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OAC 365:10

INSURANCE DEPARTMENT

supplement policy sold after December 31, 2005.

    • (12)

      Standardized Medicare supplement benefit high deductible plan "J" shall consist of only the following: 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 Section 365:10-5-127(c) of this regulation, 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 outpatient prescription drug benefit, medically necessary emergency care in a foreign county, preventive medical care benefit and at-home recovery benefit as defined in Sections 365:10-5-127(d)(1), (2), (3), (5), (7), (8), (9) and (10) respectively. 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 $1500 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 $10. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy sold after December 31, 2005.

  • (f)

    Make up of two Medicare supplement plans mandated by The Medicare Prescription Drug,

Improvement and Modernization Act of 2003 (MMA);

    • (1)

      Standardized Medicare supplement benefit plan “K” shall consist of only those benefits described in Section 365:10-5-127(e)(1).

    • (2)

      Standardized Medicare supplement benefit plan “L” shall consist of only those benefits described in Section 365:10-5-127(e)(2).

  • (g)

    New or Innovative Benefits: An issuer may, with the prior approval of the commissioner,

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 which is consistent with the goal of simplification of Medicare supplement policies. After December 31, 2005, the innovative benefit shall not include an outpatient prescription drug benefits.

[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 15 Ok Reg 3569, eff 5-29-98 (emergency); Amended at 16 Ok Reg 1088, eff 4-26-99; Amended at 22 Ok Reg 1954, eff 7-14-05; Amended at 26 Ok Reg 1529, eff 7-1-2009]

365:10-5-128.1. Medicare Select Policies and Certificates

[Source: Added at 14 Ok Reg 397, eff 1-13-97 and at 15 Ok Reg 3569, eff 5-29-98 (emergency); Added at 16 Ok Reg 1088, eff 4-26-99; Amended at 20 Ok Reg 1667, eff 7-14-03; Amended at 22 Ok Reg 1954, eff 7-14-05; Amended and Renumbered to O.A.C. 365:10-5-128.3 at 26 Ok Reg 1529, eff 7-1-2009]

365:10-5-128.2 Standard Medicare Supplement Benefit Plans for 2010 Standardized Medicare

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