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 Act of 1990,
Pub. L. No.
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