California Insurance Code § 10192.4

The following definitions apply for the purposes of this article: (a) “Applicant” means: (1) The person who seeks to contract for insurance benefits, in the case of an individual Medicare supplement policy. (2) The proposed certificate holder, in the case of a group Medicare supplement policy. (b) “Bankruptcy” means that situation in which 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. (c) “Certificate” means a certificate issued for delivery in this state under a group Medicare supplement policy. (d) “Certificate form” means the form on which the certificate is issued for delivery by the issuer. (e) “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. (f) (1) “Creditable coverage” means, with respect to an individual, coverage of the individual provided under any of the following: (A) Any individual or group contract, policy, certificate, or program that is written or administered by a health care service plan, health insurer, fraternal benefits society, self-insured employer plan, or any other entity, in this state or elsewhere, and that arranges or provides medical, hospital, and surgical coverage not designed to supplement other private or governmental plans. The term includes continuation or conversion coverage. (B) Part A or B of Title XVIII of the federal Social Security Act (42 U.S.C. Sec. 1395c et seq.) (Medicare). (C) Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) (Medicaid (known as Medi-Cal in California)), other than coverage consisting solely of benefits under Section 1928 of that act. (D) Chapter 55 of Title 10 of the United States Code (CHAMPUS). (E) A medical care program of the Indian Health Service or of a tribal organization. (F) A state health benefits risk pool. (G) A health plan offered under Chapter 89 of Title 5 of the United States Code (Federal Employees Health Benefits Program). (H) A public health plan as defined in federal regulations authorized by Section 2701(c)(1)(I) of the federal Public Health Service Act, as amended by Public Law 104-191, the federal Health Insurance Portability and Accountability Act of 1996. (I) A health benefit plan under Section 5(e) of the federal Peace Corps Act (Section 2504(e) of Title 22 of the United States Code). (J) Any other publicly sponsored program, provided in this state or elsewhere, of medical, hospital, and surgical care. (K) Any other creditable coverage as defined by subsection (c) of Section 2701 of Title XXVII of the federal Public Health Service Act (42 U.S.C. Sec. 300gg(c)). (2) “Creditable coverage” shall not include one or more, or any combination of, the following: (A) Coverage only for accident or disability income insurance, or any combination thereof. (B) Coverage issued as a supplement to liability insurance. (C) Liability insurance, including general liability insurance and automobile liability insurance. (D) Workers’ compensation or similar insurance. (E) Automobile medical payment insurance. (F) Credit-only insurance. (G) Coverage for onsite medical clinics. (H) Other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance benefits. (3) “Creditable coverage” shall not include 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: (A) Limited scope dental or vision benefits. (B) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof. (C) Other similar, limited benefits as are specified in federal regulations. (4) “Creditable cover

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