Florida Regulations 69O-156.008: Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After January 1, 1992, and with an Effective Date for Coverage Prior…
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The following applies to all 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates issued for delivery on or after January 1, 1992, and with an effective date for coverage prior to June 1, 2010.
(1) 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 subsection 69O-156.007(2), F.A.C., of this chapter.
(2) 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 subsection 69O-156.008(7) and Fl. Admin. Code R. 69O-156.030, of this chapter.
(3)(a)1. Benefit plans shall be uniform in structure, language, designation and format to the standard benefit plans “”A”” through “”L”” as provided in Form OIR-B2-MSC (Rev. 11/04), “”Outline of Medicare Supplement Coverage””, and shall conform to the definitions in Fl. Admin. Code R. 69O-156.003
2. Form OIR-B2-MSC (Rev. 11/04), “”Outline of Medicare Supplement Coverage””, is hereby adopted and incorporated by reference, is available and may be printed from the Office’s website: www.floir.com.
(b) Each benefit shall be structured in accordance with the format provided in subsections 69O-156.007(2) and (3), or (4), F.A.C., and shall list the benefits in the order shown in this rule. For purposes of this section, “”structure, language, and format”” means style, arrangement and overall content of a benefit.
(4) An issuer may use, in addition to the benefit plan designations required in subsection 69O-156.008(3), F.A.C., other designations to the extent permitted by law.
(5) Make-up of benefit plans:
(a) Standardized Medicare supplement benefit plan “”A”” shall be limited to the Basic (“”Core””) Benefits Common to All Benefit Plans, as defined in subsection 69O-156.007(2), F.A.C., of this chapter.
(b) Standardized Medicare supplement benefit plan “”B”” shall include only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, plus the Medicare Part A Deductible as defined in Fl. Admin. Code R. 69O-156.007(3)(a)
(c) Standardized Medicare supplement benefit plan “”C”” shall include only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medicare Part B Deductible and Medically Necessary Emergency Care in a Foreign Country as defined in paragraphs 69O-156.007(3)(a), (b), (c) and (h), F.A.C., respectively.
(d) Standardized Medicare supplement benefit plan “”D”” shall include only the following: The Core Benefit (as defined in subsection 69O-156.007(2), F.A.C., of this rule), plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medically Necessary Emergency Care in a Foreign Country and the At-Home Recovery Benefit as defined in paragraphs 69O-156.007(2)(a), (b), (h) and (j), F.A.C., respectively.
(e) Standardized Medicare supplement benefit plan “”E”” shall include only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medically Necessary Emergency Care in a Foreign Country and Preventive Medical Care as defined in paragraphs 69O-156.007(3)(a), (b), (h) and (i), F.A.C., respectively.
(f) Standardized Medicare supplement benefit plan “”F”” shall include only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, plus the Medicare Part A Deductible, the Skilled Nursing Facility Care, the Part B Deductible, One Hundred Percent (100%) of the Medicare Part B Excess Charges, and Medically Necessary Emergency Care in a Foreign Country as defined in paragraphs 69O-156.007(3)(a), (b), (c), (e) and (h), F.A.C., respectively.
(g) Standardized Medicare supplement benefit high deductible plan “”F”” shall include only 100% of covered expenses following the payment of the annual high deductible plan “”F”” deductible.
1. The covered expenses as defined in paragraphs 69O-156.007(3)(a), (b), (e) and (h), F.A.C., respectively include:
a. The core benefit as defined in subsection 69O-156.007(2), F.A.C;
b. The Medicare Part A deductible;
c. Skilled nursing facility care;
d. The Medicare Part B deductible;
e. One hundred percent (100%) of the Medicare Part B excess charges; and
f. Medically necessary emergency care in a foreign country.
2. The annual high deductible plan “”F”” deductible shall consist of out-of-pocket expenses, other than premiums, for services covered by the Medicare supplement plan “”F”” policy, and shall be in addition to any other specific benefit deductibles.
3. The annual high deductible plan “”F”” deductible shall be:
a. $1,500 for 1998 and 1999, and shall be based on the calendar year;
b. 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.
(h) Standardized Medicare supplement benefit plan “”G”” shall include only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this regulation, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Eighty Percent (80%) of the Medicare Part B Excess Charges, Medically Necessary Emergency Care in a Foreign Country, and the At-Home Recovery Benefit as defined in paragraphs 69O-156.007(3)(a), (b), (d), (h) and (j), F.A.C., respectively.
(i) Standardized Medicare supplement benefit plan “”H”” shall consist of only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Basic Prescription Drug Benefit and Medically Necessary Emergency Care in a Foreign Country as defined in paragraphs 69O-156.007(3)(a), (b), (f) and (h), F.A.C., respectively. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy issued after December 31, 2005.
(j) Standardized Medicare supplement benefit plan “”I”” shall consist of only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this regulation, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, One Hundred Percent (100%) of the Medicare Part B Excess Charges, Basic Prescription Drug Benefit, Medically Necessary Emergency Care in a Foreign Country and At-Home Recovery Benefit as defined in paragraphs 69O-156.007(3)(a), (b), (e), (f), (h) and (j), F.A.C., respectively. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy issued after December 31, 2005.
(k) Standardized Medicare supplement benefit plan “”J”” shall consist of only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, 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 Prescription Drug Benefit, Medically Necessary Emergency Care in a Foreign Country, Preventive Medical Care and At-Home Recovery Benefit as defined in paragraphs 69O-156.007(3)(a), (b), (c), (e), (g), (h), (i) and (j), F.A.C., respectively. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy issued after December 31, 2005.
(l) Standardized Medicare supplement benefit high deductible plan “”J”” shall include only 100% of covered expenses following the payment of the annual high deductible plan “”J”” deductible.
1. The covered expenses as defined in paragraphs 69O-156.007(3)(a), (b), (c), (e), (g), (h), (i) and (j), F.A.C., respectively include:
a. The core benefit as defined in subsection 69O-156.007(2), F.A.C;
b. The Medicare Part A deductible;
c. Skilled nursing facility care;
d. Medicare Part B deductible;
e. One hundred percent (100%) of the Medicare Part B Excess charges;
f. Extended Outpatient Prescription Drug Benefit;
g. Medically Necessary Emergency Care in a foreign Country;
h. Preventive Medical Care Benefit; and
i. At-Home Recovery Benefit.
2. 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.
3. The annual deductible shall be:
a. $1,500 for 1998 and 1999 based on a calendar year;
b. 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.
c. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy issued after December 31, 2005.
(6) Make-up of two Medicare supplement plans mandated by The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA);
(a) Standardized Medicare supplement benefit plan “”K”” shall consist of only those benefits described in Fl. Admin. Code R. 69O-156.007(4)(a)
(b) Standardized Medicare supplement benefit plan “”L”” shall consist of only those benefits described in Fl. Admin. Code R. 69O-156.007(4)(b)
(7) 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 benefit.
Rulemaking Authority 624.308, 627.674(2) FS. Law Implemented 624.307(1), 627.674, 627.6741 FS. History-New 1-1-92, Amended 12-17-96, 7-26-99, Formerly 4-156.008, Amended 9-15-05, 1-4-10.
(1) 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 subsection 69O-156.007(2), F.A.C., of this chapter.
(2) 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 subsection 69O-156.008(7) and Fl. Admin. Code R. 69O-156.030, of this chapter.
(3)(a)1. Benefit plans shall be uniform in structure, language, designation and format to the standard benefit plans “”A”” through “”L”” as provided in Form OIR-B2-MSC (Rev. 11/04), “”Outline of Medicare Supplement Coverage””, and shall conform to the definitions in Fl. Admin. Code R. 69O-156.003
2. Form OIR-B2-MSC (Rev. 11/04), “”Outline of Medicare Supplement Coverage””, is hereby adopted and incorporated by reference, is available and may be printed from the Office’s website: www.floir.com.
(b) Each benefit shall be structured in accordance with the format provided in subsections 69O-156.007(2) and (3), or (4), F.A.C., and shall list the benefits in the order shown in this rule. For purposes of this section, “”structure, language, and format”” means style, arrangement and overall content of a benefit.
(4) An issuer may use, in addition to the benefit plan designations required in subsection 69O-156.008(3), F.A.C., other designations to the extent permitted by law.
(5) Make-up of benefit plans:
(a) Standardized Medicare supplement benefit plan “”A”” shall be limited to the Basic (“”Core””) Benefits Common to All Benefit Plans, as defined in subsection 69O-156.007(2), F.A.C., of this chapter.
(b) Standardized Medicare supplement benefit plan “”B”” shall include only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, plus the Medicare Part A Deductible as defined in Fl. Admin. Code R. 69O-156.007(3)(a)
(c) Standardized Medicare supplement benefit plan “”C”” shall include only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medicare Part B Deductible and Medically Necessary Emergency Care in a Foreign Country as defined in paragraphs 69O-156.007(3)(a), (b), (c) and (h), F.A.C., respectively.
(d) Standardized Medicare supplement benefit plan “”D”” shall include only the following: The Core Benefit (as defined in subsection 69O-156.007(2), F.A.C., of this rule), plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medically Necessary Emergency Care in a Foreign Country and the At-Home Recovery Benefit as defined in paragraphs 69O-156.007(2)(a), (b), (h) and (j), F.A.C., respectively.
(e) Standardized Medicare supplement benefit plan “”E”” shall include only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medically Necessary Emergency Care in a Foreign Country and Preventive Medical Care as defined in paragraphs 69O-156.007(3)(a), (b), (h) and (i), F.A.C., respectively.
(f) Standardized Medicare supplement benefit plan “”F”” shall include only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, plus the Medicare Part A Deductible, the Skilled Nursing Facility Care, the Part B Deductible, One Hundred Percent (100%) of the Medicare Part B Excess Charges, and Medically Necessary Emergency Care in a Foreign Country as defined in paragraphs 69O-156.007(3)(a), (b), (c), (e) and (h), F.A.C., respectively.
(g) Standardized Medicare supplement benefit high deductible plan “”F”” shall include only 100% of covered expenses following the payment of the annual high deductible plan “”F”” deductible.
1. The covered expenses as defined in paragraphs 69O-156.007(3)(a), (b), (e) and (h), F.A.C., respectively include:
a. The core benefit as defined in subsection 69O-156.007(2), F.A.C;
b. The Medicare Part A deductible;
c. Skilled nursing facility care;
d. The Medicare Part B deductible;
e. One hundred percent (100%) of the Medicare Part B excess charges; and
f. Medically necessary emergency care in a foreign country.
2. The annual high deductible plan “”F”” deductible shall consist of out-of-pocket expenses, other than premiums, for services covered by the Medicare supplement plan “”F”” policy, and shall be in addition to any other specific benefit deductibles.
3. The annual high deductible plan “”F”” deductible shall be:
a. $1,500 for 1998 and 1999, and shall be based on the calendar year;
b. 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.
(h) Standardized Medicare supplement benefit plan “”G”” shall include only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this regulation, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Eighty Percent (80%) of the Medicare Part B Excess Charges, Medically Necessary Emergency Care in a Foreign Country, and the At-Home Recovery Benefit as defined in paragraphs 69O-156.007(3)(a), (b), (d), (h) and (j), F.A.C., respectively.
(i) Standardized Medicare supplement benefit plan “”H”” shall consist of only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Basic Prescription Drug Benefit and Medically Necessary Emergency Care in a Foreign Country as defined in paragraphs 69O-156.007(3)(a), (b), (f) and (h), F.A.C., respectively. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy issued after December 31, 2005.
(j) Standardized Medicare supplement benefit plan “”I”” shall consist of only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this regulation, plus the Medicare Part A Deductible, Skilled Nursing Facility Care, One Hundred Percent (100%) of the Medicare Part B Excess Charges, Basic Prescription Drug Benefit, Medically Necessary Emergency Care in a Foreign Country and At-Home Recovery Benefit as defined in paragraphs 69O-156.007(3)(a), (b), (e), (f), (h) and (j), F.A.C., respectively. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy issued after December 31, 2005.
(k) Standardized Medicare supplement benefit plan “”J”” shall consist of only the following: The Core Benefit as defined in subsection 69O-156.007(2), F.A.C., of this chapter, 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 Prescription Drug Benefit, Medically Necessary Emergency Care in a Foreign Country, Preventive Medical Care and At-Home Recovery Benefit as defined in paragraphs 69O-156.007(3)(a), (b), (c), (e), (g), (h), (i) and (j), F.A.C., respectively. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy issued after December 31, 2005.
(l) Standardized Medicare supplement benefit high deductible plan “”J”” shall include only 100% of covered expenses following the payment of the annual high deductible plan “”J”” deductible.
1. The covered expenses as defined in paragraphs 69O-156.007(3)(a), (b), (c), (e), (g), (h), (i) and (j), F.A.C., respectively include:
a. The core benefit as defined in subsection 69O-156.007(2), F.A.C;
b. The Medicare Part A deductible;
c. Skilled nursing facility care;
d. Medicare Part B deductible;
e. One hundred percent (100%) of the Medicare Part B Excess charges;
f. Extended Outpatient Prescription Drug Benefit;
g. Medically Necessary Emergency Care in a foreign Country;
h. Preventive Medical Care Benefit; and
i. At-Home Recovery Benefit.
2. 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.
3. The annual deductible shall be:
a. $1,500 for 1998 and 1999 based on a calendar year;
b. 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.
c. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy issued after December 31, 2005.
(6) Make-up of two Medicare supplement plans mandated by The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA);
(a) Standardized Medicare supplement benefit plan “”K”” shall consist of only those benefits described in Fl. Admin. Code R. 69O-156.007(4)(a)
(b) Standardized Medicare supplement benefit plan “”L”” shall consist of only those benefits described in Fl. Admin. Code R. 69O-156.007(4)(b)
(7) 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 benefit.
Rulemaking Authority 624.308, 627.674(2) FS. Law Implemented 624.307(1), 627.674, 627.6741 FS. History-New 1-1-92, Amended 12-17-96, 7-26-99, Formerly 4-156.008, Amended 9-15-05, 1-4-10.