Current through Register Vol. XLI, No. 38, September 20, 2024
7.5.
Make-up of benefit plans:
7.5.a. Standardized
Medicare supplement benefit plan "A" shall be limited to the basic core benefits
common to all benefit plans, as defined in subsection 6.3 of this rule.
7.5.b. Standardized Medicare supplement benefit
plan "B" shall include only the following: The core benefit as defined in subsection
6.3 of this rule, plus the Medicare Part A deductible as defined in subdivision a,
subsection 6.4 of this rule.
7.5.c.
Standardized Medicare supplement benefit plan "C" shall include only the following:
The core benefit as defined in subsection 6.3 of this rule, 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 subdivisions a, b, c and
h of subsection 6.4, respectively, of this rule.
7.5.d. Standardized Medicare supplement benefit
plan "D" shall include only the following: The core benefit as defined in subsection
6.3 of this rule, 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 subdivisions a, b, h and j of subsection 6.4,
respectively, of this rule.
7.5.e.
Standardized Medicare supplement benefit plan "E" shall include only the following:
The core benefit as defined in subsection 6.3 of this rule, 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 subdivisions a, b, h and i
of subsection 6.4, respectively, of this rule.
7.5.f. Standardized Medicare supplement benefit
plan "F" shall include only the following: The core benefit as defined in subsection
6.3 of this rule, plus the Medicare Part A deductible, the skilled nursing facility
care, the Part B deductible, one hundred percent (100%) of the Medicare Part B
excess charges, and medically necessary emergency care in a foreign country as
defined in subdivisions a, b, c, e and h of subsection 6.4, respectively, of this
rule.
7.5.g. Standardized Medicare
supplement benefit high deductible plan "F" shall include only the following: one
hundred percent (100%) of covered expenses following the payment of the annual high
deductible plan "F" deductible. The covered expenses include the core benefit as
defined in subsection 6.3 of this rule, plus the Medicare Part A deductible, skilled
nursing facility care, the Medicare Part B deductible, one hundred percent (100%) of
the Medicare Part B excess charges, and medically necessary emergency care in a
foreign country as defined in subdivisions a, b, c, e, and h of subsection 6.4,
respectively, of this rule. 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 one
thousand five hundred dollars ($1,500) for 1998 and 1999, and shall be based on the
calendar year. It shall be adjusted annually thereafter 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 ($10).
7.5.h.
Standardized Medicare supplement benefit plan "G" shall include only the following:
The core benefit as defined in subsection 6.3 of this rule, plus the Medicare Part A
deductible, skilled nursing facility care, eighty percent (80%) of the Medicare Part
B excess charges, medically necessary emergency care in a foreign country, and the
at-home recovery benefit as defined in subdivisions a, b, d, h and j of subsection
6.4, respectively, of this rule.
7.5.i.
Standardized Medicare supplement benefit plan "H" shall consist of only the
following: The core benefit as defined in subsection 6.3 of this rule, 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 in
subdivisions a, b, f and h of subsection 6.4, respectively, of this rule. The
outpatient prescription drug benefit shall not be included in a Medicare supplement
policy sold after December 31, 2005.
7.5.j. Standardized Medicare supplement benefit
plan "I" shall consist of only the following: The core benefit as defined in
subsection 6.3 of this rule, plus the Medicare Part A deductible, skilled nursing
facility care, one hundred percent (100%) 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 subdivisions a, b, e, f, h and j
of subsection 6.4, respectively, of this rule. The outpatient prescription drug
benefit shall not be included in a Medicare supplement policy sold after December
31, 2005.
7.5.k. Standardized Medicare
supplement benefit plan "J" shall consist of only the following: The core benefit as
defined in subsection 6.3 of this rule, plus the Medicare Part A deductible, skilled
nursing facility care, Medicare Part B deductible, one hundred percent (100%) 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 subdivisions a, b, c, e, g, h, i and j of subsection
6.4, respectively, of this rule. The outpatient drug benefit shall not be included
in a Medicare supplement policy sold after December 31, 2005.
7.5.l Standardized Medicare supplement benefit
high deductible plan "J" shall consist of only the following: one hundred percent
(100%) of covered expenses following the payment of the annual high deductible plan
"J" deductible. The covered expenses include the core benefit as defined in
subsection 6.3 of this rule, plus the Medicare Part A deductible, skilled nursing
facility care, Medicare Part B deductible, one hundred percent (100%) of the
Medicare Part B excess charges, extended prescription drug benefit, medically
necessary emergency care in a foreign country, preventive medical care benefit and
at-home recovery benefit as defined in subdivisions a, b, c, e, g, h, i and j of
subsection 6.4, respectively, of this rule. 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
one thousand five hundred dollars ($1,500) for 1998 and 1999, and shall be based on
a calendar year. It shall be adjusted annually thereafter 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 ($10). The outpatient prescription drug benefit
shall not be included in a Medicare supplement policy sold after December 31,
2005.
7.6. Make-up of two
Medicare supplement plans mandated by The Medicare Prescription Drug, Improvement
and Modernization Act of 2003 (MMA);
7.6.a.
Standardized Medicare supplement benefit plan "K" shall consist of only those
benefits described in subdivision a, subsection 6.5 of this rule.
7.6.b. Standardized Medicare supplement benefit
plan "L" shall consist of only those benefits described in subdivision b, subsection
6.5 of this rule.
7.7. New
and 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.
