Ins 3.39(3)(c)2.2. In the case of a group Medicare supplement policy, the proposed certificateholder.
Ins 3.39(3)(ce)(ce) “Balance bill” means seeking: to bill, charge, or collect a deposit, remuneration or compensation from; to file or threaten to file with a credit reporting agency; or to have any recourse against an insured or any person acting on the insured’s behalf for health care costs for which the insured is not liable. The prohibition on recovery does not affect the liability of an insured for any deductibles, coinsurance or copayments, or for premiums owed under the policy or certificate.
Ins 3.39(3)(cs)(cs) “Bankruptcy” means when a Medicare Advantage 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.
Ins 3.39(3)(d)(d) “Benefit period,” or “Medicare benefit period” shall not be defined more restrictively than as defined in the Medicare program.
Ins 3.39(3)(e)(e) “CMS” means the Centers for Medicare & Medicaid Services within the U.S. department of health and human services.
Ins 3.39(3)(f)(f) “Certificate” means a certificate delivered or issued for delivery in this state under a Medicare supplement policy or under a Medicare select policy that is issued on a group basis, i.e. employer retiree group.
Ins 3.39(3)(g)(g) “Certificate form” means the form on which the certificate is delivered or issued for delivery by the issuer to a group that receives insurance coverage through a group Medicare supplement policy, or a group Medicare select policy.
Ins 3.39(3)(gg)(gg) “Certificateholder” means an individual member of a group that is receives a certificate that identifies the individual as a participant in the group Medicare supplement policy or the group Medicare select policy issued in this state.
Ins 3.39(3)(gr)(gr) “Complaint” means any dissatisfaction expressed by an individual concerning a Medicare select issuer or its network providers.
Ins 3.39(3)(h)(h) “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.
Ins 3.39(3)(i)(i)
Ins 3.39(3)(i)1.1. “Creditable coverage” means with respect to an individual, coverage of the individual provided under any of the following:
Ins 3.39(3)(i)1.a.a. A group health plan;
Ins 3.39(3)(i)1.b.b. Health insurance coverage;
Ins 3.39(3)(i)1.c.c. Part A or Part B of Title XVIII of the social security act (Medicare);
Ins 3.39(3)(i)1.d.d. Title XIX of the social security act (Medicaid), other than coverage consisting solely of benefits under section 1928;
Ins 3.39(3)(i)1.e.e. Chapter 55 of Title 10 United States Code, commonly referred to as TRICARE (formerly known as CHAMPUS);
Ins 3.39(3)(i)1.f.f. A medical care program of the Indian Health Service or of a tribal organization;
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;