Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 5 - Health Insurance Marketed as Medicare Supplements › 3 AAC 28.456 - Standard medicare supplement benefit plans for 2010 standardized medicare supplement benefit policies or certificates issued with an effective date of coverage on or after 6/1/2010

Current through May 31, 2024
(a) A medicare
				  supplement policy or certificate delivered or issued for delivery with an
				  effective date of coverage on or after June 1, 2010 may not be advertised,
				  solicited, delivered, or issued for delivery in this state as a medicare
				  supplement policy or certificate unless it complies with the benefit
				  requirements of this section.
(b)
				  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 set out in
				  3 AAC 28.454(m).
(c) If an issuer makes available any of the
				  additional benefits as set out in
				  3 AAC 28.454(n), or offers standardized
				  benefit plans "K" or "L" as set out in (g)(8) and (9) of this section, the
				  issuer shall make available to each prospective policyholder and certificate
				  holder, in addition to a policy form or certificate form with only the basic
				  core benefits as set out in
				  3 AAC 28.454(m), a policy form or
				  certificate form containing either standardized benefit plan "C" as set out in
				  (g)(3) of this section or standardized benefit plan "F" as set out in (g)(5) of
				  this section.
(d) An issuer may not
				  offer for sale in this state a group, package, or combination of medicare
				  supplement benefits other than those listed in this section, except as may be
				  permitted under (h) of this section.
(e) Medicare supplement benefit plans must be
				  uniform in structure, language, designation, and format to the standardized
				  benefit plans listed in (g) of this section and conform to the definitions
				  under 3 AAC 28.430 and
				  3 AAC 28.510. Each benefit must be structured in
				  accordance with the format provided in
				  3 AAC 28.454(m) and (n), or, in the
				  case of plans "K" or "L," in (g)(8) or (9) of this section, and list the
				  benefits in the order shown. For purposes of this section, "structure,
				  language, and format" means style, arrangement, and overall content of a
				  benefit.
(f) An issuer may use, in
				  addition to the benefit plan designations required in (e) of this section,
				  other designations to the extent permitted by law.
(g) The 2010 standardized medicare supplement
				  benefit plans must adhere to the following requirements:
(1) standardized medicare supplement benefit
				  plan "A" must be limited to the basic core benefits as set out in
				  3 AAC 28.454(m);
(2) standardized medicare supplement benefit
				  plan "B" must consist of the core benefit as set out in
				  3 AAC 28.454(m) plus the medicare Part
				  A deductible as set out in
				  3 AAC 28.454(n) (1);
(3) standardized medicare supplement benefit
				  plan "C" must consist of the core benefit as set out in
				  3 AAC 28.454(m) plus the medicare Part
				  A deductible, skilled nursing facility care, medicare Part B deductible, and
				  medically necessary emergency care provided in a foreign country as set out in
				  3 AAC 28.454(n) (1), (3), (4), and (6);
(4) standardized medicare supplement benefit
				  plan "D" must consist of the core benefit as set out in
				  3 AAC 28.454(m) plus the medicare Part
				  A deductible, skilled nursing facility care, and medically necessary emergency
				  care provided in a foreign country as set out in
				  3 AAC 28.454(n) (1), (3), and (6);
(5) standardized medicare supplement plan "F"
				  must consist of the core benefit as set out in
				  3 AAC 28.454(m) 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 provided in a foreign country as set out in
				  3 AAC 28.454(n) (1) and (3) -
				  (6);
(6) standardized medicare
				  supplement high deductible plan "F" must consist of all of the covered expenses
				  following the payment of the annual high deductible plan "F" deductible subject
				  to the following:
(A) the covered expenses
				  include the basic core benefit as set out in
				  3 AAC 28.454(m) 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 provided in a foreign country as set out in
				  3 AAC 28.454(n) (1) and (3) -
				  (6);
(B) the annual high deductible
				  plan "F" deductible must consist of out-of-pocket expenses, other than
				  premiums, for services covered by the medicare supplement plan "F" policy, and
				  must be in addition to any other specific benefit deductibles;
(C) the annual high deductible plan "F"
				  deductible must be $1,500 for 1999, based on the calendar year, to be adjusted
				  annually after that 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, rounded to the nearest multiple of $10;
(7) standardized Medicare
				  supplement benefit plan "G" must consist of the core benefit as set out in
				  3 AAC 28.454(m) plus the Medicare Part
				  A deductible, skilled nursing facility care, 100 percent of the Medicare Part B
				  excess charges, and medically necessary emergency care provided in a foreign
				  country as set out in
				  3 AAC 28.454(n)(1), (3), (5), and (6);
				  on or after January 1.2020, an issuer may offer a standardized benefit plan
				  under 3 AAC 28.461(g)(8) to a person who was eligible for Medicare before
				  January 1, 2020.
(8) standardized
				  medicare supplement plan "K;" must consist of the following benefits:
(A) coverage of 100 percent of the medicare
				  Part A hospital coinsurance amount for each day used from the 61st through the
				  90th day in any medicare benefit period;
(B) coverage of 100 percent of the medicare
				  Part A hospital coinsurance amount for each medicare lifetime inpatient reserve
				  day used from the 91st through the 150th day in any medicare benefit
				  period;
(C) upon exhaustion of the
				  medicare hospital inpatient coverage, including the lifetime reserve days,
				  coverage of 100 percent of the medicare Part A eligible expenses for
				  hospitalization paid at the applicable prospective payment system (PPS) rate or
				  other appropriate medicare standard of payment, subject to a lifetime maximum
				  benefit of an additional 365 days;
(D) coverage for 50 percent of the medicare
				  Part A inpatient hospital deductible amount per benefit period until the
				  out-of-pocket limitation is met as set out in (J) of this paragraph;
(E) coverage for 50 percent of the
				  coinsurance amount for each day used from the 21st day through the 100th day in
				  a medicare benefit period for post-hospital skilled nursing facility care
				  eligible under medicare Part A until the out-of-pocket limitation is met as set
				  out in (J) of this paragraph;
(F)
				  coverage for 50 percent of cost sharing for all medicare Part A eligible
				  expenses and respite care until the out-of-pocket limitation is met as set out
				  in (J) of this paragraph;
(G)
				  coverage for 50 percent under medicare Part A or Part B of the reasonable cost
				  of the first three pints of blood, or an equivalent quantity of packed red
				  blood cells as defined under federal regulations, unless replaced in accordance
				  with federal regulations until the out-of-pocket limitation is met as set out
				  in (J) of this paragraph;
(H)
				  except for coverage provided under (I) of this paragraph, coverage for 50
				  percent of the cost sharing otherwise applicable under medicare Part B after
				  the policyholder pays the Part B deductible until the out-of-pocket limitation
				  is met as set out in (J) of this paragraph;
(I) coverage of 100 percent of the cost
				  sharing for medicare Part B preventive services after the policyholder pays the
				  Part B deductible;
(J) coverage of
				  100 percent of all cost sharing under medicare Part A and Part B for the
				  balance of the calendar year after the individual has reached the out-of-pocket
				  limitation on annual expenditures under medicare Part A and Part B of $4,000 in
				  2006, indexed each year by the appropriate inflation adjustment specified by
				  the secretary;
(9)
				  standardized medicare supplement plan "L" and must consist of the benefits set
				  out in
(A) the provisions of (8)(A), (B),
				  (C), and (I) of this subsection;
(B) the provisions of (8)(D), (E), (F), (G),
				  and (H) of this subsection, but substituting 75 percent for 50 percent in each
				  of those subparagraphs; and
(C) the
				  provisions of (8)(J) of this subsection, but substituting $2,000 for $4,000 in
				  that subparagraph;
(10)
				  standardized medicare supplement plan "M" must consist of the core benefit as
				  set out in 3 AAC 28.454(m),
				  plus 50 percent of the medicare Part A deductible, skilled nursing facility
				  care, and medically necessary emergency care provided in a foreign country as
				  set out in 3 AAC 28.454(n) (2), (3), and (6);
(11) standardized medicare supplement plan
				  "N" must consist of the core benefit as set out in
				  3 AAC 28.454(m) plus 100 percent of the
				  medicare Part A deductible, skilled nursing facility care, and medically
				  necessary emergency care provided in a foreign country as set out in
				  3 AAC 28.454(n) (1), (3), and (6), with
				  copayments of
(A) the lesser of $20 or the
				  medicare Part B coinsurance or copayment for each covered health care provider
				  office visit, including visits to medical specialists; and
(B) the lesser of $50 or the medicare Part B
				  coinsurance or copayment for each covered emergency room visit; this copayment
				  will be waived if the insured is admitted to any hospital and the emergency
				  visit is subsequently covered as a medicare Part A expense.