Connecticut Administrative Code
Title 38a - Insurance Department
495a - Medicare Supplement Insurance
Section 38a-495a-2 - Definitions
Current through March 14, 2024
As used in sections 38a-495a-1 to 38a-495a-20, inclusive, of the Regulations of Connecticut State Agencies:
(1)"Applicant" means:
(2) "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.
(3) "Certificate" means any certificate delivered or issued for delivery in this state under a group Medicare supplement policy.
(4) "Certificate Form" means the form on which the certificate is delivered or issued for delivery by the issuer.
(5) "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 sixty-three (63) days.
(6)
(7) "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).
(8) "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.
(9) "Issuer" includes insurance companies, fraternal benefit societies, health care service plans, health maintenance organizations, health care centers, and any other entity delivering or issuing for delivery in this state Medicare supplement policies or certificates.
(10) "Medicare" means the "Health Insurance for the Aged Act," Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.
(11) "Medicare Advantage plan" means a plan of coverage for health benefits under Medicare part C, and includes:
(12)"Medicare supplement policy" means a group or individual policy of insurance or a subscriber contract, 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. "Medicare supplement policy" does not include Medicare Advantage plans established under Medicare Part C, Outpatient Prescription Drug plans established under Medicare Part D, or any Health Care Prepayment Plan (HCPP) that provides benefits pursuant to an agreement under § 1833(a)(1)(A) of the Social Security Act.
(13) "Policy form" means the form on which the policy is delivered or issued for delivery by the issuer
(14) "Pre-standardized plan" means a group or individual policy of Medicare supplement insurance issued prior to July 30, 1992.
(15)"1992 Standardized Medicare supplement benefit plan", "1992 Standardized benefit plan" or "1992 plan" means a group or individual policy of Medicare supplement insurance issued on or after July 30, 1992, and with an effective date for coverage prior to June 1, 2010.
(16)"2010 Standardized Medicare supplement benefit plan", "2010 Standardized benefit plan" or "2010 plan" means a group or individual policy of Medicare supplement insurance issued with an effective date for coverage on or after June 1, 2010.
(17) "Secretary" means the secretary of the United States Department of Health and Human Services.