Section 760 IAC 3-7-1 - Standard Medicare supplement benefit plans for 1990 Standardized Medicare supplement benefit plan policies or certificates issued for delivery after December 31, 1991, and prior to June 1, 2010Authority: IC 27-8-13-9; IC 27-8-13-10; IC 27-8-13-10.1
Affected: IC 27-8-13-1
Sec. 1.
(a) 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 760 IAC 3-6-1(c).(b) No groups, packages, or combinations of Medicare supplement benefits other than those listed in this section shall be offered for sale in this state, except as may be permitted in 760 IAC 3-8.(c) Benefit plans shall be uniform in structure, language, designation, and format to the standard benefit Plans A through J listed in this section and conform to the definitions in 760 IAC 3-2 and 760 IAC 3-3. Each benefit shall: (1) be structured in accordance with the format provided in 760 IAC 3-6-1(c) through 760 IAC 3-6-1(d); and(2) list the benefits in the order shown in subsection (e). As used in 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) The makeup of benefit plans shall be as follows: (1) Standardized Medicare supplement benefit Plan A shall be limited to the basic (core) benefits common to all benefit plans as defined in 760 IAC 3-6-1(c).(2) Standardized Medicare supplement benefit Plan B shall include only the core benefit as defined in 760 IAC 3-6-1(c), plus the Medicare Part A deductible as defined in 760 IAC 3-6-1(d)(1).(3) Standardized Medicare supplement benefit Plan C shall include only the core benefit as defined in 760 IAC 3-6-1(c), plus: (A) the Medicare Part A deductible;(B) skilled nursing facility care;(C) the Medicare Part B deductible; and(D) medically necessary emergency care in a foreign country; as defined in 760 IAC 3-6-1(d)(1) through 760 IAC 3-6-1(d)(3) and 760 IAC 3-6-1(d)(8), respectively. (4) Standardized Medicare supplement benefit Plan D shall include only the core benefit as defined in 760 IAC 3-6-1(c), plus: (A) the Medicare Part A deductible;(B) skilled nursing facility care;(C) medically necessary emergency care in a foreign country; and(D) the at-home recovery benefit; as defined in 760 IAC 3-6-1(d)(1), 760 IAC 3-6-1(d)(2), 760 IAC 3-6-1(d)(8), and 760 IAC 3-6-1(d)(10), respectively. (5) Standardized Medicare supplement benefit Plan E shall include only the core benefit as defined in 760 IAC 3-6-1(c), plus: (A) the Medicare Part A deductible;(B) skilled nursing facility care;(C) medically necessary emergency care in a foreign country; and(D) preventive medical care; as defined in 760 IAC 3-6-1(d)(1), 760 IAC 3-6-1(d)(2), 760 IAC 3-6-1(d)(8), and 760 IAC 3-6-1(d)(9), respectively. (6) Standardized Medicare supplement benefit Plan F shall include only the core benefit as defined in 760 IAC 3-6-1(c), plus: (A) the Medicare Part A deductible;(B) skilled nursing facility care;(C) the Medicare Part B deductible;(D) one hundred percent (100%) of the Medicare Part B excess charges; and(E) medically necessary emergency care in a foreign country; as defined in 760 IAC 3-6-1(d)(1) through 760 IAC 3-6-1(d)(3), 760 IAC 3-6-1(d)(5), and 760 IAC 3-6-1(d)(8), respectively. (7) Standardized Medicare supplement benefit high deductible Plan F shall include 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 760 IAC 3-6-1(c), plus: (A) the Medicare Part A deductible;(B) skilled nursing facility care;(C) the Medicare Part B deductible;(D) one hundred percent (100%) of the Medicare Part B excess charges; and(E) medically necessary emergency care in a foreign country; as defined in 760 IAC 3-6-1(d)(1), 760 IAC 3-6-1(d)(2), 760 IAC 3-6-1(d)(8), and 760 IAC 3-6-1(d)(9), 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 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). (8) Standardized Medicare supplement benefit Plan G shall include only the core benefit as defined in 760 IAC 3-6-1(c), plus: (A) the Medicare Part A deductible;(B) skilled nursing facility care;(C) eighty percent (80%) of the Medicare Part B excess charges;(D) medically necessary emergency care in a foreign country; and(E) the at-home recovery benefit; as defined in 760 IAC 3-6-1(d)(1), 760 IAC 3-6-1(d)(2), 760 IAC 3-6-1(d)(4), 760 IAC 3-6-1(d)(8), and 760 IAC 3-6-1(d)(10), respectively. (9) Standardized Medicare supplement benefit Plan H shall consist of only the core benefit as defined in 760 IAC 3-6-1(c), plus: (A) the Medicare Part A deductible;(B) skilled nursing facility care;(C) the basic prescription drug benefit; and(D) medically necessary emergency care in a foreign country; as defined in 760 IAC 3-6-1(d)(1), 760 IAC 3-6-1(d)(2), 760 IAC 3-6-1(d)(6), and 760 IAC 3-6-1(d)(8), respectively. The outpatient 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 core benefit as defined in 760 IAC 3-6-1(c), plus: (A) the Medicare Part A deductible;(B) skilled nursing facility care;(C) one hundred percent (100%) of the Medicare Part B excess charges;(D) the basic prescription drug benefit;(E) medically necessary emergency care in a foreign country; and(F) the at-home recovery benefit; as defined in 760 IAC 3-6-1(d)(1), 760 IAC 3-6-1(d)(2), 760 IAC 3-6-1(d)(5), 760 IAC 3-6-1(d)(6), 760 IAC 3-6-1(d)(8), and 760 IAC 3-6-1(d)(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 core benefit as defined in 760 IAC 3-6-1(c), plus: (A) the Medicare Part A deductible;(B) skilled nursing facility care;(C) the Medicare Part B deductible;(D) one hundred percent (100%) of the Medicare Part B excess charges;(E) the extended prescription drug benefit;(F) medically necessary emergency care in a foreign country;(G) preventive medical care; and(H) the at-home recovery benefit; as defined in 760 IAC 3-6-1(d)(1) through 760 IAC 3-6-1(d)(3), 760 IAC 3-6-1(d)(5), and 760 IAC 3-6-1(d)(7) through 760 IAC 3-6-1(d)(10), respectively. (12) Standardized Medicare supplement benefit high deductible Plan J shall consist of 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 760 IAC 3-6-1(c), plus: (A) the Medicare Part A deductible;(B) skilled nursing facility care;(C) the Medicare Part B deductible;(D) one hundred percent (100%) of the Medicare Part B excess charges;(E) the extended outpatient prescription drug benefit;(F) medically necessary emergency care in a foreign country;(G) preventive medical care benefit; and(H) the at-home recovery benefit; as defined in 760 IAC 3-6-1(d)(1) through 760 IAC 3-6-1(d)(3), 760 IAC 3-6-1(d)(5), and 760 IAC 3-6-1(d)(7) through 760 IAC 3-6-1(d)(10), respectively. The outpatient prescription drug benefit shall not be included in a Medicare Supplement policy sold after December 31, 2005. 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 high deductible shall be one thousand five hundred dollars ($1,500) for 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. (f) The makeup of the two (2) Medicare supplement plans mandated by the Medicare Prescription Drug Improvement and Modernization Act of 2003 are as follows: (1) Standardized Medicare supplement benefit plan "K" shall consist of only those benefits described in 760 IAC 3-6-1(e).(2) Standardized Medicare supplement benefit plan "L" shall consist of only those benefits described in 760 IAC 3-6-1(f).(g) 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 as follows: (1) Appropriate to Medicare supplement insurance.(3) Not otherwise available.(5) 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.
(h) Insurers are permitted to continue to use approved forms through December 31, 2005. Insurers may offer any authorized plan upon approval of the commissioner. Department of Insurance; 760 IAC 3-7-1; filed Jul 8, 1993, 10:00 a.m.: 16 IR 2569; errata filed Sep 20, 1993, 5:00 p.m.: 17 IR 200; filed Feb 1, 1999, 10:45 a.m.: 22 IR 1974; readopted filed Sep 14, 2001, 12:22 p.m.: 25 IR 531; filed Sep 14, 2005, 3:00 p.m.: 29 IR 523; readopted filed Nov 29, 2011, 9:14 a.m.: 20111228-IR-760110553RFAReadopted filed 11/20/2015, 9:25 a.m.: 20151216-IR-760150341RFAReadopted filed 11/15/2021, 8:32 a.m.: 20211215-IR-760210419RFA