Title 3 . Commerce, Community, and Economic Development

Chapter 28 . Miscellaneous

Section 455. Standard medicare supplement benefit plans

3 AAC 28.455. Standard medicare supplement benefit plans

(a) An issuer shall make available to each prospective policyholder and certificate holder a policy form or certificate form containing only the basic core benefits set out in 3 AAC 28.453(c) .

(b) A group, package, or combination of medicare supplement benefits not listed in this section may not be offered for sale in this state, except as permitted under (e)(15) of this section.

(c) Benefit plans must be uniform in structure, language, designation, and format to the standard benefit plans "A" through "L" listed in this section and conform to the definitions under 3 AAC 28.430 and 3 AAC 28.510. For standard benefit plans "A" through "J," a benefit must be structured in accordance with the format under 3 AAC 28.453(c) and (d) and list the benefits in the order shown. For standard benefit plan "K," a benefit must be structured in accordance with the format under 3 AAC 28.453(e) , and list the benefits in the order shown. For standard benefit plan "L," a benefit must be structured in accordance with the format under 3 AAC 28.453(f) , and list the benefits in the order shown. For purposes of this subsection, "structure, language, and format" mean style, arrangement, and overall content of a benefit.

(d) An issuer may use, in addition to the benefit plan designations required in (c) of this section, other designations to the extent permitted by law.

(e) Benefit plans must adhere to the following requirements:

(1) standardized medicare supplement benefit plan "A" must be limited to the basic core benefits common to all benefit plans, as set out in 3 AAC 28.453(c) ;

(2) standardized medicare supplement benefit plan "B" must consist of the core benefit as defined in 3 AAC 28.453(c) plus the medicare Part A deductible as set out in 3 AAC 28.453(d) (1);

(3) standardized medicare supplement benefit plan "C" must consist of the core benefit as defined in 3 AAC 28.453(c) plus the medicare Part A deductible, skilled nursing facility care, medicare Part B deductible, and medically necessary emergency care provided in a foreign country as set out in 3 AAC 28.453(d) (1) - (d)(3), and (d)(8);

(4) standardized medicare supplement benefit plan "D" must consist of the core benefit as set out in 3 AAC 28.453(c) plus the medicare Part A deductible, skilled nursing facility care, medically necessary emergency care provided in a foreign country, and the at-home recovery benefit as set out in 3 AAC 28.453(d) (1), (d)(2), (d)(8), and (d)(10);

(5) standardized medicare supplement benefit plan "E" must consist of the core benefit as described in 3 AAC 28.453(c) plus the medicare Part A deductible, skilled nursing facility care, medically necessary emergency care provided in a foreign country, and preventive medical care as set out in 3 AAC 28.453(d) (1), (d)(2), (d)(8), and (d)(9);

(6) standardized medicare supplement benefit plan "F" must consist of the core benefit as described in 3 AAC 28.453(c) plus the medicare Part A deductible, skilled nursing facility care, the medicare Part B deductible, all of the medicare Part B excess charges, and medically necessary emergency care provided in a foreign country as set out in 3 AAC 28.453(d) (1) - (d)(3), (d)(5), and (d)(8);

(7) standardized medicare supplement benefit high deductible plan "F" must consist of all of the covered expenses following the payment of the annual high deductible plan "F" deductible subject to the following:

(A) the covered expenses include the basic core benefit as described in 3 AAC 28.553(c) plus the medicare Part A deductible, skilled nursing facility care, the medicare Part B deductible, all of the medicare Part B excess charges, and medically necessary emergency care provided in a foreign country as set out in 3 AAC 28.453(d) (1) - (3), (5), and (8);

(B) 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;

(C) the annual high deductible plan "F" deductible must be $1,500 for 1999, based on the calendar year, to be adjusted annually after that by the secretary 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, rounded to the nearest multiple of $10;

(8) standardized medicare supplement benefit plan "G" must consist of the core benefit as described in 3 AAC 28.453(c) plus the medicare Part A deductible, skilled nursing facility care, 80 percent of the medicare Part B excess charges, medically necessary emergency care provided in a foreign country, and the at-home recovery benefit as set out in 3 AAC 28.453(d) (1), (d)(2), (d)(4), (d)(8), and (d)(10);

(9) standardized medicare supplement benefit plan "H" must consist of the core benefit as set out in 3 AAC 28.453(c) plus the medicare Part A deductible, skilled nursing facility care, basic prescription drug benefit, and medically necessary emergency care provided in a foreign country as set out in 3 AAC 28.453(d) (1), (d)(2), (d)(6), and (d)(8); the outpatient prescription drug benefit may not be included in a medicare supplement policy issued after December 31, 2005;

(10) standardized medicare supplement benefit plan "I" must consist of the core benefit as set out in 3 AAC 28.453(c) plus the medicare Part A deductible, skilled nursing facility care, all of the medicare Part B excess charges, basic prescription drug benefit, medically necessary emergency care provided in a foreign country, and the at-home recovery benefit as set out in 3 AAC 28.453(d) (1), (d)(2), (d)(5), (d)(6), (d)(8), and (d)(10); the outpatient prescription drug benefit may not be included in a medicare supplement policy issued after December 31, 2005;

(11) standardized medicare supplement benefit plan "J" must consist of the core benefit as set out in 3 AAC 28.453(c) plus the medicare Part A deductible, skilled nursing facility care, medicare Part B deductible, all of the medicare Part B excess charges, extended prescription drug benefit, medically necessary emergency care provided in a foreign country, preventive medical care, and the at-home recovery benefit as set out in 3 AAC 28.453(d) (1) - (3), (5), and (7) - (10); the outpatient prescription drug benefit may not be included in a medicare supplement policy issued after December 31, 2005;

(12) standardized medicare supplement benefit high deductible plan "J" must consist of all of the covered expenses following the payment of the annual high deductible plan "J" deductible subject to the following:

(A) the covered expenses include the basic core benefit as described in 3 AAC 28.453(c) plus the medicare Part A deductible, skilled nursing facility care, the medicare Part B deductible, all of the medicare Part B excess charges, extended outpatient prescription drug benefit, medically necessary emergency care provided in a foreign country, preventive medical care, and at-home recovery benefit as set out in 3 AAC 28.453(d) (1) - (3), (5), and (7) - (10);

(B) 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;

(C) the annual high deductible plan "J" deductible must be $1,500 for 1999, based on the calendar year, to be adjusted annually after that by the secretary 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, rounded to the nearest multiple of $10;

(D) the outpatient prescription drug benefit may not be included in a medicare supplement policy issued after December 31, 2005;

(13) standardized medicare supplement plan "K" must consist of only the benefits described in 3 AAC 28.453(e) ;

(14) standardized medicare supplement plan "L" must consist of only the benefits described in 3 AAC 28.453(f) ;

(15) an issuer may, with the prior approval of the director, offer policies or certificates with new or innovative benefits in addition to the benefits provided in a policy or certificate that otherwise complies with the applicable standards; the new or innovative benefits may include benefits that are appropriate to medicare supplement insurance, new or innovative, not otherwise available, cost-effective, and offered in a manner that is consistent with the goal of simplification of medicare supplement policies; after December 31, 2005, a new or innovative benefit may not include outpatient prescription drug coverage.

History: Eff. 7/1/92, Register 122; am 7/12/96, Register 139; am 4/21/99, Register 150; am 9/4/2005, Register 175

Authority: AS 21.06.090

AS 21.42.130

AS 21.89.060