Illinois Administrative Code › Title 50 - INSURANCE › Part 2008 - MINIMUM STANDARDS FOR INDIVIDUAL AND GROUP MEDICARE SUPPLEMENT INSURANCE › Subpart A - GENERAL PROVISIONS › Section 2008.40 - Definitions

Current through Register Vol. 48, No. 28, July 12, 2024
For the purposes of this Part:
"1990 Standardized Medicare Supplement Benefit Plan", "1990
				  Standardized Benefit Plan" or "1990 Plan" means a group or individual policy of
				  Medicare supplement insurance issued on or after February 11, 1992 and with an
				  effective date for coverage prior to June 1, 2010 and includes Medicare
				  supplement insurance policies and certificates renewed on or after that date
				  that are not replaced by the issuer at the request of the insured.
"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.
Applicant means:
in the case of an individual Medicare supplement
				  policy, the person who seeks to contract for insurance benefits;
				  and
in the case of a group Medicare supplement policy,
				  the proposed certificateholder
(Section 363(2)(a) of the Code).
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 this State.
Certificate means
any certificate delivered or issued
				  for delivery in this State under a group Medicare supplement policy
(Section 363(2)(b) of the Code).
Certificate Form means the form on which the certificate is
				  delivered or issued for delivery by the issuer.
Continuous Period of Creditable Coverage means the period
				  during which an individual was covered by creditable coverage, if during the
				  period of coverage the individual had no breaks in coverage greater than 63
				  days.
Code means the Illinois Insurance Code [ 215 ILCS 5 ].
Department means the Illinois Department of Insurance.
Director means the Director of the Illinois Department of
				  Insurance.
Employee Welfare Benefit Plan means a plan, fund or program
				  of employee benefits as defined in
				  29
				  USC 1002 (Employee Retirement Income Security
				  Act).
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.
Issuer includes insurance companies, fraternal benefit
				  societies, health care service plans, and any other entity delivering or
				  issuing for delivery in this State Medicare supplement policies or
				  certificates.
Medicare means the Health Insurance for the Aged and Disabled
				  Act, Title XVIII of the Social Security Amendments of 1965, as then constituted
				  or later amended ( 42 USC 1801-1898 ).
Medicare Advantage Plan means a plan of coverage for health
				  benefits under Medicare Part C as defined in section 1859(b)(1) of the Social
				  Security Act (
				  42 USC
				  1395w-28(b)(1) ), and
				  includes:
Coordinated care plans that provide health care services,
				  including but not limited to health maintenance organization plans (with or
				  without a point-of-service option), plans offered by provider-sponsored
				  organizations, and preferred provider organization plans;
Medicare medical savings account plans coupled with a
				  contribution into a Medicare Advantage medical savings account; and
Medicare Advantage private fee-for-service plans.
Medicare Supplement Policy means a group or individual policy
				  of (accident and sickness) insurance or a subscriber contract (of hospital and
				  medical service associations or health maintenance organizations) other than a
				  policy issued pursuant to a contract under section 1876 of the federal Social
				  Security Act (
				  42 USC
				  1395 et seq.) or an issued policy under a
				  demonstration project specified in
				  42
				  USC 1395ss(g)(1) that 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 (section 363(2)(c) of the Code). "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 that provides benefits pursuant to an
				  agreement under section 1833(a)(1)(A) of the Social Security Act (
				  42 USC
				  1395l(a)(1)(A) ).
Policy Form means the form on which the policy is delivered
				  or issued for delivery by the issuer.
"Pre-Standardized Medicare Supplement Benefit Plan",
				  "Pre-Standardized Benefit Plan" or "Pre-Standardized Plan" means a group or
				  individual policy of Medicare supplement insurance issued prior to February 11,
				  1992.
Secretary means the Secretary of the United States Department
				  of Health and Human Services.