[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR422.102]



[Page 992]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 422_MEDICARE ADVANTAGE PROGRAM--Table of Contents

 

             Subpart C_Benefits and Beneficiary Protections

 

Sec. 422.102  Supplemental benefits.



    (a) Mandatory supplemental benefits. (1) Subject to CMS approval, an 

MA organization may require Medicare enrollees of an MA plan (other than 

an MSA plan) to accept or pay for services in addition to Medicare-

covered services described in Sec. 422.101.

    (2) If the MA organization imposes mandatory supplemental benefits, 

it must impose them on all Medicare beneficiaries enrolled in the MA 

plan.

    (3) CMS approves mandatory supplemental benefits if the benefits are 

designed in accordance with CMS' guidelines and requirements as stated 

in this part and other written instructions.

    (4) Beginning in 2006, an MA plan may reduce cost sharing below the 

actuarial value specified in section 1854(e)(4)(A) of the Act only as a 

mandatory supplemental benefit.

    (b) Optional supplemental benefits. Except as provided in Sec. 

422.104 in the case of MSA plans, each MA organization may offer (for 

election by the enrollee and without regard to health status) services 

that are not included in the basic benefits as described in Sec. 

422.100(c) and any mandatory supplemental benefits described in 

paragraph (a) of this section. Optional supplemental benefits are 

purchased at the discretion of the enrollee and must be offered to all 

Medicare beneficiaries enrolled in the MA plan.

    (c) Payment for supplemental services. All supplemental benefits are 

paid for in full, directly by (or on behalf of) the enrollee of the MA 

plan.

    (d) Marketing of supplemental benefits. MA organizations may offer 

enrollees a group of services as one optional supplemental benefit, 

offer services individually, or offer a combination of groups and 

individual services.



[65 FR 40320, June 29, 2000, as amended at 70 FR 4720, Jan. 28, 2005]