Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 031 - BUREAU OF INSURANCE › Chapter 275 - Medicare Supplement Insurance › Section 031-275-9 - Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After January 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010

Current through 2024-29, July 17, 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
				8(B) of this
				Rule.
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
				Section 9(G) and in Section
				10 of this Rule.
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 Section
				4 of this Rule. Each benefit shall be
				structured in accordance with the format provided in Sections
				8(B) and
				8(C), or
				8(D) and list the
				benefits in the order shown in this subsection. For purposes of this section,
				"structure, language, and format" includes style, arrangement, and overall
				content of a benefit.
D. An issuer
				may use, in connection with the benefit plan designations required in
				Subsection C, supplementary designations such as trade names 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
				8(B) of this
				Rule.
(2) Standardized Medicare
				supplement benefit plan "B" shall include only the following: The Core Benefit
				as defined in Section
				8(B) of this Rule,
				plus the Medicare Part A Deductible as defined in Section
				8(C)(1).
(3) Standardized Medicare supplement benefit
				plan "C" shall include only the following: The Core Benefit as defined in
				Section
				8(B) of this Rule,
				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
				8(C)(1), (2), (3), and
				(8) respectively.
(4) Standardized Medicare supplement benefit
				plan "D" shall include only the following: The Core Benefits (as defined in
				Section
				8(B) of this Rule),
				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
				8(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
				Section
				8(B) of this Rule,
				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
				8(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
				Section
				8(B) of this Rule,
				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
				8(C)(1), (2), (3), (5), and (8)
				 respectively.
(7) Standardized Medicare supplement high
				deductible benefit 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
				8(B) of this Rule,
				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
				8(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 $1530 for 2000, 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 Section
				8(B) of this Rule,
				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
				8(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
				Section
				8(B) of this Rule,
				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
				8(C)(1), (2), (6), and
				(8) respectively. This plan shall not be 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
				8(B) of this Rule,
				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
				8(C)(1), (2), (5), (6), (8), and (10)
				 respectively. This plan shall not be 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
				8(B) of this Rule,
				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
				8(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 high deductible benefit 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
				8(B) of this Rule,
				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
				8(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 $1530 for 2000, 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.