F" policy, and
must be in addition to any other specific benefit deductibles;
(C) the annual high deductible plan "F"
deductible must be $1,500 for 1999, based on the calendar year, to be adjusted
annually after that by the secretary to reflect the change in the consumer
price index for all urban consumers for the 12-month period ending with August
of the preceding year, rounded to the nearest multiple of $10;
(7) standardized Medicare
supplement benefit plan "G" must consist of the core benefit as set out in
3
AAC 28.459(m), plus the Medicare Part
A deductible, skilled nursing facility care, 100 percent of the Medicare Part B
excess charges, and medically necessary emergency care provided in a foreign
country as set out in
3
AAC 28.459(n)(l), (3), (5), and
(6);
(8) standardized Medicare supplement high
deductible plan "G" must consist of all of the covered expenses following the
payment of the annual high deductible plan "G" deductible subject to the
following:
(A) the covered expenses include
the basic core benefit as set out in 3 AAC 459(m), plus the Medicare Part A
deductible, skilled nursing facility care, 100 percent of the Medicare Part B
excess charges, and medically necessary emergency care provided in a foreign
country as set out in
3
AAC 28.459(n)(l), (3), (5) and (6);
(B) the annual high deductible
plan "G" deductible must consist of out-of-pocket expenses, other than
premiums, for services covered by the Medicare supplement plan "G" policy and
must be in addition to any other specific benefit deductibles;
(C) the annual high deductible plan "G"
deductible must be $2,200 for 2017, based on the calendar year, to be adjusted
annually after that by the secretary to reflect the change in the consumer
price index for all urban consumers for the 12-month period ending with August
of the preceding year, rounded to the nearest multiple of $10;
(9) standardized Medicare
supplement plan "K" must consist of the following benefits:
(A) coverage of 100 percent of the Medicare
Part A hospital coinsurance amount for each day used from the 61st through the
90th day in any Medicare benefit period;
(B) coverage of 100 percent of the Medicare
Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve
day used from the 91st through the 150th day in any Medicare benefit
period;
(C) upon exhaustion of the
Medicare hospital inpatient coverage, including the lifetime reserve days,
coverage of 100 percent of the 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 an additional 365 days;
(D) coverage for 50 percent of the Medicare
Part A inpatient hospital deductible amount per benefit period until the
out-of-pocket limitation is met as set out in (J) of this paragraph;
(E) coverage for 50 percent of the
coinsurance amount for each day used from the 21st day through the 100th day in
a Medicare benefit period for post-hospital skilled nursing facility care
eligible under Medicare Part A until the out-of-pocket limitation is met as set
out in (J) of this paragraph;
(F)
coverage for 50 percent of cost sharing for all Medicare Part A eligible
expenses and respite care until the out-of-pocket limitation is met as set out
in (J) of this paragraph;
(G)
coverage for 50 percent under Medicare Part A or Part B of the reasonable cOst
of the first three pints of blood, or an equivalent quantity of packed red
blood cells as defined under federal regulations, unless replaced in accordance
with federal regulations until the out-of-pocket limitation is met as set out
in (J) of this paragraph;
(H)
except for coverage provided under (I) of this paragraph, coverage for 50
percent of the cost sharing otherwise applicable under Medicare Part B after
the policyholder pays the Part B deductible until the out-of-pocket limitation
is met as set out in (J) of this paragraph;
(I) coverage of 100 percent of the cost
sharing for Medicare Part B preventive services after the policyholder pays the
Part B deductible;
(J) coverage of
100 percent of all cost sharing under Medicare Part A and Part B for the
balance of the calendar year after the individual has reached the out-of-pocket
limitation on aimual expenditures under Medicare Part A and Part B of $4,000 in
2006, indexed each year by the appropriate inflation adjustment specified by
the secretary;
(10)
standardized Medicare supplement plan "L" and must consist of the benefits set
out in
(A) the provisions of (9)(A) - (C),
and (I) of this subsection;
(B) the
provisions of (9)(D) - (H) of this subsection, but substituting 75 percent for
50 percent in each of those subparagraphs; and
(C) the provisions of (9)(J) of this
subsection, but substituting $2,000 for $4,000 in that subparagraph;
(11) standardized Medicare
supplement plan "M" must consist of the core benefit as set out in
3
AAC 28.459(m), plus 50 percent of the
Medicare Part A deductible, skilled nursing facility care, and medically
necessary emergency care provided in a foreign country as set out in
3
AAC 28.459(n)(2), (3), and (6);
(12) standardized Medicare
supplement plan "N" must consist of the core benefit as set out in
3
AAC 28.459(m), pluslOO percent of the
Medicare Part A deductible, skilled nursing facility care, and medically
necessary emergency care provided in a foreign country as set out in
3
AAC 28.459(n)(l), (3), and (6), with
copayments of
(A) the lesser of $20 or the
Medicare Part B coinsurance or copayment for each covered health care provider
office visit, including visits to medical specialists; and
(B) the lesser of $50 or the Medicare Part B
coinsurance or copayment for each covered emergency room visit; this copayment
will be waived if the insured is admitted to any hospital and the emergency
visit is subsequently covered as a Medicare Part A expense.
(h) An issuer may, with
prior approval of the director, offer a Medicare supplement policy or
certificate under this section that contains new or innovative benefits, in
addition to the standard benefits required in a policy or certificate issued
under this section that otherwise complies with the applicable standards. The
new or innovative benefits may include only benefits that are appropriate to
Medicare supplement insurance, are new or innovative, are not otherwise
available, and are cost-effective and offered in a manner that is consistent
with the goal of simplification of Medicare supplement policies. New or
innovative benefits may not include an outpatient prescription drug benefit.
New or innovative benefits may not be used to change or reduce benefits,
including a change of any cost-sharing provision, in any standardized Medicare
supplement plan.