| (D) One hundred percent of the Medicare Part B excess
charges: coverage for all of the difference between the actual Medicare
Part B charges as billed, not to exceed any charge limitation established
by the Medicare program or state law, and the Medicare-approved Part
B charge.
(E) Medically necessary emergency care in a foreign
country: coverage to the extent not covered by Medicare for 80 percent
of the billed charges for Medicare-eligible expenses for medically
necessary emergency hospital, physician, and medical care received
in a foreign country, which would have been covered by Medicare if
provided in the United States and which care began during the first
60 consecutive days of each trip outside the United States, subject
to a calendar year deductible of $250, and a lifetime maximum benefit
of $50,000. For purposes of this benefit, "emergency care" means care
needed immediately because of an injury or an illness of sudden and
unexpected onset.
(c) Standard Medicare supplement benefit plans for
2010 Standardized Medicare supplement benefit plan policies or certificates
issued or issued for delivery with an effective date for coverage
on or after June 1, 2010. The following standards are applicable to
all Medicare supplement policies or certificates issued or issued
for delivery in this state with an effective date for coverage on
or after June 1, 2010. No insurance policy, subscriber contract, certificate,
or evidence of coverage may be advertised, solicited, or issued for
delivery in this state as a Medicare supplement policy unless the
policy, contract, certificate, or evidence of coverage complies with
these benefit plan standards. Benefit plan standards applicable to
Medicare supplement policies and certificates issued or issued for
delivery with an effective date for coverage before June 1, 2010,
remain subject to the laws and rules in effect when the policy or
certificate was delivered, or issued for delivery.
(1) An issuer of a Medicare supplement policy or certificate
must comply with subparagraphs (A) and (B) of this paragraph:
(A) An issuer must make available to each prospective
policyholder and certificate holder a policy form or certificate form
containing only the basic (core) benefits, as defined in subsection
(b)(2) of this section.
(B) If an issuer makes available any of the additional
benefits described in subsection (b)(3) of this section, or offers
standardized benefit Plans K or L (as described in paragraph (5)(I)
and (J) of this subsection), then the issuer must make available to
each prospective policyholder and certificate holder who first became
eligible for Medicare before January 1, 2020, in addition to a policy
form or certificate form with only the basic (core) benefits as described
in subparagraph (A) of this paragraph, a policy form or certificate
form containing either:
(i) standardized benefit Plan C (as described in paragraph
(5)(C) of this subsection); or
(ii) standardized benefit Plan F (as described in paragraph
(5)(E) of this subsection).
(2) No groups, packages, or combinations of Medicare
supplement benefits other than those listed in this subsection may
be offered for sale in this state, except as may be permitted in paragraph
(6) of this subsection and in §3.3325 of this title (relating
to Medicare Select Policies, Certificates, and Plans of Operation).
(3) Benefit plans must be uniform in structure, language,
and format, as well as designation, to the standard benefit plans
listed in this paragraph and conform to the definitions in §3.3303
of this title (relating to Definitions). Each benefit plan must be
structured in accordance with the format provided in subsection (b)(2)
and (b)(3) of this section or, in the case of Plans K or L, in accordance
with the format provided in paragraph (5)(I) or (J) of this subsection,
and list the benefits in the order shown. For purposes of this subsection,
"structure, language, and format" means style, arrangement, and overall
content of a benefit.
(4) In addition to the benefit plan designations required
in paragraph (3) of this subsection, an issuer may use other designations
to the extent permitted by law.
(5) The make-up of 2010 Standardized Benefit Plans
is as specified in subparagraphs (A) - (L) of this paragraph.
(A) Standardized Medicare supplement benefit Plan A
must include only the following: The basic (core) benefits as defined
in subsection (b)(2) of this section.
(B) Standardized Medicare supplement benefit Plan B
must include only the following: The basic (core) benefits as defined
in subsection (b)(2) of this section, plus 100 percent of the Medicare
Part A deductible as defined in subsection (b)(3)(A)(i) of this section.
(C) Standardized Medicare supplement benefit Plan C
must include only the following: The basic (core) benefits as defined
in subsection (b)(2) of this section, plus 100 percent of the Medicare
Part A deductible, skilled nursing facility care, 100 percent of the
Medicare Part B deductible, and medically necessary emergency care
in a foreign country as defined in subsection (b)(3)(A)(i), (B), (C),
and (E) of this section, respectively.
(D) Standardized Medicare supplement benefit Plan D
must include only: The basic (core) benefits (as defined in subsection
(b)(2) of this section), plus 100 percent of the Medicare Part A deductible,
skilled nursing facility care, and medically necessary emergency care
in a foreign country as defined in subsection (b)(3)(A)(i), (B), and
(E) of this section, respectively.
(E) Standardized Medicare supplement (regular) Plan
F must include only the following: The basic (core) benefits as defined
in subsection (b)(2) of this section, plus 100 percent of the Medicare
Part A deductible, the skilled nursing facility care, 100 percent
of the Medicare Part B deductible, 100 percent of the Medicare Part
B excess charges, and medically necessary emergency care in a foreign
country as defined in subsection (b)(3)(A)(i), (B), (C), (D), and
(E) of this section, respectively.
(F) Standardized Medicare supplement Plan F with High
Deductible must include 100 percent of covered expenses following
the payment of the annual deductible set forth in clause (ii) of this
subparagraph.
(i) The basic (core) benefits as defined in subsection
(b)(2) of this section, plus 100 percent of the Medicare Part A deductible,
skilled nursing facility care, 100 percent of the Medicare Part B
deductible, 100 percent of the Medicare Part B excess charges, and
medically necessary emergency care in a foreign country as defined
in subsection (b)(3)(A)(i), (B), (C), (D), and (E) of this section,
respectively.
(ii) The annual deductible in Plan F with High Deductible
must consist of out-of-pocket expenses, other than premiums, for services
covered by regular Plan F, and must be in addition to any other specific
benefit deductibles. The basis for the deductible is $2,240 for 2018,
and will be adjusted annually 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.
(G) Standardized Medicare supplement benefit Plan G
must include only the following: The basic (core) benefits as defined
in subsection (b)(2) of this section, plus 100 percent of the Medicare
Part A deductible, skilled nursing facility care, 100 percent of the
Medicare Part B excess charges, and medically necessary emergency
care in a foreign country as defined in subsection (b)(3)(A)(i), (B),
(D), and (E), respectively. Effective January 1, 2020, Plan G with
a High Deductible, as described in subsection (c)(5)(H), may be offered
to any individual who is eligible for Medicare before January 1, 2020.
(H) Standardized Medicare supplement Plan G with High
Deductible must include 100 percent of the covered expenses following
the payment of the annual deductible set forth in clause (ii) of this
subparagraph, but will not provide coverage for any portion of the
Medicare Part B deductible. The Medicare Part B deductible paid by
the beneficiary will be considered an out-of-pocket expense in meeting
the annual high cost deductible.
(i) The basic (core) benefits as defined in subsection
(b)(2) of this section, plus 100 percent of the Medicare Part A deductible,
skilled nursing facility care, 100 percent of the Medicare Part B
excess charges, and medically necessary emergency care in a foreign
country as defined in subsection (b)(3)(A)(i), (B), (D), and (E),
respectively.
(ii) The annual deductible in Plan G with High Deductible
must consist of out-of-pocket expenses, other than premiums, for services
covered by regular Plan G, and must be in addition to any other specific
benefit deductibles. The basis for the deductible is $2,240 for 2018,
and will be adjusted annually 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.
(I) Standardized Medicare supplement Plan K must include
only the following:
Cont'd... |
