Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 160 - RULES TO IMPLEMENT TRANSITIONAL REQUIREMENTS FOR THE CONVERSION OF MEDICARE SUPPLEMENT INSURANCE BENEFITS AND PREMIUMS TO CONFORM TO REPEAL OF THE MEDICARE CATASTROPHIC COVERAGE ACT › Section 14VAC5-160-110:1 - APPENDIX A. NOTICE OF CHANGES IN MEDICARE AND YOUR MEDICARE SUPPLEMENT COVERAGE-1990

Current through Register Vol. 40, No. 24, July 15, 2024
NOTICE OF CHANGES IN MEDICARE AND YOUR MEDICARE SUPPLEMENT
				  COVERAGE-1990
THE FOLLOWING OUTLINE BRIEFLY DESCRIBES THE MODIFICATIONS IN
				  MEDICARE AND IN YOUR MEDICARE SUPPLEMENT COVERAGE. PLEASE READ THIS
				  CAREFULLY!
[A BRIEF DESCRIPTION OF THE REVISIONS TO MEDICARE PARTS A
				  & B WITH A PARALLEL DESCRIPTION OF SUPPLEMENTAL BENEFITS WITH SUBSEQUENT
				  CHANGES, INCLUDING DOLLAR AMOUNTS, PROVIDED BY THE MEDICARE SUPPLEMENT COVERAGE
				  IN SUBSTANTIALLY THE FOLLOWING FORMAT.]
SERVICES
MEDICARE BENEFITS
YOUR MEDICARE SUPPLEMENT COVERAGE
In 1989 Medicare Per Calendar Year
Effective January 1, 1990, Medicare Will Pay
In 1989 Your Coverage Pays
Effective January 1, 1990, Your Coverage Will Pay Per
						  Calendar Year
MEDICARE PART A SERVICES AND SUPPLIES
Inpatient Hospital Services
Unlimited number of hospital days after $560 deductible
All but $592 for first 60 days/benefit period
Semi-Private Room & Board
All but $148 a day for 61st-90 days/benefit period
Misc. Hospital Services & Supplies, such as Ddrugs,
						  X-Rays, Lab Tests & Operating Room
All but $296 a day for 91st-150 days (if individual
						  chooses to use 60 nonrenewable days)
BLOOD
Pays all costs except payment of deductible (equal to
						  costs for first three pints) each calendar year. Part A blood deductible
						  reduced to the extent paid under Part B
Pays all costs except nonreplacement fees (blood
						  deductible) for first three pints in each benefit period
SKILLED NURSING FACILITY CARE
There is no prior confinement requirement for this
						  benefit
100% of costs for 1st 20 days (after a three-day prior
						  hospital confinement)/benefit period
First eight days - all but $25.50 a day
All but $74 a day for 21st-100th days/benefit period
9th through 150th day - 100% of costs
Beyond 100 days Nothing/benefit period
Beyond 150 days - Nothing
MEDICARE PART B SERVICES AND SUPPLIES
80% of allowable charges (after $75 deductible/calendar
						  year)
80% of allowable charges (after $75 deductible)
PRESCRIPTION
Inpatient prescription drugs. 80% of allowable charges
						  for immuno-suppressive drugs during the first year following a covered
						  transplant (after $75 deductible/calendar year)
Inpatient prescription drugs. 80% of allowable charges
						  for immuno-suppressive drugs during the first year following a covered
						  transplant (after $75 deductible/calendar year)
BLOOD
80% of all costs except nonreplacement fees (blood
						  deductible) for first three pints in each benefit period (after $75
						  deductible/calendar year)
80% of costs except nonreplacement fees (blood
						  deductible) for first three pints in each benefit period (after $75
						  deductible/calendar year)
[Any other policy benefits not mentioned in this chart should
				  be added to the chart in the order prescribed by the outline of coverage
				  benefits. If there are corresponding Medicare benefits, they should be
				  shown.]
[Describe any coverage provisions changing due to Medicare
				  modifications.]
[Include information about when premium adjustments that may
				  be necessary due to changes in Medicare benefits will be effective.]
THIS CHART SUMMARIZING THE CHANGES IN YOUR MEDICARE BENEFITS
				  AND IN YOUR MEDICARE SUPPLEMENT PROVIDED BY [COMPANY] ONLY BRIEFLY DESCRIBES
				  SUCH BENEFITS. FOR INFORMATION ON YOUR MEDICARE BENEFITS CONTACT YOUR SOCIAL
				  SECURITY OFFICE OR THE HEALTH CARE FINANCING ADMINISTRATION. FOR INFORMATION ON
				  YOUR MEDICARE SUPPLEMENT [Policy] CONTACT:
[COMPANY OR FOR AN INDIVIDUAL POLICY - NAME OF AGENT]
[ADDRESS/PHONE NUMBER]