Utah Admin. Code R590-146-9 - Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery After July 30, 1992 and with an Effective Date for Coverage Prior to June 1, 2010
A. An issuer shall
make available to each prospective policyholder and certificateholder a policy
form or certificate form containing only the basic core benefits, as defined in
Subsection 8.B. of this rule.
B. No
groups, packages or combinations of Medicare supplement benefits other than
those listed in this section may be offered for sale in this state, except as
may be permitted in Subsection 9.G. and Section 10 of this rule.
C. Benefit plans shall be uniform in
structure, language, designation and format to the standard benefit plans A
through L listed in this section and conform to the definitions in Section 4 of
this rule. Each benefit shall be structured in accordance with the format
provided in Subsections 8.B. and 8.C., or 8.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 Subsection 8.B. of this rule.
(2) Standardized Medicare supplement benefit
plan B shall include only the following: The core benefit as defined in
Subsection 8.B. of this rule, plus the Medicare Part A deductible as defined in
Subsection 8.C.(1).
(3)
Standardized Medicare supplement benefit plan C shall include only the
following: The core benefit as defined in Subsection 8.B. of this rule, 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 Subsections 8.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
Subsection 8.B. of this rule, plus the Medicare Part A deductible, skilled
nursing facility care, medically necessary emergency care in a foreign country
and the at-home recovery benefit as defined in Subsections 8.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 Subsection 8.B. of this rule, 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 Subsections 8.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
Subsection 8.B. of this rule, plus the Medicare Part A deductible, the skilled
nursing facility care, the Part B deductible, 100% of the Medicare Part B
excess charges, and medically necessary emergency care in a foreign country as
defined in Subsections 8.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 Subsection 8.B. of
this rule, plus the Medicare Part A deductible, skilled nursing facility care,
the Medicare Part B deductible, 100% of the Medicare Part B excess charges, and
medically necessary emergency care in a foreign country as defined in
Subsections 8.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 12-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
Subsection 8.B. of this rule, plus the Medicare Part A deductible, skilled
nursing facility care, 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 Subsections 8.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 Subsection 8.B. of this rule, 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
Subsections 8.C.(1), (2), (6) and (8) respectively. The 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 Subsection 8.B. of this rule, plus
the Medicare Part A deductible, skilled nursing facility care, 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 Subsections 8.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
Subsection 8.B. of this rule, plus the Medicare Part A deductible, skilled
nursing facility care, Medicare Part B deductible, 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 Subsections 8.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
Subsection 8.B. of this rule, plus the Medicare Part A deductible, skilled
nursing facility care, Medicare Part B deductible, 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 Subsections 8.C.(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
Subsection 8.D.(1).
(2)
Standardized Medicare supplement benefit plan L shall consist of only those
benefits described in Subsection 8.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
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