20:06:13:17.13. Standards for additional benefits. The
following additional benefits shall be included in Medicare supplement benefit
Plans B, C, D, F, F with High Deductible, G, M, and N as described in
§ 20:06:13:17.11:
(1) Medicare Part A
Deductible: Coverage for 100 percent of the Medicare Part A
inpatient hospital deductible amount per benefit period;
(2) Medicare Part A
Deductible: Coverage for 50 percent of the Medicare Part A
inpatient hospital deductible amount per benefit period;
(3) Skilled Nursing
Facility Care: Coverage for the actual billed charges up to the coinsurance
amount from the 21st day through the 100th day in a
Medicare benefit period for post-hospital skilled nursing facility care
eligible under Medicare Part A;
(4) Medicare Part B
Deductible: Coverage for 100 percent of the Medicare Part B deductible amount
per calendar year regardless of hospital confinement;
(5) One Hundred Percent of
the Medicare Part B excess charges: Coverage for all of the difference between
the actual Medicare Part B charges as billed, not to exceed any charge
limitation established by the Medicare program or state law, and the
Medicare-approved Part B charge;
(6) Medically Necessary
Emergency Care in a Foreign Country: Coverage to the extent not covered by
Medicare for 80 percent of the billed charges for Medicare-eligible expenses
for medically necessary emergency hospital, physician, and medical care
received in a foreign country, which care would have been covered by Medicare
if provided in the United States and which care began during the first 60
consecutive days of each trip outside the United States, subject to a calendar
year deductible of $250, and a lifetime maximum benefit of $50,000. For
purposes of this benefit, the term, emergency care, means care needed
immediately because of an injury or an illness of sudden and unexpected onset.
Source:
35 SDR 183, effective February 2, 2009.
General
Authority: SDCL 58-17A-2.
Law
Implemented: SDCL 58-17A-2.
