Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-066 - Standard medicare supplement benefit plans

Current through Register Vol. 24-14, July 15, 2024
Standard medicare supplement benefit plans issued for delivery
				prior to June 1, 2010, must comply with this section.
(1) An issuer must make available to each
			 prospective policyholder and certificate holder a policy form or certificate
			 form containing only the basic "core" benefits, as defined in WAC
			 284-66-063(2) of
			 this regulation.
(2) No groups,
			 packages, or combinations of medicare supplement benefits other than those
			 listed in this section may be offered for sale in this state, except as
			 permitted in WAC
			 284-66-066(7)
			 and in WAC
			 284-66-073.
(3) Benefit plans must 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 WAC
			 284-66-030 and
			 284-66-040. Each benefit must be
			 structured according to the format provided in WAC
			 284-66-063(2), (3), (4) or
			 (5)  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 benefit.
(4) An issuer may use, in addition to the
			 benefit plan designations required in subsection (3) of this section, other
			 designations to the extent permitted by law.
(5) Make-up of benefit plans:
(a) Standardized medicare supplement benefit
			 plan "A" must be limited to only the basic ("core") benefits common to all
			 benefit plans, as defined in WAC
			 284-66-063(2).
(b) Standardized medicare supplement benefit
			 plan "B" consists of only the following: The core benefit as defined in WAC
			 284-66-063(2),
			 plus the medicare Part A deductible as defined in WAC
			 284-66-063(3)(a).
(c) Standardized medicare supplement benefit
			 plan "C" consists of only the following: The core benefit as defined in WAC
			 284-66-063(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 WAC
			 284-66-063(3)(a), (b), (c), and
			 (h), respectively.
(d) Standardized medicare supplement plan "D"
			 consists of only the following: The core benefit, as defined in WAC
			 284-66-063(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 WAC
			 284-66-063(3)(a), (b), (h), and
			 (j), respectively.
(e) Standardized medicare supplement benefit
			 plan "E" consists of only the following: The core benefit as defined in WAC
			 284-66-063(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 WAC
			 284-66-063(3)(a), (b), (h), and
			 (i), respectively.
(f) Standardized medicare supplement benefit
			 plan "F" consists of only the following: The core benefit as defined in WAC
			 284-66-063(2),
			 plus the medicare Part A deductible, the skilled nursing facility care, the
			 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 WAC
			 284-66-063(3)(a), (b), (c), (e), and
			 (h), respectively.
(g) Standardized medicare supplement benefit
			 high deductible plan "F" consists of 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 WAC
			 284-66-063(2),
			 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 WAC 284-66-063(3)(a), (b), (c), (e) and
			 (h)  respectively. The annual high deductible
			 plan "F" deductible must consist of out-of-pocket expenses, other than
			 premiums, for services covered by the medicare supplement plan "F" policy, and
			 must be in addition to any other specific benefit deductibles. The annual high
			 deductible plan "F" deductible is one thousand seven hundred thirty dollars for
			 2005, and is based on the calendar year. The deductible will be adjusted
			 annually by the secretary 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 ten dollars.
(h) Standardized medicare supplement benefit
			 plan "G" consists of only the following: The core benefit as defined at WAC
			 284-66-063(2),
			 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 WAC
			 284-66-063(3)(a), (b), (d), (h), and
			 (j), respectively.
(i) Standardized medicare supplement benefit
			 plan "H" consists of only the following: The core benefit as defined in WAC
			 284-66-063(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 WAC
			 284-66-063(3)(a), (b), (f), and
			 (h), respectively. The outpatient
			 prescription drug benefit may not be included in a medicare supplement policy
			 sold after December 31, 2005.
(j)
			 Standardized medicare supplement benefit plan "I" consists of only the
			 following: The core benefit as defined in WAC
			 284-66-063(2),
			 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 WAC
			 284-66-063(3)(a), (b), (e), (f), (h), and
			 (j), respectively. The outpatient
			 prescription drug benefit may not be included in a medicare supplement policy
			 sold after December 31, 2005.
(k)
			 Standardized medicare supplement benefit plan "J" consists of only the
			 following: The core benefit as defined in WAC
			 284-66-063(2),
			 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 WAC
			 284-66-063(3)(a), (b), (c), (e), (g), (h), (i),
			 and (j), respectively. The outpatient
			 prescription drug benefit may not be included in a medicare supplement policy
			 sold after December 31, 2005.
(l)
			 Standardized medicare supplement benefit high deductible plan "J" consists 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 WAC
			 284-66-063(2),
			 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, preventative medical care benefit and at-home
			 recovery benefit as defined in WAC
			 284-66-063(3)(a), (b), (c), (e), (g), (h), (i) and
			 (j)  respectively. The annual high deductible
			 plan "J" deductible must consist of out-of-pocket expenses, other than
			 premiums, for services covered by the medicare supplement plan "J" policy, and
			 must be in addition to any other specific benefit deductibles. The annual
			 deductible is one thousand seven hundred thirty dollars for 2005, and is based
			 on the calendar year. The deductible will be adjusted annually by the secretary
			 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 ten dollars. The outpatient prescription drug
			 benefit may not be included in a medicare supplement policy sold after December
			 31, 2005.