WAC 284-66-066
Standard medicare supplement benefit
plans. (1) An issuer must make available to each prospective
policyholder and certificateholder a policy form or
certificate form containing only the basic "core" benefits, as
defined in WAC 284-66-063(2) of this regulation.
(2) No groups, packages, or combinations of medicare
supplement benefits other than those listed in this section
may be offered for sale in this state, except as permitted in
WAC 284-66-066(7) and in WAC 284-66-073.
(3) Benefit plans must be uniform in structure, language,
designation, and format to the standard benefit plans "A"
through "L" listed in this subsection and conform to the
definitions in WAC 284-66-030 and 284-66-040. Each benefit
must be structured according to the format provided in WAC 284-66-063 (2), (3), (4) or (5) 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 benefit.
(4) An issuer may use, in addition to the benefit plan
designations required in subsection (3) of this section, other
designations to the extent permitted by law.
(5) Make-up of benefit plans:
(a) Standardized medicare supplement benefit plan "A"
must be limited to only the basic ("core") benefits common to
all benefit plans, as defined in WAC 284-66-063(2).
(b) Standardized medicare supplement benefit plan "B"
consists of only the following: The core benefit as defined
in WAC 284-66-063(2), plus the medicare Part A deductible as
defined in WAC 284-66-063 (3)(a).
(c) Standardized medicare supplement benefit plan "C"
consists of only the following: The core benefit as defined
in WAC 284-66-063(2), 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 WAC 284-66-063 (3)(a), (b), (c), and (h),
respectively.
(d) Standardized medicare supplement plan "D" consists of
only the following: The core benefit, as defined in WAC 284-66-063(2), 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
WAC 284-66-063 (3)(a), (b), (h), and (j), respectively.
(e) Standardized medicare supplement benefit plan "E"
consists of only the following: The core benefit as defined
in WAC 284-66-063(2), 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 WAC 284-66-063 (3)(a), (b), (h), and (i),
respectively.
(f) Standardized medicare supplement benefit plan "F"
consists of only the following: The core benefit as defined
in WAC 284-66-063(2), plus the medicare Part A deductible, the
skilled nursing facility care, the Part B deductible, one
hundred percent of the medicare Part B excess charges, and
medically necessary emergency care in a foreign country as
defined in WAC 284-66-063 (3)(a), (b), (c), (e), and (h),
respectively.
(g) Standardized medicare supplement benefit high
deductible plan "F" consists of only the following: One
hundred percent of covered expenses following the payment of
the annual high deductible plan "F" deductible. The covered
expenses include the core benefit as defined in WAC 284-66-063(2), plus the medicare Part A deductible, skilled
nursing facility care, 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
defined in WAC 284-66-063 (3)(a), (b), (c), (e) and (h)
respectively. 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. The annual high deductible plan "F" deductible
is one thousand seven hundred thirty dollars for 2005, and is
based on the calendar year. The deductible will be adjusted
annually 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.
(h) Standardized medicare supplement benefit plan "G"
consists of only the following: The core benefit as defined
at WAC 284-66-063(2), plus the medicare Part A deductible,
skilled nursing facility care, eighty percent of the medicare
Part B excess charges, medically necessary emergency care in a
foreign country, and the at-home recovery benefit as defined
in WAC 284-66-063 (3)(a), (b), (d), (h), and (j),
respectively.
(i) Standardized medicare supplement benefit plan "H"
consists of only the following: The core benefit as defined
in WAC 284-66-063(2), 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 WAC 284-66-063 (3)(a), (b), (f), and
(h), respectively. The outpatient prescription drug benefit
may not be included in a medicare supplement policy sold after
December 31, 2005.
(j) Standardized medicare supplement benefit plan "I"
consists of only the following: The core benefit as defined
in WAC 284-66-063(2), plus the medicare Part A deductible,
skilled nursing facility care, one hundred percent 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 WAC 284-66-063 (3)(a), (b), (e), (f), (h), and (j), respectively. The outpatient prescription drug benefit may not be included
in a medicare supplement policy sold after December 31, 2005.
(k) Standardized medicare supplement benefit plan "J"
consists of only the following: The core benefit as defined
in WAC 284-66-063(2), plus the medicare Part A deductible,
skilled nursing facility care, medicare Part B deductible, one
hundred percent 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 WAC 284-66-063
(3)(a), (b), (c), (e), (g), (h), (i), and (j), respectively. The outpatient prescription drug benefit may not be included
in a medicare supplement policy sold after December 31, 2005.
(l) Standardized medicare supplement benefit high
deductible plan "J" consists of only the following: One
hundred percent of covered expenses following the payment of
the annual high deductible plan "J" deductible. The covered
expenses include the core benefit as defined in WAC 284-66-063(2), plus the medicare Part A deductible, skilled
nursing facility care, medicare Part B deductible, one hundred
percent of the medicare Part B excess charges, extended
outpatient prescription drug benefit, medically necessary
emergency care in a foreign country, preventative medical care
benefit and at-home recovery benefit as defined in WAC 284-66-063 (3)(a), (b), (c), (e), (g), (h), (i) and (j)
respectively. The annual high deductible plan "J" deductible
must consist of out-of-pocket expenses, other than premiums,
for services covered by the medicare supplement plan "J"
policy, and must be in addition to any other specific benefit
deductibles. The annual deductible is one thousand seven
hundred thirty dollars for 2005, and is based on the calendar
year. The deductible will be adjusted annually 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 may not be included in a medicare supplement policy
sold 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"
consists of only those benefits described in WAC 284-66-063(4).
(b) Standardized medicare supplement benefit plan "L"
consists of only those benefits described in WAC 284-66-063(5).
(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 benefits may not include an outpatient prescription
drug benefit.
[Statutory Authority: RCW 48.06.060 and 48.66.165. 07-06-014
(Matter No. R 2006-13), § 284-66-066, filed 2/26/07, effective
3/29/07. Statutory Authority: RCW 48.02.060 and 48.66.165. 05-17-019 (Matter No. R 2004-08), § 284-66-066, filed 8/4/05,
effective 9/4/05. Statutory Authority: RCW 48.02.060. 92-17-078 (Order R 92-7), § 284-66-066, filed 8/19/92,
effective 9/19/92. Statutory Authority: RCW 48.02.060,
48.20.450, 48.20.460, 48.20.470, 48.30.010, 48.44.020,
48.44.050, 48.44.070, 48.46.030, 48.46.130 and 48.46.200. 92-06-021 (Order R 92-1), § 284-66-066, filed 2/25/92,
effective 3/27/92.]