Standard Medicare
Supplement Benefit Plans for 2010 Standardized Medicare Supplement Benefit Plan
Policies or Certificates with an Effective Date for Coverage on or After June
1, 2010.
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 plan standards. Benefit plan standards applicable to
Medicare supplement policies and certificates with an effective date for
coverage before June 1, 2010 remain subject to the requirements of Rule
120-2-8-.08.
(c) Benefit plans shall
be uniform in structure, language, designation and format to the standard
benefit plans listed in this Subsection and conform to the definitions in
Section 4 of this regulation. Each benefit shall be structured in accordance
with the format provided in Sections
120-2-8-.08(5)(b)
and
120-2-8-.08(5)(c)
of this regulation; or, in the case of plans K or L, in Sections
120-2-8-.09(8)(e) 8. or
9. of this regulation and list the benefits
in the order shown. For purposes of this Section, "structure, language, and
format" means style, arrangement and overall content of a benefit.
(e) Make-up of 2010 Standardized Benefit
Plans:
1. Standardized Medicare supplement
benefit Plan A shall include only the following: The basic (core) benefits as
defined in
120-2-8-.08(5)(b)
of this regulation.
2. Standardized
Medicare supplement benefit Plan B shall include only the following: The basic
(core) benefit as defined in Section
120-2-8-.08(5)(b)
of this regulation, plus one hundred percent (100%) of the Medicare Part A
deductible as defined in Rule Section
120-2-8-.08(5)(c)
1. of this regulation.
3. Standardized Medicare supplement benefit
Plan C shall include only the following: The basic (core) benefit as defined in
Section
120-2-8-.08(5)(b)
of this regulation, plus one hundred percent (100%) of the Medicare Part A
deductible, skilled nursing facility care, one hundred percent (100%) of the
Medicare Part B deductible, and medically necessary emergency care in a foreign
country as defined in Rule Sections
120-2-8-.08(5)(c)
1., 2., 4., and 6. of this regulation,
respectively.
4. Standardized
Medicare supplement benefit Plan D shall include only the following: The basic
(core) benefit (as defined in Section
120-2-8-.08(5)(b)
of this regulation), plus one hundred percent (100%) of the Medicare Part A
deductible, skilled nursing facility care, and medically necessary emergency
care in an foreign country as defined in Rule Sections
120-2-8-.08(5)(c)
1., 3., and 6. of this regulation,
respectively.
5. Standardized
Medicare supplement [regular] Plan F shall include only the following: The
basic (core) benefit as defined in Section
120-2-8-.08(5)(b)
of this regulation, plus one hundred percent (100%) of the Medicare Part A
deductible, the skilled nursing facility care, one hundred percent (100%) of
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 Rule Sections
120-2-8-.08(5)(c)
1., 2., 4., 5., and 6.
respectively.
6. Standardized
Medicare supplement Plan F With High Deductible shall include only the
following: one hundred percent (100%) of covered expenses following the payment
of the annual deductible set forth in Subparagraph 2.
(i) The basic (core) benefit as defined in
Section
120-2-8-.08(5)(b)
of this regulation, plus one hundred percent (100%) of the Medicare Part A
deductible, skilled nursing facility care, one hundred percent (100%) of 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 Rule Sections
120-2-8-.08(5)(c)
1., 2., 4., 5., and 6. of this regulation,
respectively.
(ii) The annual
deductible in Plan F With High Deductible shall consist of out-of-pocket
expenses, other than premiums, for services covered by [regular] Plan F, and
shall be in addition to any other specific benefit deductibles. The basis for
the deductible shall be $1,500 and shall be adjusted annually from 1999 by the
Secretary of the U.S. Department 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 ($10).
7. Standardized Medicare supplement benefit
Plan G shall include only the following: The basic (core) benefit as defined in
Section
120-2-8-.08(5)(b)
of this regulation, plus one hundred percent (100%) of the Medicare Part A
deductible, skilled nursing facility care, one hundred percent (100%) of the
Medicare Part B excess charges, and medically necessary emergency care in a
foreign country as defined in Rule Sections
120-2-8-.08(5)(c)
1., 3., 5. and 6., respectively.
8. Standardized Medicare supplement Plan K is
mandated by The Medicare Prescription Drug, Improvement and Modernization Act
of 2003, and shall include only the following:
(i) Part A Hospital Coinsurance 61st through
90th days: Coverage of one hundred percent (100%) of the Part A hospital
coinsurance amount for each day used from the 61st through the 90th day in any
Medicare benefit period;
(ii) Part
A Hospital Coinsurance, 91st through 150th days: Coverage of one hundred
percent (100%) of the Part A hospital coinsurance amount for each Medicare
lifetime inpatient reserve day used from the 91st through the 150th day in any
Medicare benefit period;
(iii) Part
A Hospitalization After 150 Days: Upon exhaustion of the Medicare hospital
inpatient coverage, including the lifetime reserve days, coverage of one
hundred percent (100%) of the Medicare Part A eligible expenses for
hospitalization paid at the applicable prospective payment system (PPS) rate,
or other appropriate Medicare standard of payment, subject to a lifetime
maximum benefit of an additional 365 days. The provider shall accept the
issuer's payment as payment in full and may not bill the insured for any
balance;
(iv) Medicare Part A
Deductible: Coverage for fifty percent (50%) of the Medicare Part A inpatient
hospital deductible amount per benefit period until the out-of-pocket
limitation is met as described in Subparagraph 10.;
(v) Skilled Nursing Facility Care: Coverage
for fifty percent (50%) of the coinsurance amount for each day used from the
21st day through the 100th day in a Medicare benefit period for posthospital
skilled nursing facility care eligible under Medicare Part A until the
out-of-pocket limitation is met as described in Subparagraph 10.;
(vi) Hospice Care: Coverage for fifty percent
(50%) of cost sharing for all Part A Medicare eligible expenses and respite
care until the out of-pocket limitation is met as described in Subparagraph
(x);
(vii) Blood: Coverage for
fifty percent (50%), under Medicare Part A or B, of the reasonable cost of the
first three (3) pints of blood (or equivalent quantities of packed red blood
cells, as defined under federal regulations) unless replaced in accordance with
federal regulations until the out-of-pocket limitation is met as described in
Subparagraph (x);
(viii) Part B
Cost Sharing: Except for coverage provided in Subparagraph (i), coverage for
fifty percent (50%) of the cost sharing otherwise applicable under Medicare
Part B after the policyholder pays the Part B deductible until the
out-of-pocket limitation is met as described in Subparagraph (x);
(ix) Part B Preventive Services: Coverage of
one hundred percent (100%) of the cost sharing for Medicare Part B preventive
services after the policyholder pays the Part B deductible; and
(x) Cost Sharing After Out-of-Pocket Limits:
Coverage of one hundred percent (100%) of all cost sharing under Medicare Parts
A and B for the balance of the calendar year after the individual has reached
the out-of-pocket limitation on annual expenditures under Medicare Parts A and
B of $4000 in 2006, indexed each year by the appropriate inflation adjustment
specified by the Secretary of the U.S. Department of Health and Human
Services.
9.
Standardized Medicare supplement Plan L is mandated by The Medicare
Prescription Drug, Improvement and Modernization Act of 2003, and shall include
only the following:
(i) The benefits described
in Rule sections
120-2-8-.09(8)(e) 8.(i), (ii), (iii) and
(ix);
(ii) The benefit described in Rule sections
120-2-8-.09(8)(e) 8.(iv), (v), (vi), (vii) and
(viii), but substituting seventy-five percent
(75%) for fifty percent (50%); and
(iii) The benefit described in Rule
120-2-8-.09(8)(e)8.(x).,
but substituting $2000 for $4000.
10. Standardized Medicare supplement Plan M
shall include only the following: The basic (core) benefit as defined in Rule
120-2-8-.08(5)(b)
of this regulation, plus fifty percent (50%) of the Medicare Part A deductible,
skilled nursing facility care, and medically necessary emergency care in a
foreign country as defined in Rule
120-2-8-.08(5)(c)1., 3. and
6. of this regulation,
respectively.
11. Standardized
Medicare supplement Plan N shall include only the following: The basic (core)
benefit as defined in Section
120-2-8-.08(5)(b)
of this regulation, plus one hundred percent (100%) of the Medicare Part A
deductible, skilled nursing facility care, and medically necessary emergency
care in a foreign country as defined in Rule
120-2-8-.08(5)(c)1., 3. and
6. of this regulation, respectively, with
copayments in the following amounts:
(i) the
lesser of twenty dollars ($20) or the Medicare Part B coinsurance or copayment
for each covered health care provider office visit (including visits to medical
specialists); and
(ii) the lesser
of fifty dollars ($50) or the Medicare Part B coinsurance or copayment for each
covered emergency room visit, however, this copayment shall be waived if the
insured is admitted to any hospital and the emergency visit is subsequently
covered as a Medicare Part A expense.