Sec. 1355.253. EXCEPTIONS. (a) This subchapter does not apply to: (1) a plan that provides coverage: (A) for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury; (B) as a supplement to a liability insurance policy; (C) for credit insurance; (D) only for dental or vision care; (E) only for hospital expenses; (F) only for indemnity for hospital confinement; or (G) only for accidents; (2) a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss(g)(1)); (3) a workers' compensation insurance policy; (4) medical payment insurance coverage provided under a motor vehicle insurance policy; or (5) a long-term care policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a health benefit plan as described by Section 1355.252 . (b) To the extent that this section would otherwise require this state to make a payment under 42 U.S.C. Section 18031(d)(3)(B)(ii), a qualified health plan, as defined by 45 C.F.R. Section 155.20, is not required to provide a benefit under this subchapter that exceeds the specified essential health benefits required under 42 U.S.C. Section 18022(b).
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