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

Current through Register Vol. 13, July 5, 2024
(1) The following
				standards are applicable to all Medicare supplement policies or certificates
				delivered or issued for delivery in this state with an effective date for
				coverage on or after June 1, 2010. No policy or certificate may be advertised,
				solicited, delivered or issued for delivery in this state as a Medicare
				supplement policy or certificate unless it complies with these benefit plan
				standards. Benefit plan standards applicable to Medicare supplement policies
				and certificates with an effective date for coverage before June 1, 2010,
				remain subject to the requirements of ARM 6.6.507A.
(2) 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
				6.6.507D(4).
(3) If an issuer makes
				available any of the additional benefits described in ARM 6.6.507D(4)(b) or
				offers standardized benefits Plans K or L (as described in ARM 6.6.507E(8)(a)
				and (b) of this subchapter), then the issuer shall make available to each
				prospective policyholder and certificateholder, in addition to a policy form or
				certificate form with only the basic core benefits as described in (2), a
				policy form or certificate form containing either Standardized Benefit Plan C
				(as described in ARM 6.6.507E(7)(c) of this subchapter) or Standardized Benefit
				Plan F (as described in ARM 6.6.507E(7)(e) of this subchapter).
(4) 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 ARM 6.6.507E(11)
				and ARM 6.6.601 -614 of these rules.
(5) Benefit plans must be uniform in
				structure, language, designation and format to the standard benefit plans
				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 6.6.507D(4)(a) and (b); or in the case of Plans K or L,
				in ARM 6.6.507E(8)(a) and (b), and list the benefits in the order shown in this
				rule. For purposes of this rule, "structure, language, and format" means style,
				arrangement and overall content of a benefit.
(6) An issuer may use, in addition to the
				benefit plan designations required in (5), other designations to the extent
				permitted by law.
(7) The
				following descriptions detail the contents of the 2010 standardized benefit
				plans:
(a) Standardized Medicare Supplement
				Benefit Plan A must be limited to the basic ("core") benefits common to all
				benefit plans, as established in ARM 6.6.507D(4)(a);
(b) Standardized Medicare Supplement Benefit
				Plan B must include only the core benefit as established in ARM 6.6.507D(4)(a),
				plus 100% of the Medicare Part A deductible as established in ARM
				6.6.507D(4)(b)(i).
(c) Standardized
				Medicare Supplement Benefit Plan C must include only the core benefit, as
				established in ARM 6.6.507D(4)(a), plus 100% of the Medicare Part A deductible,
				skilled nursing facility care, 100% of the Medicare Part B deductible, and
				medically necessary emergency care in a foreign country as established in ARM
				6.6.507D(4)(b)(i), (iii), (iv), and (vi), respectively.
(d) standardized Medicare Supplement Benefit
				Plan D must include only the core benefit, as established in ARM
				6.6.507D(4)(a), plus 100% of the Medicare Part A deductible, skilled nursing
				facility care, and medically necessary emergency care in a foreign country, as
				established in ARM 6.6.507D(4)(b)(i), (iii), and (vi), respectively.
(e) Standardized Medicare Supplement Benefit
				regular Plan F must include only the core benefit as established in ARM
				6.6.507D(4)(a), plus 100% of the Medicare Part A deductible, skilled nursing
				facility care, 100% of the Medicare Part B deductible, 100% of the Medicare
				Part B excess charges, and medically necessary emergency care in a foreign
				country, established in ARM 6.6.507D(4)(b)(i), (iii), (iv), (v), and (vi),
				respectively.
(f) 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) "Covered expenses" for this
				subsection are the core benefit as defined in ARM 6.6.507D(4)(a), plus 100% of
				the Medicare Part A deductible, skilled nursing facility care, 100% of 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
				6.6.507D(4)(b)(i), (iii), (iv), (v), and (vi), 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 regular Plan F policy, and must be
				in addition to any other specific benefit deductibles. The basis for the
				deductible will be $1500 and will be adjusted annually from 1999 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.
(g) Standardized Medicare Supplement Benefit
				Plan G must include only the core benefit as established in ARM 6.6.507D(4)(a),
				plus 100% of the Medicare Part A deductible, skilled nursing facility care,
				100% of the Medicare Part B excess charges, and medically necessary emergency
				care in a foreign country as established in ARM 6.6.507D(4)(b)(i), (iii), (v),
				and (vi), respectively. Effective January 1, 2020, the standardized benefit
				plans described in ARM 6.6.507F(2)(d) (Redesignated Plan G High Deductible) may
				be offered to any individual who was eligible for Medicare prior to January 1,
				2020.