South Dakota Administrative Rules
Title 20 - PUBLIC SAFETY
Article 20:06 - INSURANCE
Chapter 20:06:13 - Medicare supplement insurance
Section 20:06:13:17.06 - Make-up of standardized benefit plans
Current through Register Vol. 50, page 114, March 25, 2024
The requirements for the make-up of standardized Medicare supplement benefit plans issued for delivery after July 16, 1992, and prior to June 1, 2010, A to L, inclusive, are as follows:
(1) Standardized Medicare supplement benefit Plan A is limited to the basic core benefits common to all benefit plans, as defined in § 20:06:13:17.03;
(2) Standardized Medicare supplement benefit Plan B may include only the following: The core benefit as defined in § 20:06:13:17.03, plus the Medicare Part A deductible as defined in § 20:06:13:17.04;
(3) Standardized Medicare supplement benefit Plan C may include only the following: The core benefit as defined in § 20:06:13:17.03, plus the Medicare Part A deductible, skilled nursing facility care, Medicare Part B deductible, and medically necessary emergency care in a foreign country as defined in § 20:06:13:17.04;
(4) Standardized Medicare supplement benefit Plan D may include only the following: The core benefit as defined in § 20:06:13:17.03, plus the Medicare Part A deductible, skilled nursing facility care, medically necessary emergency care in a foreign country, and the at-home recovery benefit as defined in § 20:06:13:17.04;
(5) Standardized Medicare supplement benefit Plan E may include only the following: The core benefit as defined in § 20:06:13:17.03, plus the Medicare Part A deductible, skilled nursing facility care, medically necessary emergency care in a foreign country, and preventive medical care as defined in § 20:06:13:17.04;
(6) Standardized Medicare supplement benefit Plan F may include only the following: The core benefit as defined in § 20:06:13:17.03, plus the Medicare Part A deductible, the 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 as defined in § 20:06:13:17.04;
(7) Standardized Medicare supplement benefit high deductible Plan F may include only the following: One hundred 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 § 20:06:13:17.03, 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 as defined in § 20:06:13:17.04. The annual high deductible Plan F deductible consists of out-of-pocket expenses, other than premiums, for services covered by the Medicare supplement Plan F policy, and are in addition to any other specific benefit deductibles. The annual high deductible Plan F deductible is $1500 for 1998 and 1999, and is based on the calendar year. It is adjusted annually by the secretary 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 ten dollars.
(8) Standardized Medicare supplement benefit Plan G may include only the following: The core benefit as defined in § 20:06:13:17.03, 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 that at-home recovery benefit as defined in § 20:06:13:17.04;
(9) Standardized Medicare supplement benefit Plan H may include only the following: The core benefit as defined in § 20:06:13:17.03, plus the Medicare Part A deductible, skilled nursing facility care, basic prescription drug benefit, and medically necessary emergency care in a foreign country as defined § 20:06:13:17.04. The outpatient prescription drug benefit may not be included in a Medicare supplement policy sold after December 31, 2005;
(10) Standardized Medicare supplement benefit Plan I may include only the following: The core benefit as defined in § 20:06:13:17.03, 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 as defined in § 20:06:13:17.04. The outpatient prescription drug benefit may not be included in a Medicare supplement policy sold after December 31, 2005;
(11) Standardized Medicare supplement benefit Plan J may include only the following: The core benefit as defined in § 20:06:13:17.03, 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 as defined in § 20:06:13:17.04. The outpatient prescription drug benefit may not be included in a Medicare supplement policy sold after December 31, 2005;
(12) Standardized Medicare supplement benefit high deductible Plan J consists of only the following: One hundred 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 § 20:06:13:17.03, 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 as defined in § 20:06:13:17.04. The annual high deductible Plan J deductible consists of out-of-pocket expenses, other than premiums, for services covered by the Medicare supplement Plan J policy, and is in addition to any other specific benefit deductibles. The annual deductible is $1500 for 1998 and 1999, and shall be based on a calendar year. It is adjusted annually by the Secretary of Health and Human Services 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 ten dollars. The outpatient prescription drug benefit may not be included in a Medicare supplement policy sold after December 31, 2005;
(13) Standardized Medicare supplement benefit Plan K shall consist of the following:
(14) Standardized Medicare supplement benefit Plan L shall consist of the following:
General Authority: SDCL 58-17A-2(9).
Law Implemented: SDCL 58-17A-2(9).