Md. Code Regs. 31.10.06.09

Current through Register Vol. 51, No. 24, December 2, 2024

Section 31.10.06.09 - Standard Medicare Supplement Benefit Plans for 1990 Plans

A. Definitions.

(1) In this regulation, the following term has the meaning indicated.

(2) Term Defined. "Structure, language, and format" means style, arrangement, and overall content of a benefit.

B. General Standards.

(1) The standards found in §§C-I of this regulation are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this State on or after July 14, 1992, and with an effective date for coverage before June 1, 2010.

(2) A policy or certificate may not be advertised, solicited, delivered, or issued for delivery in this State as a Medicare supplement policy or certificate during the time period described in §B(1) of this regulation unless it complies with the benefit plan standards described in this regulation.

C. An issuer shall make available to each prospective policyholder and certificate holder a policy form or certificate form containing only the core benefits, as defined in Regulation .08C of this chapter.

D. Groups, packages, or combinations of Medicare supplement benefits other than those listed in this regulation may not be offered for sale in this State, except as may be permitted in §I of this regulation and Regulation .24 of this chapter.

E. Structure of Benefits.

(1) Benefit plans shall be uniform in structure, language, designation, and format to the standard benefit plans A through L listed in this regulation and conform to the definitions in Regulations .02 and .03 of this chapter.

(2) Each benefit shall be structured in accordance with the format provided in Regulation .08C-E of this chapter and list the benefits in the order shown in this regulation.

F. An issuer may use, in addition to the benefit plan designations required in §E of this regulation, other designations to the extent permitted by law.

G. Make-up of 1990 Standardized 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 Regulation .08C of this chapter.

(2) Standardized Medicare supplement benefit plan B shall include only the following: The core benefit as defined in Regulation .08C of this chapter, plus the Medicare Part A Deductible as defined in Regulation .08D(1) of this chapter.

(3) Standardized Medicare supplement benefit plan C shall include only the following: The core benefit as defined in Regulation .08C of this chapter, plus 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 Regulation .08D(1), (2), (3), and (8) of this chapter.

(4) Standardized Medicare supplement benefit plan D shall include only the following: The core benefit, as defined in Regulation .08C of this chapter, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medically Necessary Emergency Care in a Foreign Country, and the At-Home Recovery Benefit as defined in Regulation .08D(1), (2), (8), and (10) of this chapter.

(5) Standardized Medicare supplement benefit plan E shall include only the following: The core benefit as defined in Regulation .08C of this chapter, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medically Necessary Emergency Care in a Foreign Country, and Preventive Medical Care as defined in Regulation .08D(1), (2), (8), and (9) of this chapter.

(6) Standardized Medicare supplement benefit plan F shall include only the following: The core benefit as defined in Regulation .08C of this chapter, plus the Medicare Part A Deductible, the Skilled Nursing Facility Care, the Part B Deductible, 100 Percent of the Medicare Part B Excess Charges, and Medically Necessary Emergency Care in a Foreign Country as defined in Regulation .08D(1), (2), (3), (5), and (8) of this chapter.

(7) High Deductible Plan F.

(a) Standardized Medicare supplement benefit high deductible plan F shall include only 100 percent of covered expenses following the payment of the annual high deductible plan F deductible.

(b) The covered expenses include the core benefit as defined in Regulation .08C of this chapter, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, the Medicare Part B Deductible, 100 Percent of the Medicare Part B Excess Charges, and Medically Necessary Emergency Care in a Foreign Country as defined in Regulation .08D(1)-(3), (5), and (8) of this chapter.

(c) 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 is in addition to any other specific benefit deductibles.

(d) The annual high deductible plan F deductible is $1,500 for 1999, and is based on the calendar year.

(e) The deductible shall be adjusted annually after 1999 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: The core benefit as defined in Regulation .08C of this chapter, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, 80 Percent of the Medicare Part B Excess Charges, Medically Necessary Emergency Care in a Foreign Country, and the At-Home Recovery Benefit as defined in Regulation .08D(1), (2), (4), (8), and (10) of this chapter.

(9) Standardized Medicare Supplement Benefit Plan H.

(a) Standardized Medicare supplement benefit plan H shall consist of only the following: The core benefit as defined in Regulation .08C of this chapter, plus 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 Regulation .08D(1), (2), (6), and (8) of this chapter.

(b) The outpatient prescription drug benefit may not be included in a Medicare supplement policy sold after December 31, 2005.

(10) Standardized Medicare Supplement Benefit Plan I.

(a) Standardized Medicare supplement benefit plan I shall consist of only the following: The core benefit as defined in Regulation .08C of this chapter, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, 100 Percent 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 Regulation .08D(1), (2), (5), (6), (8), and (10) of this chapter.

(b) The outpatient prescription drug benefit may not be included in a Medicare supplement policy sold after December 31, 2005.

(11) Standardized Medicare Supplement Benefit Plan J.

(a) Standardized Medicare supplement benefit plan J shall consist of only the following: The core benefit as defined in Regulation .08C of this chapter, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medicare Part B Deductible, 100 Percent 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 Regulation .08D(1)-(3) and (5)-(10) of this chapter.

(b) The outpatient prescription drug benefit may not be included in a Medicare supplement policy sold after December 31, 2005.

(12) High Deductible Plan J.

(a) Standardized Medicare supplement benefit high deductible plan J shall consist of only 100 percent of covered expenses following the payment of the annual high deductible plan J deductible.

(b) The covered expenses include the core benefit as defined in Regulation .08C of this chapter, plus the Medicare Part A deductible, skilled nursing facility care, Medicare Part B deductible, 100 percent 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 Regulation .08D(1)-(3), (5), and (7)-(10) of this chapter.

(c) 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 is in addition to any other specific benefit deductibles.

(d) The annual deductible is $1,500 for 1999 and is based on a calendar year.

(f) The outpatient prescription drug benefit may not be included in a Medicare supplement policy sold after December 31, 2005.

H. Plans Mandated by the Medicare Prescription Drug, Improvement and Modernization Act of 2003.

(1) Standardized Medicare supplement benefit plan K shall consist of only those benefits described in Regulation .08E(1) of this chapter.

(2) Standardized Medicare supplement benefit plan L shall consist of only those benefits described in Regulation .08E(3) of this chapter.

I. New or Innovative Benefits.

(1) 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.

(2) The new or innovative benefits described in §I(1) of this regulation may include benefits that are 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 Medicare supplement policies.

(3) After December 31, 2005, the innovative benefit may not include an outpatient prescription drug benefit.

Md. Code Regs. 31.10.06.09

Regulations .09 adopted as an emergency provision effective July 14, 1992 (19:16 Md. R. 1466); adopted permanently effective August 3, 1992 (19:15 Md. R. 1389)
Regulation .09 amended as an emergency provision effective January 1, 1999 (26:1 Md. R. 18); amended permanently effective March 22, 1999 (26:6 Md. R. 489)
Regulation .09 amended effective September 21, 2009 (36:19 Md. R. 1439)