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16.1.1 Core Benefits

The following six minimum standards apply to all policies designated as Medicare Supplement Insurance.

  1. The policy must supplement both Part A and Part B of Medicare.
  1. The policy must automatically adjust its benefits to reflect statutory changes in Medicare.
  1. The policy must cover all expenses not covered by Part A from the 61st to the 90th day. Furthermore, it must cover the lifetime reserve copayment and must provide full coverage for an additional 365 days after Medicare benefits are exhausted.
  1. If the policy excludes coverage for preexisting conditions, the exclusion cannot exist for longer than 6 months. That is, no coverage can be denied as a preexisting condition after the policy has been in effect for 6 months.
  1. Part B expenses not covered by Medicare (that is, the 20% copayment) must be covered by the Medigap policy, up to a maximum of $5,000 per year. However, policies may include a deductible before this benefit becomes payable.
  1. The policy must include a minimum 30-day free look provision.