19 Miss. Code. R. 3-10.09
Standard Medicare Benefit Plans For 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery after July 1, 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 Rule
10.08 B of this regulation.
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
Rule10.09 G and in Rule
10.10 of this regulation.
C. Benefit plans shall be uniform in
structure, language, designation and format to the standard benefit plans "A"
through "L" listed in this subsection and conform to the definitions in Rule
10.04 of this regulation. Each
benefit shall be structured in accordance with the format provided in Rules
10.08 B and
10.08 C, or
10.08 D and list the benefits in the
order shown in this subsection. 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. Make-up of benefit plans:
1. Standardized Medicare supplement benefit
plan "A" shall be limited to the basic (core) benefits common to all benefit
plans, as defined in Rule
10.08 B of this regulation.
2. Standardized Medicare
supplement benefit plan "B" shall include only the following: The core benefit
as defined in Rule
10.08 B of this regulation, plus the
Medicare Part A deductible as defined in Rule
10.08 C(1).
3. Standardized Medicare supplement benefit
plan "C" shall include only the following: The core benefit as defined in Rule
10.08 B of this regulation, 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 Rules
10.08 C(1), (2), (3) and (8)
respectively.
4. Standardized
Medicare supplement benefit plan "D" shall include only the following: The core
benefit (as defined in Rule
10.08 B of this regulation), plus the
Medicare Part A deductible, skilled nursing facility care, medically necessary
emergency care in an foreign country and the at-home recovery benefit as
defined in Rules
10.08 C(1), (2), (8) and (10)
respectively.
5. Standardized
Medicare supplement benefit plan "E" shall include only the following: The core
benefit as defined in Rule
10.08 B of this regulation, 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
Rule
10.08 C(1), (2), (8) and (9)
respectively.
6. Standardized
Medicare supplement benefit plan "F" shall include only the following: The core
benefit as defined in Rule
10.08 B of this regulation, 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 Rule
10.08 C(1), (2), (3), (5) and (8)
respectively.
7. Standardized
Medicare supplement benefit high deductible plan "F" shall include only the
following: 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 Rule
10.08 B of this regulation, 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 Rule
10.08 C(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 $1500 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 Rule
10.08 B 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 Rules
10.08 C(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 Rule
10.08 B of this regulation, 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 Rules
10.08 C(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
Rule
10.08 B 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 Rules
10.08 C(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 Rule
10.08 B of this regulation, 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 Rules
10.08 C(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.
12. Standardized Medicare
supplement benefit high deductible plan "J" shall consist of only the
following: 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 Rule 10.08B of this regulation, 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
outpatient prescription drug benefit, medically necessary emergency care in a
foreign country, preventive medical care benefit and at-home recovery benefit
as defined in Rules 10.08C(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 $1500 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
Rule
10.08 D(1).
2. Standardized Medicare supplement benefit
plan "L" shall consist of only those benefits described in Rule
10.08 D(2).
G. 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 that 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
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.