Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.507A - STANDARD MEDICARE SUPPLEMENT BENEFIT PLANS FOR 1990 STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN POLICIES OR CERTIFICATES ISSUED FOR DELIVERY ON OR AFTER JULY 1993, AND WITH AN EFFECTIVE DATE FOR COVERAGE PRIOR TO JUNE 1, 2010

Current through Register Vol. 13, July 5, 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
				established in ARM
				6.6.507.
(2) 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 (7) and Medicare
				select policies or certificates.
(3) Benefit plans must be uniform in
				structure, language, designation and format to the standard benefit Plans A
				through L listed in this rule and conform to the definitions in
				33-22-903,
				MCA, and ARM 6.6.505. Each benefit shall be structured in accordance with the
				format provided in ARM
				6.6.507(4)(a),
				(b), and (c) and list the benefits in the
				order shown in this rule. 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 (3), other designations
				to the extent permitted by law.
(5)
				The following descriptions detail the contents of the standardized benefit
				Plans A through J:
(a) Standardized Medicare
				Supplement Benefit Plan A must be limited to the basic ("core") benefits common
				to all benefit plans, as established in ARM
				6.6.507(5).
(b) Standardized Medicare Supplement Benefit
				Plan B must include only the core benefit as established in ARM
				6.6.507(5),
				plus the Medicare Part A deductible as established in ARM
				6.6.507(5)(b)(i).
(c) Standardized Medicare Supplement Benefit
				Plan C must include only the core benefit, as established in ARM
				6.6.507(5),
				plus the Medicare Part A deductible, skilled nursing facility care, Medicare
				Part B deductible, and medically necessary emergency care in a foreign country
				as established in ARM
				6.6.507(5)(b)(i),
				(ii), (iii), and (viii),
				respectively.
(d) Standardized
				Medicare Supplement Benefit Plan D must include only the core benefit, as
				established in ARM
				6.6.507(5),
				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 established in ARM
				6.6.507(5)(b)(i),
				(ii), (viii), and (x),
				respectively.
(e) Standardized
				Medicare Supplement Benefit Plan E must include only the core benefit as
				established in ARM
				6.6.507(5),
				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 ARM
				6.6.507(5)(b)(i),
				(ii), (viii), and (ix),
				respectively.
(f) Standardized
				Medicare Supplement Benefit Plan F must include only the core benefit as
				established in ARM
				6.6.507(5),
				plus the Medicare Part A deductible, the skilled nursing facility care, the
				Part B deductible, 100% of the Medicare Part B excess charges and medically
				necessary emergency care in a foreign country as established in ARM
				6.6.507(5)(b)(i),
				(ii), (iii), (v), and (viii),
				respectively.
(g) Standardized
				Medicare Supplement Benefit High Deductible Plan F shall include only 100% of
				covered expenses following the payment of the annual High Deductible Plan F
				deductible.
(i) The covered expenses are the
				core benefit as defined in ARM
				6.6.507(5),
				plus the Medicare Part A deductible, skilled nursing facility care, 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 ARM
				6.6.507(5)(b)(i),
				(ii), (iii), (v), and (viii),
				respectively.
(ii) The annual High
				Deductible Plan F deductible must consist of out-of-pocket expenses, other than
				premiums, for services covered by the Medicare supplement Plan F policy, and
				must be in addition to any other specific benefit deductibles. The annual High
				Deductible Plan F deductible will be $1500.00 for 1998 and 1999, must be based
				on the calendar year, and will 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 $10.00.
(h) Standardized Medicare Supplement Benefit
				Plan G must include only the core benefit as established in ARM
				6.6.507(5),
				plus the Medicare Part A deductible, the skilled nursing facility care, 80% of
				the Medicare Part B excess charges, medically necessary emergency care in a
				foreign country, and the at-home recovery benefit as established in ARM
				6.6.507(5)(b)(i),
				(ii), (iv), (viii), and (x),
				respectively.
(i) Standardized
				Medicare Supplement Benefit Plan H must include only the core benefit as
				established in ARM
				6.6.507(5),
				plus the Medicare Part A deductible, the skilled nursing facility care, basic
				prescription drug benefit, and medically necessary emergency care in a foreign
				country as established in ARM
				6.6.507(5)(b)(i),
				(ii), (vi), and (viii), respectively.
However, the outpatient prescription drug benefit may not be
				  included in a Medicare supplement policy or certificate sold after December 31,
				  2005.
(j) Standardized
				Medicare Supplement Benefit Plan I must include only the core benefit as
				established in ARM
				6.6.507(5),
				plus the Medicare Part A deductible, the skilled nursing facility care, 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
				established in ARM
				6.6.507(5)(b)(i),
				(ii), (v), (vi), (viii), and (x),
				respectively.
However, the outpatient prescription drug benefit may not be
				  included in a Medicare supplement policy or certificate sold after December 31,
				  2005.
(k) Standardized
				Medicare supplement benefit plan J must include only the core benefit as
				established in ARM
				6.6.507(5),
				plus the Medicare Part A deductible, the skilled nursing facility care,
				Medicare Part B deductible, 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
				established in ARM
				6.6.507(5)(b)(i),
				(ii), (iii), (v), (vii), (viii), (ix), and
				(x), respectively.
However, the outpatient prescription drug benefit shall not
				  be included in a Medicare supplement policy or certificate sold after December
				  31, 2005.
(l) Standardized
				Medicare Supplement Benefit High Deductible Plan J shall consist of 100% of
				covered expenses following the payment of the annual High Deductible Plan J
				deductible.
(i) The covered expenses must be
				only the core benefit as defined in ARM
				6.6.507(5),
				plus the Medicare Part A deductible, skilled nursing facility care, Medicare
				Part B deductible, 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 ARM
				6.6.507(5)(b)(i),
				(ii), (iii), (v), (vii), (viii), (ix), and
				(x), respectively. However, the outpatient prescription drug benefit may not be
				included in a Medicare supplement policy or certificate sold after December 31,
				2005.
(ii) The annual High
				Deductible Plan J deductible must consist of out-of-pocket expenses, other than
				premiums, for services covered by the Medicare supplement Plan J policy, and
				must be in addition to any other specific benefit deductibles. The annual
				deductible will be $1500.00 for 1998 and 1999, must be based on a calendar
				year, and will 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 $10.00.