2002 Minnesota Statutes

     62A.316 Basic Medicare supplement plan; coverage. 

    (a) The basic Medicare supplement plan must have a level of 
 coverage that will provide: 

    (1) coverage for all of the Medicare part A inpatient 
 hospital coinsurance amounts, and 100 percent of all Medicare 
 part A eligible expenses for hospitalization not covered by 
 Medicare, after satisfying the Medicare part A deductible; 

    (2) coverage for the daily copayment amount of Medicare 
 part A eligible expenses for the calendar year incurred for 
 skilled nursing facility care; 

    (3) coverage for the copayment amount of Medicare eligible 
 expenses under Medicare part B regardless of hospital 
 confinement, subject to the Medicare part B deductible amount; 

    (4) 80 percent of the hospital and medical expenses and 
 supplies incurred during travel outside the United States as a 
 result of a medical emergency; 

    (5) coverage for the reasonable cost of the first three 
 pints of blood, or equivalent quantities of packed red blood 
 cells as defined under federal regulations under Medicare parts 
 A and B, unless replaced in accordance with federal regulations; 

    (6) 100 percent of the cost of immunizations and routine 
 screening procedures for cancer screening including mammograms 
 and pap smears; and 

    (7) 80 percent of coverage for all physician prescribed 
 medically appropriate and necessary equipment and supplies used 
 in the management and treatment of diabetes.  Coverage must 
 include persons with gestational, type I, or type II diabetes. 

    (b) Only the following optional benefit riders may be added 
 to this plan: 

    (1) coverage for all of the Medicare part A inpatient 
 hospital deductible amount; 

    (2) a minimum of 80 percent of eligible medical expenses 
 and supplies not covered by Medicare part B, not to exceed any 
 charge limitation established by the Medicare program or state 
 law; 

    (3) coverage for all of the Medicare part B annual 
 deductible; 

    (4) coverage for at least 50 percent, or the equivalent of 
 50 percent, of usual and customary prescription drug expenses; 

    (5) coverage for the following preventive health services: 

    (i) an annual clinical preventive medical history and 
 physical examination that may include tests and services from 
 clause (ii) and patient education to address preventive health 
 care measures; 

    (ii) any one or a combination of the following preventive 
 screening tests or preventive services, the frequency of which 
 is considered medically appropriate: 

    (A) fecal occult blood test and/or digital rectal 
 examination; 

    (B) dipstick urinalysis for hematuria, bacteriuria, and 
 proteinuria; 

    (C) pure tone (air only) hearing screening test, 
 administered or ordered by a physician; 

    (D) serum cholesterol screening every five years; 

    (E) thyroid function test; 

    (F) diabetes screening; 

    (iii) any other tests or preventive measures determined 
 appropriate by the attending physician. 

    Reimbursement shall be for the actual charges up to 100 
 percent of the Medicare-approved amount for each service, as if 
 Medicare were to cover the service as identified in American 
 Medical Association current procedural terminology (AMA CPT) 
 codes, to a maximum of $120 annually under this benefit.  This 
 benefit shall not include payment for a procedure covered by 
 Medicare; 

    (6) coverage for services to provide short-term at-home 
 assistance with activities of daily living for those recovering 
 from an illness, injury, or surgery: 

    (i) For purposes of this benefit, the following definitions 
 apply: 

    (A) "activities of daily living" include, but are not 
 limited to, bathing, dressing, personal hygiene, transferring, 
 eating, ambulating, assistance with drugs that are normally 
 self-administered, and changing bandages or other dressings; 

    (B) "care provider" means a duly qualified or licensed home 
 health aide/homemaker, personal care aid, or nurse provided 
 through a licensed home health care agency or referred by a 
 licensed referral agency or licensed nurses registry; 

    (C) "home" means a place used by the insured as a place of 
 residence, provided that the place would qualify as a residence 
 for home health care services covered by Medicare.  A hospital 
 or skilled nursing facility shall not be considered the 
 insured's place of residence; 

    (D) "at-home recovery visit" means the period of a visit 
 required to provide at-home recovery care, without limit on the 
 duration of the visit, except each consecutive four hours in a 
 24-hour period of services provided by a care provider is one 
 visit; 

    (ii) Coverage requirements and limitations: 

    (A) at-home recovery services provided must be primarily 
 services that assist in activities of daily living; 

    (B) the insured's attending physician must certify that the 
 specific type and frequency of at-home recovery services are 
 necessary because of a condition for which a home care plan of 
 treatment was approved by Medicare; 

    (C) coverage is limited to: 

    (I) no more than the number and type of at-home recovery 
 visits certified as necessary by the insured's attending 
 physician.  The total number of at-home recovery visits shall 
 not exceed the number of Medicare-approved home care visits 
 under a Medicare-approved home care plan of treatment; 

    (II) the actual charges for each visit up to a maximum 
 reimbursement of $40 per visit; 

    (III) $1,600 per calendar year; 

    (IV) seven visits in any one week; 

    (V) care furnished on a visiting basis in the insured's 
 home; 

    (VI) services provided by a care provider as defined in 
 this section; 

    (VII) at-home recovery visits while the insured is covered 
 under the policy or certificate and not otherwise excluded; 

    (VIII) at-home recovery visits received during the period 
 the insured is receiving Medicare-approved home care services or 
 no more than eight weeks after the service date of the last 
 Medicare-approved home health care visit; 

    (iii) Coverage is excluded for: 

    (A) home care visits paid for by Medicare or other 
 government programs; and 

    (B) care provided by family members, unpaid volunteers, or 
 providers who are not care providers; 

    (7) coverage for at least 50 percent, or the equivalent of 
 50 percent, of usual and customary prescription drug expenses to 
 a maximum of $1,200 paid by the issuer annually under this 
 benefit.  An issuer of Medicare supplement insurance policies 
 that elects to offer this benefit rider shall also make 
 available coverage that contains the rider specified in clause 
 (4). 

    HIST: 1989 c 258 s 6; 1990 c 403 s 5; 1990 c 612 s 5; 1991 c 
 129 s 2; 1992 c 554 art 1 s 5; 1993 c 330 s 5; 1997 c 225 art 2 
 s 4; 1998 c 293 s 1