The Medicare Access and CHIP Reauthorization Act of 2015
(MACRA) requires the following standards which are applicable to all Medicare
supplement policies or certificates delivered or issued for delivery in this
state to individuals newly eligible for Medicare on or after January 1, 2020.
No policy or certificate that provides coverage of the Medicare Part B
deductible may be advertised, solicited, delivered, or issued for delivery in
this state as a Medicare supplement policy or certificate to individuals newly
eligible for Medicare on or after January 1, 2020. All policies must comply
with the following benefit standards. Benefit plan standards applicable to
Medicare supplement policies and certificates issued to individuals eligible
for Medicare before January 1, 2020, remain subject to the requirements of
T.C.A. Title 56, Chapter 7, Part 14 and all applicable benefit standards in
Rules 0780-01-58-.07 and
0780-01-58-.08 of this
Chapter.
(1) Benefit Requirements. The
standards and requirements of Rule
0780-01-58-.11 shall apply to
all Medicare supplement policies or certificates delivered or issued for
delivery to individuals newly eligible for Medicare on or after January 1,
2020, with the following exceptions:
(a)
Standardized Medicare supplement benefit Plan C is redesignated as Plan D and
shall provide the benefits contained in Rule
0780-01-58-.11(5)(c)
of this Chapter but shall not provide
coverage for one hundred percent (100%) or any portion of the Medicare Part B
deductible.
(b) Standardized
Medicare supplement benefit Plan F is redesignated as Plan G and shall provide
the benefits contained in Rule
0780-01-58-.11(5)(e)
of this Chapter but shall not provide
coverage for one hundred percent (100%) or any portion of the Medicare Part B
deductible.
(c) Standardized
Medicare supplement benefit plans C, F, and F with High Deductible may not be
offered to individuals newly eligible for Medicare on or after January 1,
2020.
(d) Standardized Medicare
supplement benefit Plan F with High Deductible is redesignated as Plan G with
High Deductible and shall provide the benefits contained in Rule
0780-01-58-.11(5)(f)
of this Chapter but shall not provide
coverage for one hundred percent (100%) or any portion of the Medicare Part B
deductible; provided further that, the Medicare Part B deductible paid by the
beneficiary shall be considered an out-of-pocket expense in meeting the annual
high deductible.
(e) The reference
to Plans C or F contained in Rule
0780-01-58-.11(1)(b)
is deemed a reference to Plans D or G for
purposes of this Rule.
(2) Applicability to Certain Individuals.
This Rule applies only to individuals that are newly eligible for Medicare on
or after January 1, 2020:
(a) By reason of
attaining the age of 65 on or after January 1, 2020; or
(b) By reason of entitlement to benefits
under Part A pursuant to Section 226(b) or 226A of the Social Security Act, or
who are deemed to be eligible for benefits under Section 226(a) of the Social
Security Act on or after January 1, 2020.
(3) Guaranteed Issue for Eligible Persons.
For purposes of Rule
0780-01-58-.15(5),
in the case of any individual newly eligible for Medicare on or after January
1, 2020, any reference to a Medicare supplement policy C or F (including F with
High Deductible) shall be deemed to be a reference to Medicare supplement
policy D or G (including G with High Deductible), respectively, that meet the
requirements of Rule
0780-01-58-.12.
(4) Offer of Redesignated Plans to
Individuals Other Than Newly Eligible. On or after January 1, 2020, the
standardized benefit plans described in subparagraph (1)(d) above may be
offered to any individual who was eligible for Medicare prior to January 1,
2020, in addition to the standardized plans described in Rule
0780-01-58-.11(5)
of this Rule.
