20:06:13:17.12. Standards
for basic core benefits common to Medicare supplement insurance benefit Plans
A, B, C, D, F, F with High Deductible, G, M, and N. Every issuer of
Medicare supplement insurance benefit plans shall make available a policy or
certificate including only the following basic core package of benefits to each
prospective insured. An issuer may make available to prospective insureds any
of the other Medicare Supplement Insurance Benefit Plans in addition to the
basic core package, but not in lieu of it. The following benefits must be
included in policies or certificates issued for delivery after May 31, 2010:
(1) Coverage of Part A Medicare eligible expenses for hospitalization to the
extent not covered by Medicare from the 61st day through the 90th
day in any Medicare benefit period;
(2) Coverage of Part A Medicare eligible expenses incurred for hospitalization to
the extent not covered by Medicare for each Medicare lifetime inpatient reserve
day used;
(3) Upon exhaustion of the
Medicare hospital inpatient coverage, including the lifetime reserve days,
coverage of 100 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 the
issuer's payment as payment in full and may not bill the insured for any
balance;
(4) Coverage under Medicare
Parts A and B for the reasonable cost of the first three pints of blood or
equivalent quantities of packed red blood cells, federal regulations 42 C.F.R
409.87(a)(1) unless replaced in accordance with federal regulations 42 C.F.R.
§ 409.87(d);
(5) Coverage for the
coinsurance amount, or in the case of hospital outpatient department services
paid under a prospective payment system, the copayment amount, of Medicare
eligible expenses under Part B regardless of hospital confinement, subject to
the Medicare Part B deductible;
(6) Coverage of cost
sharing for all Part A Medicare eligible hospice care
and respite care expenses.
Source:
35 SDR 183, effective February 2, 2009.
General
Authority: SDCL 58-17A-2.
Law
Implemented: SDCL 58-17A-2.
