02-031 C.M.R. ch. 270, § 4 - Definitions

For purposes of this Rule:

(A) "Applicant" means:

(1) in the case of an individual Medicare supplement policy, the person who seeks to contract for benefits; and

(2) in the case of a group Medicare supplement policy, the proposed certificate holder.

(B) "Certificate" means any certificate issued under a group Medicare supplement policy delivered or issued for delivery in this State.

(C) "Insurance policy" or "policy" for purposes of this Rule also includes an individual or group contract for benefits to be provided by a health maintenance organization or by a nonprofit hospital or medical service organization.

(D) "Limited benefit health insurance" means any accident or health insurance policy, issued for delivery in this State to persons eligible for Medicare by reason of age, other than a Medicare supplement policy which meets the standards contained in 24-A M.R.S.A. Chapter 67 and in this Rule or a policy issued pursuant to a contract under Section 1876 of the Federal Social Security Act ( 42 U.S.C. § 1395 et seq.). In particular, this term includes: any disability income policy; any basic, catastrophic, or major medical expense policy; any single premium nonrenewable policy; and any policy identified in Section 3(C) of this Rule.

(E) "Medicare" means the United States Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965, Public Law 89-97 as amended.

(F) "Medicare supplement policy" means a group or individual health insurance policy advertised, marketed, or designed primarily as a supplement to reimbursements made under Medicare for the hospital, medical, or surgical expenses of persons eligible for Medicare by reason of age. This term does not include:

(1) a policy issued to one or more employers or labor organizations or of the trustees of a fund established by one or more employers or labor organizations, or combination thereof, or for members or former members, or combination thereof, of the labor organizations;

(2) a policy issued to any professional, trade, or occupational association for its members or former or retired members, or combination thereof, if such association:

(a) is composed of individuals all of whom are actively engaged in the same profession, trade or occupation;

(b) has been maintained in good faith for purposes other than obtaining insurance; and

(c) has been in existence for at least 2 years prior to the date of its initial offering of such policy or plan to its members; or

(3) an individual policy issued pursuant to a conversion privilege under a group or individual insurance policy that includes provisions inconsistent with the requirements of this Rule or 24-A M.R.S.A. Chapter 67.

(F) "Superintendent" means the Superintendent of Insurance.

Notes

02-031 C.M.R. ch. 270, § 4