New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 25 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 13.10.25.12 - 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 Register Vol. 35, No. 13, July 16, 2024
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 Subsection E of
				13.10.25.11
				NMAC.
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
				Subsection G of this section and in
				13.10.25.16
				NMAC.
C. Benefit plans shall 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
				13.10.25.7
				NMAC. Each benefit shall be structured in accordance with the format provided
				in Subsection B, C or D of
				13.10.25.11
				NMAC 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.
D. An
				issuer may use, in addition to the benefit plan designations required in
				Subsection C of this section, other designations to the extent permitted by
				law.
E.
Make-up of benefit
				plans:
(1)
Plan A.
Standardized Medicare Supplement benefit Plan A shall be limited to the basic
				(core) benefits common to all benefit plans, as defined in Subsection E of
				13.10.25.11
				NMAC.
(2)
Plan B.
Standardized Medicare Supplement benefit Plan B shall include only the
				following: The core benefit as defined in Subsection E of
				13.10.25.11
				NMAC, plus the Medicare Part A deductible as defined in Paragraph (1) of
				Subsection F of
				13.10.25.11
				NMAC.
(3)
Plan C.
Standardized Medicare Supplement benefit Plan C shall include only the
				following: The core benefit as defined in Subsection E of
				13.10.25.11
				NMAC, 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 Paragraphs (1), (2), (3) and (8) respectively of
				Subsection F of
				13.10.25.11
				NMAC.
(4)
Plan D.
Standardized Medicare Supplement benefit Plan D shall include only the
				following: The core benefit as defined in Subsection E of
				13.10.25.11
				NMAC, 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 Paragraphs (1), (2), (8) and (10) respectively
				of Subsection F of
				13.10.25.11.
				NMAC.
(5)
Plan E.
Standardized Medicare Supplement benefit Plan E shall include only the
				following: The core benefit as defined in Subsection E of
				13.10.25.11
				NMAC, 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 Paragraphs (1), (2), (8) and (9) respectively of Subsection
				F of
				13.10.25.11.
				NMAC.
(6)
Plan F.
Standardized Medicare Supplement benefit Plan F shall include only the
				following: The core benefit as defined Subsection E of
				13.10.25.11
				NMAC, 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 Paragraphs (1), (2), (3), (5) and (8) respectively of Subsection F
				of
				13.10.25.11
				NMAC.
(7)
High deductible
				Plan F.
Standardized Medicare Supplement benefit High Deductible Plan F
				shall include 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 E of
				13.10.25.11
				NMAC, 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 Paragraphs (1), (2), (3), (5) and (8) respectively of Subsection F of
				13.10.25.11
				NMAC. 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
				12-month period ending with August of the preceding year, and rounded to the
				nearest multiple of $10.
(8)
Plan G.
Standardized Medicare Supplement benefit Plan G shall
				include only the following: The core benefit as defined in Subsection E of
				13.10.25.11
				NMAC, 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 Paragraphs (1), (2), (4), (8) and (10) respectively of Subsection F
				of
				13.10.25.11
				NMAC.
(9)
Plan H.
Standardized Medicare Supplement benefit Plan H shall consist of only the
				following: The core benefit as defined in Subsection E of
				13.10.25.11
				NMAC, 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 Paragraphs (1), (2), (6), and (8) respectively of
				Subsection F of
				13.10.25.11
				NMAC. The outpatient prescription drug benefit shall not be included in a
				Medicare Supplement policy sold after December 31, 2005.
(10)
Plan I.
Standardized
				Medicare Supplement benefit Plan I shall consist of only the following: The
				core benefit as defined in Subsection E of
				13.10.25.11
				NMAC, 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 Paragraphs (1), (2), (5), (6), (8) and
				(10) respectively of Subsection F of
				13.10.25.11
				NMAC. The outpatient prescription drug benefit shall not be included in a
				Medicare Supplement policy sold after December 31, 2005.
(11)
Plan J.
Standardized
				Medicare Supplement benefit Plan J shall consist of only the following: The
				core benefit as defined in Subsection E of
				13.10.25.11
				NMAC, 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 Paragraphs (1), (2), (3), (5), (7), (8), (9) and (10) respectively
				of Subsection F of
				13.10.25.11
				NMAC. The outpatient prescription drug benefit shall not be included in a
				Medicare Supplement policy sold after December 31, 2005.
(12)
High deductible Plan J.
Standardized Medicare Supplement benefit High Deductible Plan J shall consist
				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 E of
				13.10.25.11
				NMAC, 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 Paragraphs (1), (2), (3), (5), (7), (8),
				(9) and (10) respectively of Subsection F of
				13.10.25.11
				NMAC. 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 12-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.
(13)
Plan K and Plan L.
Make-up
				of two Medicare Supplement plans mandated by the
Medicare Prescription
				Drug, Improvement and Modernization Act of 2003
(MMA):
(a)
Plan K.
Standardized
				Medicare Supplement benefit Plan K shall consist of only those benefits
				described in Paragraph (1) of Subsection G of 13.10.25.11 NMAC.
(b)
Plan L.
Standardized
				Medicare Supplement benefit Plan L shall consist of only those benefits
				described in Paragraph (2) of Subsection G of 13.10.25.11
				NMAC.