Illinois Administrative Code › Title 50 - INSURANCE › Part 2008 - MINIMUM STANDARDS FOR INDIVIDUAL AND GROUP MEDICARE SUPPLEMENT INSURANCE › Subpart B - COVERAGE, POLICY & BENEFIT PROVISIONS › Section 2008.67 - Standard Medicare Supplement Benefit Plans for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date for Coverage on or after June 1, 2010

Current through Register Vol. 48, No. 28, July 12, 2024
The following standards are applicable to all Medicare
				  supplement policies or certificates delivered or issued for delivery in this
				  State with an effective date for coverage on or after June 1, 2010. No policy
				  or certificate may be advertised, solicited, delivered or issued for delivery
				  in this State as a Medicare supplement policy or certificate unless it complies
				  with these benefit plan standards. Benefit plan standards applicable to
				  Medicare supplement policies and certificates issued with an effective date for
				  coverage before June 1, 2010 remain subject to the requirements of Section
				  2008.70
				  for Pre-Standardized Plans or Section
				  2008.71
				  for 1990 Plans.
a) An issuer shall
				make available to each prospective policyholder and certificateholder a policy
				form or certificate form containing only the basic (core) benefits, as defined
				in Section
				2008.64(b).
b) If an issuer makes available any of the
				additional benefits described in Section
				2008.64(c),
				or offers standardized benefit Plans K or L as described in subsections (f)(8)
				and (9) of this Section, then the issuer shall make available to each
				prospective policyholder and certificateholder, in addition to a policy form or
				certificate form with only the basic (core) benefits as described in subsection
				(a), a policy form or certificate form containing either standardized benefit
				Plan C as described in subsection (f)(3) or standardized benefit Plan F as
				described in subsection (f)(5).
c)
				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 in Section
				2008.73.
d) Benefit plans shall be uniform in
				structure, language, designation and format to the standard benefit plans
				listed in this subsection and conform to the definitions in Sections
				2008.40 and
				2008.50.
				Each benefit shall be structured in accordance with the format provided in
				Section
				2008.64(b)
				and (c); or, in the case of plans K or L, in
				subsection (f)(8) or (f)(9) 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.
e) In addition to the benefit plan
				designations required in subsection (d) of this Section, an issuer may use
				other designations to the extent permitted by law.
f) Make-up of 2010 Standardized Benefit
				Plans:
1) Standardized Medicare supplement
				benefit Plan A shall include only the following: The basic (core) benefits as
				defined in Section
				2008.64(b).
2) Standardized Medicare supplement benefit
				Plan B shall include only the following: The basic (core) benefit as defined in
				Section
				2008.64(b),
				plus 100% of the Medicare Part A deductible as defined in Section
				2008.64(c)(1).
3) Standardized Medicare supplement benefit
				Plan C shall include only the following: The basic (core) benefit as defined in
				Section
				2008.64(b),
				plus 100% of the Medicare Part A deductible, skilled nursing facility care,
				100% of the Medicare Part B deductible, and medically necessary emergency care
				in a foreign country as defined in Section
				2008.64(c)(1),
				(3), (4), and (6), respectively.
4) Standardized Medicare supplement benefit
				Plan D shall include only the following: The basic (core) benefit (as defined
				in Section
				2008.64(b)
				of this Part), plus 100% of the Medicare Part A deductible, skilled nursing
				facility care, and medically necessary emergency care in an foreign country as
				defined in Section
				2008.64(c)(1),
				(3), and (6), respectively.
5) Standardized Medicare supplement (regular)
				Plan F shall include only the following: The basic (core) benefit as defined in
				Section
				2008.64(b),
				plus 100% of the Medicare Part A deductible, the skilled nursing facility care,
				100% of the Medicare Part B deductible, 100% of the Medicare Part B excess
				charges, and medically necessary emergency care in a foreign country as defined
				in Section
				2008.64(c)(1),
				(3), (4), (5), and (6),
				respectively.
6) Standardized
				Medicare supplement Plan F With High Deductible shall include only the
				following: 100% of covered expenses following the payment of the annual
				deductible set forth in subsection (f)(6)(B).
A) The basic (core) benefit as defined in
				Section
				2008.64(b),
				plus 100% of the Medicare Part A deductible, skilled nursing facility care,
				100% of the Medicare Part B deductible, 100% of the Medicare Part B excess
				charges, and medically necessary emergency care in a foreign country as defined
				in Section
				2008.64(c)(1),
				(3), (4), (5), and (6),
				respectively.
B) The annual
				deductible in Plan F With High Deductible shall consist of out-of-pocket
				expenses, other than premiums, for services covered by (regular) Plan F, and
				shall be in addition to any other specific benefit deductibles. The basis for
				the deductible shall be $1,500 and shall be adjusted annually from 1999 by the
				Secretary of the U.S. Department of Health and Human Services 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.
7)
				Standardized Medicare supplement benefit Plan G shall include only the
				following: The basic (core) benefit as defined in Section
				2008.64(b),
				plus 100% of the Medicare Part A deductible, skilled nursing facility care,
				100% of the Medicare Part B excess charges, and medically necessary emergency
				care in a foreign country as defined in Section
				2008.64(c)(1),
				(3), (5), and (6), respectively. Effective
				January 1, 2020, the standardized benefit plans described in Section
				2008.63(a)(4) (Redesignated Plan G with High Deductible) may be offered to any
				individual who was eligible for Medicare prior to January 1, 2020.
8) Standardized Medicare supplement Plan K is
				mandated by the Medicare Prescription Drug, Improvement and Modernization Act
				of 2003, and shall include only the following:
A) Part A Hospital Coinsurance
				61st through 90th days:
				Coverage of 100% of the Part A hospital coinsurance amount for each day used
				from the 61st through the
				90th day in any Medicare benefit period;
B) Part A Hospital Coinsurance,
				91st through 150th days:
				Coverage of 100% of the 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) Part A Hospitalization
				After 150 Days: Upon exhaustion of the Medicare hospital inpatient coverage,
				including the lifetime reserve days, coverage of 100% 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. The provider
				shall accept the issuer's payment as payment in full and may not bill the
				insured for any balance;
D)
				Medicare Part A Deductible: Coverage for 50% of the Medicare Part A inpatient
				hospital deductible amount per benefit period until the out-of-pocket
				limitation is met as described in subsection (f)(8)(J);
E) Skilled Nursing Facility Care: Coverage
				for 50% 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 described in subsection
				(f)(8)(J);
F) Hospice Care:
				Coverage for 50% of cost sharing for all Part A Medicare eligible expenses and
				respite care until the out-of-pocket limitation is met as described in
				subsection (f)(8)(J);
G) Blood:
				Coverage for 50%, under Medicare Part A or B, of the reasonable cost of the
				first 3 pints of blood (or equivalent quantities 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 described in
				subsection (f)(8)(J);
H) Part B
				Cost Sharing: Except for coverage provided in subsection (f)(8)(I), coverage
				for 50% 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 described in subsection (f)(8)(J);
I) Part B Preventive Services: Coverage of
				100% of the cost sharing for Medicare Part B preventive services after the
				policyholder pays the Part B deductible; and
J) Cost Sharing After Out-of-Pocket Limits:
				Coverage of 100% of all cost sharing under Medicare Parts A and B for the
				balance of the calendar year after the individual has reached the out-of-pocket
				limitation on annual expenditures under Medicare Parts A and B of $4000 in
				2006, indexed each year by the appropriate inflation adjustment specified by
				the Secretary of the U.S. Department of Health and Human Services.
9) Standardized Medicare
				supplement Plan L is mandated by the Medicare Prescription Drug, Improvement
				and Modernization Act of 2003, and shall include only the following:
A) The benefits described in subsections
				(f)(8)(A), (B), (C) and (I);
B) The
				benefit described in subsections (f)(8)(D), (E), (F), (G) and (H), but
				substituting 75% for 50%; and
C)
				The benefit described in subsection (f)(8)(J), but substituting $2000 for
				$4000.
10) Standardized
				Medicare supplement Plan M shall include only the following: The basic (core)
				benefit as defined in Section
				2008.64(b),
				plus 50% of the Medicare Part A deductible, skilled nursing facility care, and
				medically necessary emergency care in a foreign country as defined in Section
				2008.64(c)(2),
				(3) and (6), respectively.
11) Standardized Medicare supplement Plan N
				shall include only the following: The basic (core) benefit as defined in
				Section
				2008.64(b),
				plus 100% of the Medicare Part A deductible, skilled nursing facility care, and
				medically necessary emergency care in a foreign country as defined in Section
				2008.64(c)(1),
				(3) and (6), respectively, with copayments in
				the following amounts:
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; however, this
				copayment shall be waived if the insured is admitted to any hospital and the
				emergency visit is subsequently covered as a Medicare Part A expense.