[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR403.205]



[Page 37-38]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             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 (e) of this section, Medicare 

supplemental (or Medigap) policy means a



[[Page 38]]



health insurance policy or other health benefit plan that--

    (1) A private entity offers to a Medicare beneficiary; and

    (2) 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) The term policy includes both policy form and policy as 

specified in paragraphs (b)(1) and (b)(2) of this section.

    (1) Policy form. Policy form is the form of health insurance 

contract that is approved by and on file with the State agency for the 

regulation of insurance.

    (2) Policy. Policy is the contract--

    (i) Issued under the policy form; and

    (ii) Held by the policy holder.

    (c) If the policy otherwise meets the definition in this section, a 

Medicare supplemental policy includes-

    (1) An individual policy;

    (2) A group policy;

    (3) A rider attached to an individual or group policy; or

    (4) As of January 1, 2006, a stand-alone limited health benefit plan 

or policy that supplements Medicare benefits and is sold primarily to 

Medicare beneficiaries.

    (d) Any rider attached to a Medicare supplemental policy becomes an 

integral part of the basic policy.

    (e) Medicare supplemental policy does not include a Medicare 

Advantage plan, a Prescription Drug Plan under Part D, or any of the 

other types of health insurance policies or health benefit plans that 

are excluded from the definition of a Medicare supplemental policy in 

section 1882(g)(1) of the Act.



[70 FR 4525, Jan. 28, 2005]