Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 5 - Minimum Standards; Contract Guidelines › Part 13 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 365:10-5-128 - Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates issued for delivery on or after July 1, 1992, and prior to June 1, 2010

Current through Vol.
				  41, No. 20, July 1, 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 O.A.C.
				  365:10-5-127(c).
(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 Sections
				  365:10-5-128(g) and
				  365:10-5-128.3
				  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 O.A.C.
				  365:10-5-123. Each
				  benefit shall be structured in accordance with the format provided in O.A.C.
				  365:10-5-127(c)
				  and (d) or O.A.C.
				  365:10-5-127(e)
				  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 (c)
				  of this section, other designations to the extent permitted by law.
(e) Make-up of benefit plans are as follows:
(1) Standardized Medicare supplement benefit
				  plan "A" shall be limited to the Basic ("Core") Benefits Common to All Benefit
				  Plans, as defined in
				  365:10-5-127(c).
(2) Standardized Medicare supplement benefit
				  plan "B" shall include only the following: The Core Benefit as defined in
				  365:10-5-127(c),
				  plus the Medicare Part A Deductible as defined in
				  365:10-5-127(d)(1).
(3) Standardized Medicare supplement benefit
				  plan "C" shall include only the following: The Core Benefit as defined in
				  365:10-5-127(c),
				  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
				  365:10-5-127(d)(1),
				  (2), (3) & (8) respectively.
(4) Standardized Medicare supplement benefit
				  plan "D" shall include only the following: The Core Benefit as defined in
				  365:10-5-127(c),
				  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
				  365:10-5-127(d)
				  (1), (2), (8) & (10) respectively.
(5) Standardized Medicare supplement benefit
				  plan "E" shall include only the following: The Core Benefit as defined in
				  365:10-5-127(c),
				  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
				  365:10-5-127(d)
				  (1), (2), (8) & (9) respectively.
(6) Standardized Medicare supplement benefit
				  plan "F" shall include only the following: The Core Benefit as defined in
				  365:10-5-127(c),
				  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
				  365:10-5-127(d)
				  (1), (2), (3), (5) & (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 Section
				  365:10-5-127(c)
				  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 Section
				  365:10-5-127(d)(1),
				  (2), (3), (5) and (8) respectively. The
				  annual high deductible plan "F" deductible shall consist of out-or-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
				  365:10-5-127(c),
				  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
				  365:10-5-127(d)
				  (1), (2), (4), (8) & (10) respectively.
(9) Standardized Medicare supplement benefit
				  plan "H" shall consist of only the following: The Core Benefit as defined in
				  365:10-5-127(c),
				  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
				  365:10-5-127(d)
				  (1), (2), (6) & (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
				  365:10-5-127(c),
				  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
				  365:10-5-127(d)
				  (1), (2), (5), (6), (8) & (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
				  365:10-5-127(c),
				  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
				  365:10-5-127(d)
				  (1), (2), (3), (5), (7), (8), (9) & (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 Section
				  365:10-5-127(c)
				  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 county, preventive medical care
				  benefit and at-home recovery benefit as defined in Sections
				  365:10-5-127(d)(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.