Fla. Admin. Code Ann. R. 69O-156.008 - Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After January 1, 1992, and with an Effective Date for Coverage Prior to June 1, 2010
The following applies to all 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates issued for delivery on or after January 1, 1992, and with an effective date for coverage prior to June 1, 2010.
(1) An issuer shall make
available to each prospective policyholder and certificateholder a policy form
or certificate form containing only the basic "core" benefits, as defined in
subsection 69O-156.007(2),
F.A.C., of this chapter.
(2) No
groups, packages or combinations of Medicare supplement benefits other than
those listed in this section shall be offered for sale in this state, except as
may be permitted in subsection
69O-156.008(7)
and Rule 69O-156.030, F.A.C., of this
chapter.
(3)
(a)
1.
Benefit plans shall be uniform in structure, language, designation and format
to the standard benefit plans "A" through "L" as provided in Form OIR-B2-MSC
(Rev. 11/04), "Outline of Medicare Supplement Coverage", and shall conform to
the definitions in Rule
69O-156.003, F.A.C.
2. Form OIR-B2-MSC (Rev. 11/04), "Outline of
Medicare Supplement Coverage", is hereby adopted and incorporated by reference,
is available and may be printed from the Office's website:
www.floir.com.
(b) Each benefit shall be structured in
accordance with the format provided in subsections
69O-156.007(2) and (3), or
(4), F.A.C., and shall list the benefits in
the order shown in this rule. For purposes of this section, "structure,
language, and format" means style, arrangement and overall content of a
benefit.
(4) An issuer
may use, in addition to the benefit plan designations required in subsection
69O-156.008(3),
F.A.C., other designations to the extent permitted by law.
(5) Make-up of benefit plans:
(a) Standardized Medicare supplement benefit
plan "A" shall be limited to the Basic ("Core") Benefits Common to All Benefit
Plans, as defined in subsection
69O-156.007(2),
F.A.C., of this chapter.
(b)
Standardized Medicare supplement benefit plan "B" shall include only the
following: The Core Benefit as defined in subsection
69O-156.007(2),
F.A.C., of this chapter, plus the Medicare Part A Deductible as defined in
paragraph 69O-156.007(3)(a),
F.A.C.
(c) Standardized Medicare
supplement benefit plan "C" shall include only the following: The Core Benefit
as defined in subsection
69O-156.007(2),
F.A.C., of this chapter, 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 paragraphs
69O-156.007(3)(a), (b), (c) and
(h), F.A.C., respectively.
(d) Standardized Medicare supplement benefit
plan "D" shall include only the following: The Core Benefit (as defined in
subsection 69O-156.007(2),
F.A.C., 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 paragraphs
69O-156.007(2)(a), (b), (h) and
(j), F.A.C., respectively.
(e) Standardized Medicare supplement benefit
plan "E" shall include only the following: The Core Benefit as defined in
subsection 69O-156.007(2),
F.A.C., of this chapter, 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 paragraphs
69O-156.007(3)(a), (b), (h) and
(i), F.A.C., respectively.
(f) Standardized Medicare supplement benefit
plan "F" shall include only the following: The Core Benefit as defined in
subsection 69O-156.007(2),
F.A.C., of this chapter, 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 paragraphs
69O-156.007(3)(a), (b), (c), (e) and
(h), F.A.C., respectively.
(g) Standardized Medicare supplement benefit
high deductible plan "F" shall include only 100% of covered expenses following
the payment of the annual high deductible plan "F" deductible.
1. The covered expenses as defined in
paragraphs 69O-156.007(3)(a), (b), (e) and
(h), F.A.C., respectively include:
a. The core benefit as defined in subsection
69O-156.007(2),
F.A.C;
b. The Medicare Part A
deductible;
c. Skilled nursing
facility care;
d. The Medicare Part
B deductible;
e. One hundred
percent (100%) of the Medicare Part B excess charges; and
f. Medically necessary emergency care in a
foreign country.
2. 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.
3. The annual high
deductible plan "F" deductible shall be:
a.
$1,500 for 1998 and 1999, and shall be based on the calendar year;
b. 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 $10.
(h) Standardized Medicare supplement benefit
plan "G" shall include only the following: The Core Benefit as defined in
subsection 69O-156.007(2),
F.A.C., of this regulation, 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 paragraphs
69O-156.007(3)(a), (b), (d), (h) and
(j), F.A.C., respectively.
(i) Standardized Medicare supplement benefit
plan "H" shall consist of only the following: The Core Benefit as defined in
subsection 69O-156.007(2),
F.A.C., of this chapter, 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 paragraphs
69O-156.007(3)(a), (b), (f) and
(h), F.A.C., respectively. The outpatient
prescription drug benefit shall not be included in a Medicare supplement policy
issued after December 31, 2005.
(j)
Standardized Medicare supplement benefit plan "I" shall consist of only the
following: The Core Benefit as defined in subsection
69O-156.007(2),
F.A.C., of this regulation, 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 paragraphs
69O-156.007(3)(a), (b), (e), (f), (h) and
(j), F.A.C., respectively. The outpatient
prescription drug benefit shall not be included in a Medicare supplement policy
issued after December 31, 2005.
(k)
Standardized Medicare supplement benefit plan "J" shall consist of only the
following: The Core Benefit as defined in subsection
69O-156.007(2),
F.A.C., of this chapter, 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 paragraphs
69O-156.007(3)(a), (b), (c), (e), (g), (h), (i)
and (j), F.A.C., respectively. The outpatient
prescription drug benefit shall not be included in a Medicare supplement policy
issued after December 31, 2005.
(l)
Standardized Medicare supplement benefit high deductible plan "J" shall include
only 100% of covered expenses following the payment of the annual high
deductible plan "J" deductible.
1. The
covered expenses as defined in paragraphs
69O-156.007(3)(a), (b), (c), (e), (g), (h), (i)
and (j), F.A.C., respectively include:
a. The core benefit as defined in subsection
69O-156.007(2),
F.A.C;
b. The Medicare Part A
deductible;
c. Skilled nursing
facility care;
d. Medicare Part B
deductible;
e. One hundred percent
(100%) of the Medicare Part B Excess charges;
f. Extended Outpatient Prescription Drug
Benefit;
g. Medically Necessary
Emergency Care in a foreign Country;
h. Preventive Medical Care Benefit;
and
i. At-Home Recovery
Benefit.
2. 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.
3. The annual
deductible shall be:
a. $1,500 for 1998 and
1999 based on a calendar year;
b.
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
$10.
c. The outpatient prescription
drug benefit shall not be included in a Medicare supplement policy issued after
December 31, 2005.
(6) Make-up of two 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
paragraph 69O-156.007(4)(a),
F.A.C.
(b) Standardized Medicare
supplement benefit plan "L" shall consist of only those benefits described in
paragraph 69O-156.007(4)(b),
F.A.C.
(7) New or
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.
Notes
Rulemaking Authority 624.308, 627.674(2) FS. Law Implemented 624.307(1), 627.674, 627.6741 FS.
New 1-1-92, Amended 12-17-96, 7-26-99, Formerly 4-156.008, Amended 9-15-05, 1-4-10.
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