HB-6431, As Passed Senate, December 12, 2018

 

 

 

 

 

 

 

 

 

 

 

SUBSTITUTE FOR

 

HOUSE BILL NO. 6431

 

 

 

 

 

 

 

 

 

 

      A bill to amend 1956 PA 218, entitled

 

"The insurance code of 1956,"

 

by amending sections 2266, 3801, 3803, 3811a, 3813, 3815, 3819a,

 

3827, 3829, 3831, 3835, 3843, and 3847 (MCL 500.2266, 500.3801,

 

500.3803, 500.3811a, 500.3813, 500.3815, 500.3819a, 500.3827,

 

500.3829, 500.3831, 500.3835, 500.3843, and 500.3847), section

 

2266 as added by 2018 PA 205, sections 3801, 3803, 3815, and 3831

 

as amended and sections 3811a and 3819a as added by 2009 PA 220,

 

sections 3813, 3843, and 3847 as added by 1992 PA 84, sections

 

3827 and 3835 as amended by 2006 PA 462, and section 3829 as

 

amended by 2002 PA 304, and by adding section 3811b; and to

 

repeal acts and parts of acts.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

 1        Sec. 2266. (1) Subject to the requirements of this section,

 

 1  a notice to a party or any other document that is required in an

 

 2  insurance transaction or that is to serve as evidence of

 

 3  insurance coverage may be delivered, stored, and presented by

 

 4  electronic means if it meets both of the following:

 

 5        (a) The the requirements of the uniform electronic

 

 6  transactions act, 2000 PA 305, MCL 450.831 to 450.849.

 

 7        (b) For a health insurer, the requirements of section

 

 8  2236(9)(a)(ii).

 

 9        (2) Electronic delivery of a notice or document as provided

 

10  in this section is equivalent to any delivery method otherwise

 

11  required by law, including delivery by first-class mail, first-

 

12  class mail postage prepaid, certified mail, or certificate of

 

13  mailing.

 

14        (3) If an insurer has reason to believe that a party is not

 

15  receiving notices or documents that the insurer attempts to

 

16  deliver by electronic means, including if the insurer attempts

 

17  delivery by electronic means and receives a notice that the

 

18  delivery by electronic means has failed, the insurer shall

 

19  deliver the notices or documents by first-class mail or by any

 

20  other delivery method required for the notices or documents.

 

21        (4) An insurer may use electronic delivery of a notice or a

 

22  document to a party under this section if the insurer meets the

 

23  requirements of subsection (5) and if all of the following

 

24  requirements are met:

 

25        (a) The party has affirmatively consented to the electronic

 

26  delivery method and has not withdrawn consent.

 

27        (b) Before obtaining consent, the insurer provides the party

 

 1  with a clear and conspicuous statement informing the party of all

 

 2  of the following:

 

 3        (i) The right of the party at any time to have the notice or

 

 4  the document provided or made available in paper form or by

 

 5  another nonelectronic form.

 

 6        (ii) The right of the party at any time to withdraw consent

 

 7  to have a notice or document delivered by electronic means and

 

 8  any conditions or consequences imposed if consent is withdrawn.

 

 9        (iii) The specific notice or document or categories of notices

 

10  or documents that may be delivered by electronic means during the

 

11  course of the relationship between the insurer and the party.

 

12        (iv) The means, after consent is given, by which the party

 

13  may obtain a paper copy of a notice or document delivered by

 

14  electronic means.

 

15        (v) The procedures for the party to follow to update

 

16  information needed to contact the party electronically and to

 

17  withdraw consent to have a notice or a document delivered by

 

18  electronic means.

 

19        (c) Before obtaining consent, the insurer provides the party

 

20  with a statement of the hardware and software requirements for

 

21  access to and retention of a notice or document delivered by

 

22  electronic means. The party shall provide electronic consent to

 

23  the hardware and software requirements or confirm consent

 

24  electronically in a manner that reasonably demonstrates that the

 

25  party can access information in the electronic form that will be

 

26  used for notices or documents delivered by electronic means.

 

27        (5) After the party consents as provided in subsection (4),

 

 1  if a change occurs in hardware or software needed to access or

 

 2  retain a notice or document delivered by electronic means that

 

 3  creates a material risk that the party will not be able to access

 

 4  or retain a notice or document to which consent applies, the

 

 5  insurer shall provide the party with a statement that includes

 

 6  all of the following:

 

 7        (a) Information regarding the revised hardware or software

 

 8  requirements for access to and retention of a notice or document

 

 9  delivered by electronic means.

 

10        (b) A description of the right of the party to withdraw

 

11  consent without the imposition of any condition or consequence

 

12  that was not disclosed under subsection (4)(b)(ii).

 

13        (6) Withdrawal of consent to electronic delivery does not

 

14  affect the legal effectiveness, validity, or enforceability of a

 

15  notice or a document that is delivered by electronic means to a

 

16  party before the withdrawal of consent is effective.

 

17        (7) Except as otherwise provided in this subsection,

 

18  withdrawal of consent by a party becomes effective 30 days after

 

19  the insurer receives notice of the withdrawal. Consent is

 

20  automatically withdrawn if the insurer learns that the electronic

 

21  delivery method currently used is no longer an effective delivery

 

22  mechanism.

 

23        (8) Failure by an insurer to comply with subsection (5) may

 

24  be treated, at the election of the party, as a withdrawal of

 

25  consent.

 

26        (9) This section must not be construed to modify, limit, or

 

27  supersede the federal electronic signatures in global national

 

 1  commerce act, 15 USC 7001 to 7031.

 

 2        (10) An insurance producer is not subject to civil liability

 

 3  for any harm or injury to a party that occurs as a result of

 

 4  either of the following:

 

 5        (a) The party's consent under subsection (4) to receive a

 

 6  notice or a document delivered by electronic means under this

 

 7  section.

 

 8        (b) An insurer's failure to deliver a notice or document by

 

 9  electronic means unless the insurance producer causes the harm or

 

10  injury.

 

11        (11) This section does not apply to a health insurer or

 

12  health maintenance organization.

 

13        (12) (11) As used in this section:

 

14        (a) "Delivered by electronic means", "delivery by electronic

 

15  means", or "electronic delivery" mean delivery by either of the

 

16  following methods:

 

17        (i) Delivery to an electronic mail address at which a party

 

18  has consented to receive notices or documents.

 

19        (ii) Both of the following:

 

20        (A) Posting on an electronic network or site accessible by

 

21  the internet through use of a mobile application, computer,

 

22  mobile device, tablet, or any other electronic device.

 

23        (B) Sending separate notice of the posting described in sub-

 

24  subparagraph (A) to the electronic mail address at which the

 

25  party consented to receive notice of the posting or using any

 

26  other delivery method to which the party has consented.

 

27        (b) "Party" means a recipient of a notice or document

 

 1  required as part of an insurance transaction and includes an

 

 2  applicant, insured, policy holder, or annuity contract holder.

 

 3        Sec. 3801. As used in this chapter:

 

 4        (a) "Applicant" means:

 

 5        (i) For an individual medicare Medicare supplement policy,

 

 6  the person who seeks to contract for benefits.

 

 7        (ii) For a group medicare Medicare supplement policy or

 

 8  certificate, the proposed certificate holder.

 

 9        (b) "Bankruptcy" means, when with respect to a medicare

 

10  Medicare advantage organization that is not an insurer, that the

 

11  organization has filed, or has had filed against it, a petition

 

12  for declaration of bankruptcy and has ceased doing business in

 

13  this state.

 

14        (c) "Certificate" means any certificate delivered or issued

 

15  for delivery in this state under a group medicare Medicare

 

16  supplement policy.

 

17        (d) "Certificate form" means the form on which the a

 

18  certificate is delivered or issued for delivery by the an

 

19  insurer.

 

20        (e) "Continuous period of creditable coverage" means the

 

21  period during which an individual was covered by creditable

 

22  coverage, if during the period of the coverage the individual had

 

23  no breaks in coverage greater than 63 days.

 

24        (f) "Creditable coverage" means coverage of an individual

 

25  provided under any of the following:

 

26        (i) A group health plan.

 

27        (ii) Health insurance coverage.

 

 1        (iii) Part A or part B of medicare.Medicare.

 

 2        (iv) Medicaid other than coverage consisting solely of

 

 3  benefits under section 1928 of medicaid, 42 USC 1396s.

 

 4        (v) Chapter 55 of title 10 of the United States Code, 10 USC

 

 5  1071 to 1110.1110b.

 

 6        (vi) A medical care program of the Indian health service

 

 7  Health Service or of a tribal organization.

 

 8        (vii) A state health benefits risk pool.

 

 9        (viii) A health plan offered under chapter 89 of title 5 of

 

10  the United States Code, 5 USC 8901 to 8914.

 

11        (ix) A public health plan as defined in federal regulation.

 

12        (x) Health care under section 5(e) of title I of the peace

 

13  corps act, 22 USC 2504.2504(e).

 

14        (g) "Direct response solicitation" means solicitation in

 

15  which an insurer representative does not contact the applicant in

 

16  person and explain the coverage available, such as, but not

 

17  limited to, solicitation through direct mail or through

 

18  advertisements in periodicals and other media.

 

19        (h) "Employee welfare benefit plan" means a plan, fund, or

 

20  program of employee benefits as defined in section 3 of subtitle

 

21  A of title I of the employee retirement income security act of

 

22  1974, 29 USC 1002.

 

23        (i) "Insolvency" means, when with respect to an insurer

 

24  licensed to transact the business of insurance in this state,

 

25  that the insurer has had a final order of liquidation entered

 

26  against it with a finding of insolvency by a court of competent

 

27  jurisdiction in the insurer's state of domicile.

 

 1        (j) "Insurer" includes any entity, including a health care

 

 2  corporation operating pursuant to the nonprofit health care

 

 3  corporation reform act, 1980 PA 350, MCL 550.1101 to 550.1704,

 

 4  delivering person that delivers or issuing issues for delivery in

 

 5  this state medicare Medicare supplement policies.

 

 6        (k) "Medicaid" means title subchapter XIX of the social

 

 7  security act, 42 USC 1396 to 1396v.1396w-5.

 

 8        (l) "Medicare" means title subchapter XVIII of the social

 

 9  security act, 42 USC 1395 to 1395hhh.1395lll.

 

10        (m) "Medicare advantage" means a plan of coverage for health

 

11  benefits under medicare Medicare part C as defined described in

 

12  section 12-2859 of part C of medicare, 42 USC 1395w-28, and

 

13  includes any of the following:

 

14        (i) Coordinated care plans that provide health care services,

 

15  including, but not limited to, health maintenance organization

 

16  plans with or without a point-of-service option, plans offered by

 

17  provider-sponsored organizations, and preferred provider

 

18  organization plans.

 

19        (ii) Medical savings account plans coupled with a

 

20  contribution into a medicare Medicare advantage medical savings

 

21  account.

 

22        (iii) Medicare advantage private fee-for-service plans.

 

23        (n) "Medicare supplement buyer's guide" means the document

 

24  entitled, "guide to health insurance for people with medicare",

 

25  "Choosing a Medigap Policy: A Guide to Health Insurance for

 

26  People with Medicare", developed by the national association of

 

27  insurance commissioners National Association of Insurance

 

 1  Commissioners and the United States department of health and

 

 2  human services Department of Health and Human Services, or a

 

 3  substantially similar document as approved by the

 

 4  commissioner.director.

 

 5        (o) "Medicare supplement policy" means an individual ,

 

 6  nongroup, or group policy or certificate that is advertised,

 

 7  marketed, or designed primarily as a supplement to reimbursements

 

 8  under medicare Medicare for the hospital, medical, or surgical

 

 9  expenses of persons eligible for medicare Medicare and medicare

 

10  Medicare select policies and certificates under section 3817.

 

11  Medicare supplement policy does not include a policy,

 

12  certificate, or contract of 1 or more employers or labor

 

13  organizations, or of the trustees of a fund established by 1 or

 

14  more employers or labor organizations, or both, for employees or

 

15  former employees, or both, or for members or former members, or

 

16  both, of the labor organizations. Medicare supplement policy does

 

17  not include medicare Medicare advantage plans established under

 

18  medicare Medicare part C, outpatient prescription drug plans

 

19  established under medicare Medicare part D, or any health care

 

20  prepayment plan that provides benefits pursuant to an agreement

 

21  under section 1833(a)(1)(A) of the social security act.42 USC

 

22  1395l(a)(1).

 

23        (p) "PACE" means a program of all-inclusive care for the

 

24  elderly as described in the social security act.

 

25        (q) "Prestandardized medicare Medicare supplement benefit

 

26  plan", "prestandardized benefit plan", or "prestandardized plan"

 

27  means a group or individual policy of medicare Medicare

 

 1  supplement insurance issued prior to before June 2, 1992.

 

 2        (r) "1990 standardized medicare Medicare supplement benefit

 

 3  plan", "1990 standardized benefit plan", or "1990 plan" means a

 

 4  group or individual policy of medicare Medicare supplement

 

 5  insurance issued on or after June 2, 1992 with an effective date

 

 6  for coverage prior to before June 1, 2010 and includes medicare

 

 7  Medicare supplement insurance policies and certificates renewed

 

 8  on or after that date which that are not replaced by the issuer

 

 9  at the request of the insured.

 

10        (s) "2010 standardized medicare Medicare supplement benefit

 

11  plan", "2010 standardized benefit plan", or "2010 plan" means a

 

12  group or individual policy of medicare Medicare supplement

 

13  insurance with an effective date for coverage on or after June 1,

 

14  2010.

 

15        (t) "Policy form" means the form on which the policy or

 

16  certificate is delivered or issued for delivery by the insurer.

 

17        (u) "Secretary" means the secretary of the United States

 

18  department of health and human services.Department of Health and

 

19  Human Services.

 

20        (v) "Social security act" means the social security act, 42

 

21  USC 301 to 1397jj.1397mm.

 

22        Sec. 3803. (1) Except as provided in subsections (2) and

 

23  (3), this chapter applies to a medicare Medicare supplement

 

24  policy delivered, issued for delivery, or renewed in this state.

 

25        (2) Sections 3807, 3809, 3811, and 3819 apply to a medicare

 

26  Medicare supplement policy delivered or issued for delivery in

 

27  this state on or after June 2, 1992 with an effective date for

 

 1  coverage prior to before June 1, 2010.

 

 2        (3) Sections 3807a, 3809a, 3811a, and 3819a apply to a

 

 3  medicare Medicare supplement policy delivered or issued for

 

 4  delivery in this state with an effective date for coverage on or

 

 5  after June 1, 2010.

 

 6        Sec. 3811a. (1) This section applies to all medicare

 

 7  Medicare supplement policies or certificates delivered or issued

 

 8  for delivery with an effective date for coverage on or after June

 

 9  1, 2010. A policy or certificate shall must not be advertised,

 

10  solicited, delivered, or issued for delivery in this state as a

 

11  medicare Medicare supplement policy or certificate unless it

 

12  complies with these benefit standards. Benefit plan standards

 

13  applicable to medicare Medicare supplement policies and

 

14  certificates issued before June 1, 2010 remain subject to the

 

15  requirements of section 3811.

 

16        (2) An insurer shall make available to each prospective

 

17  medicare Medicare supplement policyholder and certificate holder

 

18  a policy form or certificate form containing only the basic core

 

19  benefits as provided in section 3807a. If an insurer makes

 

20  available any of the additional benefits described in section

 

21  3809a or offers standardized benefit plans K or L, the insurer

 

22  shall make available to each prospective medicare Medicare

 

23  supplement policyholder and certificate holder a policy form or

 

24  certificate form containing either standardized benefit plan C or

 

25  standardized benefit plan F.

 

26        (3) Groups, packages, or combinations of medicare Medicare

 

27  supplement benefits other than those listed in this section shall

 

 1  must not be offered for sale in this state except as may be

 

 2  permitted in subsection (6)(k).

 

 3        (4) Benefit plans shall must be uniform in structure,

 

 4  language, designation, and format to the standard benefit plans

 

 5  in subsection (6) and shall must conform to the definitions in

 

 6  this chapter. Each benefit shall must be structured in accordance

 

 7  with sections 3807a and 3809a and list the benefits in the order

 

 8  shown in subsection (6). For purposes of As used in this section,

 

 9  "structure, language, designation, and format" means style,

 

10  arrangement, and overall content of a benefit.

 

11        (5) In addition to the benefit plan designations as provided

 

12  under subsection (6), an insurer may use other designations to

 

13  the extent permitted by law.

 

14        (6) A medicare Medicare supplement insurance benefit plan

 

15  shall must conform to 1 of the following:

 

16        (a) A standardized medicare Medicare supplement benefit plan

 

17  A shall must be limited to the basic core benefits common to all

 

18  benefit plans as defined in required under section 3807a.

 

19        (b) A standardized medicare Medicare supplement benefit plan

 

20  B shall must include only the following: the core benefits as

 

21  defined in required under section 3807a and 100% of the medicare

 

22  Medicare part A deductible as defined in section 3809a(2)(a).

 

23        (c) A standardized medicare Medicare supplement benefit plan

 

24  C shall must include only the following: the core benefits as

 

25  defined in required under section 3807a , and 100% of the

 

26  medicare Medicare part A deductible, skilled nursing facility

 

27  care, 100% of the medicare Medicare part B deductible, and

 

 1  medically necessary emergency care in a foreign country as

 

 2  defined in section 3809a(2)(a), (c), (d), and (f).

 

 3        (d) A standardized medicare Medicare supplement benefit plan

 

 4  D shall must include only the following: the core benefits as

 

 5  defined in required under section 3807a , and 100% of the

 

 6  medicare Medicare part A deductible, skilled nursing facility

 

 7  care, and medically necessary emergency care in a foreign country

 

 8  as defined in section 3809a(2)(a), (c), and (f).

 

 9        (e) A standardized medicare Medicare supplement benefit plan

 

10  F shall must include only the following: the core benefits as

 

11  defined in required under section 3807a , and 100% of the

 

12  medicare Medicare part A deductible, skilled nursing facility

 

13  care, 100% of the medicare Medicare part B deductible, 100% of

 

14  the medicare Medicare part B excess charges, and medically

 

15  necessary emergency care in a foreign country as defined in

 

16  section 3809a(2)(a), (c), (d), (e), and (f). A standardized

 

17  medicare Medicare supplement plan F high deductible shall must

 

18  include only the following: 100% of covered expenses following

 

19  the payment of the annual high deductible high-deductible plan F

 

20  deductible. The covered expenses include the core benefits as

 

21  defined in required under section 3807a , plus and 100% of the

 

22  medicare Medicare part A deductible, skilled nursing facility

 

23  care, 100% of the medicare Medicare part B deductible, 100% of

 

24  the medicare Medicare part B excess charges, and medically

 

25  necessary emergency care in a foreign country as defined in

 

26  section 3809a(2)(a), (c), (d), (e), and (f). The annual high

 

27  deductible high-deductible plan F deductible shall must consist

 

 1  of out-of-pocket expenses, other than premiums, for services

 

 2  covered by the medicare Medicare supplement plan F policy, and

 

 3  shall must be in addition to any other specific benefit

 

 4  deductibles. The annual high deductible high-deductible plan F

 

 5  deductible is $1,500.00 for calendar year 1999, and the secretary

 

 6  shall adjust it annually thereafter to reflect the change in the

 

 7  consumer price index Consumer Price Index for all urban consumers

 

 8  for the 12-month period ending with August of the preceding year,

 

 9  rounded to the nearest multiple of $10.00.

 

10        (f) A standardized medicare Medicare supplement benefit plan

 

11  G shall must include only the following: the core benefits as

 

12  defined in required under section 3807a , and 100% of the

 

13  medicare Medicare part A deductible, skilled nursing facility

 

14  care, 100% of the medicare Medicare part B excess charges, and

 

15  medically necessary emergency care in a foreign country as

 

16  defined in section 3809a(2)(a), (c), (e), and (f). Effective

 

17  January 1, 2020, the standardized plan F high deductible benefit

 

18  plan, redesignated in section 3811b(2)(d) as plan G high

 

19  deductible, may be offered to an individual who was eligible for

 

20  Medicare before January 1, 2020.

 

21        (g) Standardized medicare Medicare supplement benefit plan K

 

22  shall must consist of the following:

 

23        (i) Coverage of 100% of the part A hospital coinsurance

 

24  amount for each day used from the sixty-first day through the

 

25  ninetieth day in any medicare Medicare benefit period.

 

26        (ii) Coverage of 100% of the part A hospital coinsurance

 

27  amount for each medicare Medicare lifetime inpatient reserve day

 

 1  used from the ninety-first day through the one hundred fiftieth

 

 2  day in any medicare Medicare benefit period.

 

 3        (iii) Upon On exhaustion of the medicare Medicare hospital

 

 4  inpatient coverage, including the lifetime reserve days, coverage

 

 5  of 100% of the medicare Medicare part A eligible expenses for

 

 6  hospitalization paid at the applicable prospective payment system

 

 7  rate, or other appropriate medicare Medicare standard of payment,

 

 8  subject to a lifetime maximum benefit of an additional 365 days.

 

 9  The provider shall accept the insurer's payment as payment in

 

10  full and may not bill the insured for any balance.

 

11        (iv) Medicare part A deductible: coverage for 50% of the

 

12  medicare Medicare part A inpatient hospital deductible amount per

 

13  benefit period until the out-of-pocket limitation is met as

 

14  described in subparagraph (x).

 

15        (v) Skilled nursing facility care: coverage for 50% of the

 

16  coinsurance amount for each day used from the twenty-first day

 

17  through the one hundredth day in a medicare Medicare benefit

 

18  period for posthospital skilled nursing facility care eligible

 

19  under medicare Medicare part A until the out-of-pocket limitation

 

20  is met as described in subparagraph (x).

 

21        (vi) Hospice care: coverage for 50% of cost sharing for all

 

22  part A medicare Medicare eligible expenses and respite care until

 

23  the out-of-pocket limitation is met as described in subparagraph

 

24  (x).

 

25        (vii) Coverage for 50%, under medicare Medicare part A or B,

 

26  of the reasonable cost of the first 3 pints of blood or

 

27  equivalent quantities of packed red blood cells, as defined under

 

 1  federal regulations, unless replaced in accordance with federal

 

 2  regulations until the out-of-pocket limitation is met as

 

 3  described in subparagraph (x).

 

 4        (viii) Except for coverage provided in subparagraph (ix),

 

 5  below, coverage for 50% of the cost sharing otherwise applicable

 

 6  under medicare Medicare part B after the policyholder pays the

 

 7  part B deductible until the out-of-pocket limitation is met as

 

 8  described in subparagraph (x).

 

 9        (ix) Coverage of 100% of the cost sharing for medicare

 

10  Medicare part B preventive services after the policyholder pays

 

11  the part B deductible.

 

12        (x) Coverage of 100% of all cost sharing under medicare

 

13  Medicare parts A and B for the balance of the calendar year after

 

14  the individual has reached the out-of-pocket limitation on annual

 

15  expenditures under medicare Medicare parts A and B of $4,000.00

 

16  in 2006, indexed each year by the appropriate inflation

 

17  adjustment specified by the secretary of the United States

 

18  department of health and human services.Department of Health and

 

19  Human Services.

 

20        (h) Standardized medicare Medicare supplement benefit plan L

 

21  shall must consist of the following:

 

22        (i) The benefits described in subdivision (g)(i), (ii), (iii),

 

23  and (ix).

 

24        (ii) The benefits described in subdivision (g)(iv), (v), (vi),

 

25  (vii), and (viii), but substituting 75% for 50%.

 

26        (iii) The benefit described in subdivision (g)(x), but

 

27  substituting $2,000.00 for $4,000.00.

 

 1        (i) A standardized medicare Medicare supplement benefit plan

 

 2  M shall must include only the following: the core benefits as

 

 3  defined in required under section 3807a and 50% of the medicare

 

 4  Medicare part A deductible, skilled nursing care, and medically

 

 5  necessary emergency care in a foreign country as defined in

 

 6  section 3809a(2)(b), (c), and (f).

 

 7        (j) A standardized medicare Medicare supplement benefit plan

 

 8  N shall must include only the following: the core benefits as

 

 9  defined in required under section 3807a , and 100% of the

 

10  medicare Medicare part A deductible, skilled nursing facility

 

11  care, and medically necessary emergency care in a foreign country

 

12  as defined in section 3809a(2)(a), (c), and (f) with copayments

 

13  in the following amounts:

 

14        (i) The lesser of $20.00 or the medicare Medicare part B

 

15  coinsurance or copayment for each covered health care provider

 

16  office visit, including visits to medical specialists.

 

17        (ii) The lesser of $50.00 or the medicare Medicare part B

 

18  coinsurance or copayment for each covered emergency room visit.

 

19  The copayment shall must be waived if the insured is admitted to

 

20  any hospital and the emergency visit is subsequently covered as a

 

21  medicare Medicare part A expense.

 

22        (k) New or innovative benefits: an insurer may, with the

 

23  prior approval of the commissioner, director, offer policies or

 

24  certificates with new or innovative benefits in addition to the

 

25  benefits provided in a policy or certificate that otherwise

 

26  complies with the applicable standards. The new or innovative

 

27  benefits may include benefits that are appropriate to medicare

 

 1  Medicare supplement insurance, new or innovative, not otherwise

 

 2  available, cost-effective, and offered in a manner that is

 

 3  consistent with the goal of simplification of medicare Medicare

 

 4  supplement policies. The innovative benefit shall must not

 

 5  include an outpatient prescription drug benefit. New or

 

 6  innovative benefits shall must not be used to change or reduce

 

 7  benefits, including a change of any cost-sharing provision, in

 

 8  any standardized plan.

 

 9        Sec. 3811b. (1) This section applies to all Medicare

 

10  supplement policies or certificates delivered or issued for

 

11  delivery in this state to individuals newly eligible for Medicare

 

12  after December 31, 2019. A policy or certificate that provides

 

13  coverage of the Medicare part B deductible must not be

 

14  advertised, solicited, delivered, or issued for delivery in this

 

15  state as a Medicare supplement policy or certificate to

 

16  individuals newly eligible for Medicare after December 31, 2019,

 

17  unless it complies with the benefit standards provided in this

 

18  section. Benefit plan standards applicable to Medicare supplement

 

19  policies and certificates issued to individuals eligible for

 

20  Medicare before January 1, 2020 remain subject to the

 

21  requirements of section 3811a.

 

22        (2) The standards and requirements of section 3811a apply to

 

23  all Medicare supplement policies or certificates delivered or

 

24  issued for delivery to individuals newly eligible for Medicare

 

25  after December 31, 2019, with the following exceptions:

 

26        (a) Standardized Medicare supplement benefit plan C is

 

27  redesignated as plan D and must provide the benefits contained in

 

 1  section 3811a(6)(c), but must not provide coverage for 100% or

 

 2  any portion of the Medicare part B deductible.

 

 3        (b) Standardized Medicare supplement benefit plan F is

 

 4  redesignated as plan G and must provide the benefits contained in

 

 5  section 3811a(6)(e), as applicable, but must not provide coverage

 

 6  for 100% or any portion of the Medicare part B deductible.

 

 7        (c) Standardized Medicare supplement benefit plans C, F, and

 

 8  F high deductible may not be offered to individuals newly

 

 9  eligible for Medicare after December 31, 2019.

 

10        (d) Standardized Medicare supplement benefit plan F high

 

11  deductible is redesignated as plan G high deductible and must

 

12  provide the benefits in section 3811a(6)(e), as applicable, but

 

13  must not provide coverage for 100% or any portion of the Medicare

 

14  part B deductible. The Medicare part B deductible paid by the

 

15  beneficiary is considered an out-of-pocket expense in meeting the

 

16  annual high deductible.

 

17        (e) The reference to plan C or plan F contained in section

 

18  3811a(2) is deemed a reference to plan D or plan G, respectively,

 

19  for purposes of this section.

 

20        (3) This section only applies to individuals that are newly

 

21  eligible for Medicare after December 31, 2019 because of either

 

22  of the following:

 

23        (a) By reason of attaining age 65 after December 31, 2019.

 

24        (b) By reason of entitlement to benefits under Medicare part

 

25  A under section 226(b) or 226a of the social security act, or who

 

26  is deemed to be eligible for benefits under section 226a of the

 

27  social security act after December 31, 2019.

 

 1        (4) For purposes of section 3830(5) to (8), for an

 

 2  individual newly eligible for Medicare after December 31, 2019,

 

 3  any reference to Medicare supplement policy or certificate plans

 

 4  C, F, or F high deductible is deemed to be a reference to

 

 5  Medicare supplement policy or certificate plans D, G, or G high

 

 6  deductible, respectively, that meet the requirements of

 

 7  subsection (2).

 

 8        (5) After December 31, 2019, the standardized benefit plans

 

 9  described in subsection (2)(d) may be offered to an individual

 

10  who was eligible for Medicare before January 1, 2020, in addition

 

11  to the standardized plans described in section 3811a(6).

 

12        Sec. 3813. An insurer that issues a policy that provides

 

13  disability health insurance coverage to a person eligible for

 

14  medicare Medicare by reason of age shall provide the prospective

 

15  policyholder with a medicare Medicare supplement buyer's guide in

 

16  written or electronic format, which shall must be furnished at

 

17  the time of application, and the insurer shall obtain, in written

 

18  or electronic format, acknowledgment of receipt of the buyer's

 

19  guide. shall be obtained by the insurer. However, for direct

 

20  response solicitation policies, the guide shall must be furnished

 

21  with the policy in written or electronic format and the insurer

 

22  need not obtain acknowledgment of receipt. need not be obtained

 

23  by the insurer. This section does not apply to policies that

 

24  provide accidental death benefits for travel or other accidents,

 

25  or if the medical expense or indemnity payments are only

 

26  incidental to the accidental death benefits for travel or other

 

27  accidents.

 

 1        Sec. 3815. (1) An insurer that offers a medicare Medicare

 

 2  supplement policy shall provide to the applicant at the time of

 

 3  application an outline of coverage in written or electronic

 

 4  format and, except for direct response solicitation policies,

 

 5  shall obtain an acknowledgment of receipt of the outline of

 

 6  coverage from the applicant in written or electronic format. The

 

 7  outline of coverage provided to applicants pursuant to under this

 

 8  section shall must consist of the following 4 parts:

 

 9        (a) A cover page.

 

10        (b) Premium information.

 

11        (c) Disclosure pages.

 

12        (d) Charts displaying the features of each benefit plan

 

13  offered by the insurer.

 

14        (2) Insurers shall comply with any notice requirements of

 

15  the medicare Medicare prescription drug, improvement, and

 

16  modernization act of 2003, Public Law 108-173.

 

17        (3) If an outline of coverage is provided at the time of

 

18  application and the medicare Medicare supplement policy or

 

19  certificate is issued on a basis that would require revision of

 

20  the outline, a substitute outline of coverage properly describing

 

21  the policy or certificate shall must accompany the policy or

 

22  certificate when it is delivered and shall must contain the

 

23  following statement, in no not less than 12-point type,

 

24  immediately above the company name:

 

 

25		NOTICE: Read this outline of coverage carefully.
26		It is not identical to the outline of coverage

1		provided upon on application and the coverage
2		originally applied for has not been issued.

 

 

 3        (4) An outline of coverage under subsection (1) shall must

 

 4  be in the language and in a written or electronic format

 

 5  prescribed in this section and in not less than 12-point type.

 

 6  The letter designation of the plan shall must be shown on the

 

 7  cover page and the plans offered by the insurer shall must be

 

 8  prominently identified. Premium information shall must be shown

 

 9  on the cover page or immediately following the cover page and

 

10  shall must be prominently displayed. The premium and method of

 

11  payment mode shall must be stated for all plans that are offered

 

12  to the applicant. All possible premiums for the applicant shall

 

13  must be illustrated. The following items shall must be included

 

14  in the outline of coverage in the order prescribed below and in

 

15  substantially the following form, as approved by the

 

16  commissioner:director:

 

 

17	BENEFIT CHART OF MEDICARE SUPPLEMENT PLANS SOLD
18	ON OR AFTER JUNE 1, 2010

 

 

19        This chart shows the benefits included in each of the

 

20  standard Medicare supplement plans. Every company must make Plan

 

21  "A" available. Some plans may not be available in your state.

 

22        Plans E, H, I, and J are no longer available for sale. (This

 

23  sentence shall must not appear after June 1, 2011.)

 

 

24	BASIC BENEFITS:

1	Hospitalization: Part A coinsurance plus coverage for 365
2	additional days after Medicare benefits end.
3	Medical Expenses: Part B coinsurance (generally 20% of
4	Medicare-approved expenses) or copayments for hospital
5	outpatient services. Plans K, L, and N require insureds
6	to pay a portion of Part B coinsurance or copayments.
7	Blood: First three pints of blood each year.
8	Hospice: Part A coinsurance

 

 

 

9	A	B	C**	D	F|F* **	G/G*
10	Basic,	Basic,	Basic,	Basic,	Basic,	Basic,
11	including	including	including	including	including	including
12	100% Part	100% Part	100% Part	100% Part	100% Part	100% Part
13	B coin-	B coinsur-	B coinsur-	B coinsur-	B coinsur-	B coinsur-
14	surance	ance	ance	ance	ance	ance
15			Skilled	Skilled	Skilled	Skilled
16			Nursing	Nursing	Nursing	Nursing
17			Facility	Facility	Facility	Facility
18			Coinsur-	Coinsur-	Coinsur-	Coinsur-
19			ance	ance	ance	ance
20		Part A	Part A	Part A	Part A	Part A
21		Deductible	Deductible	Deductible	Deductible	Deductible
22			Part B		Part B
23			Deductible		Deductible
24					Part B	Part B
25					Excess	Excess
26					(100%)	(100%)
27			Foreign	Foreign	Foreign	Foreign

1			Travel	Travel	Travel	Travel
2			Emergency	Emergency	Emergency	Emergency

 

 

 3         

 

 

4	K	L	M	N
5	Hospitalization	Hospitalization	Basic,	Basic, includ-
6	and preventive	and preventive	including 100%	ing 100% Part B
7	care paid at	care paid at	Part B	coinsurance,
8	100%; other	100%; other	coinsurance	except up to
9	basic benefits	basic benefits		$20 copayment
10	paid at 50%	paid at 75%		for office
11				visit, and up
12				to $50 copay-
13				ment for ER
14	50% Skilled	75% Skilled	Skilled	Skilled
15	Nursing	Nursing	Nursing	Nursing
16	Facility	Facility	Facility	Facility
17	Coinsurance	Coinsurance	Coinsurance	Coinsurance
18	50% Part A	75% Part A	50% Part A	Part A
19	Deductible	Deductible	Deductible	Deductible
20
21
22			Foreign	Foreign
23			Travel	Travel
24			Emergency	Emergency
25	Out-of-pocket	Out-of-pocket
26	limit $4,140; $5,240;	limit $2,070; $2,620;
27	paid at 100%	paid at 100%

1	after limit	after limit
2	reached	reached

 

 

 3        * Plan Plans F and G also has an option have options called

 

 4  a high-deductible Plan F . This and high-deductible Plan G. These

 

 5  high-deductible plan pays plans pay the same benefits as Plan F

 

 6  or Plan G, as applicable, after one has paid a calendar year

 

 7  $1,860 $2,240 deductible. Benefits from high-deductible Plan F or

 

 8  high-deductible Plan G will not begin until out-of-pocket

 

 9  expenses exceed $1,860. $2,240. Out-of-pocket expenses for this

 

10  deductible these deductibles are expenses that would ordinarily

 

11  be paid by the policy. These expenses include the Medicare

 

12  deductibles for Part A and Part B, but do not include the plan's

 

13  separate foreign travel emergency deductible.

 

14        ** Plan C, Plan F, and high-deductible Plan F are only

 

15  available to individuals eligible for Medicare before January 1,

 

16  2020.

 

 

17	PREMIUM INFORMATION

 

 

18        We (insert insurer's name) can only raise your premium if we

 

19  raise the premium for all policies like yours in this state. (If

 

20  the premium is based on the increasing age of the insured,

 

21  include information specifying when premiums will change).

 

 

22	DISCLOSURES

 

 

23        Use this outline to compare benefits and premiums among

 

 1  policies, certificates, and contracts.

 

 2        This outline shows benefits and premiums of policies sold

 

 3  for effective dates on or after June 1, 2010. Policies sold for

 

 4  effective dates prior to before June 1, 2010 have different

 

 5  benefits and premiums. Plans E, H, I, and J are no longer

 

 6  available for sale. (This sentence shall must not appear after

 

 7  June 1, 2011.)

 

 

8	READ YOUR POLICY VERY CAREFULLY

 

 

 9        This is only an outline describing your policy's most

 

10  important features. The policy is your insurance contract. You

 

11  must read the policy itself to understand all of the rights and

 

12  duties of both you and your insurance company.

 

 

13	RIGHT TO RETURN POLICY

 

 

14        If you find that you are not satisfied with your policy, you

 

15  may return it to (insert insurer's address). If you send the

 

16  policy back to us within 30 days after you receive it, we will

 

17  treat the policy as if it had never been issued and return all of

 

18  your payments.

 

 

19	POLICY REPLACEMENT

 

 

20        If you are replacing another health insurance policy, do not

 

21  cancel it until you have actually received your new policy and

 

22  are sure you want to keep it.

 

 

1

NOTICE

 

 

 2        This policy may not fully cover all of your medical costs.

 

 3        [For agent issued policies]

 

 4        Neither (insert insurer's name) nor its agents are connected

 

 5  with medicare.Medicare.

 

 6        [For direct response issued policies]

 

 7        (Insert insurer's name) is not connected with

 

 8  medicare.Medicare.

 

 9        This outline of coverage does not give all the details of

 

10  medicare Medicare coverage. Contact your local social security

 

11  office or consult "the medicare handbook" "The Medicare Handbook"

 

12  for more details.

 

 

13	COMPLETE ANSWERS ARE VERY IMPORTANT

 

 

14        When you fill out the application for the new policy, be

 

15  sure to answer truthfully and completely all questions about your

 

16  medical and health history. The company may cancel your policy

 

17  and refuse to pay any claims if you leave out or falsify

 

18  important medical information. [If the policy or certificate is

 

19  guaranteed issue, this paragraph need not appear.]

 

20        Review the application carefully before you sign it. Be

 

21  certain that all information has been properly recorded.

 

22        [Include for each plan offered by the insurer a chart

 

23  showing the services, medicare Medicare payments, plan payments,

 

24  and insured payments using the same language, in the same order,

 

25  and using uniform layout and format as shown in the charts that

 

 1  follow. An insurer may use additional benefit plan designations

 

 2  on these charts pursuant to under section 3809(1)(k). Include an

 

 3  explanation of any innovative benefits on the cover page and in

 

 4  the chart, in a manner approved by the commissioner. director.

 

 5  The insurer issuing the policy shall change the dollar amounts

 

 6  each year to reflect current figures. No more than 4 plans may be

 

 7  shown on 1 chart.] Charts for each plan are as follows:

 

 

8	PLAN A
9	MEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIOD

 

 

10        *A benefit period begins on the first day you receive

 

11  service as an inpatient in a hospital and ends after you have

 

12  been out of the hospital and have not received skilled care in

 

13  any other facility for 60 days in a row.

 

 

14	SERVICES	MEDICARE PAYS	PLAN PAYS	YOU PAY
15	HOSPITALIZATION*
16	Semiprivate room and
17	board, general nursing
18	and miscellaneous
19	services and supplies
20	First 60 days	All but	$0	$992$1,340
21		$992$1,340		(Part A
22				Deductible)
23	61st thru 90th day	All but	$248$335	$0
24		$248$335	a day
25		a day

1	91st day and after:
2	—While using 60
3	lifetime reserve days	All but	$496$670	$0
4		$496$670	a day
5		a day
6	—Once lifetime reserve
7	days are used:
8	—Additional 365 days	$0	100% of	$0**
9			Medicare
10			Eligible
11			Expenses
12	—Beyond the
13	Additional 365 days	$0	$0	All Costs
14	SKILLED NURSING FACILITY
15	CARE*
16	You must meet Medicare's
17	requirements, including
18	having been in a hospital
19	for at least 3 days and
20	entered a Medicare-
21	approved facility within
22	30 days after leaving the
23	hospital
24	First 20 days	All approved
25		amounts	$0	$0
26	21st thru 100th day	All but	$0	Up to
27		$124$167.50		$124$167.50
28		a day		a day
29	101st day and after	$0	$0	All costs

1	BLOOD
2	First 3 pints	$0	3 pints	$0
3	Additional amounts	100%	$0	$0
4	HOSPICE CARE
5	You must meet	All but very		$0
6	Medicare's requirements	limited	Medicare
7	including a doctor's	copayment/	copayment/
8	certification of terminal	coinsurance	coinsurance
9	illness	for outpatient
10		drugs and
11		inpatient
12		respite care
13

 

 

14        **NOTICE: When your Medicare Part A hospital benefits are

 

15  exhausted, the insurer stands in the place of Medicare and will

 

16  pay whatever amount Medicare would have paid for up to an

 

17  additional 365 days as provided in the policy's "Core Benefits."

 

18  During this time the hospital is prohibited from billing you for

 

19  the balance based on any difference between its billed charges

 

20  and the amount Medicare would have paid.

 

 

21	PLAN A
22	MEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEAR

 

 

23        *Once you have been billed $131 $183 of Medicare-Approved

 

24  amounts for covered services (which are noted with an asterisk),

 

25  your Part B Deductible will have been met for the calendar year.

 

 

1	SERVICES	MEDICARE PAYS	PLAN PAYS	YOU PAY
2	MEDICAL EXPENSES—
3	In or out of the hospital
4	and outpatient hospital
5	treatment, such as
6	Physician's services,
7	inpatient and outpatient
8	medical and surgical
9	services and supplies,
10	physical and speech
11	therapy, diagnostic
12	tests, durable medical
13	equipment,
14	First $131 $183 of
15	Medicare Approved	$0	$0	$131$183
16	Amounts*			(Part B
17				Deductible)
18	Remainder of Medicare
19	Approved Amounts	80%	20%	$0
20	Part B Excess Charges
21	(Above Medicare
22	Approved Amounts)	$0	$0	All Costs
23	BLOOD
24	First 3 pints	$0	All Costs	$0
25	Next $131 $183 of
26	Medicare	$0	$0	$131$183
27	Approved Amounts*			(Part B
28				Deductible)
29	Remainder of Medicare

1	Approved Amounts	80%	20%	$0
2	CLINICAL LABORATORY
3	SERVICES—
4	Tests for
5	diagnostic services	100%	$0	$0

 

 

 

6	PARTS A & B

 

 

 

7	HOME HEALTH CARE
8	Medicare Approved
9	Services
10	—Medically necessary
11	skilled care services
12	and medical supplies	100%	$0	$0
13	—Durable medical
14	equipment
15	First $131 $183 of
16	Medicare	$0	$0	$131$183
17	Approved Amounts*			(Part B
18				Deductible)
19	Remainder of Medicare
20	Approved Amounts	80%	20%	$0

 

 

 

21	PLAN B
22	MEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIOD

 

 

23        *A benefit period begins on the first day you receive

 

 1  service as an inpatient in a hospital and ends after you have

 

 2  been out of the hospital and have not received skilled care in

 

 3  any other facility for 60 days in a row.

 

 

4	SERVICES	MEDICARE PAYS	PLAN PAYS	YOU PAY
5	HOSPITALIZATION*
6	Semiprivate room and
7	board, general nursing
8	and miscellaneous
9	services and supplies
10	First 60 days	All but	$992$1,340	$0
11		$992$1,340	(Part A
12			Deductible)
13	61st thru 90th day	All but	$248$335	$0
14		$248 $335 a day	a day
15	91st day and after
16	—While using 60
17	lifetime reserve days	All but	$496$670	$0
18		$496 $670 a day	a day
19	—Once lifetime reserve
20	days are used:
21	—Additional 365 days	$0	100% of	$0**
22			Medicare
23			Eligible
24			Expenses
25	—Beyond the
26	Additional 365 days	$0	$0	All Costs
27	SKILLED NURSING FACILITY
28	CARE*

1	You must meet Medicare's
2	requirements, including
3	having been in a hospital
4	for at least 3 days and
5	entered a Medicare-
6	approved facility within
7	30 days after leaving the
8	hospital
9	First 20 days	All approved
10		amounts	$0	$0
11	21st thru 100th day	All but	$0	Up to
12		$124$167.50		$124
13				$167.50
14		a day		a day
15	101st day and after	$0	$0	All costs
16	BLOOD
17	First 3 pints	$0	3 pints	$0
18	Additional amounts	100%	$0	$0
19	HOSPICE CARE
20		All but very
21		limited	Medicare	$0
22		copayment/	copayment/
23		coinsurance	coinsurance
24	You must meet	for outpatient
25	Medicare's requirements,	drugs and
26	including a doctor's	inpatient
27	certification of	respite care
28	terminal illness

 

 

 1        **NOTICE: When your Medicare Part A hospital benefits are

 

 2  exhausted, the insurer stands in the place of Medicare and will

 

 3  pay whatever amount Medicare would have paid for up to an

 

 4  additional 365 days as provided in the policy's "Core Benefits."

 

 5  During this time the hospital is prohibited from billing you for

 

 6  the balance based on any difference between its billed charges

 

 7  and the amount Medicare would have paid.

 

 

8	PLAN B
9	MEDICARE (PART B)—MEDICAL SERVICES—PER CALENDAR YEAR

 

 

10        *Once you have been billed $131 $183 of Medicare-Approved

 

11  amounts for covered services (which are noted with an asterisk),

 

12  your Part B Deductible will have been met for the calendar year.

 

 

13	SERVICES	MEDICARE PAYS	PLAN PAYS	YOU PAY
14	MEDICAL EXPENSES—
15	In or out of the hospital
16	and outpatient hospital
17	treatment, such as
18	Physician's services,
19	inpatient and outpatient
20	medical and surgical
21	services and supplies,
22	physical and speech
23	therapy, diagnostic
24	tests, durable medical
25	equipment,
26	First $131 $183 of

1	Medicare Approved	$0	$0	$131$183
2	Amounts*			(Part B
3				Deductible)
4	Remainder of Medicare
5	Approved Amounts	80%	20%	$0
6	Part B Excess Charges
7	(Above Medicare
8	Approved Amounts)	$0	$0	All Costs
9	BLOOD
10	First 3 pints	$0	All Costs	$0
11	Next $131 $183 of Medicare
12	Approved Amounts*	$0	$0	$131$183
13				(Part B
14	Remainder of Medicare			Deductible)
15	Approved Amounts	80%	20%	$0
16	CLINICAL LABORATORY
17	SERVICES—
18	Tests for
19	diagnostic services	100%	$0	$0

 

 

 

20	PARTS A & B

 

 

 

21	HOME HEALTH CARE
22	Medicare Approved
23	Services
24	—Medically necessary
25	skilled care services
26	and medical supplies	100%	$0	$0

1	—Durable medical
2	equipment
3	First $131 $183 of
4	Medicare
5	Approved Amounts*	$0	$0	$131$183
6				(Part B
7				Deductible)
8	Remainder of Medicare
9	Approved Amounts	80%	20%	$0

 

 

 

10	PLAN C
11	MEDICARE (PART A)—HOSPITAL SERVICES—PER BENEFIT PERIOD

 

 

12        *A benefit period begins on the first day you receive

 

13  service as an inpatient in a hospital and ends after you have

 

14  been out of the hospital and have not received skilled care in

 

15  any other facility for 60 days in a row.

 

 

16	SERVICES	MEDICARE PAYS	PLAN PAYS	YOU PAY
17	HOSPITALIZATION*
18	Semiprivate room and
19	board, general nursing
20	and miscellaneous
21	services and supplies
22	First 60 days	All but	$992$1,340	$0
23		$992$1,340	(Part A
24			Deductible)
25	61st thru 90th day	All but	$248$335	$0