Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 10 - HEALTH INSURANCE-GENERAL
Chapter 31.10.06 - Standards for Medicare Supplement Policies
Section 31.10.06.27 - Benefit Standards for 2010 Standardized Medicare Supplement Benefit Plans

(1) The standards found in §§B-D of this regulation are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this State with an effective date for coverage on or after June 1, 2010.

(2) A policy or certificate may not be advertised, solicited, delivered, or issued for delivery in this State as a Medicare supplement policy or certificate on or after June 1, 2010, unless it complies with the benefit standards found in this regulation.

(3) An issuer may not offer a 1990 standardized Medicare supplement benefit plan for sale on or after June 1, 2010. Benefit standards applicable to Medicare supplement policies and certificates issued with an effective date for coverage before June 1, 2010, remain subject to the requirements of Regulation .08 of this chapter.

(1) The standards in this section apply to Medicare supplement policies and certificates and are in addition to all other requirements of this chapter.

(2) A Medicare supplement policy or certificate may not exclude or limit benefits for a loss incurred more than 6 months after the effective date of coverage because the loss involved a preexisting condition. The policy or certificate may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within 6 months before the effective date of coverage.

(3) A Medicare supplement policy or certificate may not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents.

(4) A Medicare supplement policy or certificate shall provide that benefits designed to cover cost sharing amounts under Medicare will be changed automatically to coincide with any changes in the applicable Medicare deductible, copayment, or coinsurance amounts. Premiums may be modified to correspond with the changes to the cost-sharing amounts.

(5) A Medicare supplement policy or certificate may not provide for termination of coverage of a spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than the nonpayment of premium.

(6) Each Medicare supplement policy shall be guaranteed renewable. The issuer may not:

(7) If the Medicare supplement policy is terminated by the group policyholder and is not replaced as provided under §B(9) of this regulation, the issuer shall offer each certificate holder an individual Medicare supplement policy, which at the option of the certificate holder provides for:

(8) If an individual is a certificate holder in a group Medicare supplement policy and the individual terminates membership in the group, the issuer shall:

(9) If a group Medicare supplement policy is replaced by another group Medicare supplement policy purchased by the same policyholder, the issuer of the replacement policy shall offer coverage to each individual covered under the old group policy on the group policy's date of termination. Coverage under the new policy may not result in an exclusion for a preexisting condition that would have been covered under the group policy being replaced.

(10) Extension of Benefits.

(11) Suspension of Benefits.

(1) Every issuer of Medicare supplement insurance benefit plans shall make available a policy or certificate including only the following basic core package of benefits to each prospective insured:

(2) The provider shall accept the issuer's payment of the Medicare Part A eligible expenses for hospitalization under §C(1)(c) of this regulation as payment in full and may not bill the insured for any balance.

(3) An issuer may make available to prospective insureds any of the other Medicare supplement insurance benefit plans in addition to the basic core package, but not instead of it.

(1) Medicare Part A Deductible-Coverage for 100 percent of the Medicare Part A inpatient hospital deductible amount per benefit period;

(2) Medicare Part A Deductible-Coverage for 50 percent of the Medicare Part A inpatient hospital deductible amount per benefit period;

(3) Skilled Nursing Facility Care-Coverage for the actual billed charges up to the coinsurance amount 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;

(4) Medicare Part B Deductible-Coverage for 100 percent of the Medicare Part B deductible amount per calendar year regardless of hospital confinement;

(5) 100 Percent of the Medicare Part B Excess Charges-Coverage for all of the difference between the actual Medicare Part B charges as billed, not to exceed any charge limitation established by the Medicare program or state law, and the Medicare-approved Part B charge; and

(6) Medically Necessary Emergency Care in a Foreign Country-Coverage to the extent not covered by Medicare for 80 percent of the billed charges for Medicare-eligible expenses for medically necessary emergency hospital, physician, and medical care received in a foreign country, which care would have been covered by Medicare if provided in the United States and which care began during the first 60 consecutive days of each trip outside the United States, subject to a calendar year deductible of $250, and a lifetime maximum benefit of $50,000; for purposes of this benefit, "emergency care" means care needed immediately because of an injury or an illness of sudden and unexpected onset.