760 IAC 3-7.1-1 - Standard Medicare supplement benefit plans for 2010 Standardized Medicare supplement benefit plan policies or certificates issued for delivery with an effective date for coverage on or after June 1, 2010
Authority: IC 27-8-13
Affected: IC 27-8-13-1
Sec. 1.
(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
760
IAC 3-6-1(c).
(b) If an issuer makes available any of the
additional benefits described in
760
IAC 3-6.1-1(d) or offers
standardized benefit Plans K or L, then the issuer shall make available to each
prospective policyholder and certificate holder, in addition to a policy form
or certificate form with only the basic core benefits as described in
760
IAC 3-6.1-1(c), a policy form or
certificate form containing either standardized benefit Plan C or standardized
benefit Plan F.
(c) 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
760 IAC
3-8.
(d)
Benefit plans shall be uniform in structure, language, designation, and format
to the standard benefit plans listed in this section and conform to the
definitions in
760 IAC 3-2 and
760 IAC
3-3. Each benefit shall:
(1) be structured in accordance with the
format provided in
760
IAC 3-6-1(c) through
760
IAC 3-6-1(d); and
(2) list the benefits in the order shown in
subsection (f).
As used in this section, "structure, language, and format" means style, arrangement, and overall content of a benefit.
(e) An issuer may use, in addition
to the benefit plan designations required in subsection (d), other designations
to the extent permitted by law.
(f)
The makeup of 2010 standardized benefit plans shall be 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
760
IAC 3-6-1(c).
(2) Standardized Medicare supplement benefit
Plan B shall include only the core benefit as defined in
760
IAC 3-6-1(c), plus the Medicare Part
A deductible as defined in
760
IAC 3-6-1(d)(1).
(3) Standardized Medicare supplement benefit
Plan C shall include only the core benefit as defined in
760
IAC 3-6-1(c), plus:
(A) the Medicare Part A deductible;
(B) skilled nursing facility care;
(C) the Medicare Part B deductible;
and
(D) medically necessary
emergency care in a foreign country; as defined in
760
IAC 3-6-1(d)(1) through
760
IAC 3-6-1(d)(3) and
760
IAC 3-6-1(d)(8), respectively.
(4) Standardized
Medicare supplement benefit Plan D shall include only the core benefit as
defined in
760
IAC 3-6-1(c), plus:
(A) the Medicare Part A deductible;
(B) skilled nursing facility care;
and
(C) medically necessary
emergency care in a foreign country.
(5) Standardized Medicare supplement benefit
Plan F shall include only the core benefit as defined in
760
IAC 3-6-1(c), plus:
(A) the Medicare Part A deductible;
(B) skilled nursing facility care;
(C) the Medicare Part B deductible;
(D) one hundred percent (100%) of the
Medicare Part B excess charges; and
(E) medically necessary emergency care in a
foreign country; as defined in
760
IAC 3-6-1(d)(1) through
760
IAC 3-6-1(d)(3),
760
IAC 3-6-1(d)(5), and
760
IAC 3-6-1(d)(8), respectively.
(6) Standardized
Medicare supplement benefit high deductible Plan F shall include 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
760
IAC 3-6-1(c), plus:
(A) the Medicare Part A deductible;
(B) skilled nursing facility care;
(C) the Medicare Part B deductible;
(D) one hundred percent (100%) of the
Medicare Part B excess charges; and
(E) medically necessary emergency care in a
foreign country; as defined in
760
IAC 3-6-1(d)(1),
760
IAC 3-6-1(d)(2),
760
IAC 3-6-1(d)(8), and
760
IAC 3-6-1(d)(9), 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 one thousand
five hundred dollars ($1,500) for 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 (12) 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 core benefit as defined in
760
IAC 3-6-1(c), plus:
(A) the Medicare Part A deductible;
(B) skilled nursing facility care;
(C) one hundred percent (100%) of the
Medicare Part B excess charges; and
(D) medically necessary emergency care in a
foreign country.
Effective January 1, 2020, the standardized benefit plans described in 760 IAC 3-7.2-1(a)(3) may be offered to any individual who was eligible for Medicare prior to January 1, 2020.
(8) Standardized
Medicare supplement Plan M shall include only the basic core benefit as defined
in
760
IAC 3-6-1(c), plus:
(A) fifty percent (50%) of the Medicare Part
A deductible;
(B) skilled nursing
facility care; and
(C) medically
necessary emergency care in a foreign country.
(9) Standardized Medicare supplement Plan N
shall include only the basic core benefit as defined in
760
IAC 3-6-1(c), plus:
(A) one hundred percent (100%) of the
Medicare Part A deductible;
(B)
skilled nursing facility care; and
(C) medically necessary emergency care in a
foreign country.
(10)
Copayments shall be the following amounts:
(A)
The lesser of:
(i) twenty dollars ($20);
or
(ii) the Medicare Part B
coinsurance or copayment for each covered health care provider office visit,
including visits to medical specialists.
(B) The lesser of:
(i) fifty dollars ($50); or
(ii) the Medicare Part B coinsurance or
copayment for each covered emergency room visit.
The copayment set forth in clause (B) shall be waived if the insured is admitted to any hospital and the emergency visit is subsequently covered as a Medicare Part A expense.
(g) The makeup of the two (2)
Medicare supplement plans mandated by the Medicare Prescription Drug
Improvement and Modernization Act of 2003 are as follows:
(1) Standardized Medicare supplement benefit
Plan K shall consist of only those benefits described in
760
IAC 3-6-1(e).
(2) Standardized Medicare supplement benefit
Plan L shall consist of only those benefits described in
760
IAC 3-6-1(f).
(h) 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 as follows:
(1) Appropriate to Medicare supplement
insurance.
(2) New or
innovative.
(3) Not otherwise
available.
(4) Cost
effective.
(5) Offered in a manner
that is consistent with the goal of simplification of Medicare supplement
policies.
(6) New or innovative
benefits shall not be used to change or reduce benefits, including a change of
any cost-sharing provision, in any standardized plan.
After December 31, 2005, the innovative benefit shall not include an outpatient prescription drug benefit.
(i) The standards set forth in this section
are applicable to all Medicare supplement policies delivered or issued for
delivery 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 as a Medicare supplement policy unless it complies with this section.
No issuer may offer any 1990 Standardized Medicare supplement benefit plan for
sale on or after 2010. Benefit standards applicable to Medicare supplement
policies issued with an effective date for coverage prior to June 1, 2010,
remain subject to the requirements of
760
IAC 3-6-1.
Notes
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