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;
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