North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-07 - 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 for coverage prior to June 1, 2010

Current through Supplement No. 393, July, 2024
1. 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
				subsection 2 of section 45-06-01.1 -06.
2. No groups, packages, or combinations of
				medicare supplement benefits other than those listed in this section may be
				offered for sale in this state, except as may be permitted in subsection 7 of
				this section and in section
				45-06-01.1-08.
3. Benefit plans must be uniform in
				structure, language, designation, and format to the standard benefit plans "A"
				through" L" listed in this section and conform to the definitions in section
				45-06-01.1 -02 and contained in North Dakota Century Code section 26.1 -36.1
				-01. Each benefit must be structured in accordance with the format provided in
				subsections 2 and 3 or 4 of section
				45-06-01.1-06 and list the
				benefits in the order shown in this section. 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 subsection 3,
				other designations to the extent permitted by law.
5. Makeup of benefit plans:
a. Standardized medicare supplement benefit
				plan "A" is limited to the basic (core) benefits common to all benefit plans,
				as defined in subsection 2 of section
				45-06-01.1-06.
b. Standardized medicare supplement benefit
				plan "B" may include only the following: The core benefit as defined in
				subsection 2 of section
				45-06-01.1-06, plus the medicare
				part A deductible as defined in subdivision a of subsection 3 of section
				45-06-01.1-06.
c. Standardized medicare supplement benefit
				plan "C" may include only the following: The core benefit as defined in
				subsection 2 of section
				45-06-01.1-06, 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
				subdivisions a, b, c, and h of subsection 3 of section 45-06-01.1 -06,
				respectively.
d. Standardized
				medicare supplement benefit plan "D" may include only the following: The core
				benefit as defined in subsection 2 of section
				45-06-01.1-06, 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
				subdivisions a, b, h, and j of subsection 3 of section 45-06-01.1 -06,
				respectively.
e. Standardized
				medicare supplement benefit plan "E" may include only the following: The core
				benefit as defined in subsection 2 of section
				45-06-01.1-06, 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
				subdivisions a, b, h, and i of subsection 3 of section 45-06-01.1 -06,
				respectively.
f. Standardized
				medicare supplement benefit plan "F" may include only the following: The core
				benefit as defined in subsection 2 of section
				45-06-01.1-06, plus the medicare
				part A deductible, the skilled nursing facility care, the medicare part B
				deductible, one hundred percent of the medicare part B excess charges, and
				medically necessary emergency care in a foreign country as defined in
				subdivisions a, b, c, e, and h of subsection 3 of section 45-06-01.1 -06,
				respectively.
g. Standardized
				medicare supplement benefit high deductible plan "F" includes only the
				following: one hundred 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 subsection 2 of section
				45-06-01.1-06, plus the medicare
				part A deductible, skilled nursing facility care, the medicare part B
				deductible, one hundred percent of the medicare part B excess charges, and
				medically necessary emergency care in a foreign country as defined in
				subdivisions a, b, c, e, and h of subsection 3 of section
				45-06-01.1-06, respectively. The
				annual high deductible plan "F" deductible consists of out-of-pocket expenses,
				other than premiums, for services covered by the medicare supplement plan "F"
				policy, and are in addition to any other specific benefit deductibles. The
				annual high deductible plan "F" deductible is one thousand five hundred dollars
				for 1998 and 1999 and must be based on the calendar year. It must 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 ten
				dollars.
h. Standardized medicare
				supplement benefit plan "G" may include only the following: The core benefit as
				defined in subsection 2 of section
				45-06-01.1-06, plus the medicare
				part A deductible, skilled nursing facility care, eighty 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 subdivisions a, b, d,
				h, and j of subsection 3 of section
				45-06-01.1-06, respectively.
i. Standardized medicare
				supplement benefit plan "H" may consist of only the following: The core benefit
				as defined in subsection 2 of section
				45-06-01.1-06, 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 subdivisions a, b, f, and h of subsection 3 of section
				45-06-01.1-06, respectively. The
				outpatient prescription drug benefit shall not be included in a medicare
				supplement policy sold after December 31, 2005.
j. Standardized medicare supplement benefit
				plan "I" may consist of only the following: The core benefit as defined in
				subsection 2 of section
				45-06-01.1-06, plus the medicare
				part A deductible, skilled nursing facility care, one hundred percent 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 subdivisions a, b, e, f, h, and j of subsection 3 of section
				45-06-01.1-06, respectively. The
				outpatient prescription drug benefit shall not be included in a medicare
				supplement policy sold after December 31, 2005.
k. Standardized medicare supplement benefit
				plan "J" may consist of only the following: The core benefit as defined in
				subsection 2 of section
				45-06-01.1-06, plus the medicare
				part A deductible, skilled nursing facility care, medicare part B deductible,
				one hundred 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
				subdivisions a, b, c, e, g, h, i, and j of subsection 3 of section
				45-06-01.1-06, respectively. The
				outpatient prescription drug benefit shall not be included in a medicare
				supplement policy sold after December 31, 2005.
I. Standardized medicare supplement benefit
				high deductible plan "J" consists of only the following: one hundred 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
				subsection 2 of section
				45-06-01.1-06, plus the medicare
				part A deductible, skilled nursing facility care, medicare part B deductible,
				one hundred 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 subdivisions a, b, c, e, g, h, i, and j of subsection 3 of section
				45-06-01.1-06, respectively. The
				annual high deductible plan "J" deductible consists of out-of-pocket expenses,
				other than premiums, for services covered by the medicare supplement plan "J"
				policy, and are in addition to any other specific benefit deductibles. The
				annual deductible is one thousand five hundred dollars for 1998 and 1999 and
				must be based on a calendar year. It must 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 ten dollars. The outpatient prescription
				drug benefit shall not be included in a medicare supplement policy sold after
				December 31, 2005.