Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 12 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 16-12-6 - Standard Medicare supplement benefit plans for 1990 standardized Medicare supplement benefit plan policies or certificates issued or delivered on or after September 3, 1992, and with an effective date for coverage prior to June 1, 2010

Current through June, 2024
(a) 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 defined in subsection
			 16-12-5.5(c).
(b) No groups, packages, or combinations of
			 Medicare supplement benefits other than those listed in this section shall be
			 offered for sale in this State, except as may be permitted in subsection (g)
			 and section
			 16-12-6.1.
(c) Benefit plans shall be uniform in
			 structure, language, designation, and format to the standard benefit plans "A"
			 through "L" listed in subsection (e) and conform to the definitions in section
			 16-12-3.
			 Each benefit shall be structured in accordance with the format provided in
			 subsections (c) and (d) or (e) of section
			 16-12-5.5
			 and list the benefits in the order shown in this subsection (Exhibit A (revised
			 2019)). For purposes of this section, "structure, language, and format" means
			 style, arrangement, and overall content of a benefit.
(d) An issuer may use, in addition to the
			 benefit plan designations required in subsection (c), other designations to the
			 extent permitted by law.
(e) The
			 composition of the benefit plans is as follows:
(1) Standardized Medicare supplement benefit
			 plan "A" shall be limited to the basic ("core") benefits common to all benefit
			 plans, as defined in subsection
			 16-12-5.5(c);
(2) Standardized Medicare supplement benefit
			 plan "B" shall include only the following: The core benefit as defined in
			 subsection
			 16-12-5.5(c),
			 plus the Medicare Part A deductible as defined in paragraph
			 16-12-5.5(d)(1);
(3) Standardized Medicare supplement benefit
			 plan "C" shall include only the following: The core benefit as defined in
			 subsection
			 16-12-5.5(c),
			 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 paragraphs
			 16-12-5.5(d)(1),
			 (2), (3), and (8), respectively;
(4) Standardized Medicare supplement benefit
			 plan "D" shall include only the following: The core benefit as defined in
			 subsection
			 16-12-5.5(c),
			 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 paragraphs
			 16-12-5.5(d)(1),
			 (2), (8), and (10), respectively;
(5) Standardized Medicare supplement benefit
			 plan "E" shall include only the following: The core benefit as defined in
			 subsection
			 16-12-5.5(c),
			 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 paragraphs
			 16-12-5.5(d)(1),
			 (2), (8), and (9), respectively;
(6) Standardized Medicare supplement benefit
			 plan "F" shall include only the following: The core benefit as defined in
			 subsection
			 16-12-5.5(c),
			 plus the Medicare Part A deductible, the skilled nursing facility care, the
			 Part B deductible, 100 per cent of the Medicare Part B excess charges, and
			 medically necessary emergency care in a foreign country as defined in
			 paragraphs
			 16-12-5.5(d)(1),
			 (2), (3), (5), and (8),
			 respectively;
(7) Standardized
			 Medicare supplement benefit high deductible plan "F" shall include only the
			 following: 100 per cent of covered expenses following the payment of the annual
			 high deductible plan "F" deductible. The covered expenses include the core
			 benefit as defined in subsection
			 16-12-5.5(c)
			 of this regulation, plus the Medicare Part A deductible, skilled nursing
			 facility care, the Medicare Part B deductible, 100 per cent of the Medicare
			 Part B excess charges, and medically necessary emergency care in a foreign
			 country as defined in paragraphs
			 16-12-5.5(d)(1),
			 (2), (3), (5), and (8), respectively. 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 $1,500 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-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 subsection
			 16-12-5.5(c),
			 plus the Medicare Part A deductible, skilled nursing facility care, 80 per cent
			 of the Medicare Part B excess charges, medically necessary emergency care in a
			 foreign country, and the at-home recovery benefit as defined in paragraphs
			 16-12-5.5(d)(1),
			 (2), (4), (8), and (10),
			 respectively;
(9) Standardized
			 Medicare supplement benefit plan "H" shall consist of only the following: The
			 core benefit as defined in subsection
			 16-12-5.5(c),
			 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 paragraphs
			 16-12-5.5(d)(1),
			 (2), (6), and (8), respectively. The
			 outpatient prescription drug benefit shall not be included in a Medicare
			 supplement policy sold after December 31, 2005;
(10) Standardized Medicare supplement benefit
			 plan "I" shall consist of only the following: The core benefit as defined in
			 subsection
			 16-12-5.5(c),
			 plus the Medicare Part A deductible, skilled nursing facility care, 100 per
			 cent 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 paragraphs
			 16-12-5.5(d)(1),
			 (2), (5), (6), (8), and (10), respectively.
			 The outpatient prescription drug benefit shall not be included in a Medicare
			 supplement policy sold after December 31, 2005;
(11) Standardized Medicare supplement benefit
			 plan "J" shall consist of only the following: The core benefit as defined in
			 subsection
			 16-12-5.5(c),
			 plus the Medicare Part A deductible, skilled nursing facility care, Medicare
			 Part B deductible, 100 per cent 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
			 paragraphs
			 16-12-5.5(d)(1),
			 (2), (3), (5), (7), (8), (9), and (10),
			 respectively. The outpatient prescription drug benefit shall not be included in
			 a Medicare supplement policy sold after December 31, 2005; and
(12) Standardized Medicare supplement benefit
			 high deductible plan "J" shall consist of only the following: 100 per cent of
			 covered expenses following the payment of the annual high deductible plan "J"
			 deductible. The covered expenses include the core benefit as defined in
			 subsection
			 16-12-5.5(c)
			 of this regulation, plus the Medicare Part A deductible, skilled nursing
			 facility care, Medicare Part B deductible, 100 per cent 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 paragraphs
			 16-12-5.5(d)(1),
			 (2), (3), (5), (7), (8), (9) and (10),
			 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 plan "J" policy, and shall be in addition to any other
			 specific benefit deductibles. The annual deductible shall be $1,500 for 1998
			 and 1999, and shall be based on a 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-month period ending with August of the
			 preceding year, and rounded to the nearest multiple of $10. The outpatient
			 prescription drug benefit shall not be included in a Medicare supplement policy
			 sold after December 31, 2005.