Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-6 - Standard Medicare supplement benefit plans for 1992 standardized Medicare supplement benefit plan policies or certificates issued for delivery on or after July 30, 1992 and with an effective date for coverage prior to June 1, 2010

Current through July 10, 2024
(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
			 38a-495a-5(b)
			 of the Regulations of Connecticut State Agencies.
(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 sections
			 38a-495a-6(f)
			 (3) and 38a-495a-7 of the Regulations of Connecticut State Agencies.
(c) Benefit plans shall be uniform in
			 structure, language, designation and format to the standard benefit plans "A"
			 through "L" listed in this section and conform to the definitions in section
			 38a-495a-2 of the
			 Regulations of Connecticut State Agencies. Each benefit shall be structured in
			 accordance with the format provided in sections
			 38a-495-5(b)
			 and
			 38a-495a-5(c)
			 of the Regulations of Connecticut State Agencies 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.
(d) An issuer may use, in
			 addition to the benefit plan designations required in subsection (c) of this
			 section, other designations to the extent permitted by law.
(e)
Make-up of benefit plans:
(1) Standardized Medicare supplement benefit
			 plan "A" shall be limited to the Basic ("Core") Benefits Common to All Benefit
			 Plans, as defined in section
			 38a-495a-5(b)
			 of the Regulations of Connecticut State Agencies.
(2) Standardized Medicare supplement benefit
			 plan "B" shall include only the following: The Core Benefit as defined in
			 section
			 38a-495a-5(b)
			 of the Regulations of Connecticut State Agencies, plus the Medicare Part A
			 Deductible as defined in section
			 38a-495a-5(c)
			 (1) of the Regulations of Connecticut State Agencies.
(3) Standardized Medicare supplement benefit
			 plan "C" shall include only the following: The Core Benefit as defined in
			 38a-495a-5(b) of the Regulations of Connecticut State Agencies, 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
			 38a-495a-5(c)
			 (1), (2), (3) and (8) of the Regulations of Connecticut State Agencies
			 respectively.
(4) Standardized
			 Medicare supplement benefit plan "D" shall include only the following: The Core
			 Benefit as defined in section
			 38a-495a-5(b)
			 of the Regulations of Connecticut State Agencies, 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 sections
			 38a-495a-5(c)
			 (1), (2), (8) and (10) of the Regulations of Connecticut State Agencies
			 respectively.
(5) Standardized
			 Medicare supplement benefit plan "E" shall include only the following: The Core
			 Benefit as defined in section
			 38a-495a-5(b)
			 of the Regulations of Connecticut State Agencies, 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
			 38a-495a-5(c)
			 (1), (2), (8) and (9) of the Regulations of Connecticut State Agencies
			 respectively.
(6) Standardized
			 Medicare supplement benefit plan "F" shall include only the following: The Core
			 Benefit as defined in section
			 38a-495a-5(b)
			 of the Regulations of Connecticut State Agencies, 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
			 38a-495a-5(c)
			 (1), (2), (3), (5) and (8) of the Regulations of Connecticut State Agencies
			 respectively.
(7) Standardized
			 Medicare supplement benefit high deductible plan "F" shall include only the
			 following: one hundred percent (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
			 38a-495a-5(b)
			 of the Regulations of Connecticut State Agencies, 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
			 38a-495a-5(c)
			 (1), (2), (3), (5) and (8) of the Regulations of Connecticut State Agencies
			 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 one thousand five hundred dollars 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 ten dollars.
(8) Standardized Medicare supplement benefit
			 plan "G" shall include only the following: The Core Benefit as defined in
			 section
			 38a-495a-5(b)
			 of the Regulations of Connecticut State Agencies, 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
			 38a-495a-5(c)
			 (1), (2), (4), (8) and (10) respectively of the Regulations of Connecticut
			 State Agencies.
(9) Standardized
			 Medicare supplement benefit plan "H" shall consist of only the following: The
			 Core Benefit as defined in section
			 38a-495a-5(b)
			 of the Regulations of Connecticut State Agencies, 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
			 38a-495a-5(c)
			 (1), (2), (6) and (8) of the Regulations of Connecticut State Agencies
			 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
			 section
			 38a-495a-5(b)
			 of the Regulations of Connecticut State Agencies, 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
			 38a-495a-5(c)
			 (1), (2), (5), (6), (8) and (10) of the Regulations of Connecticut State
			 Agencies 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 section
			 38a-495a-5(b)
			 of the Regulations of Connecticut State Agencies, 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
			 38a-495a-5(c)
			 (1), (2), (3), (5), (7), (8), (9) and (10) of the Regulations of Connecticut
			 State Agencies respectively. The outpatient prescription drug benefit plan
			 shall not be included in a Medicare supplement policy sold after December 31,
			 2005.
(12) Standardized Medicare
			 supplement benefit high deductible plan "J" shall consist of only the
			 following: one hundred percent (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
			 38a-495a-5(b)
			 of the Regulations of Connecticut State Agencies, 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
			 38a-495a-5(c)
			 (1), (2), (3), (5), (7), (8), (9) and (10) of the Regulations of Connecticut
			 State Agencies 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 one
			 thousand five hundred dollars 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 ten dollars. The outpatient prescription drug benefit
			 plan shall not be included in a Medicare supplement policy sold after December
			 31, 2005.