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OAC 365:10

INSURANCE DEPARTMENT

(c)

certificateholder had the coverage not been suspended. Standards for Basic (Core) Benefits Common to Medicare Supplement Insurance

Benefit Plans A, B, C, D, F, F with High Deductible, G, M and N. Every issuer of Medicare supplement insurance benefit plans shall make available a policy or certificate including only the following basic “core” package of benefits to each prospective insured. An issuer may make available to prospective insureds any of the other Medicare Supplement Insurance Benefit Plans in

addition to the basic core package, but not in lieu of it.

(1)

Coverage of Part A Medicare eligible expenses for hospitalization to the extent not

covered by Medicare from the 61st day through the 90th day in any Medicare benefit period;

(2)

Coverage of Part A Medicare eligible expenses incurred for hospitalization to the

extent not covered by Medicare for each Medicare lifetime inpatient reserve day used;

(3)

Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime

reserve days, coverage of one hundred percent (100%) of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer’s payment as payment in full and may not bill the insured for any balance; (4) Coverage under Medicare Parts A and B for the 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;

(5)

Coverage for the coinsurance amount, or in the case of hospital outpatient department

services paid under a prospective payment system, the copayment amount, of Medicare eligible expenses under Part B regardless of hospital confinement, subject to the Medicare

Part B deductible;

    • (6)

      Hospice Care: Coverage of cost sharing for all Part A Medicare eligible hospice care and respite care expenses.

  • (d)

    Standards for additional benefits. The following additional benefits shall be included in

Medicare supplement benefit Plans B, C, D, F, F with High Deductible, G, M, and N as provided by

  • O.

    A.C. 365:10-5-128.2.

    • (1)

      Medicare Part A Deductible: Coverage for one hundred percent (100%) of the Medicare Part A inpatient hospital deductible amount per benefit period.

    • (2)

      Medicare Part A Deductible: Coverage for fifty percent (50%) of the Medicare Part A inpatient hospital deductible amount per benefit period.

    • (3)

      Skilled Nursing Facility Care: Coverage for the actual billed charges up to the coinsurance amount 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.

    • (4)

      Medicare Part B Deductible: Coverage for one hundred percent (100%) of the Medicare Part B deductible amount per calendar year regardless of hospital confinement.

    • (5)

      One Hundred Percent (100%) of the Medicare Part B Excess Charges: Coverage for all of the difference between the actual Medicare Part B charges as billed, not to exceed any charge limitation established by the Medicare program or state law, and the Medicare- approved Part B charge.

    • (6)

      Medically Necessary Emergency Care in a Foreign Country: Coverage to the extent not covered by Medicare for eighty percent (80%) of the billed charges for Medicare-eligible

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