Ind. Admin. Code tit. 760, r. 3-7.1-1 – Standard Medicare supplement benefit plans for 2010 Standardized Medicare supplement benefit plan policies or certificates issued for delivery with an effective date for coverage on or after June 1, 2010

Sec. 1. (a) 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 760 IAC 3-6-1(c).

(b) If an issuer makes available any of the additional benefits described in 760 IAC 3-6.1-1(d) or offers standardized benefit Plans K or L, 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 760 IAC 3-6.1-1(c), a policy form or certificate form containing either standardized benefit Plan C or standardized benefit Plan F.

(c) No groups, packages, or combinations of Medicare supplement benefits other than those listed in this section shall be offered for sale in this state, except as may be permitted in 760 IAC 3-8.

(d) Benefit plans shall be uniform in structure, language, designation, and format to the standard benefit plans listed in this section and conform to the definitions in 760 IAC 3-2 and 760 IAC 3-3. Each benefit shall:

(1) be structured in accordance with the format provided in 760 IAC 3-6-1(c) through 760 IAC 3-6-1(d); and
(2) list the benefits in the order shown in subsection (f).

As used in this section, "structure, language, and format" means style, arrangement, and overall content of a benefit.

(e) An issuer may use, in addition to the benefit plan designations required in subsection (d), other designations to the extent permitted by law.

(f) The makeup of 2010 standardized benefit plans shall be as follows:

(1) Standardized Medicare supplement benefit Plan A shall be limited to the basic (core) benefits common to all benefit plans as defined in 760 IAC 3-6-1(c).
(2) Standardized Medicare supplement benefit Plan B shall include only the core benefit as defined in 760 IAC 3-6-1(c), plus the Medicare Part A deductible as defined in 760 IAC 3-6-1(d)(1).
(3) Standardized Medicare supplement benefit Plan C shall include only the core benefit as defined in 760 IAC 3-6-1(c), plus:
1. (A) the Medicare Part A deductible;
2. (B) skilled nursing facility care;
3. (C) the Medicare Part B deductible; and
4. (D) medically necessary emergency care in a foreign country;
as defined in 760 IAC 3-6-1(d)(1) through 760 IAC 3-6-1(d)(3) and 760 IAC 3-6-1(d)(8), respectively.
(4) Standardized Medicare supplement benefit Plan D shall include only the core benefit as defined in 760 IAC 3-6-1(c), plus:
1. (A) the Medicare Part A deductible;
2. (B) skilled nursing facility care; and
3. (C) medically necessary emergency care in a foreign country.
(5) Standardized Medicare supplement benefit Plan F shall include only the core benefit as defined in 760 IAC 3-6-1(c), plus:
1. (A) the Medicare Part A deductible;
2. (B) skilled nursing facility care;
3. (C) the Medicare Part B deductible;
4. (D) one hundred percent (100%) of the Medicare Part B excess charges; and
5. (E) medically necessary emergency care in a foreign country;
as defined in 760 IAC 3-6-1(d)(1) through 760 IAC 3-6-1(d)(3), 760 IAC 3-6-1(d)(5), and 760 IAC 3-6-1(d)(8), respectively.
(6) Standardized Medicare supplement benefit high deductible Plan F shall include one hundred percent (100%) of covered expenses following the payment of the annual high deductible Plan F deductible. The covered expenses include the core benefit as defined in 760 IAC 3-6-1(c), plus:
1. (A) the Medicare Part A deductible;
2. (B) skilled nursing facility care;
3. (C) the Medicare Part B deductible;
4. (D) one hundred percent (100%) of the Medicare Part B excess charges; and
5. (E) medically necessary emergency care in a foreign country;
as defined in 760 IAC 3-6-1(d)(1), 760 IAC 3-6-1(d)(2), 760 IAC 3-6-1(d)(8), and 760 IAC 3-6-1(d)(9), respectively. The annual high deductible Plan F deductible shall consist of out-of-pocket expenses, other than premiums, for services covered by the Medicare supplement Plan F policy and shall be in addition to any other specific benefit deductibles. The annual high deductible Plan F deductible shall be one thousand five hundred dollars ($1,500) for 1999 and shall be based on the calendar year. It shall be adjusted annually thereafter by the Secretary to reflect the change in the Consumer Price Index for all urban consumers for the twelve (12) month period ending with August of the preceding year and rounded to the nearest multiple of ten dollars ($10).
(7) Standardized Medicare supplement benefit Plan G shall include only the core benefit as defined in 760 IAC 3-6-1(c), plus:
1. (A) the Medicare Part A deductible;
2. (B) skilled nursing facility care;
3. (C) one hundred percent (100%) of the Medicare Part B excess charges; and
4. (D) medically necessary emergency care in a foreign country.
Effective January 1, 2020, the standardized benefit plans described in 760 IAC 3-7.2-1(a)(3) may be offered to any individual who was eligible for Medicare prior to January 1, 2020.
(8) Standardized Medicare supplement Plan M shall include only the basic core benefit as defined in 760 IAC 3-6-1(c), plus:
1. (A) fifty percent (50%) of the Medicare Part A deductible;
2. (B) skilled nursing facility care; and
3. (C) medically necessary emergency care in a foreign country.
(9) Standardized Medicare supplement Plan N shall include only the basic core benefit as defined in 760 IAC 3-6-1(c), plus:
1. (A) one hundred percent (100%) of the Medicare Part A deductible;
2. (B) skilled nursing facility care; and
3. (C) medically necessary emergency care in a foreign country.
(10) Copayments shall be the following amounts:
1. (A) The lesser of:
  1. (i) twenty dollars ($20); or
  2. (ii) the Medicare Part B coinsurance or copayment for each covered health care provider office visit, including visits to medical specialists.
2. (B) The lesser of:
  1. (i) fifty dollars ($50); or
  2. (ii) the Medicare Part B coinsurance or copayment for each covered emergency room visit.
The copayment set forth in clause (B) shall be waived if the insured is admitted to any hospital and the emergency visit is subsequently covered as a Medicare Part A expense.

(g) The makeup of the two (2) Medicare supplement plans mandated by the Medicare Prescription Drug Improvement and Modernization Act of 2003 are as follows:

(1) Standardized Medicare supplement benefit Plan K shall consist of only those benefits described in 760 IAC 3-6-1(e).
(2) Standardized Medicare supplement benefit Plan L shall consist of only those benefits described in 760 IAC 3-6-1(f).

(h) 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 as follows:

(1) Appropriate to Medicare supplement insurance.
(2) New or innovative.
(3) Not otherwise available.
(4) Cost effective.
(5) Offered in a manner that is consistent with the goal of simplification of Medicare supplement policies.
(6) 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.

After December 31, 2005, the innovative benefit shall not include an outpatient prescription drug benefit.

(i) The standards set forth in this section are applicable to all Medicare supplement policies delivered or issued for delivery with an effective date for coverage on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered, or issued for delivery as a Medicare supplement policy unless it complies with this section. No issuer may offer any 1990 Standardized Medicare supplement benefit plan for sale on or after 2010. Benefit standards applicable to Medicare supplement policies issued with an effective date for coverage prior to June 1, 2010, remain subject to the requirements of 760 IAC 3-6-1.

(Department of Insurance; 760 IAC 3-7.1-1; filed Jul 27, 2009, 10:36 a.m.: 20090826-IR-760090211FRA; readopted filed Nov 20, 2015, 9:25 a.m.: 20151216-IR-760150341RFA; filed Sep 11, 2019, 9:47 a.m.: 20191009-IR-760190257FRA; readopted filed Nov 15, 2021, 8:32 a.m.: 20211215-IR-760210419RFA; readopted filed Oct 22, 2025, 3:17 p.m.: 20251119-IR-760240637RFA)