Minnesota Administrative Rules
Agency 120 - Commerce Department
Chapter 2740 - COMPREHENSIVE HEALTH INSURANCE
ACTUARIAL EQUIVALENCE OF QUALIFIED PLANS AND QUALIFIED MEDICARE SUPPLEMENT PLANS
Part 2740.9909 - COMPOSITE POINT VALUES FOR QUALIFIED PLAN NUMBER THREE

Universal Citation: MN Rules 2740.9909
Current through Register Vol. 49, No. 27, December 30, 2024

The composite point values for a qualified plan number three for 1984 are as shown herein.

Composite Point Values for Minnesota Qualified Plan Number 3
Points Benefit
363 Hospital room and board, unlimited days, semiprivate.
480 Hospital extras (i.e., hospital services, hospital miscellaneous, hospital special services, or ancillary services) including anesthesia.
243 Surgery, including administration of anesthesia, assistant surgeon and oral surgery but no tooth repair or extractions.
215 Home and office physician care, unlimited.
51 Physician care in hospital, unlimited.
63 Obstetrics, unlimited.
110 Hospital maternity, unlimited.
105 X-rays and laboratory tests, outpatient and out of hospital.
100 Prescription drugs and medicine, outpatient and out of hospital.
15 Radioactive therapy, outpatient and out of hospital.
16 Nursing or convalescent facility.
8 Home health agency care.
10 Physical therapy.
4 Oxygen.
5 Prostheses.
5 Durable medical equipment rental or purchase.
2 Second opinion surgery.
2 Private duty nursing.
3 Ambulance.
-12 Adjustment for major medical maximum.
_____ 1788 Total reasonable and customary medical services
-245 $150 deductible.
-309 20 percent coinsurance.
_____ 1234 Total after deductions for deductible and coinsurance
-49 Coordination of benefits.
-31 Nonduplication with no-fault.
30 3,000 annual "out-of-pocket" expense limit.
8 Well baby care.
0 Emergency accident.
0 Supplement accident.
0 Student dependents.
_____ 1192 Grand Total

Statutory Authority: MS s 62E.09

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