Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-8 - MEDICARE SUPPLEMENT INSURANCE › Rule 120-2-8-.09 - Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After September 8, 2005 and With an Effective Date for Coverage Prior to June 1, 2010

Current through Rules and Regulations filed through June 27, 2024
(1) 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
				120-2-8-.08(2) of
				this regulation.
(2) 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 Section
				120-2-8-.09(7) and
				in Section
				120-2-8-.10 of this
				regulation.
(3) Benefit plans shall
				be uniform in structure, language, designation and format to the standard
				benefit plans "A" through "L" listed in this subsection and conform to the
				definitions in
				120-2-8-.04 of this regulation. Each
				benefit shall be structured in accordance with the format provided in Sections
				120-2-8-.08(2) and
				120-2-8-.08(3), or
				120-2-8-.08(4) and
				list the benefits in the order shown in this subsection. For purposes of this
				section," structure, language, and format" means style, arrangement and overall
				content of a benefit.
(4) An issuer
				may use, in addition to the benefit plan designations required in Subsection
				(3), other designations to the extent permitted by law.
(5) Make-up of benefit plans:
(a) Standardized Medicare supplement benefit
				plan "A" shall be limited to the basic (core) benefits common to all benefit
				plans, as defined in Section
				120-2-8-.08(2) of
				this regulation.
(b) Standardized
				Medicare supplement benefit plan "B" shall include only the following: The core
				benefit as defined in Section
				120-2-8-.08(2) of
				this regulation, plus the Medicare Part A deductible as defined in Section
				120-2-8-.08(3)(a).
(c) Standardized Medicare supplement benefit
				plan "C" shall include only the following: The core benefit as defined in
				Section 120-2-8-.08(2) of
				this regulation, 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 Sections
				120-2-8-.08(3)(a), (b), (c) and
				(h) respectively.
(d) Standardized Medicare supplement benefit
				plan "D" shall include only the following: The core benefit (as defined in
				Section 120-2-8-.08(2) of
				this regulation), plus the Medicare Part A deductible, skilled nursing facility
				care, medically necessary emergency care in an foreign country and the at-home
				recovery benefit as defined in Sections
				120-2-8-.08(3)(a), (b), (h) and
				(j) respectively.
(e) Standardized Medicare supplement benefit
				plan "E" shall include only the following: The core benefit as defined in
				Section 120-2-8-.08(2) of
				this regulation, 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 Sections
				120-2-8-.08(3)(a), (b), (h) and
				(i) respectively.
(f) Standardized Medicare supplement benefit
				plan "F" shall include only the following: The core benefit as defined in
				Section 120-2-8-.08(2) of
				this regulation, plus the Medicare Part A deductible, the skilled nursing
				facility care, the Part B deductible, one hundred percent (100%) of the
				Medicare Part B excess charges, and medically necessary emergency care in a
				foreign country as defined in Sections
				120-2-8-.08(3)(a), (b), (c), (e) and
				(h) respectively.
(g) Standardized Medicare supplement benefit
				high deductible plan "F" shall include only the following: 100% of covered
				expenses following the payment of the annual high deductible plan "F"
				deductible. The covered expenses include the core benefit as defined in Section
				120-2-8-.08(2) of
				this regulation, plus the Medicare Part A deductible, skilled nursing facility
				care, the Medicare Part B deductible, one hundred percent (100%) of the
				Medicare Part B excess charges, and medically necessary emergency care in a
				foreign country as defined in Sections
				120-2-8-.08(3)(a), (b), (c), (e) and
				(h) 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 $1500 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.
(h) Standardized Medicare supplement benefit
				plan "G" shall include only the following: The core benefit as defined in
				Section 120-2-8-.08(2) of
				this regulation, plus the Medicare Part A deductible, skilled nursing facility
				care, eighty percent (80%) of the Medicare Part B excess charges, medically
				necessary emergency care in a foreign country, and the at-home recovery benefit
				as defined in Sections
				120-2-8-.08(3)(a), (b), (d), (h) and
				(j) respectively.
(i) Standardized Medicare supplement benefit
				plan "H" shall consist of only the following: The core benefit as defined in
				Section 120-2-8-.08(2) of
				this regulation, 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 Sections
				120-2-8-.08(3)(a), (b), (f) and
				(h) respectively. The outpatient prescription
				drug benefit shall not be included in a Medicare supplement policy sold after
				December 31, 2005.
(j) Standardized
				Medicare supplement benefit plan "I" shall consist of only the following: The
				core benefit as defined in Section
				120-2-8-.08(2) of
				this regulation, plus the Medicare Part A deductible, skilled nursing facility
				care, one hundred percent (100%) 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 Sections
				120-2-8-.08(3)(a), (b), (e), (f), (h) and
				(j) respectively. The outpatient prescription
				drug benefit shall not be included in a Medicare supplement policy sold after
				December 31, 2005.
(k) Standardized
				Medicare supplement benefit plan "J" shall consist of only the following: The
				core benefit as defined in Section
				120-2-8-.08(2) of
				this regulation, plus the Medicare Part A deductible, skilled nursing facility
				care, Medicare Part B deductible, one hundred percent (100%) 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 Sections
				120-2-8-.08(3)(a), (b), (c), (e), (g), (h), (i) and
				(j) respectively. The outpatient prescription
				drug benefit shall not be included in a Medicare supplement policy sold after
				December 31, 2005.
(l) Standardized
				Medicare supplement benefit high deductible plan "J" shall consist of only the
				following: 100% of covered expenses following the payment of the annual high
				deductible plan "J" deductible. The covered expenses include the core benefit
				as defined in Section
				120-2-8-.08(2) of
				this regulation, plus the Medicare Part A deductible, skilled nursing facility
				care, Medicare Part B deductible, one hundred percent (100%) 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 Sections
				120-2-8-.08(3)(a), (b), (c), (e), (g), (h), (i) and
				(j) 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 $1500 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.