West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-24 - Medicare Supplement Insurance › Section 114-24-7 - Standard Medicare Supplement Benefit Plans 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After August 5, 1991 and with an Effective Date for Coverage Prior to June 1, 2010

Current through Register Vol. XLI, No. 28, July 12, 2024
7.1. 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 subsection 6.3 of this
				rule.
7.2. No groups, packages or
				combinations of Medicare supplement benefits other than those listed in this section
				shall be offered for sale in this state, except as may be permitted in subsection
				7.7 of this section and in section 8 of this rule.
7.3. 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 section 2 of this rule.
				Each benefit shall be structured in accordance with the format provided in
				subsections 6.3 and 6.4 or 6.5 of this rule 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.
7.4. An issuer may use, in addition to the benefit
				plan designations required in subsection 7.3 of this section, other designations to
				the extent permitted by law.
7.5.
				Make-up of benefit plans:
7.5.a. Standardized
				Medicare supplement benefit plan "A" shall be limited to the basic core benefits
				common to all benefit plans, as defined in subsection 6.3 of this rule.
7.5.b. Standardized Medicare supplement benefit
				plan "B" shall include only the following: The core benefit as defined in subsection
				6.3 of this rule, plus the Medicare Part A deductible as defined in subdivision a,
				subsection 6.4 of this rule.
7.5.c.
				Standardized Medicare supplement benefit plan "C" shall include only the following:
				The core benefit as defined in subsection 6.3 of this rule, 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 subdivisions a, b, c and
				h of subsection 6.4, respectively, of this rule.
7.5.d. Standardized Medicare supplement benefit
				plan "D" shall include only the following: The core benefit as defined in subsection
				6.3 of this rule, 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 subdivisions a, b, h and j of subsection 6.4,
				respectively, of this rule.
7.5.e.
				Standardized Medicare supplement benefit plan "E" shall include only the following:
				The core benefit as defined in subsection 6.3 of this rule, 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 subdivisions a, b, h and i
				of subsection 6.4, respectively, of this rule.
7.5.f. Standardized Medicare supplement benefit
				plan "F" shall include only the following: The core benefit as defined in subsection
				6.3 of this rule, plus the Medicare Part A deductible, the skilled nursing facility
				care, the Part B deductible, one hundred percent (100%) of the Medicare Part B
				excess charges, and medically necessary emergency care in a foreign country as
				defined in subdivisions a, b, c, e and h of subsection 6.4, respectively, of this
				rule.
7.5.g. Standardized Medicare
				supplement benefit high deductible plan "F" shall include only the following: one
				hundred percent (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 subsection 6.3 of this rule, plus the Medicare Part A deductible, skilled
				nursing facility care, the Medicare Part B deductible, one hundred percent (100%) of
				the Medicare Part B excess charges, and medically necessary emergency care in a
				foreign country as defined in subdivisions a, b, c, e, and h of subsection 6.4,
				respectively, of this rule. 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 one
				thousand five hundred dollars ($1,500) for 1998 and 1999, and shall be based on the
				calendar year. It shall be adjusted annually thereafter 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 ($10).
7.5.h.
				Standardized Medicare supplement benefit plan "G" shall include only the following:
				The core benefit as defined in subsection 6.3 of this rule, plus the Medicare Part A
				deductible, skilled nursing facility care, eighty percent (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 subdivisions a, b, d, h and j of subsection
				6.4, respectively, of this rule.
7.5.i.
				Standardized Medicare supplement benefit plan "H" shall consist of only the
				following: The core benefit as defined in subsection 6.3 of this rule, 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
				subdivisions a, b, f and h of subsection 6.4, respectively, of this rule. The
				outpatient prescription drug benefit shall not be included in a Medicare supplement
				policy sold after December 31, 2005.
7.5.j. Standardized Medicare supplement benefit
				plan "I" shall consist of only the following: The core benefit as defined in
				subsection 6.3 of this rule, plus the Medicare Part A deductible, skilled nursing
				facility care, one hundred percent (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 subdivisions a, b, e, f, h and j
				of subsection 6.4, respectively, of this rule. The outpatient prescription drug
				benefit shall not be included in a Medicare supplement policy sold after December
				31, 2005.
7.5.k. Standardized Medicare
				supplement benefit plan "J" shall consist of only the following: The core benefit as
				defined in subsection 6.3 of this rule, plus the Medicare Part A deductible, skilled
				nursing facility care, Medicare Part B deductible, one hundred percent (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 subdivisions a, b, c, e, g, h, i and j of subsection
				6.4, respectively, of this rule. The outpatient drug benefit shall not be included
				in a Medicare supplement policy sold after December 31, 2005.
7.5.l Standardized Medicare supplement benefit
				high deductible plan "J" shall consist of only the following: one hundred percent
				(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
				subsection 6.3 of this rule, plus the Medicare Part A deductible, skilled nursing
				facility care, Medicare Part B deductible, one hundred percent (100%) of the
				Medicare Part B excess charges, extended prescription drug benefit, medically
				necessary emergency care in a foreign country, preventive medical care benefit and
				at-home recovery benefit as defined in subdivisions a, b, c, e, g, h, i and j of
				subsection 6.4, respectively, of this rule. 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
				one thousand five hundred dollars ($1,500) for 1998 and 1999, and shall be based on
				a calendar year. It shall be adjusted annually thereafter 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 ($10). The outpatient prescription drug benefit
				shall not be included in a Medicare supplement policy sold after December 31,
				2005.