Haw. Code R. § 16-12-6 - Standard Medicare supplement benefit plans for 1990 standardized Medicare supplement benefit plan policies or certificates issued or delivered on or after September 3, 1992, and with an effective date for coverage prior to June 1, 2010
(a) 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 subsection
16-12-5.5(c).
(b) 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 (g)
and section
16-12-6.1.
(c) Benefit plans shall be uniform in
structure, language, designation, and format to the standard benefit plans "A"
through "L" listed in subsection (e) and conform to the definitions in section
16-12-3.
Each benefit shall be structured in accordance with the format provided in
subsections (c) and (d) or (e) of section
16-12-5.5 and list the benefits in the order shown in this subsection (Exhibit A (revised
2019)). For purposes of this section, "structure, language, and format" means
style, arrangement, and overall content of a benefit.
(d) An issuer may use, in addition to the
benefit plan designations required in subsection (c), other designations to the
extent permitted by law.
(e) The
composition of the benefit plans is as follows:
(1) Standardized Medicare supplement benefit
plan "A" shall be limited to the basic ("core") benefits common to all benefit
plans, as defined in subsection
16-12-5.5(c);
(2) Standardized Medicare supplement benefit
plan "B" shall include only the following: The core benefit as defined in
subsection
16-12-5.5(c),
plus the Medicare Part A deductible as defined in paragraph
16-12-5.5(d)(1);
(3) Standardized Medicare supplement benefit
plan "C" shall include only the following: The core benefit as defined in
subsection
16-12-5.5(c),
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
16-12-5.5(d)(1),
(2), (3), and (8), respectively;
(4) Standardized Medicare supplement benefit
plan "D" shall include only the following: The core benefit as defined in
subsection
16-12-5.5(c),
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
16-12-5.5(d)(1),
(2), (8), and (10), respectively;
(5) Standardized Medicare supplement benefit
plan "E" shall include only the following: The core benefit as defined in
subsection
16-12-5.5(c),
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
16-12-5.5(d)(1),
(2), (8), and (9), respectively;
(6) Standardized Medicare supplement benefit
plan "F" shall include only the following: The core benefit as defined in
subsection
16-12-5.5(c),
plus the Medicare Part A deductible, the skilled nursing facility care, the
Part B deductible, 100 per cent of the Medicare Part B excess charges, and
medically necessary emergency care in a foreign country as defined in
paragraphs
16-12-5.5(d)(1),
(2), (3), (5), and (8),
respectively;
(7) Standardized
Medicare supplement benefit high deductible plan "F" shall include only the
following: 100 per cent 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
16-12-5.5(c)
of this regulation, plus the Medicare Part A deductible, skilled nursing
facility care, the Medicare Part B deductible, 100 per cent of the Medicare
Part B excess charges, and medically necessary emergency care in a foreign
country as defined in paragraphs
16-12-5.5(d)(1),
(2), (3), (5), and (8), respectively. 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 $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
$10;
(8) Standardized Medicare
supplement benefit plan "G" shall include only the following: The core benefit
as defined in subsection
16-12-5.5(c),
plus the Medicare Part A deductible, skilled nursing facility care, 80 per cent
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
16-12-5.5(d)(1),
(2), (4), (8), and (10),
respectively;
(9) Standardized
Medicare supplement benefit plan "H" shall consist of only the following: The
core benefit as defined in subsection
16-12-5.5(c),
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
16-12-5.5(d)(1),
(2), (6), and (8), respectively. The
outpatient prescription drug benefit shall not be included in a Medicare
supplement policy sold after December 31, 2005;
(10) Standardized Medicare supplement benefit
plan "I" shall consist of only the following: The core benefit as defined in
subsection
16-12-5.5(c),
plus the Medicare Part A deductible, skilled nursing facility care, 100 per
cent 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
16-12-5.5(d)(1),
(2), (5), (6), (8), and (10), respectively.
The outpatient prescription drug benefit shall not be included in a Medicare
supplement policy sold after December 31, 2005;
(11) Standardized Medicare supplement benefit
plan "J" shall consist of only the following: The core benefit as defined in
subsection
16-12-5.5(c),
plus the Medicare Part A deductible, skilled nursing facility care, Medicare
Part B deductible, 100 per cent 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
16-12-5.5(d)(1),
(2), (3), (5), (7), (8), (9), and (10),
respectively. The outpatient prescription drug benefit shall not be included in
a Medicare supplement policy sold after December 31, 2005; and
(12) Standardized Medicare supplement benefit
high deductible plan "J" shall consist of only the following: 100 per cent 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
16-12-5.5(c)
of this regulation, plus the Medicare Part A deductible, skilled nursing
facility care, Medicare Part B deductible, 100 per cent 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 paragraphs
16-12-5.5(d)(1),
(2), (3), (5), (7), (8), (9) and (10),
respectively. 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 $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 $10. The outpatient
prescription drug benefit shall not be included in a Medicare supplement policy
sold after December 31, 2005.
(f) Make-up of two Medicare supplement plans
mandated by the Medicare Prescription Drug, Improvement, and Modernization Act
of 2003 (MMA):
(1) Standardized Medicare
supplement benefit plan "K" shall consist of only those benefits described in
section
16-12-5.5(e)(1).
(2) Standardized Medicare supplement benefit
plan "L" shall consist of only those benefits described in section
16-12-5.5(e)(2).
(g) 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
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