Section 3.28.456. Standard medicare supplement benefit plans for 2010 standardized medicare supplement benefit policies or certificates issued with an effective date of coverage on or after 6/1/2010.

	(a)  A medicare supplement policy or certificate delivered or issued for delivery with an effective date of coverage on or after June 1, 2010 may not be advertised, solicited, delivered, or issued for delivery in this state as a medicare supplement policy or certificate unless it complies with the benefit requirements of this section.  
	(b)  An issuer shall make available to each prospective policyholder and certificate holder a policy form or certificate form containing only the basic core benefits, as set out in 3 AAC 28.454(m).  
	(c)  If an issuer makes available any of the additional benefits as set out in 3 AAC 28.454(n), or offers standardized benefit plans "K" or "L" as set out in (g)(8) and (9) of this section, the issuer shall make available to each prospective policyholder and certificate holder, in addition to a policy form or certificate form with only the basic core benefits as set out in 3 AAC 28.454(m), a policy form or certificate form containing either standardized benefit plan "C" as set out in (g)(3) of this section or standardized benefit plan "F" as set out in (g)(5) of this section.  
	(d)  An issuer may not offer for sale in this state a group, package, or combination of medicare supplement benefits other than those listed in this section, except as may be permitted under (h) of this section.  
	(e)  Medicare supplement benefit plans must be uniform in structure, language, designation, and format to the standardized benefit plans listed in (g) of this section and conform to the definitions under 3 AAC 28.340 and 3 AAC 28.510. Each benefit must be structured in accordance with the format provided in 3 AAC 28.454(m) and (n), or, in the case of plans "K" or "L," in (g)(8) or (9) of this section, and list the benefits in the order shown. For purposes of this section, "structure, language, and format" means style, arrangement, and overall content of a benefit.  
	(f)  An issuer may use, in addition to the benefit plan designations required in (e) of this section, other designations to the extent permitted by law.  
	(g)  The 2010 standardized medicare supplement benefit plans must adhere to the following requirements:  
		(1) standardized medicare supplement benefit plan "A" must be limited to the basic core benefits as set out in 3 AAC 28.454(m);  
		(2) standardized medicare supplement benefit plan "B" must consist of the core benefit as set out in 3 AAC 28.454(m) plus the medicare Part A deductible as set out in 3 AAC 28.454(n)(1);  
		(3) standardized medicare supplement benefit plan "C" must consist of the core benefit as set out in 3 AAC 28.454(m) plus the medicare Part A deductible, skilled nursing facility care, medicare Part B deductible, and medically necessary emergency care provided in a foreign country as set out in 3 AAC 28.454(n)(1), (3), (4), and (6);  
		(4) standardized medicare supplement benefit plan "D" must consist of the core benefit as set out in 3 AAC 28.454(m) plus the medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care provided in a foreign country as set out in 3 AAC 28.454(n)(1), (3), and (6);  
		(5) standardized medicare supplement plan "F" must consist of the core benefit as set out in 3 AAC 28.454(m) plus the medicare Part A deductible, skilled nursing facility care, the medicare Part B deductible, 100 percent of the medicare Part B excess charges, and medically necessary emergency care provided in a foreign country as set out in 3 AAC 28.454(n)(1) and (3) - (6);  
		(6) standardized medicare supplement high deductible plan "F" must consist of all of the covered expenses following the payment of the annual high deductible plan "F" deductible subject to the following:  
			(A) the covered expenses include the basic core benefit as set out in 3 AAC 28.454(m) plus the medicare Part A deductible, skilled nursing facility care, the medicare Part B deductible, 100 percent of the medicare Part B excess charges, and medically necessary emergency care provided in a foreign country as set out in 3 AAC 28.454(n)(1) and (3) - (6);  
			(B) the annual high deductible plan "F" deductible must consist of out-of-pocket expenses, other than premiums, for services covered by the medicare supplement plan "F" policy, and must be in addition to any other specific benefit deductibles;  
			(C) the annual high deductible plan "F" deductible must be $1,500 for 1999, based on the calendar year, to be adjusted annually after that by the secretary to reflect the change in the consumer price index for all urban consumers for the 12-month period ending with August of the preceding year, rounded to the nearest multiple of $10;  
		(7) standardized medicare supplement benefit plan "G" must consist of the core benefit as set out in 3 AAC 28.454(m) plus the medicare Part A deductible, skilled nursing facility care, 100 percent of the medicare Part B excess charges, and medically necessary emergency care provided in a foreign country as set out in 3 AAC 28.454(n)(1), (3), (5), and (6);  
		(8) standardized medicare supplement plan "K;" must consist of the following benefits:  
			(A) coverage of 100 percent of the medicare Part A hospital coinsurance amount for each day used from the 61st through the 90th day in any medicare benefit period;  
			(B) coverage of 100 percent of the medicare Part A hospital coinsurance amount for each medicare lifetime inpatient reserve day used from the 91st through the 150th day in any medicare benefit period;  
			(C) upon exhaustion of the medicare hospital inpatient coverage, including the lifetime reserve days, coverage of 100 percent of the medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate or other appropriate medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days;  
			(D) coverage for 50 percent of the medicare Part A inpatient hospital deductible amount per benefit period until the out-of-pocket limitation is met as set out in (J) of this paragraph;  
			(E) coverage for 50 percent of the coinsurance amount for each day used from the 21st day through the 100th day in a medicare benefit period for post-hospital skilled nursing facility care eligible under medicare Part A until the out-of-pocket limitation is met as set out in (J) of this paragraph;  
			(F) coverage for 50 percent of cost sharing for all medicare Part A eligible expenses and respite care until the out-of-pocket limitation is met as set out in (J) of this paragraph;  
			(G) coverage for 50 percent under medicare Part A or Part B of the reasonable cost of the first three pints of blood, or an equivalent quantity of packed red blood cells as defined under federal regulations, unless replaced in accordance with federal regulations until the out-of-pocket limitation is met as set out in (J) of this paragraph;  
			(H) except for coverage provided under (I) of this paragraph, coverage for 50 percent of the cost sharing otherwise applicable under medicare Part B after the policyholder pays the Part B deductible until the out-of-pocket limitation is met as set out in (J) of this paragraph;  
			(I) coverage of 100 percent of the cost sharing for medicare Part B preventive services after the policyholder pays the Part B deductible;  
			(J) coverage of 100 percent of all cost sharing under medicare Part A and Part B for the balance of the calendar year after the individual has reached the out-of-pocket limitation on annual expenditures under medicare Part A and Part B of $4,000 in 2006, indexed each year by the appropriate inflation adjustment specified by the secretary;  
		(9) standardized medicare supplement plan "L" and must consist of the benefits set out in  
			(A) the provisions of (8)(A), (B), (C), and (I) of this subsection;  
			(B) the provisions of (8)(D), (E), (F), (G), and (H) of this subsection, but substituting 75 percent for 50 percent in each of those subparagraphs; and  
			(C) the provisions of (8)(J) of this subsection, but substituting $2,000 for $4,000 in that subparagraph;  
		(10) standardized medicare supplement plan "M" must consist of the core benefit as set out in 3 AAC 28.454(m), plus 50 percent of the medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care provided in a foreign country as set out in 3 AAC 28.454(n)(2), (3), and (6);  
		(11) standardized medicare supplement plan "N" must consist of the core benefit as set out in 3 AAC 28.454(m) plus 100 percent of the medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care provided in a foreign country as set out in 3 AAC 28.454(n)(1), (3), and (6), with copayments of  
			(A) the lesser of $20 or the medicare Part B coinsurance or copayment for each covered health care provider office visit, including visits to medical specialists; and  
			(B) the lesser of $50 or the medicare Part B coinsurance or copayment for each covered emergency room visit; this copayment will be waived if the insured is admitted to any hospital and the emergency visit is subsequently covered as a medicare Part A expense.  
	(h)  An issuer may, with prior approval of the director, offer a medicare supplement policy or certificate under this section that contains new or innovative benefits, in addition to the standard benefits required in a policy or certificate issued under this section that otherwise complies with the applicable standards. The new or innovative benefits may include only benefits that are appropriate to medicare supplement insurance, are new or innovative, are not otherwise available, and are cost-effective and offered in a manner that is consistent with the goal of simplification of medicare supplement policies. New or innovative benefits may not include an outpatient prescription drug benefit. New or innovative benefits may not be used to change or reduce benefits, including a change of any cost-sharing provision, in any standardized medicare supplement plan.  

Authorities

21.06.090;21.42.130;21.96.060;01.05.031;21.89.060;44.62.125

Notes

Reference

3 AAC 28.454
3 AAC 28.490

Authority

AS 21.06.090 AS 21.42.130 AS 21.96.060 Editor's note: In 2010 the revisor of statutes, acting under AS 01.05.031, renumbered former AS 21.89.060 as AS 21.96.060. As of Register 196 (January 2011), the regulations attorney made a conforming technical revision under AS 44.62.125(b)(6), to the authority citation that follows 3 AAC 28.456, so that the citation to former AS 21.89.060 now refers to the renumbered statute, AS 21.96.060.

History

Eff. 9/19/2009, Register 191

References

3.28.456