Minn. R. agency 120, ch. 2740, ACTUARIAL EQUIVALENCE OF QUALIFIED PLANS AND QUALIFIED MEDICARE SUPPLEMENT PLANS, pt. 2740.9954
Current through Register Vol. 49, No. 25, December 16, 2024
Comprehensive Health Insurance
Test for Actuarial Equivalence
Other than Medicare Supplement Plans
| Major Medical | ||||
| Subparts of part 2740.9964 | Benefit | Basic | Superimposed | Comprehensive |
| 1. | Hospital room and board | |||
| 2. | Hospital extras | |||
| 3. | Surgery | |||
| 4. | Physician care; home, office | |||
| 5. | Physician care; hospital | |||
| 6. | Maternity | |||
| 7. | Diagnostic X-ray and lab | |||
| 8. | Drugs and medicine | |||
| 9. | Radioactive therapy | |||
| 10. | Nursing/convalescent facility | |||
| 11. | Home health care | |||
| 12. | Physical therapy | |||
| 12. | Oxygen | |||
| 12. | Prostheses | |||
| 12. | Durable medical equipment | |||
| 12. | Second opinion surgery | |||
| 12. | Private duty nursing | |||
| 12. | Ambulance | |||
| 13. | Hospital room and board in full | |||
| 14. | All hospital expenses in full | |||
| 15. | Major medical maximums | |||
| Subtotal reasonable and customary medical services | ||||
| 16. | Deductible | |||
| 16. | Coinsurance | |||
| Subtotal net of deductible and coinsurance | ||||
| 17. | Adjust (Comb. medical/dental deductible) | |||
| 18. | COB/No-Fault | |||
| 19. | Limit on "out-of-pocket" expenses | |||
| 20. | Well baby care | |||
| 21. | Emergency and supplemental accident | |||
| 22. | Student dependents | |||
| 23.-25. | Superimposed major medical | |||
| Grand Total | ||||
| Combined Basic and Superimposed | XXX | XXX | ||
| Equivalent to Minnesota qualified plan number _____ nonqualified ______ |
| Date _____ By _____ |
Minn. R. agency 120, ch. 2740, ACTUARIAL EQUIVALENCE OF QUALIFIED PLANS AND QUALIFIED MEDICARE SUPPLEMENT PLANS, pt. 2740.9954
Statutory Authority: MS s 62E.09