Current through Register Vol. 63, No. 9, September 1, 2024
(1) 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 OAR 836-052-0133(3).
(2) No groups, packages or combinations of
Medicare supplement benefits other than those listed in this rule shall be
offered for sale in this state except as may be permitted in section (6) of
this rule and in OAR 836-052-0139.
(3) Benefit plans must be uniform in
structure, language, designation and format to the standard benefit plans "A"
through "L" listed in this rule and conform to the definitions in OAR
836-052-0119. Each standard
benefit plan must be designated by the letter assigned to it under this rule.
Each benefit must be structured in accordance with the format provided in
836-052-0133(3) and (4) or
(5) and list the benefits in the order shown
in this rule. For purposes of this rule, "structure, language, and format"
means style, arrangement, and overall content of a benefit.
(4) In addition to the benefit plan
designations required in section (3) of this rule, an issuer may use other
designations to the extent permitted by law.
(5) The content of benefit plans must be as
follows:
(a) Standardized Medicare supplement
benefit plan "A" shall be limited to the basic core benefits common to all
benefit plans, as defined in OAR
836-052-0133(3);
(b) Standardized Medicare supplement benefit
plan "B" shall include only the following: The core benefit as defined in OAR
836-052-0133(3),
plus the Medicare Part A Deductible as defined in
836-052-0133(4)(a);
(c) Standardized Medicare supplement benefit
plan "C" shall include only the following: the core benefit as defined in OAR
836-052-0133(3),
plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medicare
Part B Deductible and Medically Necessary Emergency Care in a Foreign Country,
each as defined in 836-052-0133(4);
(d) Standardized Medicare supplement benefit
plan "D" shall include only the following: The core benefit, as defined in OAR
836-052-0133(3),
plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medically
Necessary Emergency Care in a Foreign Country and the At-Home Recovery Benefit,
each as defined in 836-052-0133(4);
(e) Standardized Medicare supplement benefit
plan "E" shall include only the following: The core benefit as defined in OAR
836-052-0133(3),
plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medically
Necessary Emergency Care in a Foreign Country and Preventive Medical Care, each
as defined in 836-052-0133(4);
(f) Standardized Medicare supplement benefit
plan "F" shall include only the following: The core benefit as defined in OAR
836-052-0133(3),
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, each as defined in
836-052-0133(4);
(g) 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 OAR
836-052-0133(3),
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, each as defined in
836-052-0133(4).
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 $1500 for
1998 and 1999, and shall be based on the calendar year. The deductible shall be
adjusted annually thereafter according to the method prescribed in
42 U.S.C.
1395 ss(p)(11)(C) to reflect the change in
the Consumer Price Index for all urban consumers for the twelve-month period
ending with August of the preceding year, and rounded to the nearest multiple
of $10.
(h) Standardized Medicare
supplement benefit plan "G" shall include only the following: The core benefit
as defined in OAR 836-052-0133(3),
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, each as defined in
836-052-0133(4).
(i) Standardized Medicare supplement benefit
plan "H" shall consist of only the following: The core benefit as defined in
OAR 836-052-0133(3),
plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Basic
Prescription Drug Benefit and Medically Necessary Emergency Care in a Foreign
Country, each as defined in
836-052-0133(4).
The outpatient prescription drug benefit shall not be included in a Medicare
supplement policy sold after December 31, 2005;
(j) Standardized Medicare supplement benefit
plan "I" shall consist of only the following: The core benefit as defined in
OAR 836-052-0133(3),
plus the Medicare Part A Deductible, Skilled Nursing Facility Care, 100 percent
of the Medicare Part B Excess Charges, Basic Prescription Drug Benefit,
Medically Necessary Emergency Care in a Foreign Country and At-Home Recovery
Benefit, each as defined in
836-052-0133(4).
The outpatient prescription drug benefit shall not be included in a Medicare
supplement policy sold after December 31, 2005;
(k) Standardized Medicare supplement benefit
plan "J" shall consist of only the following: The core benefit as defined in
OAR 836-052-0133(3),
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, each as defined
in 836-052-0133(4).
The outpatient prescription drug benefit shall not be included in a Medicare
supplement policy sold after December 31, 2005.
(l) 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 OAR
836-052-0133(3),
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,
each as defined in 836-052-0133(4).
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 $1500 for 1998 and 1999, and shall
be based on a calendar year. The deductible shall be adjusted annually
thereafter according to the method prescribed in
42 U.S.C.
1395 ss(p)(11)(C) 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.
(6) Make-up of two additional 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 OAR
836-052-0133(5).
(b) Standardized Medicare supplement benefit
plan "L" shall consist of only those benefits described in OAR
836-052-0133(5).
(7) New or innovative benefits.
With the prior approval of the Director, an issuer may 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 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.
Stat. Auth.: ORS
743.683
Stats. Implemented: ORS
743.010(1)(a),
(2) &
743.683(2)
