X hits on this document

174 views

0 shares

0 downloads

0 comments

21 / 46

OAC 365:10

INSURANCE DEPARTMENT

Supplement Benefit Plan Policies or Certificates issued for delivery on or after June 1, 2010 (a) 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 plan standards. Benefit plan standards applicable to Medicare supplement policies and certificates issued before June 1, 2010 remain subject to the requirements of O.A.C. 365:10-5-126 and 365:10-5-127. (b) 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-

    • 127.1.

      If an issuer makes available any of the additional benefits described in O.A.C. 365:10-5-

    • 127.1

      (d), or offers standardized benefit Plans K or L (as described in O.A.C 365:10-5-128.3(f)(8)

and (9)), then the issuer shall make available to each prospective policyholder and certificateholder, in addition to a policy form or certificate form with only the basic (core) benefits as described above, a policy form or certificate form containing either standardized benefit Plan C (as described in

  • O.

    A.C. 365:10-5-128.2(f)(3)) or standardized benefit Plan F (as described in O.A.C. 365:10-5-

    • 128.2

      (f)(5)).

      • (c)

        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 O.A.C. 365:10-5-128.2(g) and in O.A.C. 365:10-5-128.3. (d) Benefit plans shall be uniform in structure, language, designation and format to the standard benefit plans 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. 365:10-5-127.1(c) and (d); or, in the case of plans K or L, in O.A.C. 365:10-5-128.2(f)(8) or (9) of this regulation and list the benefits in the order shown. For purposes of this Section, “structure, language, and format”

m e a n s s t y l e , a r r a n g e m e n t a n d o v e r a l l c o n t e n t o f a b e n e f i t . In addition to the benefit plan designations required in Subsection (d) of this section, an (e)

issuer may use other designations to the extent permitted by law.

  • (f)

    Make-up of 2010 Standardized Benefit Plans:

    • (1)

      Standardized Medicare supplement benefit Plan A shall include only the following: The basic (core) benefits as defined in O.A.C. 365:10-5-127.1(c).

    • (2)

      Standardized Medicare supplement benefit Plan B shall include only the following: The basic (core) benefit as defined in Section of this regulation, plus one hundred percent (100%) of the Medicare Part A deductible as defined in 365:10-5-127.1(d)(1).

    • (3)

      Standardized Medicare supplement benefit Plan C shall include only the following: The basic (core) benefit as defined in O.A.C. 365:10-5-127.1(c), plus one hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, one hundred percent (100%) of the Medicare Part B deductible, and medically necessary emergency care in a foreign country as defined in O.A.C. 365:10-5-127.1(d)(1), (3), (4), and (6), respectively.

    • (4)

      Standardized Medicare supplement benefit Plan D shall include only the following: The basic (core) benefit (as defined in O.A.C. 365:10-5-127.1(c), plus one hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in an foreign country as defined in O.A.C. 365:10-5-127.1(d) (1),

    • (3)

      , and (6), respectively.

    • (5)

      Standardized Medicare supplement [regular] Plan F shall include only the following:

Document info
Document views174
Page views174
Page last viewedSun Dec 11 06:14:14 UTC 2016
Pages46
Paragraphs1387
Words22930

Comments