R.C.S.A. § 38a-495a-6
Standard Medicare supplement benefit plans for 1992 standardized Medicare supplement benefit plan policies or certificates issued for delivery on or after July 30, 1992 and with an effective date for coverage prior to June 1, 2010
Cite as Conn. Agencies Regs. § 38a-495a-6
benefit plan policies or certificates issued for delivery on or after July 30, 1992
and with an effective date for coverage prior to June 1, 2010
(a) 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 section 38a-495a-5(b) of the Regulations of Connecticut State Agencies.
(b) 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 sections 38a-495a-6(f) (3) and 38a-495a-7 of the Regulations of Connecticut State
Agencies.
(c) Benefit plans shall be uniform in structure, language, designation and format to the
standard benefit plans "A" through "L" listed in this section and conform to the definitions
in section 38a-495a-2 of the Regulations of Connecticut State Agencies. Each benefit
shall be structured in accordance with the format provided in sections 38a-495-5(b)
and 38a-495a-5(c) of the Regulations of Connecticut State Agencies and list the benefits
in the order shown in this subsection. For purposes of this section, "structure, language,
and format" means style, arrangement and overall content of a benefit.
(d) An issuer may use, in addition to the benefit plan designations required in subsection
(c) of this section, other designations to the extent permitted by law.
(e) Make-up of benefit plans:
(1) Standardized Medicare supplement benefit plan "A" shall be limited to the Basic ("Core")
Benefits Common to All Benefit Plans, as defined in section 38a-495a-5(b) of the Regulations
of Connecticut State Agencies.
(2) Standardized Medicare supplement benefit plan "B" shall include only the following:
The Core Benefit as defined in section 38a-495a-5(b) of the Regulations of Connecticut
State Agencies, plus the Medicare Part A Deductible as defined in section 38a-495a-5(c)
(1) of the Regulations of Connecticut State Agencies.
(3) Standardized Medicare supplement benefit plan "C" shall include only the following:
The Core Benefit as defined in 38a-495a-5(b) of the Regulations of Connecticut State
Agencies, 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 sections 38a-495a-5(c) (1), (2), (3) and (8) of the Regulations of Connecticut
State Agencies respectively.
(4) Standardized Medicare supplement benefit plan "D" shall include only the following:
The Core Benefit as defined in section 38a-495a-5(b) of the Regulations of Connecticut
State Agencies, 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 sections 38a-495a-5(c) (1), (2), (8) and (10) of the Regulations of
Connecticut State Agencies respectively.
(5) Standardized Medicare supplement benefit plan "E" shall include only the following:
The Core Benefit as defined in section 38a-495a-5(b) of the Regulations of Connecticut
State Agencies, 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 sections 38a-495a-5(c) (1), (2), (8) and (9) of the Regulations of Connecticut
State Agencies respectively.
(6) Standardized Medicare supplement benefit plan "F" shall include only the following:
The Core Benefit as defined in section 38a-495a-5(b) of the Regulations of Connecticut
State Agencies, 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
sections 38a-495a-5(c) (1), (2), (3), (5) and (8) of the Regulations of Connecticut
State Agencies respectively.
(7) Standardized Medicare supplement benefit high deductible plan "F" shall include only
the following: one hundred percent (100%) of covered expenses following the payment
of the annual high deductible plan "F" deductible. The covered expenses include the
core benefit as defined in section 38a-495a-5(b) of the Regulations of Connecticut
State Agencies, plus the Medicare part a deductible, skilled nursing facility care,
the Medicare 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 sections 38a-495a-5(c) (1), (2), (3), (5) and (8) of the Regulations of Connecticut
State Agencies respectively. 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. The annual high deductible plan "F" deductible shall be one thousand
five hundred dollars for 1998 and 1999, and shall be based on the calendar year. It
shall be 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 ten dollars.
(8) Standardized Medicare supplement benefit plan "G" shall include only the following:
The Core Benefit as defined in section 38a-495a-5(b) of the Regulations of Connecticut
State Agencies, 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 sections
38a-495a-5(c) (1), (2), (4), (8) and (10) respectively of the Regulations of Connecticut
State Agencies.
(9) Standardized Medicare supplement benefit plan "H" shall consist of only the following:
The Core Benefit as defined in section 38a-495a-5(b) of the Regulations of Connecticut
State Agencies, 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 sections 38a-495a-5(c) (1), (2), (6) and (8) of the Regulations
of Connecticut State Agencies respectively. The outpatient prescription drug benefit
shall not be included in a Medicare supplement policy sold after December 31, 2005.
(10) Standardized Medicare supplement benefit plan "I" shall consist of only the following:
The Core Benefit as defined in section 38a-495a-5(b) of the Regulations of Connecticut
State Agencies, 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 sections 38a-495a-5(c) (1), (2), (5), (6), (8) and
(10) of the Regulations of Connecticut State Agencies respectively. The outpatient
prescription drug benefit shall not be included in a Medicare supplement policy sold
after December 31, 2005.
(11) Standardized Medicare supplement benefit plan "J" shall consist of only the following:
The Core Benefit as defined in section 38a-495a-5(b) of the Regulations of Connecticut
State Agencies, 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 sections 38a-495a-5(c) (1), (2), (3), (5), (7), (8), (9) and (10) of the Regulations
of Connecticut State Agencies respectively. The outpatient prescription drug benefit
plan shall not be included in a Medicare supplement policy sold after December 31,
2005.
(12) Standardized Medicare supplement benefit high deductible plan "J" shall consist of
only the following: one hundred percent (100%) of covered expenses following the payment
of the annual high deductible plan "J" deductible. The covered expenses include the
core benefit as defined in section 38a-495a-5(b) of the Regulations of Connecticut
State Agencies, 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 outpatient prescription drug benefit, medically necessary emergency
care in a foreign country, preventive medical care benefit and at-home recovery benefit
as defined in sections 38a-495a-5(c) (1), (2), (3), (5), (7), (8), (9) and (10) of
the Regulations of Connecticut State Agencies respectively. 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. The annual deductible shall be one thousand
five hundred dollars for 1998 and 1999, and shall be based on a calendar year. It
shall be 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 ten dollars.
The outpatient prescription drug benefit plan shall not be included in a Medicare
supplement policy sold after December 31, 2005.
(f) Make-up of two Medicare supplement plans mandated by The Medicare Prescription Drug,
Improvement and Modernization Act of 2003 (MMA);
(1) Standardized Medicare supplement benefit plan "K" shall consist of only those benefits
described in section 38a-495a-5(d) (1) of the Regulations of Connecticut State Agencies.
(2) Standardized Medicare supplement benefit plan "L" shall consist of only those benefits
described in section 38a-495a-5(d) (2) of the Regulations of Connecticut State Agencies.
(3) 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. Such 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.