N.Y. Comp. Codes R. & Regs. tit. 11 § 52.11

Current through Register Vol. 46, No. 19, May 8, 2024

Section 52.11 - Medicare supplement insurance

(a) Medicare supplement insurance is an individual or group policy or certificate of accident and health insurance that is advertised, marketed or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical or surgical expenses of persons eligible for Medicare. This definition is applicable regardless of whether the policy form is labeled as Medicare supplement insurance. A Medicare supplement insurance policy and certificate thereunder is governed by the rules set forth in Part 58 of this Title. The disclosure requirements for Medicare supplement insurance are set forth in sections 58.3 and 58.5 of this Title.

(b) Medicare supplement insurance shall not include:

(1) a policy or certificate which provides continued coverage for persons beyond age 65;

(2) a policy or certificate issued pursuant to a contract under section 1876 of the Federal Social Security Act ( 42 U.S.C. section 1395 et seq.);

(3) a policy or certificate issued under a demonstration project specified in 42 U.S.C. section 1395 ss(g)(1);

(4) a policy or contract offered through one or more employers or labor organizations, or through the trustees of a fund established by one or more employers or labor organizations, or combination thereof, for employees or former employees, or a combination thereof, or for members or former members, or a combination thereof, of the labor organizations; or

(5) a Medicare Advantage plan under part C of Medicare ( 42 U.S.C. section 1395w-21 et seq.).

N.Y. Comp. Codes R. & Regs. Tit. 11 § 52.11