Title 33, Chapter 43, Section 1
As used in this chapter, the term:
(1) "Applicant" means:
(A) In the case of an individual medicare supplement policy or
subscriber contract, the person who seeks to contract for
insurance benefits; and
(B) In the case of a group medicare supplement policy, the
proposed certificate holder.
(1.1) "Bankruptcy" means when a Medicare+Choice organization that
is not an issuer has filed, or has had filed against it, a
petition for declaration of bankruptcy and has ceased doing
business in the state.
(2) "Certificate" means any certificate delivered or issued for
delivery in this state under a group medicare supplement policy.
(3) "Certificate form" means the form on which the certificate is
delivered or issued for delivery by the issuer.
(3.1) "Continuous period of creditable coverage" means the period
during which an individual was covered by creditable coverage if
during the period of the coverage the individual had no breaks in
coverage greater than 63 days.
(3.2)(A) "Creditable coverage" means, with respect to an
individual, coverage of the individual provided under any of the
(i) A group health plan;
(ii) Health insurance coverage;
(iii) Part A or Part B of Title XVIII of the Social Security
(iv) Title XIX of the Social Security Act (Medicaid), other
than coverage consisting solely of benefits under Section
(v) Chapter 5 of Title 10 of the United States Code (CHAMPUS);
(vi) A medical care program of the Indian Health Service or of
a tribal organization;
(vii) A state health benefits risk pool;
(viii) A health plan offered under Chapter 89 of Title 5 of
the United States Code (Federal Employees Health Benefits
(ix) A public health plan as defined in federal regulation; or
(x) A health benefit plan under Section 5(e) of the Peace
Corps Act (22 U.S.C. Section 2504(e)).
(B) Creditable coverage shall not include one or more, or any
combination of, the following:
(i) Coverage only for accident or disability income insurance,
or any combination thereof;
(ii) Coverage issued as a supplement to liability insurance;
(iii) Liability insurance, including general liability
insurance and automobile liability insurance;
(iv) Workers' compensation or similar insurance;
(v) Automobile medical payment insurance;
(vi) Credit only insurance;
(vii) Coverage for on-site medical clinics; or
(viii) Other similar insurance coverage, specified in the Code
of Federal Regulations as of July 1, 2000, under which
benefits for medical care are secondary or incidental to other
(C) Creditable coverage shall not include the following benefits
if they are provided under a separate policy, certificate, or
contract of insurance or are otherwise not an integral part of
(i) Limited scope dental or vision benefits;
(ii) Benefits for long-term care, nursing home care, home
health care, community based care, or any combination thereof;
(iii) Such other similar, limited benefits as are specified in
the Code of Federal Regulations as of July 1, 2000.
(D) Creditable coverage shall not include the following benefits
if offered as independent, noncoordinated benefits:
(i) Coverage only for a specified disease or illness; or
(ii) Hospital indemnity or other fixed indemnity insurance.
(E) Creditable coverage shall not include the following if
offered as a separate policy, certificate, or contract of
(i) Medicare supplemental health insurance as defined under
Section 1882(g)(1) of the Social Security Act;
(ii) Coverage supplemental to the coverage provided under
Chapter 55 of Title 10 of the United States Code; or
(iii) Similar supplemental coverage provided to coverage under
a group health plan.
(3.3) "Employee welfare benefit plan" means a plan, fund, or
program of employee benefits as defined in 29 U.S.C. Section 1002
(Employee Retirement Income Security Act).
(3.4) "Insolvency" means when an issuer, licensed to transact the
business of insurance in this state, has had a final order of
liquidation entered against it with a finding of insolvency by a
court of competent jurisdiction in the issuer's state of domicile.
(4) "Issuer" includes insurance companies, fraternal benefit
societies, health care service plans, health maintenance
organizations, and any other entity delivering or issuing for
delivery in this state medicare supplement policies or
(5) "Medicare" means the "Health Insurance for the Aged Act,"
Title XVIII of the Social Security Act Amendments of 1965, as then
constituted or later amended.
(6) "Medicare supplement policy" means a group or individual
policy of accident and sickness insurance or a subscriber contract
of hospital and medical service associations or health maintenance
organizations, other than a policy issued pursuant to a contract
under Section 1876 of the federal Social Security Act (42 U.S.C.
Section 1395, et seq.) or an issued policy under a demonstration
project specified in 42 U.S.C. Section 1395ss(g)(1), which is
advertised, marketed, or designed primarily as a supplement to
reimbursements under medicare for the hospital, medical, or
surgical expenses of persons eligible for medicare.
(6.1) "Medicare+Choice plan" means a plan of coverage for health
benefits under medicare Part C as defined in P.L. 105-33, and
(A) Coordinated care plans which provide health care services,
including but not limited to health maintenance organization
plans (with or without a point-of-service option), plans offered
by provider sponsored organizations, and preferred provider
(B) Medical savings account plans coupled with a contribution
into a Medicare+Choice medical savings account; and
(C) Medicare+Choice private fee-for-service plans.
(7) "Policy form" means the form on which the policy is delivered
or issued for delivery by the issuer.
(8) "Secretary" means the secretary of the United States
Department of Health and Human Services.