Current through Register Vol. 35, No. 18, September 24, 2024
The following standards 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. No policy
or certificate may be advertised, solicited, delivered, or issued for delivery
in this state as a Medicare Supplement policy or certificate unless it complies
with these benefit standards. No issuer may offer any 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 of coverage before June 1, 2010 remain subject to the
requirements of
13.10.25.11
NMAC.
A.
General
standards. The following standards apply to 2010 Standardized Benefit
Plan policies and certificates and are in addition to all other requirements of
this regulation.
(1)
Preexisting
conditions. Refer to Paragraph (1) of Subsection A of
13.10.25.11
NMAC.
(2)
Losses from
sickness. Refer to Paragraph (2) of Subsection A of
13.10.25.11
NMAC.
(3)
Cost
sharing. Refer to Paragraph (3) of Subsection A of
13.10.25.11
NMAC.
(4)
Termination of
spousal coverage. Refer to Paragraph (4) of Subsection A of
13.10.25.11
NMAC.
B.
Renewal
and continuation of coverage for policies or certificates. Each Medicare
Supplement policy shall be guaranteed renewable.
(1)
Cancellation for health
status. Refer to Paragraph (1) of Subsection B of
13.10.25.11
NMAC.
(2)
Cancellation by
issuer. Refer to Paragraph (2) of Subsection B of
13.10.25.11
NMAC.
(3)
Termination by
group. Refer to Paragraph (3) of Subsection B of
13.10.25.11
NMAC.
(4)
Group membership
termination. Refer to Paragraph (4) of Subsection B of
13.10.25.11
NMAC.
(5)
Replacement.
Refer to Paragraph (5) of Subsection B of
13.10.25.11
NMAC.
(6)
Coverage of
continuous loss. Refer to Paragraph (6) of Subsection B of
13.10.25.11
NMAC.
C.
Coordination with medical assistance under Title XIX of the Social
Security Act. Refer to Subsection C of
13.10.25.11
NMAC.
D.
Standards for basic
(core) benefits common to Medicare Supplement insurance benefit plans A, B, C,
D, F, F with high deductible, G, M and N: Every issuer shall make
available a policy or certificate including only the following basic "core"
package of benefits to each prospective insured. 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 in lieu of it.
(1)
Medicare Part A coinsurance after
day 60. Refer to Paragraph (1) of Subsection E of
13.10.25.11
NMAC;
(2)
Medicare Part A
reserve lifetime days coinsurance. Refer to Paragraph (2) of Subsection
E of
13.10.25.11
NMAC;
(3)
Medicare Part A
uncovered hospitalization coverage. Refer to Paragraph (3) of Subsection
E of
13.10.25.11
NMAC;
(4)
Medicare Part A and
Medicare Part B blood. Refer to Paragraph (4) of Subsection E of
13.10.25.11
NMAC;
(5)
Medicare Part B
cost sharing. Refer to Paragraph (5) of Subsection E of
13.10.25.11
NMAC; and
(6)
Hospice care
cost sharing. Coverage of cost sharing for all Medicare Part A-eligible
hospice care and respite care expenses.
E.
Standards for additional benefits:
The following additional benefits shall be included in Medicare
Supplement benefit Plans B, C, D, F, F with High Deductible, G, M, and N as
provided by
13.10.25.14
NMAC.
(1)
Medicare Part A deductible,
one-hundred percent. Refer to Paragraph (1) of Subsection F of
13.10.25.11
NMAC;
(2)
Medicare Part A
deductible, fifty percent. Coverage for fifty percent of the Medicare
Part A inpatient hospital deductible amount per benefit period.
(3)
Skilled nursing facility care.
Refer to Paragraph (2) of Subsection F of
13.10.25.11
NMAC.
(4)
Medicare Part B
deductible. Refer to Paragraph (3) of Subsection F of
13.10.25.11
NMAC;
(5)
One-hundred percent
of the Medicare Part B excess charges. Refer to Paragraph (5) of
Subsection F of
13.10.25.11
NMAC; and
(6)
Medically
necessary emergency care in a foreign country. Refer to Paragraph (8) of
Subsection F of
13.10.25.11
NMAC.
F.
Standards
for Plans K and L.
(1)
Plan
K. Plan K as mandated by the
Medicare Prescription Drug,
Improvement and Modernization Act of 2003, shall include only the
following:
(a)
Medicare Part A
coinsurance after day 60. Refer to Subparagraph (a) of Paragraph (1) of
Subsection G of
13.10.25.11
NMAC;
(b)
Medicare Part A
hospital coinsurance, 91st through 150th days. Refer to Subparagraph (b)
of Paragraph (1) of Subsection G of
13.10.25.11
NMAC;
(c)
Medicare Part A
hospitalization after lifetime reserve days are exhausted. Refer to
Subparagraph (c) of Paragraph (1) of Subsection G of
13.10.25.11
NMAC;
(d)
Medicare Part A
deductible. Refer to Subparagraph (d) of Paragraph (1) of Subsection G
of
13.10.25.11
NMAC
(e)
Skilled nursing
facility care. Refer to Subparagraph (e) of Paragraph (1) of Subsection
G of
13.10.25.11
NMAC;
(f)
Hospice
Care. Refer to Subparagraph (f) of Paragraph (1) of Subsection G of
13.10.25.11
NMAC;
(g)
Blood. Refer
to Subparagraph (g) of Paragraph (1) of Subsection G of
13.10.25.11
NMAC;
(h)
Medicare Part B
Cost sharing. Refer to Subparagraph (h) of Paragraph (1) of Subsection G
of
13.10.25.11
NMAC;
(i)
Medicare Part B
preventive services. Refer to Subparagraph (i) of Paragraph (1) of
Subsection G of
13.10.25.11
NMAC;
(j)
Cost sharing after
out-of-pocket limits. Refer to Subparagraph (j) of Paragraph (1) of
Subsection G of
13.10.25.11
NMAC.
(2)
Plan
L. Plan L as mandated by the
Medicare Prescription Drug
Improvement and Modernization Act of 2003, shall include only the
following:
(a) The benefits described in
Subparagraphs (a), (b), (c) and (i) of the preceding paragraph;
(b) The benefit described in Subparagraphs
(d), (e), (f), (g) and (h) of the preceding paragraph, but substituting
seventy-five percent for fifty percent; and
(c) The benefit described in Subparagraph (j)
of the preceding paragraph, but substituting $2000 for $4000.
