Ins 3.39(30)(n)1.1. Each Medicare select issuer shall make available to each individual insured under a Medicare select policy or certificate the opportunity to purchase any Medicare supplement policy or certificate offered by the issuer, which has comparable or lesser benefits and which does not contain a restricted network provision. The issuer shall make such policies and certificates available without requiring evidence of insurability.
Ins 3.39(30)(n)2.2. For the purposes of subd. 1., a Medicare supplement policy or certificate shall be considered to have comparable or lesser benefits unless it contains one or more significant benefits not included in the Medicare select policy or certificate being replaced. For the purposes of this paragraph, a significant benefit means coverage for the Medicare Part A deductible, coverage for at–home recovery services or coverage for Medicare Part B excess charges.
Ins 3.39(30)(o)(o) A Medicare select issuer shall comply with reasonable requests for data made by state or federal agencies, including the CMS, for the purpose of evaluating the Medicare select program.
Ins 3.39(30)(p)(p) Except as provided in par. (q) or (r), a Medicare select policy shall contain the following benefits:
Ins 3.39(30)(p)1.1. The “basic Medicare supplement coverage” as described in sub. (5) (c).
Ins 3.39(30)(p)2.2. Coverage for the Medicare Part A hospital deductible as described in sub. (5) (i) 1.
Ins 3.39(30)(p)3.3. Coverage for home health care for an aggregate of 365 visits per policy year as described in sub. (5) (i) 2.
Ins 3.39(30)(p)4.4. Coverage for the Medicare Part B medical deductible as described in sub. (5) (i) 3.
Ins 3.39(30)(p)5.5. Coverage for the difference between Medicare Part B eligible charges and the actual charges for authorized referral services. This coverage shall not be described with words or terms that would lead insureds to believe the coverage is for Medicare part B Excess Charges as described in sub. (5) (i) 4.
Ins 3.39(30)(p)6.6. Coverage for benefits obtained outside of the United States as described in sub. (5) (i) 5.
Ins 3.39(30)(p)7.7. Coverage for preventive health care services as described in sub. (5) (c) 14.
Ins 3.39(30)(p)8.8. Coverage for at least 80% of the charges for outpatient prescription drugs after a drug deductible of no more than $6,250 per calendar year. This coverage may only be included in a Medicare select policy issued before January 1, 2006.
Ins 3.39(30)(q)(q) The Medicare Select 50% Cost-Sharing plans shall only contain the following:
Ins 3.39(30)(q)1.1. The designation: MEDICARE SELECT 50% COST-SHARING PLAN;
Ins 3.39(30)(q)2.2. Coverage of 100% of the Medicare Part A hospital coinsurance amount for each day used from the 61st through the 90th day in any Medicare benefit period;
Ins 3.39(30)(q)3.3. Coverage for 100% of the Medicare Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period;
Ins 3.39(30)(q)4.4. Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of 100% of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system rate, or other appropriate Medicare standard of payment, subject to a lifetime limitation benefit of an additional 365 days;
Ins 3.39(30)(q)5.5. Medicare Part A Deductible: Coverage for 50% of the Medicare Part A inpatient hospital deductible amount per benefit period until the out-of-pocket limitation is met as described in subd. 12.;
Ins 3.39(30)(q)6.6. Skilled Nursing Facility Care: Coverage for 50% of the coinsurance amount for each day used 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 until the out-of-pocket limitation is met as described in subd. 12.;
Ins 3.39(30)(q)7.7. Hospice Care: Coverage for 50% of cost sharing for all Medicare Part A eligible expenses and respite care until the out-of-pocket limitation is met as described in subd. 12.;
Ins 3.39(30)(q)8.8. Coverage for 50%, under Medicare Part A or B, of the reasonable cost of the first 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 subd. 12.;
Ins 3.39(30)(q)9.9. Except for coverage provided in subd. 11., coverage for 50% of the cost sharing otherwise applicable under Medicare Part B after the policyholder pays the Medicare Part B deductible until the out-of-pocket limitation is met as described under subd. 12.;
Ins 3.39(30)(q)10.10. Coverage of 100% of the cost sharing for the benefits described in sub. (5) (c) 1., 5., 6., 8., 13., 16., and 17., and (i) 2., to the extent the benefits do not duplicate benefits paid by Medicare and after the policyholder pays the Medicare Part A and Part B deductible and meets the out-of-pocket limitation described under subd. 12.;
Ins 3.39(30)(q)11.11. Coverage of 100% of the cost sharing for Medicare Part B preventive services after the policyholder pays the Medicare Part B deductible; and
Ins 3.39(30)(q)12.12. Coverage of 100% of all cost sharing under Medicare Part A or 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 $4,000 in 2006, indexed each year by the appropriate inflation adjustment specified by the secretary.
Ins 3.39(30)(r)(r) The Medicare Select 25% Coverage Cost-Sharing plans shall only contain the following:
Ins 3.39(30)(r)1.1. The designation: MEDICARE SELECT 25% COST-SHARING PLAN;
Ins 3.39(30)(r)2.2. Coverage of 100% of the Medicare Part A hospital coinsurance amount for each day used from the 61st through the 90th day in any Medicare benefit period;
Ins 3.39(30)(r)3.3. Coverage for 100% of the Medicare Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period;