Sec.38a-495a-6a. Standard Medicare supplement benefit plans for 2010 standardized Medicare supplement benefit plan policies or certificates with an effective date for coverage on or after June 1, 2010

(a) The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state with an effective date for coverage on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered or issued for delivery in this state as a Medicare supplement policy or certificate on or after June 1, 2010 unless it complies with these benefit plan standards. Benefit plan standards applicable to Medicare supplement policies and certificates with an effective date for coverage on or after July 30, 1992, and before June 1, 2010, remain subject to the requirements of sections 38a-495a-5 and 38a-495a-6 of the Regulations of Connecticut State Agencies.

(1) (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-5a of the Regulations of Connecticut State Agencies.

(B) If an issuer makes available any of the additional benefits set forth in section 38a-495a-5a(c) of the Regulations of Connecticut State Agencies or offers standardized benefit plan K or L as set forth in this section, the issuer shall also make available to each prospective policyholder and certificateholder standardized benefit plan C or F, as set forth in this section, in addition to the basic core benefit plan required under subparagraph (A) of this subdivision.

(b) No groups, packages or combinations of Medicare supplement benefits other than those listed in this section and section 38a-495a-7 of the Regulations of Connecticut State Agencies shall be offered for sale in this state.

(c) Benefit plans shall be uniform in structure, language, designation and format to the standard benefit plans 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 section 38a-495a-5a of the Regulations of Connecticut State Agencies, or, in the case of plans K or L, this section, and list the benefits in the order shown. For purposes of this section, "structure", "language", "designation" and "format" means style, arrangement and overall content of a benefit.

(d) In addition to the benefit plan designation required in subsection (c) of this section, an issuer may use other designations to the extent permitted by law.

(e) Make-up of 2010 standardized benefit plans:

(1) Standardized Medicare supplement benefit plan A shall include only the following: The basic core benefit as set forth in section 38a-495a-5a(b) of the Regulations of Connecticut State Agencies.

(2) Standardized Medicare supplement benefit plan B shall include only the following: The basic core benefit as set forth in section 38a-495a-5a(b) of the Regulations of Connecticut State Agencies, plus one hundred percent of the Medicare Part A deductible, as set forth in section 38a-495a-5a(c)(1) of the Regulations of Connecticut State Agencies.

(3) Standardized Medicare supplement benefit plan C shall include only the following: The basic core benefit as set forth in section 38a-495a-5a(b) of the Regulations of Connecticut State Agencies, plus one hundred percent of the Medicare Part A deductible, skilled nursing facility care, one hundred percent of the Medicare Part B deductible, and medically necessary emergency care in a foreign country, as set forth in section 38a-495a-5a(c) of the Regulations of Connecticut State Agencies.

(4) Standardized Medicare supplement benefit plan D shall include only the following: The basic core benefit as set forth in section 38a-495a-5a(b) of the Regulations of Connecticut State Agencies, plus one hundred percent of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country, as set forth in section 38a-495a-5a(c) of the Regulations of Connecticut State Agencies.

(5) Standardized Medicare supplement plan F shall include only the following: The basic core benefits as set forth in section 38a-495a-5a(b) of the Regulations of Connecticut State Agencies, plus one hundred percent of the Medicare Part A deductible, the skilled nursing facility care, one hundred percent of the Medicare Part B deductible, one hundred percent of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country, as set forth in section 38a-495a-5a(c) of the Regulations of Connecticut State Agencies.

(6) Standardized Medicare supplement plan F with High Deductible shall include only the following:

(A) The basic core benefit as set forth in section 38a-495a-5a(b) of the Regulations of Connecticut State Agencies, plus one hundred percent of the Medicare Part A deductible, skilled nursing facility care, one hundred percent of the Medicare Part B deductible, one hundred percent of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country, as set forth in section 38a-495a-5a(c) of the Regulations of Connecticut State Agencies, plus one hundred percent of covered expenses following payment of the annual deductible set forth in subparagraph (B) of this subdivision.

(B) The annual deductible in plan F with High Deductible shall consist of out-of-pocket expenses, other than premiums, for services covered by plan F, and shall be in addition to any other specific benefit deductibles. The basis for the deductible shall be $1500 and shall be adjusted annually from 1999 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.

(7) Standardized Medicare supplement plan G shall include only the following: The basic core benefit as set forth in section 38a-495a-5a(b) of the Regulations of Connecticut State Agencies, plus one hundred percent of the Medicare Part A deductible, skilled nursing facility care, one hundred percent of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country, as set forth in section 38a-495a-5a(c) of the Regulations of Connecticut State Agencies. Effective January 1, 2020, the standardized benefit plans described in section 38a-495a-6b of the Regulations of Connecticut State Agencies may be offered to any individual who was eligible for Medicare prior to January 1, 2020.

(8) Standardized Medicare supplement plan K shall include only the following:

(A) Part A hospital coinsurance 61^st through 90^th days: Coverage of one hundred percent of the Part A hospital coinsurance amount for each day used from the 61^st through the 90^th day in any Medicare benefit period;

(B) Part A hospital coinsurance, 91^st through 150^th days: Coverage of one hundred percent of the Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91^st through the 150^th day in any Medicare benefit period;

(C) Part A hospitalization after 150 days: Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of one hundred 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. The provider shall accept issuer's payment as payment in full and may not bill the insured for any balance;

(D) Medicare Part A deductible: Coverage for fifty percent of the Medicare Part A inpatient hospital deductible amount per benefit period until the out-of-pocket limitation is met as set forth in subparagraph (J) of this subdivision;

(E) Skilled Nursing Facility Care: Coverage for fifty percent of the coinsurance amount for each day used from the 21^st day through the 100^th 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 forth in subparagraph (J) of this subdivision;

(F) Hospice Coverage: Coverage for fifty percent of cost sharing for all Part A Medicare eligible expenses and respite care until the out-of-pocket limitation is met as set forth in subparagraph (J) of this subdivision;

(G) Blood: Coverage for fifty percent under Medicare Part A or B, of the reasonable cost of the first three pints of blood, or equivalent quantities 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 forth in subparagraph (J) of this subdivision;

(H) Part B Cost Sharing: Except for coverage provided in subparagraph (I) of this subdivision, coverage for fifty 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 forth in subparagraph (J) of this subdivision:

(I) Part B Preventive Services: Coverage of one hundred percent of the cost sharing for Medicare Part B preventive services after the policyholder pays the Part B deductible; and

(J) Cost Sharing After Out-Of-Pocket Limits: Coverage of one hundred percent of all cost sharing under Medicare Parts A and B for the balance of the calendar year after the individual has reached the out-of-pocket limitation on annual expenditures under Medicare Parts A and B of $5,240 in 2018, indexed each year by the appropriate inflation adjustment specified by the secretary.

(9) Standardized Medicare supplement plan L shall include only the following:

(A) The benefits set forth in subparagraphs (A), (B), (C) and (I) of subdivision (8) of this subsection;

(B) The benefits set forth in subparagraphs (D), (E), (F) and (G) of subdivision (8) of this subsection, but substituting seventy-five percent for fifty percent, and

(C) The benefit set forth in subparagraph (J) of subdivision (8) of this subsection, but substituting $2,620 for $5,240.

(10) Standardized Medicare supplement plan M shall include only the following: The basic core benefits as set forth in section 38a-495a-5a(b) of the Regulations of Connecticut State Agencies, plus fifty percent of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country, as set forth in section 38a-495a-5a(c) of the Regulations of Connecticut State Agencies.

(11) Standardized Medicare supplement plan N shall include only the following: The basic core benefits as set forth in section 38a-495a-5a(b) of the Regulations of Connecticut State Agencies, plus one hundred percent of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country, as set forth in section 38a-495a-5a(c) of the Regulations of Connecticut State Agencies with copayments in the following amounts:

(A) the lesser of twenty dollars 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 fifty dollars 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.

(f) New or Innovative Benefits: An issuer may, with the prior approval of the commissioner, offer 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 shall 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.

(Adopted effective November 30, 2009; Amended April 4, 2019)