OAR 836-052-0136
Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010


(1)

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 OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(3).

(2)

No groups, packages or combinations of Medicare supplement benefits other than those listed in this rule shall be offered for sale in this state except as may be permitted in section (6) of this rule and in OAR 836-052-0139 (Medicare Select Policies and Certificates).

(3)

Benefit plans must be uniform in structure, language, designation and format to the standard benefit plans “A” through “L" listed in this rule and conform to the definitions in OAR 836-052-0119 (Definitions). Each standard benefit plan must be designated by the letter assigned to it under this rule. Each benefit must be structured in accordance with the format provided in 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(3) and (4) or (5) and list the benefits in the order shown in this rule. For purposes of this rule, “structure, language, and format” means style, arrangement, and overall content of a benefit.

(4)

In addition to the benefit plan designations required in section (3) of this rule, an issuer may use other designations to the extent permitted by law.

(5)

The content of benefit plans must be as follows:

(a)

Standardized Medicare supplement benefit plan “A” shall be limited to the basic core benefits common to all benefit plans, as defined in OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(3);

(b)

Standardized Medicare supplement benefit plan “B” shall include only the following: The core benefit as defined in OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(3), plus the Medicare Part A Deductible as defined in 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(4)(a);

(c)

Standardized Medicare supplement benefit plan “C” shall include only the following: the core benefit as defined in OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(3), plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medicare Part B Deductible and Medically Necessary Emergency Care in a Foreign Country, each as defined in 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(4);

(d)

Standardized Medicare supplement benefit plan “D” shall include only the following: The core benefit, as defined in OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(3), plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medically Necessary Emergency Care in a Foreign Country and the At-Home Recovery Benefit, each as defined in 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(4);

(e)

Standardized Medicare supplement benefit plan “E” shall include only the following: The core benefit as defined in OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(3), plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medically Necessary Emergency Care in a Foreign Country and Preventive Medical Care, each as defined in 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(4);

(f)

Standardized Medicare supplement benefit plan “F” shall include only the following: The core benefit as defined in OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(3), plus the Medicare Part A Deductible, the Skilled Nursing Facility Care, the Part B Deductible, 100 percent of the Medicare Part B excess Charges and Medically Necessary Emergency Care in a Foreign Country, each as defined in 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(4);

(g)

Standardized Medicare supplement benefit high deductible plan “F” shall include only the following: 100 percent of covered expenses following the payment of the annual high deductible plan “F” deductible. The covered expenses include the core benefit as defined in OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(3), plus the Medicare Part A Deductible, skilled nursing facility care, the Medicare Part B deductible, 100 percent of the Medicare Part B excess charges and medically necessary emergency care in a foreign country, each as defined in 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(4). 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 $1500 for 1998 and 1999, and shall be based on the calendar year. The deductible shall be adjusted annually thereafter according to the method prescribed in 42 U.S.C. 1395ss(p)(11)(C) to reflect the change in the Consumer Price Index for all urban consumers for the twelve-month period ending with August of the preceding year, and rounded to the nearest multiple of $10.

(h)

Standardized Medicare supplement benefit plan “G” shall include only the following: The core benefit as defined in OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(3), plus the Medicare Part A Deductible, Skilled Nursing Facility Care, 80 percent of the Medicare Part B Excess Charges, Medically Necessary Emergency Care in a Foreign Country, and the At-Home Recovery Benefit, each as defined in OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(4).

(i)

Standardized Medicare supplement benefit plan “H” shall consist of only the following: The core benefit as defined in OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(3), plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Basic Prescription Drug Benefit and Medically Necessary Emergency Care in a Foreign Country, each as defined in 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(4). The outpatient prescription drug benefit shall not be included in a Medicare supplement policy sold after December 31, 2005;

(j)

Standardized Medicare supplement benefit plan “I” shall consist of only the following: The core benefit as defined in OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(3), plus the Medicare Part A Deductible, Skilled Nursing Facility Care, 100 percent of the Medicare Part B Excess Charges, Basic Prescription Drug Benefit, Medically Necessary Emergency Care in a Foreign Country and At-Home Recovery Benefit, each as defined in 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(4). The outpatient prescription drug benefit shall not be included in a Medicare supplement policy sold after December 31, 2005;

(k)

Standardized Medicare supplement benefit plan “J” shall consist of only the following: The core benefit as defined in OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(3), plus the Medicare Part A Deductible, Skilled Nursing Facility Care, Medicare Part B Deductible, 100 percent of the Medicare Part B Excess Charges, Extended Prescription Drug Benefit, Medically Necessary Emergency Care in a Foreign Country, Preventive Medical Care and At-Home Recovery Benefit, each as defined in 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(4). The outpatient prescription drug benefit shall not be included in a Medicare supplement policy sold after December 31, 2005.

(l)

Standardized Medicare supplement benefit high deductible plan “J” shall consist of only the following: 100 percent of covered expenses following the payment of the annual high deductible plan “J” deductible. The covered expenses include the core benefit as defined in OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(3), plus the Medicare Part A deductible, skilled nursing facility care, Medicare Part B deductible, 100 percent of the Medicare Part B excess charges, extended outpatient prescription drug benefit, medically necessary emergency care in a foreign country, preventive medical care benefit and at home recovery benefit, each as defined in 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(4). The annual high deductible plan “J” deductible shall consist of out-of-pocket expenses, other than premiums, for services covered by the Medicare supplement plan “J” policy, and shall be in addition to any other specific benefit deductibles. The annual deductible shall be $1500 for 1998 and 1999, and shall be based on a calendar year. The deductible shall be adjusted annually thereafter according to the method prescribed in 42 U.S.C. 1395ss(p)(11)(C) to reflect the change in the Consumer Price Index for all urban consumers for the 12-month period ending with August of the preceding year, and rounded to the nearest multiple of $10. The outpatient prescription drug benefit shall not be included in a Medicare supplement policy sold after December 31, 2005.

(6)

Make-up of two additional Medicare supplement plans mandated by The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA);

(a)

Standardized Medicare supplement benefit plan “K” shall consist of only those benefits described in OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(5).

(b)

Standardized Medicare supplement benefit plan “L” shall consist of only those benefits described in OAR 836-052-0133 (Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010)(5).

(7)

New or innovative benefits. With the prior approval of the Director, an issuer may 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 appropriate to Medicare supplement insurance, new or innovative, not otherwise available, cost-effective and offered in a manner consistent with the goal of simplification of Medicare supplement policies. After December 31, 2005, the innovative benefit shall not include an outpatient prescription drug benefit.

Source: Rule 836-052-0136 — Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=836-052-0136.

836‑052‑0103
Purpose
836‑052‑0107
Authority
836‑052‑0114
Applicability and Scope
836‑052‑0119
Definitions
836‑052‑0124
Policy Definitions and Terms
836‑052‑0129
Policy Provisions
836‑052‑0132
Benefit Standards for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date of Coverage on or After June 1, 2010
836‑052‑0133
Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010
836‑052‑0134
Minimum Benefit Standards for Policies or Certificates Issued for Delivery Prior to July 1, 1992
836‑052‑0136
Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010
836‑052‑0138
Open Enrollment
836‑052‑0139
Medicare Select Policies and Certificates
836‑052‑0140
Standards for Claims Payment
836‑052‑0141
Standard Medicare Supplement Benefit Plans for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates with an Effective Date of Coverage on or After June 1, 2010
836‑052‑0142
Guaranteed Issue for Eligible Persons
836‑052‑0143
Annual Opportunity to Select Another Medicare Supplement Policy or Certificate
836‑052‑0144
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, 2020.
836‑052‑0145
Loss Ratio Standards and Refund or Credit of Premium
836‑052‑0151
Filing and Approval of Policies and Certificates and Premium Rates
836‑052‑0156
Permitted Compensation Arrangements
836‑052‑0160
Required Disclosure Provisions
836‑052‑0165
Requirements for Application Forms, Replacement Coverage
836‑052‑0170
Filing Requirements for Advertising
836‑052‑0175
Standards for Marketing
836‑052‑0180
Appropriateness of Recommended Purchase and Excessive Insurance
836‑052‑0185
Reporting of Multiple Policies
836‑052‑0190
Prohibition Against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies and Certificates
836‑052‑0192
Prohibition Against Use of Genetic Information and Requests for Genetic Testing
836‑052‑0194
Separability
836‑052‑0225
Durational Limits for Health Maintenance Organizations
836‑052‑0230
Provider Services Limits for Insurers and Health Care Contractors
836‑052‑0500
Statutory Authority
836‑052‑0508
Definitions
836‑052‑0516
Policy Definitions
836‑052‑0526
Policy Practices and Provisions
836‑052‑0531
Long Term Care Insurance Partnership Program
836‑052‑0546
Required Policy Provisions
836‑052‑0556
Required Disclosure of Rating Practices to Consumers
836‑052‑0566
Initial Rate Filing Requirements
836‑052‑0576
Prohibition Against Post-Claims Underwriting, Applications
836‑052‑0586
Minimum Standards for Home Health and Community Care Benefits in Long-Term Care Insurance Policies
836‑052‑0596
Standards for Covered Services
836‑052‑0606
Use and Definition of “Home” or Similar Wording
836‑052‑0616
Requirement to Offer Inflation Protection
836‑052‑0626
Requirements for Application Forms and Replacement Coverage
836‑052‑0636
Reporting Requirements
836‑052‑0637
Annual Rate Certification Requirements
836‑052‑0639
Training for Insurance Producers
836‑052‑0646
Benefits Provided Through Advancement of Life Insurance Proceeds
836‑052‑0656
Reserve Standards
836‑052‑0666
Loss Ratio
836‑052‑0676
Premium Rate Schedule Increases
836‑052‑0680
Premium Rate Schedule Increases for Policies Subject to Loss Ratio Limits Related to Original Filings
836‑052‑0686
Filing Requirements for Out-of-State Group Policies
836‑052‑0696
Filing Requirements for Advertising
836‑052‑0706
Standards for Marketing
836‑052‑0716
Disclosure Statement
836‑052‑0726
Suitability
836‑052‑0736
Prohibition Against Preexisting Conditions, Waiting Periods and Probationary Periods in Replacement Policies and Certificates
836‑052‑0738
Availability of New Services or Providers
836‑052‑0740
Right to Reduce Coverage and Lower Premiums
836‑052‑0746
Nonforfeiture Benefit Requirement
836‑052‑0756
Standards for Benefit Triggers
836‑052‑0766
Additional Standards for Benefit Triggers for Qualified Long-Term Care Insurance Contracts
836‑052‑0768
Appealing An Insurer’s Determination That The Benefit Trigger Is Not Met
836‑052‑0770
Prompt Payment of Clean Claims
836‑052‑0776
Standard Format Outline of Coverage
836‑052‑0786
Requirement to Deliver Shopper’s Guide
836‑052‑0790
Disclosure of Benefits Paid
836‑052‑0800
Purpose
836‑052‑0810
Replacement Upon Termination
836‑052‑0840
Termination of Coverage
836‑052‑0850
Multiple Employer Trusts
836‑052‑0860
Form of Notice to Group Policyholder
836‑052‑1000
Prosthetic and Orthotic Devices
Last Updated

Jun. 8, 2021

Rule 836-052-0136’s source at or​.us