New Hampshire Code of Administrative Rules
Ins - Commissioner, Insurance Department
Chapter Ins 1900 - ACCIDENT AND HEALTH INSURANCE
Part Ins 1905 - MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES
Section Ins 1905.09 - Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and Prior to June 1, 2010
Universal Citation: NH Admin Rules Ins 1905.09
Current through Register No. 12, March 21, 2024
(a) 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 defined in Ins 1905.07(c)of this rule.
(b) No groups, packages or combinations of Medicare supplement benefits other than those listed in this section shall be offered for sale in this state, except as may be permitted in Ins 1905.09(f) and Ins 1905.12.
(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 Ins 1905.03. Each benefit shall be structured in accordance with the format provided in Ins 1905.07(c), (d), and (e) 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.
(d) An issuer may use, in addition to the benefit plan designations required in paragraph (c) above, other designations to the extent permitted by law.
(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 Ins 1905.07(c);
(2) Standardized Medicare supplement benefit
plan "B" shall include only the following:
a.
The core benefit as specified in Ins 1905.07(c)of this rule; plus
b. The Medicare Part A deductible as defined
in Ins 1905.07(d)(1);
(3) Standardized Medicare supplement benefit
plan "C" shall include only the following:
a.
The core benefit as defined in Ins 1905.07(c); plus
b. The Medicare Part A deductible as defined
in Ins 1905.07(d)(1);
c. Skilled
nursing facility care as defined in Ins 1905.07(d)(2);
d. Medicare Part B deductible as defined in
Ins 1905.07(d)(3); and
e. Medically
necessary emergency care in a foreign country as defined in Ins
1905.07(d)(8);
(4)
Standardized Medicare supplement benefit plan "D" shall include only the
following:
a. The core benefit as defined in
Ins 1905.07(c)of this rule; plus
b.
The Medicare Part A deductible as defined in Ins 1905.07(d)(1);
c. Skilled nursing facility care as defined
in Ins 1905.07(d)(2);
d. Medically
necessary emergency care in a foreign country as defined in Ins 1905.07(d)(8);
and
e. The at-home recovery benefit
as defined in Ins 1905.07(d)(10);
(5) Standardized Medicare supplement benefit
plan "E" shall include only the following:
a.
The core benefit as defined in Ins 1905.07(c) of this rule; plus
b. The Medicare Part A deductible as defined
in Ins 1905.07(d)(1);
c. Skilled
nursing facility care as defined in Ins 1905.07(d)(2);
d. Medically necessary emergency care in a
foreign country as defined in Ins 1905.07(d)(8); and
e. Preventive medical care as defined in Ins
1905.07(d)(9);
(6)
Standardized Medicare supplement benefit plan "F" shall include only the
following:
a. The core benefit as defined in
Ins 1905.07(c)of this rule; plus
b.
The Medicare Part A deductible as defined in Ins 1905.07(d)(1);
c. The skilled nursing facility care as
defined in Ins 1905.07(d)(2);
d.
The Part B deductible as defined in Ins 1905.07(d)(3);
e. One hundred percent of the Medicare Part B
excess charges as defined in Ins 1905.07(d)(5); and
f. Medically necessary emergency care in a
foreign country as defined in Ins 1905.07(d)(8);
(7) Standardized Medicare supplement benefit
high deductible plan "F" shall include only the following:
a. 100% of covered expenses following the
payment of the annual high deductible plan F deductible. The covered expenses
include:
1. The core benefit as defined in
Ins 1905.07(c) of this rule; plus
2. The Medicare Part A deductible as defined
in Ins 1905.07(d)(1);
3. Skilled
nursing facility care as defined in Ins 1905.07(d)(2);
4. The Medicare Part B deductible as defined
in Ins 1905.07(d)(3);
5. One
hundred percent of the Medicare Part B excess charges as defined in Ins
1905.07(d)(5); and
6. Medically
necessary emergency care in a foreign country as defined in Ins
1905.07(d)(8);
b. 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;
c. The annual high
deductible plan "F" deductible shall be $1500 for 1998 and 1999, and shall be
based on the calendar year; and
d.
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:
a. The core benefit as defined in Ins
1905.07(c) of this rule; plus
b.
The Medicare Part A deductible as defined in Ins 1905.07(d)(1);
c. Skilled nursing facility care as defined
in Ins 1905.07(d)(2);
d. Eighty
percent of the Medicare Part B excess charges as defined in Ins
1905.07(d)(4);
e. Medically
necessary emergency care in a foreign country as defined in Ins 1905.07(d)(8);
and
f. The at-home recovery benefit
as defined in Ins 1905.07(d)(10);
(9) Standardized Medicare supplement benefit
plan "H" shall consist of only the following:
a. The core benefit as defined in Ins
1905.07(c) of this rule; plus
b.
The Medicare Part A deductible as defined in Ins 1905.07(d)(1);
c. Skilled nursing facility care as defined
in Ins 1905.07(d)(2);
d. Basic
prescription drug benefit as defined in Ins 1905.07(d)(6); and
e. Medically necessary emergency care in a
foreign country as defined in Ins 1905.07(d)(8); and
f. 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:
a. The core benefit as defined in Ins
1905.07(c)of this rule; plus
b. The
Medicare Part A deductible as defined in Ins 1905.07(d)(1);
c. Skilled nursing facility care as defined
in Ins 1905.07(d)(2);
d. One
hundred percent of the Medicare Part B excess charges as defined in Ins
1905.07(d)(5);
e. Basic
prescription drug benefit as defined in Ins 1905.07(d)(6);
f. Medically necessary emergency care in a
foreign country as defined in Ins 1905.07(d)(8);
g. At-home recovery benefits as defined in
Ins 1905.07(d)(10); and
h. 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:
a. The core benefit as defined in Ins
1905.07(c) of this rule; plus
b.
The Medicare Part A deductible as defined in Ins 1905.07(d)(1);
c. Skilled nursing facility care as defined
in Ins 1905.07(d)(2);
d. Medicare
Part B deductible as defined in Ins 1905.07(d)(3);
e. One hundred percent of the Medicare Part B
excess charges as defined in Ins 1905.07(d)(5);
f. Extended prescription drug benefit as
defined in Ins 1905.07(d)(7);
g.
Medically necessary emergency care in a foreign country as defined in Ins
1905.07(d)(8);
h. Preventive
medical care as defined in Ins 1905.07(d)(9);
i. At-home recovery benefit as defined in Ins
1905.07(d)(10); and
j. 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:
a. One hundred percent of covered expenses,
following the payment of the annual high deductible plan "J" deductible. The
covered expenses include:
1. The core benefit
as defined in Ins 1905.07(c) of this rule; plus
2. The Medicare Part A deductible as defined
in Ins 1905.07(d)(1);
3. Skilled
nursing facility care as defined in Ins 1905.07(d)(2);
4. Medicare Part B deductible as defined in
Ins 1905.07(d)(3);
5. One hundred
percent of the Medicare Part B excess charges as defined in Ins
1905.07(d)(5);
6. Extended
outpatient prescription drug benefit as defined in Ins 1905.07(d)(7);
7. Medically necessary emergency care in a
foreign country as defined in Ins 1905.07(d)(8);
8. Preventive medical care benefit as defined
in Ins 1905.07(d)(9); and
9.
At-home recovery benefit as defined in Ins 1905.07(d)(10);
b. 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;
c. The annual deductible shall be $1500 for
1998 and 1999, and shall be based on a calendar year;
d. 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; and
e. The outpatient prescription drug benefit
shall not be included in a Medicare supplement policy sold after December 31,
2005; and
(13) Make-up
of two Medicare supplement plans mandated by The Medicare Prescription Drug,
Improvement and Modernization Act of 2003 (MMA):
a. Standardized Medicare supplement benefit
plan "K" shall consist of only those benefits described in Ins 1905.07(e)(1);
and
b. Standardized Medicare
supplement benefit plan "L" shall consist of only those benefits described in
Ins 1905.07(e)(2).
(f) 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.
#5390, eff 7-1-92; ss by #5656, eff 7-1-93; ss by #7017, INTERIM, eff 7-1-99, EXPIRED: 10-29-99
New. #7174, eff 12-22-99; ss by #8051, eff 3-1-04; ss by #8363, eff 9-8-05; ss by #9559, eff 10-13-09
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