(c) Benefit plans shall be uniform in
structure, language, designation and format to the standard benefit plans "A"
through "L" listed in this section and conform to the definitions in section
38a-495a-2 of the
Regulations of Connecticut State Agencies. Each benefit shall be structured in
accordance with the format provided in sections
38a-495-5(b)
and
38a-495a-5(c)
of the Regulations of Connecticut State Agencies and list the benefits in the
order shown in this subsection. For purposes of this section, "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 section
38a-495a-5(b)
of the Regulations of Connecticut State Agencies.
(2) Standardized Medicare supplement benefit
plan "B" shall include only the following: The Core Benefit as defined in
section
38a-495a-5(b)
of the Regulations of Connecticut State Agencies, plus the Medicare Part A
Deductible as defined in section
38a-495a-5(c)
(1) of the Regulations of Connecticut State Agencies.
(3) Standardized Medicare supplement benefit
plan "C" shall include only the following: The Core Benefit as defined in
38a-495a-5(b) of the Regulations of Connecticut State Agencies, 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 sections
38a-495a-5(c)
(1), (2), (3) and (8) of the Regulations of Connecticut State Agencies
respectively.
(4) Standardized
Medicare supplement benefit plan "D" shall include only the following: The Core
Benefit as defined in section
38a-495a-5(b)
of the Regulations of Connecticut State Agencies, plus the Medicare Part A
Deductible, Skilled Nursing Facility Care, Medically Necessary Emergency Care
in a Foreign Country and the At-Home Recovery Benefit as defined in sections
38a-495a-5(c)
(1), (2), (8) and (10) of the Regulations of Connecticut State Agencies
respectively.
(5) Standardized
Medicare supplement benefit plan "E" shall include only the following: The Core
Benefit as defined in section
38a-495a-5(b)
of the Regulations of Connecticut State Agencies, 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 sections
38a-495a-5(c)
(1), (2), (8) and (9) of the Regulations of Connecticut State Agencies
respectively.
(6) Standardized
Medicare supplement benefit plan "F" shall include only the following: The Core
Benefit as defined in section
38a-495a-5(b)
of the Regulations of Connecticut State Agencies, 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 sections
38a-495a-5(c)
(1), (2), (3), (5) and (8) of the Regulations of Connecticut State Agencies
respectively.
(7) Standardized
Medicare supplement benefit high deductible plan "F" shall include only the
following: one hundred percent (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 section
38a-495a-5(b)
of the Regulations of Connecticut State Agencies, 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 sections
38a-495a-5(c)
(1), (2), (3), (5) and (8) of the Regulations of Connecticut State Agencies
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 one thousand five hundred dollars 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 ten dollars.
(8) Standardized Medicare supplement benefit
plan "G" shall include only the following: The Core Benefit as defined in
section
38a-495a-5(b)
of the Regulations of Connecticut State Agencies, 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 sections
38a-495a-5(c)
(1), (2), (4), (8) and (10) respectively of the Regulations of Connecticut
State Agencies.
(9) Standardized
Medicare supplement benefit plan "H" shall consist of only the following: The
Core Benefit as defined in section
38a-495a-5(b)
of the Regulations of Connecticut State Agencies, 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 sections
38a-495a-5(c)
(1), (2), (6) and (8) of the Regulations of Connecticut State Agencies
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
section
38a-495a-5(b)
of the Regulations of Connecticut State Agencies, 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 sections
38a-495a-5(c)
(1), (2), (5), (6), (8) and (10) of the Regulations of Connecticut State
Agencies 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 section
38a-495a-5(b)
of the Regulations of Connecticut State Agencies, 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
sections
38a-495a-5(c)
(1), (2), (3), (5), (7), (8), (9) and (10) of the Regulations of Connecticut
State Agencies respectively. The outpatient prescription drug benefit plan
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: one hundred percent (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 section
38a-495a-5(b)
of the Regulations of Connecticut State Agencies, 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 sections
38a-495a-5(c)
(1), (2), (3), (5), (7), (8), (9) and (10) of the Regulations of Connecticut
State Agencies 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 one
thousand five hundred dollars 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 ten dollars. The outpatient prescription drug benefit
plan 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 section
38a-495a-5(d)
(1) of the Regulations of Connecticut State Agencies.
(2) Standardized Medicare supplement benefit
plan "L" shall consist of only those benefits described in section
38a-495a-5(d)
(2) of the Regulations of Connecticut State Agencies.
(3) 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. Such 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 which 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.