Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 10 - Regulation to Implement the Medicare Supplement Insurance Minimum Standards Model Act, as amended › Rule 19-3-10.09

Current through June 25, 2024
Standard Medicare Benefit Plans For 1990 Standardized
				  Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery
				  after July 1, 1992 and with an Effective Date for Coverage Prior to June 1,
				  2010
A. An issuer shall make
				available to each prospective policyholder and certificate holder a policy form
				or certificate form containing only the basic core benefits, as defined in Rule
				10.08 B 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
				Rule10.09 G and in Rule
				10.10 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 Rule
				10.04 of this regulation. Each
				benefit shall be structured in accordance with the format provided in Rules
				10.08 B and
				10.08 C, or
				10.08 D 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 Rule
				10.08 B of this regulation.
2. Standardized Medicare
				supplement benefit plan "B" shall include only the following: The core benefit
				as defined in Rule
				10.08 B of this regulation, plus the
				Medicare Part A deductible as defined in Rule
				10.08 C(1).
3. Standardized Medicare supplement benefit
				plan "C" shall include only the following: The core benefit as defined in Rule
				10.08 B 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 Rules
				10.08 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
				10.08 B of this regulation), 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
				10.08 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
				10.08 B 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
				Rule
				10.08 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
				10.08 B of this regulation, 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 Rule
				10.08 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
				10.08 B of this regulation, 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 Rule
				10.08 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
				10.08 B of this regulation, 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
				10.08 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
				10.08 B of this regulation, 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
				10.08 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
				10.08 B of this regulation, 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
				10.08 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
				10.08 B of this regulation, 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
				10.08 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 10.08B of this regulation, 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 10.08C(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.