44-3602. Terms, defined.

340 words·~2 min read·/ne/chapter-44/44-3602

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

For purposes of the Medicare Supplement Insurance Minimum Standards Act:

(1)Applicant means:

(a)In the case of an individual medicare supplement policy, the person who seeks to contract for insurance benefits; and

(b)In the case of a group medicare supplement policy, the proposed certificate holder;

(2)Balance bill means charging or collecting an amount in excess of the medicare-approved amount from a medicare beneficiary;

(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)Director means the Director of Insurance;

(6)Issuer means insurance companies, fraternal benefit societies, health care service plans, health maintenance organizations, and any other entities delivering or issuing for delivery in this state medicare supplement policies or certificates;

(7)Medicare means the Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended;

(8)Medicare-approved amount means the current payment rate listed in the applicable fee schedule established by the federal Centers for Medicare and Medicaid Services;

(9)Medicare supplement policy means a group or individual policy of sickness and accident insurance or a subscriber contract of health maintenance organizations, other than a policy issued pursuant to a contract under section 1876 of the federal Social Security Act, 42 U.S.C. 1395 et seq., or an issued policy under a demonstration project specified in 42 U.S.C. 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;

(10)Policy form means the form on which the policy is delivered or issued for delivery by the issuer; and

(11)Supplier has the same meaning as defined in 42 C.F.R. 400.202, as such regulation existed on January 1, 2024, including an entity or individual that sells or rents Medicare Part B covered durable medical equipment, prosthetics, orthotics, and supplies to medicare beneficiaries.