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Coverage Question Meaning
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(a) Part 146 of this chapter conducts the requirements of the title XXVII of the Law on Public Health (Act of PHS, 42 US 300g,
(b) Part 147 of this under -channel conducts the provisions of the Law on Patient Protection and Accessible Care related to group health plans and issues of health insurance companies in the group and individual markets.
(c) Part 148 of this under -staff conducts individual health insurance requirements of the PHS Law. The aim is to improve access to individual health insurance for certain people who had previously had group coverage, guarantee the recovery of the entire health insurance on the individual market and to offer some protection for mothers and infants in terms of hospital admission delivery and to offer certain protection for patients with breast reconstruction.
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(d) Part 149 of this under -steering provides the provisions of parts D and is titled XXVII of the PHS Law relating to group health plans, holidays of health insurance companies in group and individual markets, care providers and facilities and service providers.
(e) Part 150 of this under -staff conducts the provisions for the implementation of parts 2723 and 2761 of the Law on PHS regarding the following:
(1) It states that there are no provisions of Part 146 compared to group insurance, one or more provisions of Part 147 regarding group or individual health insurance, or the requirements of part 148 of this Chapter of Individual Health Insurance shall not be significantly implemented.
(f) Parts 2791 and 2792 of the PHS Law define the terms used in regulations in this under -channel and provide the basis for publishing these regulations.
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[64 FR 45795, 20 August 1999, edited to 74 fr 51688, October 7, 2009; 75 FR 27137, May 13, 2010; 78 FR 13435, February 27, 2013; 86 FR 36970, July 13, 2021]
(a) For the purposes of 45 parts of CFR 144 to 149, all health insurance is generally divided into two markets – the group market and the individual market. The group market is further divided into the market for large groups and the small group market.
(b) Protecting under 45 parts of CFR 144 to 149 of private individuals and employers (and other health insurance sponsors offered related to the group health plan) are determined by the question of whether the coverage is obtained in the small group market, the large group market or the individual market.
(c) Coverage given to associations, but is not related to employment, and the sale of individuals is not considered a group cover below 45 parts of CR 144 to 149. If coverage is offered to an association with a group of tea. Insurance coverage for purposes or 45 parts of CFR 144 to 149. The coverage is considered to cover the individual market, whether considered a group coverage under state law. If health insurance coverage is offered in connection with the group health plan, as defined at 45 CFR 144.103, this is considered group insurance for 45 parts CFR 144 to 149.
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(d) The provisions regarding the implementation of CMS in parts 146, 147, 148 and 149 are included in part 150 of this under -ghanant.
For the purposes of parts 146 (group market), 147 (group and individual market), 148 (individual market), 149 (surprising invoicing and transparency) and 150 (execution) of this under -Gurant, the following definitions apply unless otherwise provided:
So a period that must expire before health insurance is provided by the HMO, it comes into force and in which HMO is not obliged to offer benefits.
Funds, regarding the issuance of a health insurance policy in one country, the State Commissioner for Insurance or State -appointed officials to implement the requirements of 45 parts of the CR 146 and 148 for the state interested in relation to the publisher.
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It is meaningful based on Part 3 (8) of the Law on Pension Revenue Revenue of the 1974 (ERISA) employees, which states: “One person appointed by a participant, or under the terms of the employee’s benefit plan, which has the right to benefit” according to the plan.
In terms of covering the health insurance policies offered in the country, it means an association that meets the following conditions:
(3) It does not condition membership in the Factor Association related to a health condition relative to the person (including an employee of an employer or dependent on an employee).
(4) Makes health insurance offered through an association available to all members, regardless of any factor related to health in relation to members (or persons entitled to member coverage).
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(5) Does not make health insurance offered through the available association, except in relation to a member of the association.
Sources 601-608 of the Law on Employee Revenue Revenue Revenue, Part 4980B of the 1986 Internal Revenue Code (except for part (f) of such a part 4980B if it applies to pediatricians), or title XXII of PHS Law.
So covering under the determination of the first lines of cobra or a similar state program. Covering provided by a plan that is subject to the front of the front of the cobra or similar state program, but it does not meet all the requirements of that provision or program is considered to be extended if it enables the person to decide for a period of at least 18 months. The sequel coverage does not include a cover under a conversion policy that must be offered to the person in the event of an exhaustion of the sequel, nor does it cover the extension within the Federal Employees’ Health Benefit Program.
Means that the cobra for the first lines of the individual will stand for any reason, except for the failure of the individual to pay premiums on time, or for the reason (such as making fraud for claiming or deliberately misrepresenting equipment related to the plan). A person is considered to be exhausted covering the sequel to cobra if such coverage stops –
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(i) due to the failure of the employer or other responsible entity to complete the premiums on time;
(ii) when the individual no longer lives, lives or works in the HMO service area or a similar program (whether within the individual choice) and has no other cobra for the individual available to the individual; or
(iii) When a person notices a request that will contain or exceed a lifetime limit for all benefits and there is no other COBRA forcing accessory available to the individual.
Means that the extension of the individual will cease for any reason, except for the failure of the individual to pay premiums on time, or for the reason (such as making fraud for claiming or deliberately misrepresenting the material fact regarding the plan). A person is considered to be exhausted covering the sequel as-
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(i) covering the failure of the employer or other responsible entity to complete the premiums on time;
(ii) if the individual no longer lives, lives or works in a service area of HMO or a similar program (whether within the choice of individual) and has no other capacity to extend the individual; or
(iii) When a person notices a request that will contain or exceed a lifetime limit for all benefits and there is no other extension line available to the individual.
Means that every person who is entitled to coverage under conditions of a group health plan for a relationship with a participant.
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(1) The provisions of the group market in 45 CFR section 146, below -e, are defined in 45 CFR 146.150 (b); And
Gave the meaning the term under Part 3 (6)
