Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 5 - Regulation 33-Medicare Supplement Insurance Minimum Standards › Section XIII-520 - Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or after July 20, 1992 and with an Effective Date for Coverage Prior to June 1, 2010

Current through Register Vol. 50, No. 6, June 20, 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 §515. A.2 of this regulation.
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 §520. G and in
				§525 of this regulation.
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
				§503 of this regulation. Each benefit
				shall be structured in accordance with the format provided in §515. A.2 or 515.A.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.
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 §515. A.2 of this
				regulation.
2. Standardized
				Medicare supplement benefit plan "B" shall include only the following. The core
				benefit as defined in §515. A.2 of this regulation, plus the Medicare Part A
				deductible as defined in §515. A.3.a
3. Standardized Medicare supplement benefit
				plan "C" shall include only the following: The core benefit as defined in §515.
				A.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 §515. A.3 a, b, c and h,
				respectively.
4. Standardized
				Medicare supplement benefit plan "D" shall include only the following: The core
				benefit as defined in §515. A.2 of this regulation, 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 §515.
				A.3 a, b, h and j, respectively.
5.
				Standardized Medicare supplement benefit plan "E" shall include only the
				following: The core benefit as defined in §515. A.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 §515. A.3 a, b, h and i, respectively.
6. Standardized Medical supplement benefit
				plan "F" shall include only the following: The core benefit as defined in §515.
				A.2 of this regulation, plus the Medicare Part A deductible, the skilled
				nursing facility care, the Part B deductible, 100 percent of the Medicare Part
				B excess charges, and medically necessary emergency care in a foreign country,
				as defined in §515. A.3 a, b, c, e and h, respectively.
7. Standardized Medicare supplement benefit
				high deductible plan "F" shall include only the following: 100 percent of
				covered expenses following the payment of the annual high deductible plan "F"
				deductible. The covered expenses include the core benefit as defined in §515.
				A.2 of this regulation, plus the Medicare Part A deductible, skilled nursing
				facility care, the Medicare Part B deductible, 100 percent of the Medicare Part
				B excess charges, and medically necessary emergency care in a foreign country
				as defined in §515. A.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 $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 12-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 §515.
				A.2 of this regulation, plus the Medicare Part A deductible, skilled nursing
				facility care, 80 percent of the Medicare Part B excess charges, medically
				necessary emergency care in a foreign country, and the at-home recovery benefit
				as defined in §515. A.3 a, b, d, h and j, respectively.
9. Standardized Medicare supplement benefit
				plan "H" shall consist of only the following: The core benefit as defined in
				§515. A.2 of this regulation, plus the Medicare Part A deductible, skilled
				nursing facility care, basic outpatient prescription drug benefit, and
				medically necessary emergency care in a foreign country, as defined in §515.
				A.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.
10. Standardized Medicare
				supplement benefit plan "I" shall consist of only the following: The core
				benefit as defined in §515. A.2 of this regulation, plus the Medicare Part A
				deductible, skilled nursing facility care, 100 percent of the Medicare Part B
				excess charges, basic outpatient prescription drug benefit, medically necessary
				emergency care in a foreign country and at-home recovery benefit as defined in
				§515. A.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.
11. Standardized
				Medicare supplement benefit plan "J" shall consist of only the following: The
				core benefit as defined in §515. A.2 of this regulation, plus the Medicare Part
				A deductible, skilled nursing facility care, Medicare Part B deductible, 100
				percent 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 §515. A.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.
12. Standardized Medicare
				supplement benefit high deductible plan "J" shall consist of only the
				following: 100 percent of covered expenses following the payment of the annual
				high deductible plan "J" deductible. The covered expenses include the core
				benefit as defined in §515. A.2 of this regulation, plus the Medicare Part A
				deductible, skilled nursing facility care, Medicare Part B deductible, 100
				percent 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
				§515. A.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 $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 12-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.