Minn. R. 2740.9954
Current through Register Vol. 48, No. 51, June 17, 2024
Comprehensive Health Insurance
Test for Actuarial Equivalence
Other than Medicare Supplement Plans
| Major Medical | ||||
| Subparts of part 2740.9964 | Benefit | Basic | Superimposed | Comprehensive |
| 1. | Hospital room and board | |||
| 2. | Hospital extras | |||
| 3. | Surgery | |||
| 4. | Physician care; home, office | |||
| 5. | Physician care; hospital | |||
| 6. | Maternity | |||
| 7. | Diagnostic X-ray and lab | |||
| 8. | Drugs and medicine | |||
| 9. | Radioactive therapy | |||
| 10. | Nursing/convalescent facility | |||
| 11. | Home health care | |||
| 12. | Physical therapy | |||
| 12. | Oxygen | |||
| 12. | Prostheses | |||
| 12. | Durable medical equipment | |||
| 12. | Second opinion surgery | |||
| 12. | Private duty nursing | |||
| 12. | Ambulance | |||
| 13. | Hospital room and board in full | |||
| 14. | All hospital expenses in full | |||
| 15. | Major medical maximums | |||
| Subtotal reasonable and customary medical services | ||||
| 16. | Deductible | |||
| 16. | Coinsurance | |||
| Subtotal net of deductible and coinsurance | ||||
| 17. | Adjust (Comb. medical/dental deductible) | |||
| 18. | COB/No-Fault | |||
| 19. | Limit on "out-of-pocket" expenses | |||
| 20. | Well baby care | |||
| 21. | Emergency and supplemental accident | |||
| 22. | Student dependents | |||
| 23.-25. | Superimposed major medical | |||
| Grand Total | ||||
| Combined Basic and Superimposed | XXX | XXX | ||
| Equivalent to Minnesota qualified plan number _____ nonqualified ______ |
| Date _____ By _____ |
Minn. R. 2740.9954
Statutory Authority: MS s 62E.09