Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-071 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS REGULATION › Section 482-1-071-.09 - Standard Medicare Supplement Benefit Plans For 1990 Standardized Medicare Supplement Benefit Plan Policies Or Certificates Issued For Delivery On Or After March 25, 1996 And With An Effective Date For Coverage Prior To June 1, 2010

Current through Register Vol. 42, No. 9, June 28, 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
			 Rule 482-1-071-.08 B.
B. No groups, packages or combinations of
			 Medicare supplement benefits other than those listed in this rule shall be
			 offered for sale in this state, except as may be permitted in Rules
			 482-1-071-.09 G and
			 482-1-071-.010.
C. 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 Rule
			 482-1-071-.04. Each benefit shall
			 be structured in accordance with the format provided in Subsections B and C or
			 D of Rule
			 482-1-071-.08 and list the
			 benefits in the order shown in this subsection. For purposes of this rule,
			 "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. 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 Rule
			 482-1-071-.08 B.
(2) Standardized Medicare supplement benefit
			 plan "B" shall include only the following: The core benefit as defined in Rule
			 482-1-071-.08 B, plus the
			 Medicare Part A deductible as defined in Rule
			 482-1-071-.08 C(1).
(3) Standardized Medicare supplement benefit
			 plan "C" shall include only the following: The core benefit as defined in Rule
			 482-1-071-.08 B, 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 Rules
			 482-1-071-.08 C(1), (2), (3) and
			 (8) respectively.
(4) Standardized
			 Medicare supplement benefit plan "D" shall include only the following: The core
			 benefit (as defined in Rule
			 482-1-071-.08 B), 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 Rules
			 482-1-071-.08 C(1), (2), (8) and
			 (10) respectively.
(5) Standardized
			 Medicare supplement benefit plan "E" shall include only the following: The core
			 benefit as defined in Rule
			 482-1-071-.08 B, 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
			 Rules 482-1-071-.08 C(1), (2), (8) and
			 (9) respectively.
(6) Standardized
			 Medicare supplement benefit plan "F" shall include only the following: The core
			 benefit as defined in Rule
			 482-1-071-.08 B, 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 Rules
			 482-1-071-.08 C(1), (2), (3), (5)
			 and (8) respectively.
(7)
			 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 Rule
			 482-1-071-.08 B, 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 Rules
			 482-1-071-.08 C(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 $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.
(8) Standardized Medicare
			 supplement benefit plan "G" shall include only the following: The core benefit
			 as defined in Rule
			 482-1-071-.08 B, 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 Rules
			 482-1-071-.08 C(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 Rule
			 482-1-071-.08 B, 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 Rules
			 482-1-071-.08 C(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 Rule
			 482-1-071-.08 B, 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 Rules
			 482-1-071-.08 C(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 Rule
			 482-1-071-.08 B, 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 Rules
			 482-1-071-.08 C(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.
(12)
			 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 Rule
			 482-1-071-.08 B, 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 Rules
			 482-1-071-.08 C(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 $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.