Ins 3.39(30m)(n)(n) Medicare select policies and certificates shall provide for continuation of coverage in the event the secretary determines that Medicare select policies and certificates issued pursuant to this section should be discontinued due to either the failure of the Medicare select federal program to be reauthorized under law or its substantial amendment, then the following apply:
Ins 3.39(30m)(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(30m)(n)2.2. For the purposes of this paragraph, 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. In this subdivision, 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(30m)(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(30m)(p)(p) Except as provided in par. (r) or (s), a Medicare select policy or certificate shall contain the following coverages:
Ins 3.39(30m)(p)1.1. The “basic Medicare supplement coverage” as described in sub. (5m) (d).
Ins 3.39(30m)(p)2.2. Coverage for 100% of the Medicare Part A hospital deductible as described in sub. (5m) (e) 1.
Ins 3.39(30m)(p)3.3. Coverage for home health care for an aggregate of 365 visits per policy or certificate year as described in sub. (5m) (e) 3.
Ins 3.39(30m)(p)4.4. Coverage for 100% of the Medicare Part B medical deductible as described in sub. (5m) (e) 4.
Ins 3.39(30m)(p)5.5. Coverage for preventive health care services as described in sub. (5m) (d) 15.
Ins 3.39(30m)(p)6.6. Coverage for emergency care obtained outside of the United States as described in sub. (5m) (e) 7.
Ins 3.39(30m)(q)(q) Permissible additional coverage may only be added to the policy or certificate as separate riders. The issuer shall issue a separate rider for each additional coverage offered. Issuers shall ensure that the riders offered are compliant with MMA, each rider is priced separately, available for purchase separately at any time, subject to underwriting and the preexisting limitation allowed in sub. (4m) (a) 2., and may consist of the following:
Ins 3.39(30m)(q)1.1. Coverage for 50% of the Medicare Part A hospital deductible with no out-of-pocket maximum as described in sub. (5m) (e) 2.
Ins 3.39(30m)(q)2.2. Coverage for 100% of the Medicare Part B medical deductible subject to copayment or coinsurance as described in sub. (5m) (e) 5.
Ins 3.39(30m)(r)(r) The Medicare Select 50% Cost-Sharing plans issued with an effective date on or after June 1, 2010, shall only contain the following coverages:
Ins 3.39(30m)(r)1.1. The designation: MEDICARE SELECT 50% COST-SHARING PLAN.
Ins 3.39(30m)(r)2.2. Coverage for 100% of the Medicare Part A hospital coinsurance or copayment amount for each day used from the 61st through the 90th day in any Medicare benefit period.
Ins 3.39(30m)(r)3.3. Coverage for 100% of the Medicare Part A hospital coinsurance or copayment amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period.
Ins 3.39(30m)(r)4.4. Upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage for 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(30m)(r)5.5. 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(30m)(r)6.6. Coverage for 50% of the coinsurance or copayment 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(30m)(r)7.7. 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(30m)(r)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(30m)(r)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 or certificateholder pays the Medicare Part B deductible until the out-of-pocket limitation is met as described in subd. 12.
Ins 3.39(30m)(r)10.10. Coverage for 100% of the cost sharing for the benefits described in sub. (5m) (d) 1., 6., 7., 9., 14., 16., and 17., and (e) 3., to the extent the benefits do not duplicate benefits paid by Medicare and after the policyholder or certificateholder pays the Medicare Part A and B deductible and meets the out-of-pocket limitation described in subd. 12.
Ins 3.39(30m)(r)11.11. Coverage for 100% of the cost sharing for Medicare Part B preventive services after the policyholder or certificateholder pays the Medicare Part B deductible.
Ins 3.39(30m)(r)12.12. Coverage for 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 [$4,440] in 2010, indexed each year by the appropriate inflation adjustment specified by the secretary.
Ins 3.39(30m)(s)(s) The Medicare Select 25% Coverage Cost-Sharing plans issued with an effective date on or after June 1, 2010, shall only contain the following coverages:
Ins 3.39(30m)(s)1.1. The designation: MEDICARE SELECT 25% COST-SHARING PLAN.