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OAC 365:10

INSURANCE DEPARTMENT

expenses for medically necessary emergency hospital, physician and medical care received in a foreign country, which care would have been covered by Medicare if provided in the United States and which care began during the first sixty (60) consecutive days of each trip outside the United States, subject to a calendar year deductible of $250, and a lifetime maximum benefit of $50,000. For purposes of this benefit, “emergency care” shall mean care needed immediately because of an injury or an illness of sudden and unexpected onset.

[Source: Added at 26 Ok Reg 1529, eff 7-1-2009]

365:10-5-128. Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates issued for delivery on or after July 1, 1992, and prior to June 1, 2010 (a) An issuer shall make available to each prospective policyholder and certificateholder a policy form or certificate form containing only the basic "core" benefits, as defined in O.A.C. 365:10-5- 127(c). (b) 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 Sections 365:10-5-128(g) and 365:10-5-128.3 of this regulation. (c) 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 O.A.C. 365:10-5-123. Each benefit shall be structured in accordance with the format provided in O.A.C. 365:10-5-127(c) and (d) or O.A.C. 365:10-5-127(e) 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.

(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)

    Make-up of benefit plans are as follows:

    • (1)

      Standardized Medicare supplement benefit plan "A" shall be limited to the Basic ("Core") Benefits Common to All Benefit Plans, as defined in 365:10-5-127(c).

    • (2)

      Standardized Medicare supplement benefit plan "B" shall include only the following: The Core Benefit as defined in 365:10-5-127(c), plus the Medicare Part A Deductible as defined in 365:10-5-127(d)(1).

    • (3)

      Standardized Medicare supplement benefit plan "C" shall include only the following: The Core Benefit as defined in 365:10-5-127(c), 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 365:10-5-127(d)(1), (2), (3) & (8) respectively. (4) Standardized Medicare supplement benefit plan "D" shall include only the following: The Core Benefit as defined in 365:10-5-127(c), plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medically Necessary Emergency Care in an Foreign Country and the At-Home Recovery Benefit as defined in 365:10-5-127(d) (1), (2), (8) & (10) respectively. (5) Standardized Medicare supplement benefit plan "E" shall include only the following: The Core Benefit as defined in 365:10-5-127(c), 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 365:10-5-127(d) (1), (2), (8) & (9) respectively.

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