(a)

1. (1) The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in Arkansas with an effective date of coverage on or after June 1, 2010.
2. (2) No policy or certificate may be advertised, solicited, delivered, or issued for delivery in Arkansas as a Medicare supplement policy or certificate unless it complies with these benefit plan standards.
3. (3) Benefit plan standards applicable to Medicare supplement policies and certificates issued with an effective date of coverage before June 1, 2010, remain subject to the requirements of the Medicare Supplement Insurance Minimum Standards Act, Arkansas Code § 23-79-401 et seq.

(b)

1. (1) An issuer shall make available to each prospective policyholder and certificate holder a policy form or certificate form containing only the basic (core) benefits, as defined in 23 CAR § 89-108(c).

2. (2) If an issuer makes available any of the additional benefits described in 23 CAR § 89-108(d) or offers standardized benefit Plans K or L (as described in subdivisions (f)(8) and (f)(9) of this section), then the issuer shall make available to each prospective policyholder and certificate holder, in addition to a policy form or certificate form with only the basic (core) benefits as described in subdivision (b)(1) of this section, a policy form or certificate form containing either:

   1. (A) Standardized benefit Plan C (as described in subdivision (f)(3) of this section); or
   2. (B) Standardized benefit Plan F (as described in subdivision (f)(5) of this section).

(d)

1. (1) Benefit plans shall:

   1. (A) Be uniform in structure, language, designation, and format to the standard benefit plans listed in this subsection; and
   2. (B) Conform to the definitions in 23 CAR § 89-103.

2. (2) Each benefit shall:

   1. (A) Be structured in accordance with the format provided in 23 CAR § 89-108(c) and (d) or, in the case of Plans K or L, in subdivision (f)(8) or (f)(9) of this section; and
   2. (B) List the benefits in the order shown.
3. (3) For purposes of this section, “structure, language, and format” means style, arrangement, and overall content of a benefit.

(f) Makeup of 2010 standardized benefit plans:

1. (1) Standardized Medicare supplement benefit Plan A shall include only the following: the basic (core) benefits as defined in 23 CAR § 89-108(c);

2. (2) Standardized Medicare supplement benefit Plan B shall include only the following:

   1. (A) The basic (core) benefit as defined in 23 CAR § 89-108(c); plus
   2. (B) One hundred percent (100%) of the Medicare Part A deductible as defined in 23 CAR § 89-108(d)(1);

3. (3) Standardized Medicare supplement benefit Plan C shall include only the following:

   1. (A) The basic (core) benefit as defined in 23 CAR § 89-108(c); plus
   2. (B) One hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, one hundred percent (100%) of the Medicare Part B deductible, and medically necessary emergency care in a foreign country as defined in 23 CAR § 89-108(d)(1), (3), (4), and (6), respectively;

4. (4) Standardized Medicare supplement benefit Plan D shall include only the following:

   1. (A) The basic (core) benefit (as defined in 23 CAR § 89-108(c)); plus
   2. (B) One hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in an foreign country as defined in 23 CAR § 89-108(d)(1), (3), and (6), respectively;

5. (5) Standardized Medicare supplement Standard Plan F shall include only the following:

   1. (A) The basic (core) benefit as defined in 23 CAR § 89-108(c); plus
   2. (B) One hundred percent (100%) of the Medicare Part A deductible, the skilled nursing facility care, one hundred percent (100%) of the Medicare Part B deductible, one hundred percent (100%) of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in 23 CAR § 89-108(d)(1), (3), (4), (5), and (6), respectively;

6. (6)

   1. (A) Standardized Medicare supplement Plan F with High Deductible shall include only the following: one hundred percent (100%) of covered expenses following the payment of the annual deductible set forth in subdivision (f)(6)(C) of this section.
   2. (B) The basic (core) benefit as defined in 23 CAR § 89-108(c), plus one hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, one hundred percent (100%) of the Medicare Part B deductible, one hundred percent (100%) of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in 23 CAR § 89-108(d)(1), (3), (4), (5), and (6), respectively.
   3. (C)

(i) The annual deductible in Plan F with High Deductible shall consist of out-of-pocket expenses, other than premiums, for services covered by Standard Plan F and shall be in addition to any other specific benefit deductibles.

1. (ii) The basis for the deductible shall be one thousand five hundred dollars ($1,500) and shall be adjusted annually from 1999 by the Secretary of the United States Department of Health and Human Services 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 ($10.00);

2. (7)

   1. (A) Standardized Medicare supplement benefit Plan G shall include only the following:

      1. (i) The basic (core) benefit as defined in 23 CAR § 89-108(c); plus
      2. (ii) One hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, one hundred percent (100%) of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in 23 CAR § 89-108(d)(1), (3), (5), and (6), respectively.
   2. (B) Effective January 1, 2020, the standardized benefit plans described in 23 CAR § 89-111(b)(4) (Redesignated Plan G with High Deductible) may be offered to any individual who was eligible for Medicare prior to January 1, 2020;

3. (8) Standardized Medicare supplement Plan K is mandated by The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 and shall include only the following:

   1. (A) Part A hospital coinsurance, sixty-first through ninetieth days. Coverage of one hundred percent (100%) of the Part A hospital coinsurance amount for each day used from the sixty-first through the ninetieth day in any Medicare benefit period;
   2. (B) Part A hospital coinsurance, ninety-first through one hundred fiftieth days. Coverage of one hundred percent (100%) of the Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the ninety-first through the one hundred fiftieth day in any Medicare benefit period;

   3. (C) Part A hospitalization after one hundred fifty (150) days.

      1. (i) Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of one hundred percent (100%) 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 three hundred sixty-five (365) days.
      2. (ii) The provider shall accept the issuer’s payment as payment in full and may not bill the insured for any balance;
   4. (D) Medicare Part A deductible. Coverage for fifty percent (50%) of the Medicare Part A inpatient hospital deductible amount per benefit period until the out-of-pocket limitation is met as described in subdivision (f)(8)(J) of this section;
   5. (E) Skilled nursing facility care. Coverage for fifty percent (50%) of the coinsurance amount for each day used from the twenty-first day through the one hundredth 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 described in subdivision (f)(8)(J) of this section;
   6. (F) Hospice care. Coverage for fifty percent (50%) of cost sharing for all Part A Medicare eligible expenses and respite care until the out-of-pocket limitation is met as described in subdivision (f)(8)(J) of this section;
   7. (G) Blood. Coverage for fifty percent (50%), under Medicare Part A or B, of the reasonable cost of the first three (3) 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 described in subdivision (f)(8)(J) of this section;
   8. (H) Part B cost sharing. Except for coverage provided in subdivision (f)(8)(I) of this section, coverage for fifty percent (50%) 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 described in subdivision (f)(8)(J) of this section;
   9. (I) Part B preventive services. Coverage of one hundred percent (100%) of the cost sharing for Medicare Part B preventive services after the policyholder pays the Part B deductible; and
   10. (J) Cost sharing after out-of-pocket limits. Coverage of one hundred percent (100%) 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 four thousand dollars ($4,000) in 2006, indexed each year by the appropriate inflation adjustment specified by the Secretary of the United States Department of Health and Human Services;

4. (9) Standardized Medicare supplement Plan L is mandated by The Medicare Prescription Drug, Improvement, and Modernization Act of 2003, and shall include only the following:

   1. (A) The benefits described in subdivisions (f)(8)(A), (B), (C), and (I) of this section;
   2. (B) The benefit described in subdivisions (f)(8)(D) – (H) of this section, but substituting seventy-five percent (75%) for fifty percent (50%); and
   3. (C) The benefit described in subdivision (f)(8)(J) of this section, but substituting two thousand dollars ($2,000) for four thousand dollars ($4,000);

5. (10) Standardized Medicare supplement Plan M shall include only the following:

   1. (A) The basic (core) benefit as defined in 23 CAR § 89-108(c); plus
   2. (B) Fifty percent (50%) of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country as defined in 23 CAR § 89-108(d)(2), (3), and (6), respectively; and

6. (11) Standardized Medicare supplement Plan N shall include only the following:

   1. (A) The basic (core) benefit as defined in 23 CAR § 89-108(c); plus

   2. (B) One hundred percent (100%) of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country as defined in 23 CAR § 89-108(d)(1), (3), and (6), respectively, with copayments in the following amounts:

      1. (i) The lesser of twenty dollars ($20.00) or the Medicare Part B coinsurance or copayment for each covered healthcare provider office visit (including visits to medical specialists); and
      2. (ii)

(g) New or innovative benefits.

1. (1) An issuer may, with the prior approval of the Insurance Commissioner, offer policies or certificates with new or innovative benefits in addition to the standardized benefits provided in a policy or certificate that otherwise complies with the applicable standards.

2. (2) The new or innovative benefits shall include only benefits that are:

   1. (A) Appropriate to Medicare supplement insurance;
   2. (B) New or innovative;
   3. (C) Not otherwise available; and
   4. (D) Cost-effective.
3. (3) Approval of new or innovative benefits must not adversely impact the goal of Medicare supplement simplification.
4. (4) New or innovative benefits shall not include an outpatient prescription drug benefit.
5. (5) 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.