Tenn. Comp. R. & Regs. 0780-01-58-.10 - STANDARD MEDICARE SUPPLEMENT BENEFIT PLANS FOR 1990 STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN POLICIES OR CERTIFICATES ISSUED FOR DELIVERY ON OR AFTER JULY 1, 1992, AND WITH AN EFFECTIVE DATE OF COVERAGE PRIOR TO JUNE 1, 2010
(1) 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
0780-01-58-.08(2)
of this Chapter.
(2) No groups,
packages or combinations of Medicare supplement benefits other than those
listed in this Rule shall be offered for sale in this state , except as may be
permitted in Rule 0780-01-58-.10(7) and in Rule
0780-01-58-.13 of
this Chapter.
(3) Benefit plans
shall be uniform in structure, language, designation and format to the standard
benefit plans A through L listed in this Rule and conform to the definitions in
Rule
0780-01-58-.04 of
this Chapter. Each benefit shall be structured in accordance with the format
provided in Rule
0780-01-58-.08(2)
and Rule
0780-01-58-.08(3),
or Rule
0780-01-58-.08(4)
and list the benefits in the order shown in this Rule. For purposes of this
Rule, "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 Paragraph
(3), 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 Rule
0780-01-58-.08(2)
of this Chapter.
(b) Standardized
Medicare supplement benefit plan B shall include only the following: The core
benefit as defined in Rule
0780-01-58-.08(2)
of this Chapter, plus the Medicare Part A deductible as defined in Rule
0780-01-58-.08(3)(a)
of this Chapter.
(c) Standardized
Medicare supplement benefit plan C shall include only the following: The core
benefit as defined in Rule
0780-01-58-.08(2)
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 Rules
0780-01-58-.08(3)(a),
(b), (c), and (h) of this Chapter,
respectively.
(d) Standardized
Medicare supplement benefit plan D shall include only the following: The core
benefit as defined in Rule
0780-01-58-.08(2)
of this Chapter, 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
0780-01-58-.08(3)(a),
(b), (h), and (j) of this Chapter,
respectively.
(e) Standardized
Medicare supplement benefit plan E shall include only the following: The core
benefit as defined in Rule
0780-01-58-.08(2)
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 Rules
0780-01-58-.08(3)(a),
(b), (h), and (i) of this Chapter,
respectively.
(f) Standardized
Medicare supplement benefit plan F shall include only the following: The core
benefit as defined in Rule
0780-01-58-.08(2)
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 Rules
0780-01-58-.08(3)(a),
(b), (c), (e), and (h) of this Chapter,
respectively.
(g) Standardized
Medicare supplement benefit high deductible plan F shall include only the
following: 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 Rule
0780-01-58-.08(2)
of this Chapter, 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 Rules
0780-01-58-.08(3)(a),
(b), (c), (e), and (h) of this Chapter,
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 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 (12) month period ending with August of the
preceding year, and rounded to the nearest multiple of ten dollars
($10).
(h) Standardized Medicare
supplement benefit plan G shall include only the following: The core benefit as
defined in Rule
0780-01-58-.08(2)
of this Chapter, 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
0780-01-58-.08(3)(a),
(b), (d), (h), and (j) of this Chapter,
respectively.
(i) Standardized
Medicare supplement benefit plan H shall consist of only the following: The
core benefit as defined in Rule
0780-01-58-.08(2)
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 Rules
0780-01-58-.08(3)(a),
(b), (f), and (h) of this Chapter,
respectively. The outpatient prescription drug benefit shall not be included in
a Medicare supplement policy sold after December 31, 2005.
(j) Standardized Medicare supplement benefit
plan I shall consist of only the following: The core benefit as defined in Rule
0780-01-58-.08(2)
of this Chapter, 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
0780-01-58-.08(3)(a),
(b), (e), (f), (h), and (j) of this Chapter,
respectively. The outpatient prescription drug benefit shall not be included in
a Medicare supplement policy sold after December 31, 2005.
(k) Standardized Medicare supplement benefit
plan J shall consist of only the following: The core benefit as defined in Rule
0780-01-58-.08(2)
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 Rules
0780-01-58-.08(3)(a),
(b), (c), (e), (g), (h), (i), and (j) of this
Chapter, respectively. The outpatient prescription drug benefit shall not be
included in a Medicare supplement policy sold after December 31,
2005.
(l) Standardized Medicare
supplement benefit high deductible plan J shall consist of only the following:
one hundred percent (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
0780-01-58-.08(2)
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 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
0780-01-58-.08(3)(a),
(b), (c), (e), (g), (h), (i), and (j) of this
Chapter, 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 one thousand five
hundred dollars ($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 (12)
month period ending with August of the preceding year, and rounded to the
nearest multiple of ten dollars ($10). The outpatient prescription drug benefit
shall not be included in a Medicare supplement policy sold 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 Rule
0780-01-58-.08(4)(a)
of this Chapter.
(b) Standardized
Medicare supplement benefit plan L shall consist of only those benefits
described in Rule
0780-01-58-.08(4)(b)
of this Chapter.
(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
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
Authority: T.C.A. ยงยง
56-1-701;
56-2-301; 56-6-112; 56-6-124(a); 56-7-1401, et seq.; 56-7-1453; 56-7-1454;
56-7-1455; 56-7-1457; 56-7-1501, et seq.; 56-7-1503; 56-7-1504; 56-7-1505;
56-7-1507; and 56-32-118(a); Omnibus Budget Reconciliation
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