Terms Used In Michigan Laws 500.3829

  • Applicant: means :
  (i) For an individual Medicare supplement policy, the person who seeks to contract for benefits. See Michigan Laws 500.3801
  • Certificate: means any certificate delivered or issued for delivery in this state under a group Medicare supplement policy. See Michigan Laws 500.3801
  • 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. See Michigan Laws 500.3801
  • Contract: A legal written agreement that becomes binding when signed.
  • Creditable coverage: means coverage of an individual provided under any of the following:
  •   (i) A group health plan. See Michigan Laws 500.3801
  • Insurer: includes any person that delivers or issues for delivery in this state Medicare supplement policies. See Michigan Laws 500.3801
  • Medicare: means subchapter XVIII of the social security act, 42 USC 1395 to 1395lll. See Michigan Laws 500.3801
  • Medicare supplement policy: means an individual or group policy or certificate 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 and Medicare select policies and certificates under section 3817. See Michigan Laws 500.3801
  • month: means a calendar month; the word "year" a calendar year; and the word "year" alone shall be equivalent to the words "year of our Lord". See Michigan Laws 8.3j
  • Secretary: means the secretary of the United States Department of Health and Human Services. See Michigan Laws 500.3801
  • state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories belonging to the United States; and the words "United States" shall be construed to include the district and territories. See Michigan Laws 8.3o
  • United States: shall be construed to include the district and territories. See Michigan Laws 8.3o
  •   (1) An insurer shall not deny or condition the issuance or effectiveness of a Medicare supplement policy available for sale in this state, or discriminate in the pricing of such a policy, because of the health status, claims experience, receipt of health care, or medical condition of an applicant if an application for the policy is submitted during the 6-month period beginning with the first month in which an individual who is 65 years of age or older enrolled for benefits under Medicare part B. Each Medicare supplement policy currently available from an insurer must be made available to all applicants who qualify under this section without regard to age.
      (2) If an applicant qualifies under subsection (1), submits an application during the time period provided in subsection (1), and as of the date of application has had a continuous period of creditable coverage of not less than 6 months, the insurer shall not exclude benefits based on a preexisting condition. If the applicant qualifies under subsection (1), submits an application during the time period in subsection (1), and as of the date of application has had a continuous period of creditable coverage that is less than 6 months, the insurer shall reduce the period of any preexisting condition exclusion by the aggregate of the period of creditable coverage applicable to the applicant as of the enrollment date. The secretary shall specify the manner of the reduction under this subsection.
      (3) Except as provided in subsection (2) and section 3833, subsection (1) does not prevent the exclusion of benefits under a policy, during the first 6 months, based on a preexisting condition for which the policyholder or certificate holder received treatment or was otherwise diagnosed during the 6 months before the coverage became effective.
      (4) As used in this section, “creditable coverage” does not include any of the following:
      (a) One or more of the following:
      (i) Coverage only for accident or disability income insurance, or any combination of accident or disability income insurance.
      (ii) Coverage issued as a supplement to liability insurance.
      (iii) Liability insurance, including general liability insurance and automobile liability insurance.
      (iv) Workers’ compensation or similar insurance.
      (v) Automobile medical payment insurance.
      (vi) Credit-only insurance.
      (vii) Coverage for on-site medical clinics.
      (viii) Other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.
      (b) 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:
      (i) Limited scope dental or vision benefits.
      (ii) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination of long-term care, nursing home care, home health care, or community-based care.
      (iii) Such other similar, limited benefits as are specified in federal regulations.
      (c) The following benefits if offered as independent, noncoordinated benefits:
      (i) Coverage only for a specified disease or illness.
      (ii) Hospital indemnity or other fixed indemnity insurance.
      (d) The following if it is offered as a separate policy, certificate, or contract of insurance:
      (i) Medicare supplemental policy as defined in 42 USC 1395ss.
      (ii) Coverage supplemental to the coverage provided under chapter 55 of title 10 of the United States Code, 10 USC 1071 to 1110b.
      (iii) Similar supplemental coverage provided to coverage under a group health plan.