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OAC 365:10

INSURANCE DEPARTMENT

termination. Coverage under the new group policy shall not result in any exclusion for preexisting conditions that would have been covered under the group policy being replaced.

    • (6)

      Termination of a Medicare supplement policy or certificate shall be without prejudice to any continuous loss which commenced while the policy was in force, but the extension of benefits beyond the period during which the policy was in force may be predicated upon the continuous total disability of the insured, limited to the duration of the policy benefit period, if any, or to payment of the maximum benefits. Receipt of Medicare Part D benefits will not be considered in determining a continuous loss.

    • (7)

      If a Medicare supplement policy eliminates an outpatient prescription drug benefit as a result of requirements imposed by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, the modified policy shall be deemed to satisfy the guaranteed renewal requirements of this subsection.

  • (c)

    Minimum benefit standards.

    • (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 for either all or none of the Medicare Part A inpatient hospital deductible amount;

    • (3)

      Coverage of Part A Medicare eligible expenses incurred as daily hospital charges during use of Medicare's lifetime hospital inpatient reserve days;

    • (4)

      Upon exhaustion of all Medicare hospital inpatient coverage including the lifetime reserve days, coverage of ninety percent (90%) of all Medicare Part A eligible expenses for hospitalization not covered by Medicare subject to a lifetime maximum benefit of an additional 365 days;

    • (5)

      Coverage under Medicare Part A 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 or already paid for under Part B;

    • (6)

      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 a maximum calendar year out-of-pocket amount equal to the Medicare Part B deductible;

    • (7)

      Effective January 1, 1990, coverage under Medicare Part 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 or already paid for under Part A, subject to the Medicare deductible amount.

[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 22 Ok Reg 1954, eff 7-14-05]

365:10-5-127. Benefit standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates issued or delivered on or after July 1, 1992 and Prior to June 1, 2010

(a)

Benefit standards. The following standards are applicable to all Medicare supplement

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