WILLIAM DONALD SCHAEFER, Governor Ch. 474

(IV) COVERAGE FOR DRUGS IN ACCORDANCE WITH
PARAGRAPH (3)(III) OF THIS SUBSECTION; AND

(v) Coverage in the amount of 20 percent of
Medicare eligible expenses under Medicare Part B, which coverage
may be limited to a maximum benefit in any calendar year of not
less than $5,000, BUT IN NO EVENT IN EXCESS OF THE APPLICABLE
OUT-OF-POCKET LIMIT UNDER MEDICARE.

(3) In addition to the coverage set forth in
paragraph (2) of this subsection, a Medicare supplement policy
shall:

(i) Provide coverage of not more than $100 for
an annual screening by low-dose mammography for the presence of
occult breast cancer; [and]

(ii) Provide, or offer as an option, coverage
of the initial annual deductible for Medicare eligible expenses
under Medicare Part B; AND

(III) EFFECTIVE JANUARY 1, 1990, PROVIDE
COVERAGE FOR COPAYMENT AMOUNTS OF MEDICARE ELIGIBLE EXPENSES FOR

ANY DRUG BENEFITS PROVIDED UNDER MEDICARE COVERED HOME

INTRAVENOUS THERAPY DRUGS AND OUTPATIENT DRUGS USED IN
IMMUNOSUPPRESSIVE THERAPY AS DETERMINED BY THE SECRETARY OF
HEALTH AND HUMAN SERVICES, SUBJECT TO ANY APPLICABLE MEDICARE
DEDUCTIBLE.

(c)  A Medicare supplement policy shall provide that
benefits designed to cover deductibles or coinsurance amounts
under Medicare will be changed automatically to coincide with any
changes in the applicable Medicare deductible and copayment
provisions. Subject to approval by the Insurance Commissioner,
the insurer may reserve the right to change premiums to
correspond with these changes in benefits.

(d)  (1) Payment of a benefit for a Medicare eligible
expense under a Medicare supplement policy may be conditioned on
the same or less restrictive payment conditions, including
determination of medical necessity, as are applicable to a
Medicare claim.

(2) Coverage under a Medicare supplement policy may
not be subject to any exclusions, limitations, or reductions not
consistent with the exclusions, limitations, or reductions under
Medicare, except:

(i) The policy shall provide that, to the
extent a benefit is available to the insured person under
Medicare, coverage is not duplicated for the benefit; and

- 3031 -