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OAC 365:10

INSURANCE DEPARTMENT

(E)

Skilled Nursing Facility Care: Coverage for Fifty percent (50%) of the

coinsurance

amount

for

each

day

used

from

the

21st

day

through

the

100th

day

in

a

Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare part A until the out-of-pocket limitation is met as described in Subparagraph (J); (F) Hospice Care: Coverage for Fifty percent (50%) of the cost sharing for all part A Medicare eligible expenses and respite care until the out-of-pocket limitation

is met as described in Subparagraph (J);

(G)

Coverage for Fifty percent (50%), under Medicare Part A or B, of the

(2)

reasonable cost of the first three (3) pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations until the out-of-pocket limitation is met as described in Subparagraph (J); (H) Except for coverage provided in Subparagraph (I) below, coverage for Fifty percent (50%) of the cost sharing otherwise applicable under Medicare Part B after the policyholder pays the Part B deductible until the out-of-pocket limitation is met as described in subparagraph (J) below; (I) Coverage of One Hundred percent (100%) of the cost sharing for Medicare Part B preventive services after the policyholder pays the Part B deductible; and (J) Coverage of One Hundred percent (100%) of all cost sharing under Medicare Parts A and B for the balance fo the calendar year after the individual has reached the out-of-pocket limitation on annual expenditures under Medicare Parts A and B of Four Thousand dollars ($4,000.00) in 2006, indexed each year by the appropriate inflation adjustment specified by the Secretary of the U.S. Department of Health and Human Services. Standardized Medicare supplement benefit plan “L” shall consist of the following:

  • (A)

    The benefits described in Paragraphs (1) (A), (B), (C) and (I);

  • (B)

    The benefits described in Paragraphs (1) (D), (E), (F), (G) and (H), but

substituting Seventy Five percent (75%) for Fifty percent (50%); and

(C)

The benefit described in Paragraph (1) (J), but substituting Two Thousand

dollars ($2,000.00) for Four Thousand dollars ($4,000.00).

[Source: Added at 9 Ok Reg 549, eff 12-13-91 (emergency); Added at 9 Ok Reg 2499, eff 6-26-92; Amended at 9 Ok Reg 3899, eff 8-24-92 (emergency); Amended at 10 Ok Reg 1475, eff 5-1-93; Amended at 14 Ok Reg 2292, eff 7-1-97; Amended at 17 Ok Reg 1621, eff 7-14-00; Amended at 20 Ok Reg 1667, eff 7-14-03; Amended at 22 Ok Reg 1954, eff 7-14-05; Amended at 26 Ok Reg 1529, eff 7-1-2009]

365:10-5-127.1. Benefit standards for 2010 Standardized Medicare Supplement Benefit Plan policies or certificates issued for delivery on or after June 1, 2010 (a) Benefit Standards. The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered, or issued for delivery in this state as a Medicare supplement policy or certificate unless it complies with these benefit standards. No issuer

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