Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 170 - RULES GOVERNING MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES › Section 14VAC5-170-80 - Standard plans for 1990 Medicare supplement policies delivered on or after July 30, 1992, and prior to June 1, 2010

Current through Register Vol. 40, No. 24, July 15, 2024
A. The following standard Medicare supplement
				benefit plans are applicable to all Medicare supplement benefit plan policies
				or certificates delivered or issued for delivery in this Commonwealth on or
				after July 30, 1992, and with an effective date for coverage prior to June 1,
				2010. 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
				14VAC5-170-70 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 Commonwealth, except as may be permitted in subsection
				G of this section and
				14VAC5-170-90.
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
				14VAC5-170-30. Each benefit shall
				be structured in accordance with the format provided in
				14VAC5-170-70 C, D, or 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 subsection C,
				other designations to the extent permitted by law.
E. Make-up of benefit plans:
1. Standardized Medicare supplement benefit
				plan "A" shall be limited to the basic (core) benefits common to all benefit
				plans, as defined in
				14VAC5-170-70 C.
2. Standardized Medicare supplement benefit
				plan "B" shall include only the following: The core benefits as defined in
				14VAC5-170-70 C, plus the Medicare
				Part A deductible as defined in
				14VAC5-170-70 D 1.
3. Standardized Medicare supplement benefit
				plan "C" shall include only the following: The core benefits as defined in
				14VAC5-170-70 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
				14VAC5-170-70 D 1, 2, 3, and 8
				respectively.
4. Standardized
				Medicare supplement benefit plan "D" shall include only the following: The core
				benefits as defined in
				14VAC5-170-70 C, 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
				14VAC5-170-70 D 1, 2, 8, and 10
				respectively.
5. Standardized
				Medicare supplement benefit plan "E" shall include only the following: The core
				benefits as defined in
				14VAC5-170-70 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
				14VAC5-170-70 D 1, 2, 8, and 9
				respectively.
6. Standardized
				Medicare supplement benefit plan "F" shall include only the following: The core
				benefits as defined in
				14VAC5-170-70 C, plus the Medicare
				Part A deductible, the skilled nursing facility care, the Part B deductible,
				100% of the Medicare Part B excess charges, and medically necessary emergency
				care in a foreign country as defined in
				14VAC5-170-70 D 1, 2, 3, 5, and 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 benefits
				as defined in
				14VAC5-170-70 C, 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
				14VAC5-170-70 D 1, 2, 3, 5, and 8
				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 calendar year deductible shall be $1,500 for
				1998 and 1999. 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 on August 31st 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 benefits as defined in
				14VAC5-170-70 C, 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
				14VAC5-170-70 D 1, 2, 4, 8, and 10
				respectively.
9. Standardized
				Medicare supplement benefit plan "H" shall include only the following: The core
				benefits as defined in
				14VAC5-170-70 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 14VAC5-170-70 D 1, 2, 6, and 8
				respectively. The basic 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 include only the following: The core benefits as defined in
				14VAC5-170-70 C, 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
				14VAC5-170-70 D 1, 2, 5, 6, 8, and
				10 respectively. The basic 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 include only the following: The core benefits as defined in
				14VAC5-170-70 C, 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
				14VAC5-170-70 D 1, 2, 3, 5, 7, 8,
				9, and 10 respectively. The extended 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 include only the following:
				100% of covered expenses following the payment of the annual high deductible
				plan "J" deductible. The covered expenses include the core benefits as defined
				in 14VAC5-170-70 C, 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
				14VAC5-170-70 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 calendar year deductible shall be $1,500 for
				1998 and 1999. 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 on August 31st of the preceding year and rounded to the
				nearest multiple of $10. The extended outpatient prescription drug benefit
				shall not be included in a Medicare supplement policy sold after December 31,
				2005.