Pennsylvania Code › Title 31 - INSURANCE › Part IV - Life Insurance › Chapter 89 - APPROVAL OF LIFE, ACCIDENT AND HEALTH INSURANCE › Subchapter K - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 89.777 - Standard Medicare supplement benefit plans for 1990 Standardized Medicare supplement benefit plan policies or certificates issued or delivered on or after July 30, 1992, and prior to June 1, 2010

Current through Register Vol. 54, No. 28, July 13, 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 §
										89.776(2)
				  (relating to benefits standards for policies or certificates issued for
				  delivery on or after July 30, 1992, and prior to June 1, 2010). An issuer shall
				  also offer a policy or certificate to prospective insureds meeting the Plan B
				  benefit plan.
(b) Groups, packages
				  or combinations of Medicare supplement benefits other than those listed in this
				  section may not be offered for sale in this Commonwealth except as may be
				  permitted in subsection (f) and §
										89.777a (relating to Medicare
				  select policies and certificates).
(c) Benefit plans shall be uniform in
				  structure, language, designation and format to the standard benefit Plans A-L
				  listed in this section and conform to the definitions in §
										89.773 (relating to policy
				  definitions and terms). Each benefit shall be structured in accordance with the
				  format in §
										89.776(2) and (3) or
				  (4) 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), other designations to the
				  extent permitted by law.
(e) The
				  make up of benefit plans shall be 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 §
											89.776(2).
(2) Standardized Medicare supplement benefit
				  Plan B shall include only the following: the core benefit as defined in §
											89.776(2), plus
				  the Medicare Part A Deductible as defined in §
											89.776(3)(i).
(3) Standardized Medicare supplement benefit
				  Plan C shall include only the following: the core benefit as defined in §
											89.776(2), 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 § 89.776(3)(i)-(iii) and (viii).
(4) Standardized Medicare supplement benefit
				  Plan D shall include only the following: the core benefit (as defined in §
											89.776(2)), 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 § 89.776(3)(i), (ii), (viii) and (x).
(5) Standardized Medicare supplement benefit
				  Plan E shall include only the following: the core benefit as defined in §
											89.776(2), 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 § 89.776(3)(i), (ii), (viii) and (ix).
(6) Standardized Medicare supplement benefit
				  Plan F shall consist of only the following: the core benefit as defined in
				  §
											89.776(2), plus
				  the Medicare Part A deductible, skilled nursing facility care, 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 §
											89.776(3)(i)-(iii), (v) and
				  (viii).
(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 §
											89.776(2), plus
				  the Medicare Part A deductible, skilled nursing facility care, 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 §
				  89.776(3)(i)-(iii), (v) and (viii) 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 $1,500 for 1998 and 1999, and shall be based on the
				  calendar year. It shall be adjusted annually thereafter by the HHS 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)
				  Standardized Medicare supplemental benefit Plan G shall include only the
				  following: the core benefit as defined in §
											89.776(2), plus
				  the Medicare Part A deductible, skilled nursing facility care, 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 § 89.776(3)(i),
				  (ii), (iv), (viii) and (x).
(9)
				  Standardized Medicare supplement benefit Plan H shall consist of only the
				  following: the core benefit as defined in §
											89.776(2), 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 §
											89.776(3)(i), (ii), (vi) and
				  (viii). The outpatient prescription drug
				  benefit may 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 §
											89.776(2), plus
				  the Medicare Part A deductible, skilled nursing facility care, 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 §
											89.776(3)(i), (ii), (v), (vi), (viii) and
				  (x). The outpatient prescription drug benefit
				  may 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 §
											89.776(2), plus
				  the Medicare Part A deductible, skilled nursing facility care, Medicare Part B
				  deductible, 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 §
											89.776(3)(i)-(iii), (v) and
				  (vii)-(x). The outpatient prescription drug
				  benefit may 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 §
											89.776(2) plus
				  the Medicare Part A deductible, skilled nursing facility care, Medicare Part B
				  deductible, 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 §
											89.776(3)(i)-(iii), (v) and
				  (vii)-(x) 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 $1,500 for 1998 and 1999, and shall be based on a calendar
				  year. It shall be adjusted annually thereafter by the HHS 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 may not be included
				  in a Medicare supplement policy sold after December 31, 2005.
(13) Standardized Medicare Supplement benefit
				  Plan K shall consist of only those benefits described in § 89.776
				  (4)(i).
(14) Standardized Medicare
				  Supplement benefit Plan L shall consist of only those benefits described in
				  § 89.776 (4)(ii).