Ins 3.39(3)(i)1.g. g. A state health benefits risk pool;

Ins 3.39(3)(i)1.h. h. A health plan offered under chapter 89 of Title 5 United States Code commonly referred to as the Federal Employees Health Benefits Program;

Ins 3.39(3)(i)1.i. i. A public health plan as defined in federal regulation; and

Ins 3.39(3)(i)1.j. j. A health benefit plan under Section 5 (e) of the Peace Corps Act (22 United States Code 2504 (e)).

Ins 3.39(3)(i)2. 2. “Creditable coverage” does not include any of the following:

Ins 3.39(3)(i)2.a. a. Coverage only for accident or disability income insurance, or any combination thereof;

Ins 3.39(3)(i)2.b. b. Coverage issued as a supplement to liability insurance;

Ins 3.39(3)(i)2.c. c. Liability insurance, including general liability insurance and automobile liability insurance;

Ins 3.39(3)(i)2.d. d. Worker’s compensation or similar insurance;

Ins 3.39(3)(i)2.e. e. Automobile medical payment insurance;

Ins 3.39(3)(i)2.f. f. Credit-only insurance;

Ins 3.39(3)(i)2.g. g. Coverage for on-site medical clinics; and

Ins 3.39(3)(i)2.h. h. Other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.

Ins 3.39(3)(i)3. 3. “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 the plan:

Ins 3.39(3)(i)3.a. a. Limited scope dental or vision benefits;

Ins 3.39(3)(i)3.b. b. Benefits for long-term care, nursing home care, home health care, community-based care, or any combination; and

Ins 3.39(3)(i)3.c. c. Such other similar, limited benefits as are specified in federal regulations.

Ins 3.39(3)(i)4. 4. “Creditable coverage” shall not include the following benefits if offered as independent, non-coordinated benefits:

Ins 3.39(3)(i)4.a. a. Coverage only for a specified disease or illness; and

Ins 3.39(3)(i)4.b. b. Hospital indemnity or other fixed indemnity insurance.

Ins 3.39(3)(i)5. 5. “Creditable coverage” shall not include the following if it is offered as a separate policy, certificate or contract of insurance:

Ins 3.39(3)(i)5.a. a. Medicare supplemental health insurance as defined under section 1882 (g) (1) of the social security act;

Ins 3.39(3)(i)5.b. b. Coverage supplemental to the coverage provided under chapter 55 of title 10, United States Code; and

Ins 3.39(3)(i)5.c. c. Similar supplemental coverage provided to coverage under a group health plan.

Ins 3.39(3)(j) (j) “Employee welfare benefit plan” means a plan, fund or program of employee benefits as defined in 29 USC 1002 (Employee Retirement Income Security Act).

Ins 3.39(3)(jm) (jm) “Grievance” means dissatisfaction with the administration, claims practices or provision of services concerning a Medicare select issuer or its network providers that is expressed in writing by a policyholder or certificateholder under a Medicare select policy or certificate.

Ins 3.39(3)(k) (k) “Health care expense” means, for purposes of sub. (16), expense of health maintenance organizations associated with the delivery of health care services that are analogous to incurred losses of insurers.

Ins 3.39(3)(L) (L) “Health maintenance organization (HMO)” means an insurer as defined in s. 609.01 (2), Stats.

Ins 3.39(3)(m) (m) “Hospital” may be defined in relation to its status, facilities and available services or to reflect its accreditation by the Joint Commission on Accreditation of Hospitals, but not more restrictively than as defined in the Medicare program.