X hits on this document





24 / 46

OAC 365:10


copayment for each covered health care provider office visit (including visits to medical specialists); and

    • (B)

      the lesser of fifty dollars ($50) or the Medicare Part B coinsurance or copayment for each covered emergency room visit, however, this copayment shall be waived if the insured is admitted to any hospital and the emergency visit is subsequently covered as a Medicare Part A expense.

  • (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 standardized benefits provided in a policy or certificate that otherwise complies with the applicable standards. The new or innovative benefits shall include only benefits that are appropriate to Medicare supplement insurance, are new or innovative, are not otherwise available, and are cost-effective. Approval of new or innovative benefits must not adversely impact the goal of Medicare supplement simplification. New or innovative benefits shall not include an outpatient prescription drug benefit. New or innovative benefits shall not be used to change or reduce benefits, including a change of any cost-sharing provision, in any standardized plan.

[Source: Added at 26 Ok Reg 1529, eff 7-1-2009; Amended at 28 Ok Reg 1960, eff 7-14-11]

365:10-5-128.3. Medicare Select Policies and Certificates


Application. This section shall apply to Medicare Select policies and certificates, as defined

in this section. No policy or certificate may be advertised as a Medicare Select policy or certificate

unless it meets the requirements of this section.

  • (b)

    Definitions. For the purposes of this section:

    • (1)

      "Complaint" means any dissatisfaction expressed by an individual concerning a Medicare Select issuer or its network providers.

    • (2)

      "Grievance" means dissatisfaction expressed in writing by an individual insured under a Medicare Select policy or certificate with the administration, claims practices, or provision of services concerning a Medicare Select issuer or its network providers.

    • (3)

      "Medicare Select issuer" means an issuer offering, or seeking to offer, a Medicare Select policy or certificate.

    • (4)

      "Medicare Select policy" or "Medicare Select certificate" mean respectively a Medicare supplement policy or certificate that contains restricted network provisions.

    • (5)

      "Network provider" means a provider of health care, or a group of providers of health care, which has entered into a written agreement with the issuer to provide benefits insured under a Medicare Select policy.

    • (6)

      "Restricted network provision" means any provision which conditions the payment of benefits, in whole or in part, on the use of network providers.

    • (7)

      "Service area" means the geographic area approved by the Commissioner within which an issuer is authorized to offer a Medicare Select policy.

  • (c)

    Authorization. The Commissioner may authorize an issuer to offer a Medicare Select policy

or certificate, pursuant to this section and Section 4358 of the Omnibus Budget Reconciliation Act (OBRA) of 1990 if the Commissioner finds that the issuer has satisfied all of the requirements of this regulation.


Plan of operation approval. A Medicare Select issuer shall not issue a Medicare Select

Document info
Document views190
Page views190
Page last viewedWed Jan 18 10:38:30 UTC 2017