Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0136 - 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 with an Effective Date of Coverage Prior to June 1, 2010

Current through Register Vol. 63, No. 7, July 1, 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
			 OAR 836-052-0133(3).
(2) 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 section (6) of this rule and in OAR 836-052-0139.
(3) Benefit plans must be uniform in
			 structure, language, designation and format to the standard benefit plans "A"
			 through "L" listed in this rule and conform to the definitions in OAR
			 836-052-0119. Each standard benefit plan must be designated by the letter
			 assigned to it under this rule. Each benefit must be structured in accordance
			 with the format provided in 836-052-0133(3) and (4) or (5)  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.
(4) In addition to
			 the benefit plan designations required in section (3) of this rule, an issuer
			 may use other designations to the extent permitted by law.
(5) The content of benefit plans must be as
			 follows:
(a) Standardized Medicare supplement
			 benefit plan "A" shall be limited to the basic core benefits common to all
			 benefit plans, as defined in OAR 836-052-0133(3);
(b) Standardized Medicare supplement benefit
			 plan "B" shall include only the following: The core benefit as defined in OAR
			 836-052-0133(3), plus the Medicare Part A Deductible as defined in
			 836-052-0133(4)(a);
(c)
			 Standardized Medicare supplement benefit plan "C" shall include only the
			 following: the core benefit as defined in OAR 836-052-0133(3), plus the
			 Medicare Part A Deductible, Skilled Nursing Facility Care, Medicare Part B
			 Deductible and Medically Necessary Emergency Care in a Foreign Country, each as
			 defined in 836-052-0133(4);
(d)
			 Standardized Medicare supplement benefit plan "D" shall include only the
			 following: The core benefit, as defined in OAR 836-052-0133(3), plus the
			 Medicare Part A Deductible, Skilled Nursing Facility Care, Medically Necessary
			 Emergency Care in a Foreign Country and the At-Home Recovery Benefit, each as
			 defined in 836-052-0133(4);
(e)
			 Standardized Medicare supplement benefit plan "E" shall include only the
			 following: The core benefit as defined in OAR 836-052-0133(3), plus the
			 Medicare Part A Deductible, Skilled Nursing Facility Care, Medically Necessary
			 Emergency Care in a Foreign Country and Preventive Medical Care, each as
			 defined in 836-052-0133(4);
(f)
			 Standardized Medicare supplement benefit plan "F" shall include only the
			 following: The core benefit as defined in OAR 836-052-0133(3), plus the
			 Medicare Part A Deductible, the Skilled Nursing Facility Care, the Part B
			 Deductible, 100 percent of the Medicare Part B excess Charges and Medically
			 Necessary Emergency Care in a Foreign Country, each as defined in
			 836-052-0133(4);
(g) Standardized
			 Medicare supplement benefit high deductible plan "F" shall include only the
			 following: 100 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 OAR 836-052-0133(3), plus the Medicare Part A Deductible,
			 skilled nursing facility care, the Medicare Part B deductible, 100 percent of
			 the Medicare Part B excess charges and medically necessary emergency care in a
			 foreign country, each as defined in 836-052-0133(4). 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. The deductible shall be adjusted annually
			 thereafter according to the method prescribed in
			 42 U.S.C.
			 1395 ss(p)(11)(C) 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.
(h) Standardized Medicare
			 supplement benefit plan "G" shall include only the following: The core benefit
			 as defined in OAR 836-052-0133(3), plus the Medicare Part A Deductible, Skilled
			 Nursing Facility Care, 80 percent of the Medicare Part B Excess Charges,
			 Medically Necessary Emergency Care in a Foreign Country, and the At-Home
			 Recovery Benefit, each as defined in 836-052-0133(4).
(i) Standardized Medicare supplement benefit
			 plan "H" shall consist of only the following: The core benefit as defined in
			 OAR 836-052-0133(3), plus the Medicare Part A Deductible, Skilled Nursing
			 Facility Care, Basic Prescription Drug Benefit and Medically Necessary
			 Emergency Care in a Foreign Country, each as defined in 836-052-0133(4). 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" shall consist of only the following: The core benefit as defined in
			 OAR 836-052-0133(3), plus the Medicare Part A Deductible, Skilled Nursing
			 Facility Care, 100 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, each as defined in 836-052-0133(4). 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" shall consist of only the following: The core benefit as defined in
			 OAR 836-052-0133(3), plus the Medicare Part A Deductible, Skilled Nursing
			 Facility Care, Medicare Part B Deductible, 100 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, each as defined in 836-052-0133(4). The outpatient
			 prescription drug benefit shall not be included in a Medicare supplement policy
			 sold after December 31, 2005.
(l)
			 Standardized Medicare supplement benefit high deductible plan "J" shall consist
			 of only the following: 100 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 OAR 836-052-0133(3), plus the Medicare Part A
			 deductible, skilled nursing facility care, Medicare Part B deductible, 100
			 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, each as defined
			 in 836-052-0133(4). 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. The deductible shall be adjusted
			 annually thereafter according to the method prescribed in
			 42 U.S.C.
			 1395 ss(p)(11)(C) 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.