D.C. Mun. Regs. tit. 26, r. 26-A2208
Current through Register Vol. 71, No. 49, December 6, 2024
Rule 26-A2208 - STANDARD MEDICARE SUPPLEMENT BENEFIT PLANS2208.1An 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 subsection 2207.14.
2208.2No groups, packages or combinations of Medicare supplement benefits other than those listed in this section shall be offered for sale in the District, except as may be permitted in subsection 2208.9 and 2208 A.
2208.3Benefit 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 section 2299.
2208.4Each benefit shall be structured in accordance with the format provided in subsections 2207.14 and 2207.15 or 2207.16 and list the benefits in the order shown in subsection 2208.7.
2208.5For purposes of section 2208, "structure, language, and format" means style, arrangement and overall content of a benefit.
2208.6An issuer may use, in addition to the benefit plan designations required in subsection 2208.3, other designations to the extent permitted under District law.
2208.7Make-up of benefit plans:
(a) Standardized Medicare supplement benefit plan "A" shall be limited to the Basic ("Core") Benefits common to all benefit plans, as defined in subsection 2207.14;(b) Standardized Medicare supplement benefit plan "B" shall include only the following:(1) The Core Benefit as defined in subsection 2207.14; plus(2) The Medicare Part A Deductible as defined in subsection 2207.15(a);(c) Standardized Medicare supplement benefit plan "C" shall include only the following:(1) The Core Benefit as defined in subsection 2207.14; and(2) The Medicare Part A Deductible, Skilled Nursing Facility Care, Medicare Part B Deductible and Medically Necessary Emergency Care in a foreign Country as defined in subsection 2207.15(a), (b), (c), and (h);(d) Standardized Medicare supplement benefit plan "D" shall include only the following:(1) The Core Benefit as defined in subsection 2207.14; and(2) The Medicare Part A Deductible, Skilled Nursing Facility Care, Medically Necessary Emergency Care in an foreign Country and the At-Home Recovery Benefit as defined in subsections 2207.15(a) and (b), (h), and (j);(e) Standardized Medicare supplement benefit plan "E" shall include only the following:(1) The Core Benefit as defined in subsection 2207.14; and(2) The Medicare Part A Deductible, Skilled Nursing Facility Care, Medically Necessary Emergency Care in a foreign Country and Preventive Medical Care as defined in subsection 2207.5(a), (b), (h), and (i);(f)(1) Standardized Medicare supplement benefit plan "F" shall include only the following:(A) The Core Benefit as defined in subsection 2207.14; and(B) The Medicare Part A Deductible, the Skilled Nursing Facility Care, the Part B Deductible, One Hundred Percent (100%) of the Medicare Part B Excess Charges, and Medically Necessary Emergency Care in a foreign Country as defined in subsections 2207.15(a), (b), (c), (e), and (h);(2) Standardized Medicare supplement benefit high deductible "F" shall include only the following: 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 section 2207.14, plus the Medicare Part A deductible, skilled nursing facility care, the Medicare Part B deductible, one hundred percent (100%) of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in section 2207.15(a), (b), (c), (e), and (h). 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 $ 1500 for 1998 and 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).(g) Standardized Medicare supplement benefit plan "G" shall include only the following:(1) The Core Benefit as defined in subsection 2207.14; and(2) The Medicare Part A Deductible, the Skilled Nursing Facility Care, Eighty Percent (80%) of the Medicare Part B Excess Charges, Medically Necessary Emergency Care in a Foreign Country, and the At-Home Recovery Benefit as defined in subsections 2207.15(a), (b), (d), (h), and (j);(h) Standardized Medicare supplement benefit plan "H" shall consist of only the following:(1) The Core Benefit as defined in subsection 2207.14;(2) The Medicare Part A Deductible, Skilled Nursing Facility Care, Basic Prescription Drug Benefit and Medically Necessary Emergency Care in a Foreign Country as defined in subsections 2207.15(a), (b), (f), and (h); and(3) The outpatient prescription drug benefit shall not be included in a Medicare supplement policy sold after December 31, 2005.(i) Standardized Medicare supplement benefit plan "I" shall consist of only the following: (1) The Core Benefit as defined in subsection 2207.14;(2) The Medicare Part A Deductible, Skilled Nursing Facility Care, One Hundred Percent (100%) of the Medicare Part B Excess Charges, Basic Prescription Drug Benefit, Medically Necessary Emergency Care in a Foreign Country and At-Home Recovery Benefit as defined in subsections 2207.15(a), (b), (e), (f), (h), and (j); and(3) The outpatient prescription drug benefit shall not be included in a Medicare supplement policy sold after December 31, 2005;(j) Standardized Medicare supplement benefit plan "J" shall consist of only the following: (1) The Core Benefit as defined in subsection 2207.14; and(2) The Medicare Part A Deductible, Skilled Nursing Facility Care, Medicare Part B Deductible, One Hundred Percent (100%) of the Medicare Part B Excess Charges, Extended Prescription Drug Benefit, Medically Necessary Emergency Care in a foreign Country, Preventive Medical Care and At-Home Recovery Benefit as defined in subsections 2207.15(a), (b), (c), (e), (g), (h), (i), and (j); and(3) The outpatient prescription drug benefit shall not be included in a Medicare supplement policy sold after December 31, 2005; and(l) Standardized Medicare supplement benefit high deductible plan "J" shall consist of only the following: 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 section 2207 of this regulation, plus the Medicare Part A deductible, skilled nursing facility care, Medicare Part B deductible, one hundred percent (100%) of the Medicare Part B excess charges, extended outpatient prescription drug benefit, medically necessary emergency care in a foreign country, preventive medical care benefit and at-home recovery benefit as defined in sections 2207.15(a), (b), (c), (d), (h), (i) and (j) respectively. The annual high deductible plan "J" deductible shall consist of out-of-pocket expenses other than premiums for services covered by the Medicare supplement "J" policy, and shall be in addition to any other specific benefit deductibles. The annual deductible shall be fifteen hundred dollars ($1500) for 1998 and 1999, and shall be based on the calendar year. It shall include the annual adjustments made thereafter by the Secretary to reflect the change in the Consumer Price Index for all urban consumers for the twelve-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, 2005.2208.8Make-up of two Medicare supplement plans mandated by the Medicare Prescription Drug, Improvement and Modernization Act of 2003:
(a) Standardized Medicare supplement benefit plan "K" shall consist of only those benefits described in subsection 2207.16(a).(b) Standardized Medicare supplement benefit plan "L" shall consist of only those benefits described in subsection 2207.16(b).2208.9New 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.
D.C. Mun. Regs. tit. 26, r. 26-A2208
Final Rulemaking published at 46 DCR 10175 (December 17, 1999); as amended by Final Rulemaking published at 50 DCR 4166 (May 30, 2003); as amended by Final Rulemaking published at 50 DCR 5882 (July 25, 2003); as amended by Final Rulemaking published at 53 DCR 2955(April 14, 2006); as amended by Final Rulemaking published at 53 DCR 8467(October 20, 2006)Text of rule contains section 2208 a, created by Final Rulemaking published at 56 DCR 8840 (November 13, 2009).Authority: Sections 4, 5, 6, 9, and 11 of the Medicare Supplement Insurance Minimum Standards Act of 1992, effective July 22, 1992 (D.C. Law 9-170; D.C. Official Code §§ 31-3703, 31-3704, 31-3705, 31-3708 and 31-3710 (2001)), and section 4 of Department of Insurance and Securities Regulation Establishment Act of 1996, effective May 21 , 1997 (D.C. Law 11-268; D.C. Official Code § 31-103 (2009 Supp.))