Current through Register Vol. 50, No. 9, September 20, 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
§503 of this regulation. Each benefit
shall be structured in accordance with the format provided in
§515. A.2 or 515.A.4
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
§515. A.2 of this
regulation.
2. Standardized
Medicare supplement benefit plan "B" shall include only the following. The core
benefit as defined in
§515. A.2 of this
regulation, plus the Medicare Part A deductible as defined in
§515. A.3.a
3. Standardized Medicare supplement benefit
plan "C" shall include only the following: The core benefit as defined in
§515. A.2 of this
regulation, 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
§515. A.3 a, b, c and
h, respectively.
4. Standardized
Medicare supplement benefit plan "D" shall include only the following: The core
benefit as defined in
§515. A.2 of this
regulation, 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
§515. A.3 a, b, h and
j, respectively.
5. Standardized
Medicare supplement benefit plan "E" shall include only the following: The core
benefit as defined in
§515. A.2 of this
regulation, 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
§515. A.3 a, b, h and
i, respectively.
6. Standardized
Medical supplement benefit plan "F" shall include only the following: The core
benefit as defined in
§515. A.2 of this
regulation, plus the Medicare Part A deductible, the skilled nursing facility
care, the Part B deductible, 100 percent of the Medicare Part B excess charges,
and medically necessary emergency care in a foreign country, as defined in
§515. A.3 a, b, c, e
and h, respectively.
7.
Standardized Medicare supplement benefit high deductible plan "F" shall include
only the following: 100 percent of covered expenses following the payment of
the annual high deductible plan "F" deductible. The covered expenses include
the core benefit as defined in
§515. A.2 of this
regulation, 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 in a foreign country as defined
in §515.
A.3 a, b, c, e and h, 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 $1,500 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 12-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
§515. A.2 of this
regulation, plus the Medicare Part A deductible, skilled nursing facility care,
80 percent of the Medicare Part B excess charges, medically necessary emergency
care in a foreign country, and the at-home recovery benefit as defined in
§515. A.3 a, b, d, h
and j, respectively.
9.
Standardized Medicare supplement benefit plan "H" shall consist of only the
following: The core benefit as defined in
§515. A.2 of this
regulation, plus the Medicare Part A deductible, skilled nursing facility care,
basic outpatient prescription drug benefit, and medically necessary emergency
care in a foreign country, as defined in
§515. A.3 a, b, f and
h, 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
§515. A.2 of this
regulation, plus the Medicare Part A deductible, skilled nursing facility care,
100 percent of the Medicare Part B excess charges, basic outpatient
prescription drug benefit, medically necessary emergency care in a foreign
country and at-home recovery benefit as defined in
§515. A.3 a, b, e, f, h
and j, 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
§515. A.2 of this
regulation, plus the Medicare Part A deductible, skilled nursing facility care,
Medicare Part B deductible, 100 percent 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
§515. A.3 a, b, c, e,
g, h, i and j, 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 percent of covered expenses following the payment of the annual
high deductible plan "J" deductible. The covered expenses include the core
benefit as defined in
§515. A.2 of this
regulation, plus the Medicare Part A deductible, skilled nursing facility care,
Medicare Part B deductible, 100 percent 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
§515. A.3 a, b, c, e,
g, h, i and j, 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 $1,500
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 12-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
§515. A.4(1)
2. Standardized Medicare supplement benefit
plan "L" shall consist of only those benefits described in
§515. A.4(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 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.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
22:224 and
42 U.S.C.
1395 et seq.
