Section R590-146-9 - Standard Plans for 1990 Standardized Plans Issued for Delivery After July 30, 1992, and with an Effective Date for Coverage Prior to June 1, 2010(1) An issuer offering a 1990 plan shall offer to an applicant a policy or certificate that only contains the basic core benefits.(2) A group, package, or combinations of Medicare supplement insurance benefits, other than those listed in this section, may not be offered for sale, except as permitted in Subsection (6) and Section R590-146-10.(3) A 1990 plan shall be:(a) uniform in structure, language, designation, and format; and(b) structured according to the format provided in Subsection R590-146-8(2), R590-146-8(3), or R590-146-8(4) and list the benefits in the order shown in Subsection (5) of this section.(4) An issuer may use, in addition to the plan designations required in Subsection (3), other designations to the extent permitted by law.(5) A 1990 plan shall include the benefits listed in this subsection. (a) Standardized Plan A shall only include the basic core benefits.(b) Standardized Plan B shall only include: (i) basic core benefits; and(ii) 100% of the Medicare Part A deductible.(c) Standardized Plan C shall only include: (ii) 100% of the Medicare Part A deductible;(iii) skilled nursing facility care;(iv) 100% of the Medicare Part B deductible; and(v) medically necessary emergency care in a foreign country.(d) Standardized Plan D shall only include: (ii) 100% of the Medicare Part A deductible;(iii) skilled nursing facility care;(iv) medically necessary emergency care in a foreign country; and(v) at-home recovery benefit.(e) Standardized Plan E shall only include: (ii) 100% of the Medicare Part A deductible;(iii) skilled nursing facility care;(iv) medically necessary emergency care in a foreign country; and(v) preventive medical care.(f) Standardized Plan F shall only include: (ii) 100% of the Medicare Part A deductible;(iii) skilled nursing facility care;(iv) 100% of the Medicare Part B deductible;(v) 100% of the Medicare Part B excess charges; and(vi) medically necessary emergency care in a foreign country.(g)(i) Standardized Plan High Deductible F shall only include 100% of covered expenses following the payment of the annual Plan High Deductible F deductible. The covered expenses after payment of the deductible include:(B) 100% of the Medicare Part A deductible;(C) skilled nursing facility care;(D) 100% of the Medicare Part B deductible;(E) 100% of the Medicare Part B excess charges; and(F) medically necessary emergency care in a foreign country.(ii) The annual Plan High Deductible F deductible shall: (A) consist of out-of-pocket expenses, other than premiums, for services covered by Plan F; and(B) be in addition to any other specific benefit deductibles.(iii) The annual Plan High Deductible F deductible shall be based on the calendar year as adjusted annually by the Secretary.(h) Standardized Plan G shall only include:(ii) 100% of the Medicare Part A deductible;(iii) skilled nursing facility care; (iv) 80% of the Medicare Part B excess charges;(v) medically necessary emergency care in a foreign country; and(vi) at-home recovery benefit. (i) Standardized Plan H shall only include: (ii) 100% of the Medicare Part A deductible;(iii) skilled nursing facility care;(iv) for a policy issued before January 1, 2006, basic prescription drug benefit; and(v) medically necessary emergency care in a foreign country.(j) Standardized Plan I shall only include:(ii) 100% of the Medicare Part A deductible;(iii) skilled nursing facility care; (iv) 100% of the Medicare Part B excess charges;(v) for a policy issued before January 1, 2006, basic prescription drug benefit;(vi) medically necessary emergency care in a foreign country; and(vii) at-home recovery benefit.(k) Standardized Plan J shall only include:(ii) 100% of the Medicare Part A deductible;(iii) skilled nursing facility care; (iv) 100% of the Medicare Part B deductible;(v) 100% of the Medicare Part B excess charges;(vi) for a policy issued before January 1, 2006, extended prescription drug benefit; (vii) medically necessary emergency care in a foreign country;(viii) preventive medical care; and(ix) at-home recovery benefit.(l)(i) Standardized Plan High Deductible J shall only include 100% of covered expenses following the payment of the annual Plan High Deductible J deductible. The covered expenses after payment of the deductible include: (B) 100% of the Medicare Part A deductible;(C) skilled nursing facility care;(D) 100% of the Medicare Part B deductible;(E) 100% of the Medicare Part B excess charges;(F) for a policy issued before January 1, 2006, extended outpatient prescription drug benefit;(G) medically necessary emergency care in a foreign country;(H) preventive medical care benefit; and(I) at-home recovery benefit.(ii) The annual Plan High Deductible J deductible shall: (A) consist of out-of-pocket expenses, other than premiums, for services covered by Plan J;(B) be in addition to any other specific benefit deductibles; and(C) be based on the calendar year, as adjusted annually by the Secretary.(m) Standardized Plan K shall only consist of those benefits under Subsection R590-146-8(3).(n) Standardized Plan L shall only consist of those benefits under Subsection R590-146-8(4).(6)(a) An issuer may, with the prior approval of the commissioner, offer a policy or certificate with a new or innovative benefit in addition to the standardized benefits provided in a policy or certificate.(b)(i) A new or innovative benefit may include a benefit that is 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 a polic y.(ii) After December 31, 2005, an innovative benefit may not include an outpatient prescription drug benefit.Utah Admin. Code R590-146-9
Amended by Utah State Bulletin Number 2019-13, effective 6/7/2019Adopted by Utah State Bulletin Number 2024-16, effective 8/7/2024