N.H. Admin. Code § Ins 1905.09

Current through Register No. 45, November 7, 2024

Section Ins 1905.09 - Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and Prior to June 1, 2010

(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 Ins 1905.07(c)of this rule.

(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 Ins 1905.09(f) and Ins 1905.12.

(c) Benefit plans shall be uniform in structure, language, designation, and format to the standard benefit plans "A" through "L" listed in this subsection and conform to the definitions in Ins 1905.03. Each benefit shall be structured in accordance with the format provided in Ins 1905.07(c), (d), and (e) 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 paragraph (c) above, 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 Ins 1905.07(c);

(2) Standardized Medicare supplement benefit plan "B" shall include only the following:

a. The core benefit as specified in Ins 1905.07(c)of this rule; plus

b. The Medicare Part A deductible as defined in Ins 1905.07(d)(1);

(3) Standardized Medicare supplement benefit plan "C" shall include only the following:

a. The core benefit as defined in Ins 1905.07(c); plus

b. The Medicare Part A deductible as defined in Ins 1905.07(d)(1);

c. Skilled nursing facility care as defined in Ins 1905.07(d)(2);

d. Medicare Part B deductible as defined in Ins 1905.07(d)(3); and

e. Medically necessary emergency care in a foreign country as defined in Ins 1905.07(d)(8);

(4) Standardized Medicare supplement benefit plan "D" shall include only the following:

a. The core benefit as defined in Ins 1905.07(c)of this rule; plus

b. The Medicare Part A deductible as defined in Ins 1905.07(d)(1);

c. Skilled nursing facility care as defined in Ins 1905.07(d)(2);

d. Medically necessary emergency care in a foreign country as defined in Ins 1905.07(d)(8); and

e. The at-home recovery benefit as defined in Ins 1905.07(d)(10);

(5) Standardized Medicare supplement benefit plan "E" shall include only the following:

a. The core benefit as defined in Ins 1905.07(c) of this rule; plus

b. The Medicare Part A deductible as defined in Ins 1905.07(d)(1);

c. Skilled nursing facility care as defined in Ins 1905.07(d)(2);

d. Medically necessary emergency care in a foreign country as defined in Ins 1905.07(d)(8); and

e. Preventive medical care as defined in Ins 1905.07(d)(9);

(6) Standardized Medicare supplement benefit plan "F" shall include only the following:

a. The core benefit as defined in Ins 1905.07(c)of this rule; plus

b. The Medicare Part A deductible as defined in Ins 1905.07(d)(1);

c. The skilled nursing facility care as defined in Ins 1905.07(d)(2);

d. The Part B deductible as defined in Ins 1905.07(d)(3);

e. One hundred percent of the Medicare Part B excess charges as defined in Ins 1905.07(d)(5); and

f. Medically necessary emergency care in a foreign country as defined in Ins 1905.07(d)(8);

(7) Standardized Medicare supplement benefit high deductible plan "F" shall include only the following:

a. 100% of covered expenses following the payment of the annual high deductible plan F deductible. The covered expenses include:

1. The core benefit as defined in Ins 1905.07(c) of this rule; plus

2. The Medicare Part A deductible as defined in Ins 1905.07(d)(1);

3. Skilled nursing facility care as defined in Ins 1905.07(d)(2);

4. The Medicare Part B deductible as defined in Ins 1905.07(d)(3);

5. One hundred percent of the Medicare Part B excess charges as defined in Ins 1905.07(d)(5); and

6. Medically necessary emergency care in a foreign country as defined in Ins 1905.07(d)(8);

b. 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;

c. The annual high deductible plan "F" deductible shall be $1500 for 1998 and 1999, and shall be based on the calendar year; and

d. 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:

a. The core benefit as defined in Ins 1905.07(c) of this rule; plus

b. The Medicare Part A deductible as defined in Ins 1905.07(d)(1);

c. Skilled nursing facility care as defined in Ins 1905.07(d)(2);

d. Eighty percent of the Medicare Part B excess charges as defined in Ins 1905.07(d)(4);

e. Medically necessary emergency care in a foreign country as defined in Ins 1905.07(d)(8); and

f. The at-home recovery benefit as defined in Ins 1905.07(d)(10);

(9) Standardized Medicare supplement benefit plan "H" shall consist of only the following:

a. The core benefit as defined in Ins 1905.07(c) of this rule; plus

b. The Medicare Part A deductible as defined in Ins 1905.07(d)(1);

c. Skilled nursing facility care as defined in Ins 1905.07(d)(2);

d. Basic prescription drug benefit as defined in Ins 1905.07(d)(6); and

e. Medically necessary emergency care in a foreign country as defined in Ins 1905.07(d)(8); and

f. 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 following:

a. The core benefit as defined in Ins 1905.07(c)of this rule; plus

b. The Medicare Part A deductible as defined in Ins 1905.07(d)(1);

c. Skilled nursing facility care as defined in Ins 1905.07(d)(2);

d. One hundred percent of the Medicare Part B excess charges as defined in Ins 1905.07(d)(5);

e. Basic prescription drug benefit as defined in Ins 1905.07(d)(6);

f. Medically necessary emergency care in a foreign country as defined in Ins 1905.07(d)(8);

g. At-home recovery benefits as defined in Ins 1905.07(d)(10); and

h. 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:

a. The core benefit as defined in Ins 1905.07(c) of this rule; plus

b. The Medicare Part A deductible as defined in Ins 1905.07(d)(1);

c. Skilled nursing facility care as defined in Ins 1905.07(d)(2);

d. Medicare Part B deductible as defined in Ins 1905.07(d)(3);

e. One hundred percent of the Medicare Part B excess charges as defined in Ins 1905.07(d)(5);

f. Extended prescription drug benefit as defined in Ins 1905.07(d)(7);

g. Medically necessary emergency care in a foreign country as defined in Ins 1905.07(d)(8);

h. Preventive medical care as defined in Ins 1905.07(d)(9);

i. At-home recovery benefit as defined in Ins 1905.07(d)(10); and

j. 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:

a. One hundred percent of covered expenses, following the payment of the annual high deductible plan "J" deductible. The covered expenses include:

1. The core benefit as defined in Ins 1905.07(c) of this rule; plus

2. The Medicare Part A deductible as defined in Ins 1905.07(d)(1);

3. Skilled nursing facility care as defined in Ins 1905.07(d)(2);

4. Medicare Part B deductible as defined in Ins 1905.07(d)(3);

5. One hundred percent of the Medicare Part B excess charges as defined in Ins 1905.07(d)(5);

6. Extended outpatient prescription drug benefit as defined in Ins 1905.07(d)(7);

7. Medically necessary emergency care in a foreign country as defined in Ins 1905.07(d)(8);

8. Preventive medical care benefit as defined in Ins 1905.07(d)(9); and

9. At-home recovery benefit as defined in Ins 1905.07(d)(10);

b. 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;

c. The annual deductible shall be $1500 for 1998 and 1999, and shall be based on a calendar year;

e. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy sold after December 31, 2005; and

(13) Make-up of two Medicare supplement plans mandated by The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA):

a. Standardized Medicare supplement benefit plan "K" shall consist of only those benefits described in Ins 1905.07(e)(1); and

b. Standardized Medicare supplement benefit plan "L" shall consist of only those benefits described in Ins 1905.07(e)(2).

(f) 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 which 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.

N.H. Admin. Code § Ins 1905.09

#5390, eff 7-1-92; ss by #5656, eff 7-1-93; ss by #7017, INTERIM, eff 7-1-99, EXPIRED: 10-29-99

New. #7174, eff 12-22-99; ss by #8051, eff 3-1-04; ss by #8363, eff 9-8-05; ss by #9559, eff 10-13-09

Amended by Volume XXXVII Number 37, Filed September 14, 2017, Proposed by #12370, Effective 10/13/2017, Expires 10/13/2027.