[Code of Federal Regulations]
[Title 42, Volume 2]
[Revised as of October 1, 2002]
From the U.S. Government Printing Office via GPO Access
[CITE: 42CFR403.205]

[Page 37]
 
                         TITLE 42--PUBLIC HEALTH
 
                             HUMAN SERVICES
 
PART 403--SPECIAL PROGRAMS AND PROJECTS--Table of Contents
 
                Subpart B--Medicare Supplemental Policies
 
Sec. 403.205  Medicare supplemental policy.

    (a) Except as specified in paragraph (d) of this section, Medicare 
supplemental policy (policy) means a health insurance policy or other 
health benefit plan--
    (1) That a private entity offers to a Medicare beneficiary; and
    (2) That is primarily designed, or is advertised, marketed, or 
otherwise purported to provide payment for expenses incurred for 
services and items that are not reimbursed under the Medicare program 
because of deductibles, coinsurance, or other limitations under 
Medicare.
    (b) Unless otherwise specified in this subpart, the term policy 
includes both policy form and policy.
    (1) Policy form means the form of health insurance contract that is 
approved by and on file with the State agency for the regulation of 
insurance.
    (2) Policy means the contract--
    (i) Issued under the policy form; and
    (ii) Held by the policyholder.
    (c) Medicare supplemental policy includes the following--
    (1) An individual policy.
    (2) A group policy.
    (d) Medicare supplemental policy does not include a Medicare+Choice 
plan or any of the following health insurance policies or health benefit 
plans:
    (1) A policy or plan of one or more employers for employees, former 
employees, or any combination thereof.
    (2) A policy or plan of one or more labor organizations for members, 
former members, or any combination thereof.
    (3) A policy or plan of the trustees of a fund established by one or 
more labor organizations, one or more employers, or any combination, for 
any one or combination of the following--
    (i) Employees.
    (ii) Former employees.
    (iii) Members.
    (iv) Former members.
    (4) A policy or plan of a profession, trade, or occupational 
association, if the association--
    (i) Is composed of individuals all of whom are actively engaged in 
the same profession, trade, or occupation;
    (ii) Has been maintained in good faith for a purpose other than 
obtaining insurance; and
    (iii) Has been in existence for at least two years before the date 
of its initial offering of a Medicare supplemental health insurance 
policy to its members.
    (5) For purposes of the voluntary certification program, a policy 
issued to an employee or to a member of a labor organization as an 
addition to a franchise plan (a plan that enables members of the same 
entity to purchase an individual policy marketed to them under group 
underwriting procedures), if the plan is in existence on July 1, 1982.

[47 FR 32400, July 26, 1982, as amended at 63 FR 35066, June 26, 1998]