Section 45-06-01.1-07.2 - Standard Medicare supplement benefit plans for 2020 standardized Medicare supplement benefit plan policies or certificates issued for delivery to individuals newly eligible for Medicare on or after January 1, 2020The Medicare Access and CHIP Reauthorization Act of 2015 requires the following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state to individuals newly eligible for Medicare on or after January 1, 2020. No policy or certificate that provides coverage of the Medicare part B deductible may be advertised, solicited, delivered or issued for delivery in this state as a Medicare supplement policy or certificate to individuals newly eligible for Medicare on or after January 1, 2020. All policies must comply with the following benefit standards. Benefit plan standards applicable to Medicare supplement policies and certificates issued to individuals eligible for Medicare before January 1, 2020, remain subject to the requirements of sections 45-06-01.1-06, 45-06-01.1-06.1, 45-06-01.1-07, and 45-06-01.1-07.1.
1. Benefit requirements. The standards and requirements of section 45-06-01.1-07.1 apply to all Medicare supplement policies or certificates delivered or issued for delivery to individuals newly eligible for Medicare on or after January 1, 2020, with the following exceptions: a. Standardized Medicare supplement benefit plan C is redesignated as plan D and must provide the benefits contained in subdivision c of subsection 5 of section 45-06-01.1-07.1 of this regulation but may not provide coverage for one hundred percent or any portion of the Medicare part B deductible.b. Standardized Medicare supplement benefit plan F is redesignated as plan G and must provide the benefits contained in subdivision e of subsection 5 of section 45-06-01.1-07.1 of this regulation but may not provide coverage for one hundred percent or any portion of the Medicare part B deductible.c. Standardized Medicare supplement benefit places C, F, and F with high deductible may not be offered to individuals newly eligible for Medicare on or after January 1, 2020.d. Standardized Medicare supplement benefit plan F with high deductible is redesignated as plan G with high deductible and must provide the benefits contained in subdivision f of subsection 5 of section 45-06-01.1-07.1 of this regulation but may not provide coverage for one hundred percent or any portion of the Medicare part B deductible; provided further that, the Medicare part B deductible paid by the beneficiary shall be considered an out-of-pocket expense in meeting the annual high deductible.e. The reference to plans C or F contained in subdivision b of subsection 1 of section 45-06-01.1-07.1 is deemed a reference to plans D or G for purposes of this section.2. Applicability to certain individuals. This section applies to only individuals newly eligible for Medicare on or after January 1, 2020: a. By reason of attaining age sixty-five on or after January 1, 2020; orb. By reason of entitlement to benefits under part A pursuant to section 226(b) or 226A of the Social Security Act, or who is deemed to be eligible for benefits under section 226(a) of the Social Security Act on or after January 1, 2020.3. Guaranteed issue for eligible persons. For purposes of subsection 5 of section 45-06-01.1-09.1 in the case of any individual newly eligible for Medicare on or after January 1, 2020, any reference to a Medicare supplement policy C or F (including F with high deductible) is deemed to be a reference to Medicare supplement policy D or G (including G with high deductible), respectively, that meet the requirements of subsection 1.4. Applicability to waivered states. In the case of a state described in section 1882(p)(6) of the Social Security Act ("waivered" alternative simplification states) Medicare Access and CHIP Reauthorization Act of 2015 prohibits the coverage of the Medicare part B deductible for any Medicare supplement policy sold or issued to an individual that is newly eligible for Medicare on or after January 1, 2020.5. Offer of redesignated plans to individuals other than newly eligible. On or after January 1, 2020, the standardized benefit plans described in subdivision d of subsection 1 may be offered to any individual who was eligible for Medicare prior to January 1, 2020, in addition to the standardized plans described in subsection 5 of section 45-06-01.1-07.1 of this regulation. N.D. Admin Code 45-06-01.1-07.2
Adopted by Administrative Rules Supplement 374, October 2019, effective 1/1/2020.General Authority: NDCC 26.1-36.1-02(1)(2), 26.1-36.1-03
Law Implemented: NDCC 26.1-36.1-02