Section 0780-01-58-.12 - STANDARD MEDICARE SUPPLEMENT BENEFIT PLANS FOR 2020 STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN POLICIES OR CERTIFICATES ISSUED FOR DELIVERY ON OR AFTER JANUARY 1, 2020The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires the following standards which are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state to individuals newly eligible for Medicare on or after January 1, 2020. No policy or certificate that provides coverage of the Medicare Part B deductible may be advertised, solicited, delivered, or issued for delivery in this state as a Medicare supplement policy or certificate to individuals newly eligible for Medicare on or after January 1, 2020. All policies must comply with the following benefit standards. Benefit plan standards applicable to Medicare supplement policies and certificates issued to individuals eligible for Medicare before January 1, 2020, remain subject to the requirements of T.C.A. Title 56, Chapter 7, Part 14 and all applicable benefit standards in Rules 0780-01-58-.07 and 0780-01-58-.08 of this Chapter.
(1) Benefit Requirements. The standards and requirements of Rule 0780-01-58-.11 shall apply to all Medicare supplement policies or certificates delivered or issued for delivery to individuals newly eligible for Medicare on or after January 1, 2020, with the following exceptions: (a) Standardized Medicare supplement benefit Plan C is redesignated as Plan D and shall provide the benefits contained in Rule 0780-01-58-.11(5)(c) of this Chapter but shall not provide coverage for one hundred percent (100%) or any portion of the Medicare Part B deductible.(b) Standardized Medicare supplement benefit Plan F is redesignated as Plan G and shall provide the benefits contained in Rule 0780-01-58-.11(5)(e) of this Chapter but shall not provide coverage for one hundred percent (100%) or any portion of the Medicare Part B deductible.(c) Standardized Medicare supplement benefit plans C, F, and F with High Deductible may not be offered to individuals newly eligible for Medicare on or after January 1, 2020.(d) Standardized Medicare supplement benefit Plan F with High Deductible is redesignated as Plan G with High Deductible and shall provide the benefits contained in Rule 0780-01-58-.11(5)(f) of this Chapter but shall not provide coverage for one hundred percent (100%) or any portion of the Medicare Part B deductible; provided further that, the Medicare Part B deductible paid by the beneficiary shall be considered an out-of-pocket expense in meeting the annual high deductible.(e) The reference to Plans C or F contained in Rule 0780-01-58-.11(1)(b) is deemed a reference to Plans D or G for purposes of this Rule.(2) Applicability to Certain Individuals. This Rule applies only to individuals that are newly eligible for Medicare on or after January 1, 2020:(a) By reason of attaining the age of 65 on or after January 1, 2020; or(b) By reason of entitlement to benefits under Part A pursuant to Section 226(b) or 226A of the Social Security Act, or who are deemed to be eligible for benefits under Section 226(a) of the Social Security Act on or after January 1, 2020.(3) Guaranteed Issue for Eligible Persons. For purposes of Rule 0780-01-58-.15(5), in the case of any individual newly eligible for Medicare on or after January 1, 2020, any reference to a Medicare supplement policy C or F (including F with High Deductible) shall be deemed to be a reference to Medicare supplement policy D or G (including G with High Deductible), respectively, that meet the requirements of Rule 0780-01-58-.12.(4) Offer of Redesignated Plans to Individuals Other Than Newly Eligible. On or after January 1, 2020, the standardized benefit plans described in subparagraph (1)(d) above may be offered to any individual who was eligible for Medicare prior to January 1, 2020, in addition to the standardized plans described in Rule 0780-01-58-.11(5) of this Rule.Tenn. Comp. R. & Regs. 0780-01-58-.12
New rule filed November 20, 2018; effective 2/18/2019.Authority: T.C.A. §§ 56-2-301; 56-6-112; 56-6-124(a); 56-7-1401, et seq.; 56-7-1501, et seq.; 56-7-1503; 56-7-1504; 56-7-1505; 56-7-1507; and 56-32-118(a); Omnibus Budget Reconciliation Act of 1990, Pub. L. No. 101-508, (1990); Genetic Information Non Discrimination Act, Pub. L. No. 110-233 (2008); Medicare Improvements for Patients and Providers Act, Pub. L. No. 110-275 (2008); and Medicare Access and CHIP Reauthorization Act, Pub. L. No. 114-10 (2015).