{"data":{"id":"us-va/14vac5-160-110-1","jurisdiction":"us-va","citation":"14VAC5-160-110:1","heading":"APPENDIX A. NOTICE OF CHANGES IN MEDICARE AND YOUR MEDICARE SUPPLEMENT COVERAGE-1990","body":"APPENDIX A.\n\n[COMPANY NAME]\n\nNOTICE OF CHANGES IN MEDICARE AND YOUR MEDICARE SUPPLEMENT COVERAGE-1990\n\nTHE FOLLOWING OUTLINE BRIEFLY DESCRIBES THE MODIFICATIONS IN MEDICARE AND IN YOUR MEDICARE SUPPLEMENT COVERAGE. PLEASE READ THIS CAREFULLY!\n\n[A BRIEF DESCRIPTION OF THE REVISIONS TO MEDICARE PARTS A \u0026 B WITH A PARALLEL DESCRIPTION OF SUPPLEMENTAL BENEFITS WITH SUBSEQUENT CHANGES, INCLUDING DOLLAR AMOUNTS, PROVIDED BY THE MEDICARE SUPPLEMENT COVERAGE IN SUBSTANTIALLY THE FOLLOWING FORMAT.]\n\nSERVICES\n\nMEDICARE BENEFITS\n\nYOUR MEDICARE\n\nSUPPLEMENT COVERAGE\n\nIn 1989 Medicare Per Calendar Year\n\nEffective January 1, 1990, Medicare Will Pay\n\nIn 1989 Your Coverage Pays\n\nEffective January 1, 1990, Your Coverage Will Pay Per   Calendar Year\n\nMEDICARE PART A SERVICES AND SUPPLIES\n\nInpatient Hospital Services\n\nUnlimited number of hospital days after $560 deductible\n\nAll but $592 for first 60 days/benefit period\n\nSemi-Private Room \u0026 Board\n\nAll but $148 a day for 61st-90 days/benefit period\n\nMisc. Hospital Services \u0026 Supplies, such as Ddrugs,   X-Rays, Lab Tests \u0026 Operating Room\n\nAll but $296 a day for 91st-150 days (if individual chooses   to use 60 nonrenewable days)\n\nBLOOD\n\nPays all costs except payment of deductible (equal to costs   for first three pints) each calendar year. Part A blood deductible reduced to   the extent paid under Part B\n\nPays all costs except nonreplacement fees (blood deductible)   for first three pints in each benefit period\n\nSKILLED NURSING FACILITY CARE\n\nThere is no prior confinement requirement for this benefit\n\n100% of costs for 1st 20 days (after a three-day prior   hospital confinement)/benefit period\n\nFirst eight days - all but $25.50 a day\n\nAll but $74 a day for 21st-100th days/benefit period\n\n9th through 150th day - 100% of costs\n\nBeyond 100 days\n\nNothing/benefit period\n\nBeyond 150 days - Nothing\n\nMEDICARE PART B SERVICES AND SUPPLIES\n\n80% of allowable charges (after $75 deductible/calendar   year)\n\n80% of allowable charges (after $75 deductible)\n\nPRESCRIPTION\n\nInpatient prescription drugs. 80% of allowable charges for   immuno-suppressive drugs during the first year following a covered transplant   (after $75 deductible/calendar year)\n\nInpatient prescription drugs. 80% of allowable charges for   immuno-suppressive drugs during the first year following a covered transplant   (after $75 deductible/calendar year)\n\nBLOOD\n\n80% of all costs except nonreplacement fees (blood   deductible) for first three pints in each benefit period (after $75   deductible/calendar year)\n\n80% of costs except nonreplacement fees (blood deductible)   for first three pints in each benefit period (after $75 deductible/calendar   year)\n\n[Any other policy benefits not mentioned in this chart should be added to the chart in the order prescribed by the outline of coverage benefits. If there are corresponding Medicare benefits, they should be shown.]\n\n[Describe any coverage provisions changing due to Medicare modifications.]\n\n[Include information about when premium adjustments that may be necessary due to changes in Medicare benefits will be effective.]\n\nTHIS CHART SUMMARIZING THE CHANGES IN YOUR MEDICARE BENEFITS AND IN YOUR MEDICARE SUPPLEMENT PROVIDED BY [COMPANY] ONLY BRIEFLY DESCRIBES SUCH BENEFITS. FOR INFORMATION ON YOUR MEDICARE BENEFITS CONTACT YOUR SOCIAL SECURITY OFFICE OR THE HEALTH CARE FINANCING ADMINISTRATION. FOR INFORMATION ON YOUR MEDICARE SUPPLEMENT [Policy] CONTACT:\n\n[COMPANY OR FOR AN INDIVIDUAL POLICY - NAME OF AGENT]\n\n[ADDRESS/PHONE NUMBER]","path":["Title 14. Insurance","Agency 5. State Corporation Commission, Bureau of Insurance","Chapter 160. Rules to Implement Transitional Requirements for the Conversion of Medicare Supplement Insurance Benefits and Premiums to Conform to Repeal of the Medicare Catastrophic Coverage Act"],"source_url":"https://law.lis.virginia.gov/admincode/title14/agency5/chapter160/section110:1/","current_through":"2026 Regular Session (effective July 1, 2026)","vintage":"","retrieved_at":"2026-09-14T04:51:52Z","sha256":"1c38c1a7af50c47db97e5ecb64c60b41cbd33fb348ed4990ec909584a94b8c10","source_id":"us-va-vac","stale":false,"prev":"us-va/14vac5-160-110","next":"us-va/14vac5-170-10"},"notice":"GroundRules: Original legal text. Not legal advice."}