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OAC 365:10


has had filed against it, a petition for declaration of bankruptcy and has ceased doing business in the state.

"Certificate" means any certificate delivered or issued for delivery in this state under a group Medicare supplement policy.

"Certificate Form" means the form on which the certificate is delivered or issued for delivery by the issuer.

"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 sixty-three (63) days.

"Creditable coverage" means, with respect to an individual, coverage of the individual provided under any of the following:

  • (A)

    A group health plan;

  • (B)

    Health insurance coverage;

  • (C)

    Part A or Part B of title XVIII of the Social Security Act (Medicare);

  • (D)

    Title XIX of the Social Security Act (Medicaid), other than coverage consisting

solely of benefits under Section 1928;

  • (E)

    Chapter 55 of Title 10 United States Code (CHAMPUS);

  • (F)

    A medical care program of the Indian Health Service or of a tribal organization;

  • (G)

    A state health benefits risk pool;

  • (H)

    A state health benefits program;

  • (I)

    A health plan offered under Chapter 89 of Title 5 United States Code (Federal

Employees Health Benefits Program);

  • (J)

    A public health plan as defined in federal regulation; and

  • (K)

    A health benefit plan under section 5(e) of the Peace Corps Act (22 United States

Code 2504(e)). "Creditable coverage" shall not include one or more, or any combination of the following:


Coverage only for accident or disability income insurance, or any combination


  • (B)

    Coverage issued as a supplement to liability insurance;

  • (C)

    Liability insurance, including general liability insurance and automobile liability


  • (D)

    Workers’ compensation or similar insurance;

  • (E)

    Automobile medical payment insurance;

  • (F)

    Credit-only insurance;

  • (G)

    Coverage for on-site medical clinics; and

  • (H)

    Other similar insurance coverage, specified in federal regulations, under which

benefits for medical care are secondary or incidental to other insurance benefits; "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; and


Such other similar, limited benefits as are specified in federal regulations.

"Creditable coverage" shall not include the following benefits if offered as independent,

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