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Results from search: http://www.medicare.gov/

Medicare.gov - The Official U.S. Government Site for People with Medicare d   Screen Reader Version   |   Español   |     | Home   |  Glossary   |  Help   | Frequently Asked Questions   |  The Official U.S. Government Site for People with Medicare    Search Help   |   Site Map   |   Index   |   Site Tips   | Medicare Eligibility, Enrollment, and Premiums Nursing Homes Medicare Plan Choices Medicare Claims, Appeals Information, and Medicare Summary Notices Information to Help You Stay Healthy Frequently Asked Questions Have a question? Your answer could be here. Search Tools Medicare Personal Plan Finder Nursing Home Compare Prescription Drug Assistance Programs Dialysis Facility Compare Participating Physician Directory Supplier Directory Helpful Contacts Publications Your Medicare Coverage (coming soon) Local Medicare Events Medicare Health Plan Compare Medigap Compare News and Updates Frequently Asked Questions More News and Updates Search Tools Medicare Personal Plan Finder Helping you compare health plans in your area. Nursing Home Compare Compare nursing homes in your area. Prescription Drug Assistance Programs Programs that offer discounted or free medications. Dialysis Facility Compare Compare dialysis facilities in your area. Participating Physician Directory Locate Medicare participating physicians in your area. Supplier Directory Locate Medicare participating suppliers in your area. Helpful Contacts Find phone numbers and websites. Publications View, order, or download Medicare publications. Your Medicare Coverage (coming soon) Your health care coverage in the Original Medicare Plan. Local Medicare Events Includes events on Medicare related topics. Medicare Health Plan Compare Compare health plans in your area. Medigap Compare Locate supplemental insurance policies to cover expenses not paid by Medicare.   Home   |   Privacy Policy   |   Awards   |   Comments   |   Mailing List   |   Website Accessibility   | Centers for Medicare & Medicaid Services Department of Health and Human Services 77

Results from search: http://www.medicare.gov/Choices/Overview.asp

Medicare.gov - Medicare Plan Choices Overview d   Screen Reader Version   |   Español   |     | Home   |  Glossary   |  Help   | Frequently Asked Questions   |  The Official U.S. Government Site for People with Medicare    Search Help   |   Site Map   |   Index   |   Site Tips   | Medicare Eligibility, Enrollment, and Premiums Nursing Homes Medicare Plan Choices Medicare Claims, Appeals Information, and Medicare Summary Notices Information to Help You Stay Healthy Frequently Asked Questions Have a question? Your answer could be here. Search Tools Medicare Personal Plan Finder Nursing Home Compare Prescription Drug Assistance Programs Dialysis Facility Compare Participating Physician Directory Supplier Directory Helpful Contacts Publications Your Medicare Coverage (coming soon) Local Medicare Events Medicare Health Plan Compare Medigap Compare Medicare Plan Choices Overview Medicare Health Plan Choices in 2002: Describes your health plan choices for 2002. Search Tools Medicare Personal Plan Finder: Helps you compare the Original Medicare plan, Medicare + Choice plans and Medigap plans available in your area. Medicare Health Plan Compare: Helps you comparison shop for health plans by looking at costs, benefits, and quality. Also included is information on plan members leaving managed care plans. Health plans include: Original Medicare Plan, Medicare Managed Care Plans (HMOs), and Medicare Private Fee-for-Service Plans. Medigap Compare: Helps you locate supplemental insurance policies to cover expenses not paid by Medicare. It also gives you information on how to contact the insurance companies. Local Medicare Events: Allows you to search for upcoming beneficiary events in your area. These events cover a broad range of Medicare topics and many types of events may be sponsored in your area. Supplemental Insurance Guide to Health Insurance for People With Medicare: links you to an information guide to help beneficiaries with purchasing Medigap supplemental insurance, using Medigap supplemental insurance and other kinds of health insurance. Employer or Union Group Health Insurance: describes the special rules that apply to beneficiaries who have group health plan coverage through their own or their spouse's current employment. Other Information Medicare Plan Options and Supplemental Insurance Publications: links you to the site's Publications Page. You will be taken directly to the section containing "Medicare Plan Options and Supplemental Insurance" related publications. Easy Print Overview Medicare Health Plan Choices in 2002 Medicare Health Plan Compare Medicare Personal Plan Finder Medigap Compare Local Medicare Events Guide to Health Insurance for People with Medicare Employer or Union Group Health Insurance Medicare Plan Options and Supplemental Insurance Publications   Home   |   Privacy Policy   |   Awards   |   Comments   |   Mailing List   |   Website Accessibility   | Centers for Medicare & Medicaid Services Department of Health and Human Services 144

Results from search: http://moneycentral.msn.com/insure/healthlp.asp

Health Insurance Quotes: Insurance - MSN Money   MSN Home    |   My MSN    |   Hotmail    |   Search    |   Shopping    |   Money    |   People & Chat    |      Home       My Money       Investing       Banking       Planning       Taxes       |   Help         Planning Home       Retirement       Budgeting       Insurance       College        Insurance Quotes   Auto Insurance   Home Insurance   Life Insurance     Health Insurance   Planner   Insurance Planner   Resources   Step-by-Step Guide   Articles   More Tools     Related Links   Message Boards   Retirement Planner Get Quick Quote Type of Health Plan: Individual Health Medicare Supplemental Small Business Zip Code:   Find the right health insurance Need health coverage for yourself? Your family? You're less than 2 minutes away from receiving free health quotes from some of the nation's leading insurers. You'll need to enter some basic information about the people to be covered and select the type of health insurance you want. Individual & Family Health Insurance If you're one of the 40 million Americans without health insurance -- or the millions more who are looking for better coverage -- MSN Money can help. Individual health insurance is for people who either don't have insurance through their employer or need to supplement the insurance they do have. Individual and family coverage is generally available for anyone not covered by Medicare. Medicare Supplemental Health Insurance Medicare is the government-supported health-care program for people 65 and older or who are disabled. If you are eligible for Medicare, you may want to find out what types of supplementary and/or alternative coverage is available to you, and at what cost. Small Business Health Insurance Are you a small business owner looking to provide health insurance to your employees? MSN Money can help. Small business health plans are designed for companies with 2 - 50 employees and are a valuable recruiting and retention tool for employers. Costs are generally shared with the employee and may be more reasonable than you might expect. Get a free quote today!   Ask our expert Need personalized advice? Ask your insurance questions of our financial expert, Ginger Applegarth, in MSN Money's Your Money discussion group. Health Insurance Info Step-by-step guide Research your options and know what to expect when searching for health insurance with help from our step-by-step guide to Insure Your Health. Quick Reference MSN Money has answers to 40 of the most commonly asked questions about health insurance in our Quick Reference guide . Insurance Planner In less than 15 minutes, the Insurance Planner will evaluate your overall insurance needs. Just the facts Know your COBRA rights How small businesses can pick a group health plan Know your emergency room rights Health insurance for home-business owners How divorce affects your health insurance MSN Money Search MSN Money | Message Boards | Site Map | Contact Us     ©2002 Microsoft Corporation. All rights reserved. Terms of Use    Advertise    TRUSTe Approved Privacy Statement

Results from search: http://www.state.sd.us/social/ASA/SHIINE/

SHIINE   | DSS Home | Local DSS Offices | Site Index | Contact Us | Search |        Optional Survey      Department of    Social Services    SHIINE Program    700 Governors Drive    Pierre, SD 57501    1-800-822-8804       Email SHIINE (Insurance Counseling) Senior Health Information and Insurance Education (SHIINE) has trained volunteer counselors across South Dakota to assist senior citizens who have problems or questions with Medicare or private Medicare supplemental insurance. This federally-funded program is free to the citizens of South Dakota. SHIINE's goals are to: Educate older Americans about their health insurance coverage and benefits, consumer rights, insurance industry performance, and consumer safeguards. Provide hands-on advice and service to the consumer in understanding their health insurance coverage and eligibility for programs. Protect consumers from fraud, misdirected collection agencies, and unlawful or overzealous providers. Empower consumers to make informed decisions concerning health insurance options, exercising appeal and grievance rights, and recommending system reforms. Services SHIINE provides the following c ounseling services on a one-on-one basis, and the information is kept strictly confidential. For more information about SHIINE or to obtain SHIINE services call 1-800-822-8804. Medicare+Choice Program: Providing answers and information to frequently asked consumer questions about health plans offered in the Medicare+Choice program such as Health Maintenance Organizations (HMO's); Preferred Provider Organizations (PPO's); Provider Sponsored Organizations (PSO's); Private Fee-For-Service (PFFS); and a Medicare Savings Account (MSA) demonstration project. Information on Medicare+Choice terminology such as coordinated election periods, enrollment, disenrollment, benefits, access, consumer protections and premiums. Information on the relationship between Medicare+Choice plans and original Medicare. Medicare Counseling, Part A: Helping someone to understand what Medicare Part A does and does not pay for, eligibility questions, or understanding intermediary action. Medicare Counseling Part B: Helping someone to understand what Medicare Part B does and does not pay for, eligibility questions, or understanding carrier action. Medicare Billing and Claims: Problems of easy correction related to Medicare Summary Notices; Helping a person sort their bills to determine what medical providers have or have not been paid, and to determine the liability of the Medicare beneficiary; Teaching a Medicare beneficiary to organize and understand Medicare billings and claims. Medicare Supplemental Insurance Claims: Claims submittal to an issuer of Medicare supplemental insurance of a Medicare beneficiary, advocacy to get a Medicare supplemental insurance carrier to meet policy obligations such as payment of provider bills, eligibility issues, coding errors, etc. Medicare Appeals: Review, reconsideration, or formal appeal regarding Medicare's Summary Notices--including referral and involvement of an attorney when required for appeals. Medicare Supplemental Insurance Counseling: Medicare supplemental insurance policy analysis and comparison, eligibility for insurance, Medicare supplemental insurance rate comparison, explanation of Medicare supplemental insurance standardized plans. Medicaid, QMB or SLMB referral: Outreach to Medicare beneficiaries for recommendation to apply to the Department of Social Services for determination of eligibility for the Medicaid, Qualified Medicare Beneficiary or Special Low Income Medicare Beneficiary program. SHARECARE referral: Outreach to Medicare beneficiaries for recommendation to apply to the South Dakota State Medical Association for a SHARECARE card. The SHARECARE program allows for mandatory assignment of South Dakota physician claims for Medicare beneficiaries with incomes between 100% and 150% of the federal poverty level. Long Term Care Insurance Counseling: Long Term Care Insurance policy analysis and comparison, eligibility, explanation of policy benefits, etc. Additional Information   How do I get help understanding my i nsurance coverage and benefits?   What clients had to say about the SHIINE program   SD Consumer's Guide to Long-Term Care Insurance     2001 SD Consumer's Guide to Insurance to Supplement Medicare   Medicare Fact Sheets   Order SHIINE publications   Optional SHIINE Survey   How do I become a SHIINE volunteer?   SHIINE Links and Resources   SHIINE Administrative Forms (staff only)   S tate Health Insurance Assistance Programs | DSS Home | SD Home |  

Results from search: http://www.aarphealthcare.com/

AARP Health Care Options - Medigap and Supplemental Health Insurance   Welcome to AARP Health Care Options AARP Health Care Options is the trusted source for health insurance plans, services, and information for men and women age 50+. The Program is a collection of health resources, including insurance plans and services that can make it more convenient and less costly to help members stay well. And each has been researched and endorsed by AARP to ensure their members a best-in-class combination of prices, benefits, and services. AARP Health Care Options is the name of AARP's insurance and service program. It is not the insurer. AARP contracts with United HealthCare Insurance Company, United HealthCare Insurance Company of New York and MetLife to make coverage available to AARP members. We invite you to learn more about the family of health products and services . The health insurance offers first-class coverage at competitive rates. Visit the online newsletter for more health information and news. Want to know more about the AARP Health Care Options program , or have questions ? Not a member of AARP? Would you like to join AARP ? Privacy Policy SA4542 B  

Results from search: http://www.myflorida.com/doea/healthfamily/learn/elderissues/doeamplusc.html

MyFlorida.com Skip left hand navigation and go to main body of page.    directory | contact us | 411 | newsletters | first time user MEDICARE AND HEALTH INSURANCE FOR ELDERS   You will need Acrobat Reader to view the PDF files. You can convert a PDF file to HTML through Adobe.   Medicare And Health Insurance For Elder Floridians   Knowledge is the key to making the right health insurance decisions for you and your family, but the subject can be confusing, especially if information is limited or conflicting. The Department of Elder Affairs maintains this web page as part of our mission to empower elders and their caregivers to make informed decisions by providing information about Medicare and health insurance that is easy to understand, useful and up-to-date.   If you need individual assistance, the Department offers our SHINE program. SHINE , which stands for S erving H ealth I nsurance N eeds of E lders, is a statewide network of trained volunteer counselors that can provide you with free insurance counseling and information about your Medicare and health insurance coverage. To contact a SHINE volunteer, call the Florida Elder Helpline, toll-free, at 1-800-96-ELDER (1-800-963-5337) or click here to obtain a listing of Elder Helplines in each of Florida's 67 counties. Learn What's New View the latest news and information about Medicare and Health Insurance for Elders in Florida. Stay Informed Join our mailing list to receive regular updates about Medicare and health insurance via e-mail. Tell Us What You Think After you have finished looking at this page, please take two minutes to complete our brief customer satisfaction survey. Medicare Medicare Plan Choices in Florida (PDF, 13KB)  Explains the various types of Medicare health plan options currently available  in Florida including original Medicare and managed care plans. Medicare Contract HMOs in Florida (PDF, 9KB) Lists the names and phone numbers of Medicare contract HMOS available by county. Medicare HMO Non-Renewal Resource Guide (PDF, 383KB) Information about choices and rights for beneficiaries affected by the recent HMO non-renewals and service area reductions. Medigap (Medicare Supplemental) Policies in Florida (PDF, 489KB) A consumer guide to Medigap (Medicare supplemental) policies in Florida. Medicare Options for Disabled Beneficiaries Under 65 (PDF, 241KB)  Things to consider when seeking a Medicare supplemental policy if you are disabled and under age 65, and a list of companies currently selling policies. Preventive Services Covered by Medicare (PDF, 9KB) Types of preventive health service covered by Medicare including information on who is covered, how often, and how much you pay. Medicare Fraud and Abuse   Important information you should know about Medicare fraud and abuse including detection and prevention tips. Frequently Asked Questions   Answers to the Top 20 questions received by the national Medicare toll-free Helpline (1-800-MEDICARE or 1-800-633-4227.) Medicaid Medicaid/SSI Related Programs in Florida (PDF, 170KB) A fact sheet that summarizes Medicaid programs for aged and disabled people, including the institutional care program. Explains eligibility criteria, and gives contact names and phone numbers. Medicaid Fraud and Abuse Important information you should know about Medicaid fraud including how to report fraud and abuse. Prescription Drug Assistance Prescription Affordability Act for Seniors (PDF, 165KB) A fact sheet that explains the Medicare Prescription Discount Program and Pharmaceutical Expense Assistance Program passed by the 2000 legislature. PhRMA Directory of Prescription Drug Patient Assistance Programs A directory of prescription drug assistance programs offered by the pharmaceutical industry. Long Term Care  Options for Lifelong Care Consumer Guide (PDF, 1337KB) A consumer guide that explains long-term care insurance policies in Florida and community care retirement centers. Where to Go for Additional Help Learn about SHINE Find out more about Florida's volunteer network of SHINE ( S erving H ealth I nsurance N eeds of E lders) counselors who help elders and their caregivers understand their rights and options concerning Medicare and other health insurance issues. How to contact a SHINE counselor A listing of Elder Helplines by county where you can be put in touch with a SHINE counselor in your community. Ask a SHINE Information Specialist   Submit a question about Medicare or other health insurance issues affecting elders to a SHINE information specialist. Other Helpful Web Sites Medicare.gov The official Medicare web site where you can learn the basics of Medicare and search for information on Medicare HMO plans, nursing homes, dialysis facilities, Medicare participating physicians and much more. Centers for Medicare and Medicaid Services The official web site of the federal agency that oversees Medicare and Medicaid.  The Administration on Aging The official web site of the agency of the U.S. Department of Health and Human Services that serves as a federal focal point and advocate for elder Americans and their concerns.   * This web page is provided as part of the Department of Elder Affairs Self-Care Campaign. ** Developed through a grant from the Administration on Aging .   Copyright© 2000-2001 State Of Florida Privacy Statement

Results from search: http://www.nwinc.com/

Health Insurance Quotes Nationwide! Affordable Health Insurance for the Self Employed, Small Businesses, Individuals and Families. COMPARE OUR RATES! Temporary Health Insurance for 6 Months or Less Here! Instant On Line Health Insurance Quotes for Individuals, Families, Self Employed, and Small Businesses Are your health insurance expenses costly and unpredictable? We can help! Find out below how easy it can be to get insured. NO questions or forms to complete to receive quotes , your zip code and date of birth is all that is needed for an instant health insurance quote for your area from the nation's leading health insurance companies. NO AGENTS WILL CALL! Get an instant quote and view complete health insurance plan information for your area HERE! International Health and Travel Insurance Coverage Worldwide Worldwide Health and Travel Insurance Plans for anyone traveling outside your home country. Coverage for 15 days to 12 months. Coverage for 12 months and longer. Trip Protection and Trip Cancellation Plans. International Life Insurance Coverage. Insured by of London Get an instant international health insurance quote HERE! Small Business Group Health Plans Healthy employees are critical to the success of your business, so making sure they have the right health plan is important. We provide you with the ability to: View health plan and ancillary product quotes. Compare the benefits of each plan. Ongoing customer care to meet your changing health insurance needs. Getting the right small group coverage may be easier and cheaper than you expect - check it out! Get an instant quote HERE! Medicare Supplemental Plans Are you tired of holes in your Medicare coverage? A "medigap" policy can help! Choose from a Wide Selection of Health Plans. View Health Plan Provider Directories to See if Your Doctor is in the Network. Research a range of publications created by the Health Care Financing Administration (HCFA) that administers Medicare. Get an instant quote HERE! for Medicare Supplemental insurance and have peace of mind knowing that you are well protected. HealthQuote-USA ® Norman Wyatt Agency Tulsa, Oklahoma 800-909-7476 | Contact Us | About Us |

Results from search: http://www.aarp.org/hcchoices/medicare/supplement/home.html

AARP Webplace | Educated Health Care Choices search  jump to  - select one & press go - ........................ Member Services About AARP Computers & Technology Health & Wellness Learning Legislation & Elections Life Answers Money & Work Research Travel & Leisure Volunteering This information is designed for people who have Original Medicare and want to learn more and make educated decisions about how to cover their health care costs. Medigap (Medicare Supplemental) insurance covers some of the costs not paid by Original Medicare, like the coinsurance payments for doctors' and hospital services. Contents Medicare and Medigap Medigap Basics Medigap Extra Benefits Medigap Coverage By Benefit Medigap Coverage By Plan How to Choose a Medigap Insurance Company Enrollment Waiting Periods and Switching Things You Need to Know If... Your Rights Resources Glossary | Educated Health Care Choices | AARP home   |   advanced search   |   join/renew AARP   |   contact AARP   |   online community   |   what's new Copyright 1995-2002, AARP. All rights reserved. AARP Privacy Policy .

Results from search: http://www.lpitr.state.sc.us/bills/4724.htm

2001-2002 Bill 4724: Health insurance pools, Medicare supplemental health insurance, and major medical expenses; provisions regarding - www.scstatehouse.net - LPITS Scroll to History Page Scroll to Previous Versions Links List Scroll to Full Text Download This Bill in Microsoft Word97 format Bill 4724 Indicates Matter Stricken Indicates New Matter Current Status Bill Number: 4724 Type of Legislation: General Bill GB Introducing Body: House Introduced Date: 20020214 Primary Sponsor: Cato All Sponsors: Cato Drafted Document Number: l:\council\bills\skb\18195zcw02.doc Residing Body: House Current Committee: Labor, Commerce and Industry Committee 26 HLCI Subject: Health insurance pools, Medicare supplemental health insurance, and major medical expenses; provisions regarding History Body Date Action Description Com Leg Involved ______ ________ ______________________________________ _______ ____________ House 20020214 Introduced, read first time, 26 HLCI referred to Committee Versions of This Bill (Text matches printed bills. Document has been reformatted to meet World Wide Web specifications.) A BILL TO AMEND SECTION 38-74-10 , CODE OF LAWS OF SOUTH CAROLINA, 1976, RELATING TO DEFINITIONS PERTAINING TO THE SOUTH CAROLINA HEALTH INSURANCE POOL, SO AS TO MODIFY THE DEFINITIONS OF "HEALTH INSURANCE" AND "INDIVIDUAL MARKET"; TO AMEND SECTION 38-74-30 , RELATING TO HEALTH INSURANCE POOL COVERAGE ELIGIBILITY, SO AS TO EXTEND MEDICARE SUPPLEMENT HEALTH INSURANCE COVERAGE TO THOSE INDIVIDUALS WHO ARE ELIGIBLE FOR MEDICARE DUE TO DISABILITY AND UNDER SIXTY-FIVE YEARS OF AGE; TO AMEND SECTION 38-74-60 , RELATING TO MAJOR MEDICAL EXPENSE COVERAGE, SO AS TO EXTEND COVERAGE TO THOSE INDIVIDUALS WHO ARE ELIGIBLE FOR MEDICARE DUE TO DISABILITY AND UNDER SIXTY-FIVE YEARS OF AGE AND TO PROVIDE FOR THE TYPES OF BENEFIT PLANS TO BE OFFERED TO THESE INDIVIDUALS AND THE METHOD FOR ESTABLISHING PREMIUM RATES FOR THE COVERAGE; AND TO AMEND SECTION 38-74-80 , RELATING TO TAX EXEMPTIONS AND CREDITS, SO AS TO PROVIDE THAT IF THE TOTAL ASSESSMENT FOR ALL MEMBERS OF THE POOL EXCEEDS TEN MILLION DOLLARS IN ANY ONE YEAR, THE CREDIT FOR ANY MEMBER SHALL BE LIMITED TO THE AMOUNT DETERMINED BY MULTIPLYING THE MEMBER'S ASSESSMENT BY A FRACTION, THE NUMERATOR OF WHICH EQUALS TEN MILLION DOLLARS AND THE DENOMINATOR OF WHICH EQUALS THE TOTAL ASSESSMENT IN THE YEAR FOR ALL MEMBERS OF THE POOL. Be it enacted by the General Assembly of the State of South Carolina: SECTION    1.    Section 38-74-10 of the 1976 Code is amended to read:     "Section    38-74-10 .        As used in this chapter:     (1)    'Pool' means the South Carolina Health Insurance Pool.     (2)    'Board' means the Board of Directors of the pool.     (3)    'Insured' means any individual resident of this State who is eligible to receive benefits from any insurer.     (4)    'Insurer' means any entity that provides health insurance in this State. For purposes of this section, insurer includes an insurance company, a health maintenance organization, and any other entity providing health insurance which is licensed to engage in the business of insurance in this State and which is subject to state insurance regulation.     (5)    'Health insurance' or 'health insurance coverage' means benefits consisting of medical care provided directly, through insurance or reimbursement, or otherwise and including items and services paid for as medical care under a hospital or medical service policy or certificate, hospital, or medical service plan contract, or health maintenance organization contract offered by an insurer, except:         (a)    coverage only for accident , or disability income insurance, or any combination thereof;         (b)    coverage issued as a supplement to liability insurance;         (c)    liability insurance, including general liability insurance and automobile liability insurance;         (d)    workers' compensation or similar insurance;         (e)    automobile medical payment insurance;         (f)    credit-only insurance;         (g)    coverage for on-site medical clinics;         (h)    other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits;         (i)        if offered separately:             (i)        limited scope dental or vision benefits;             (ii)    benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof;             (iii)    such other similar, limited benefits as are specified in regulations;         (j)        if offered as independent, noncoordinated benefits:             (i)        coverage only for a specified disease or illness; and             (ii)    hospital indemnity or other fixed indemnity insurance;         (k)    if offered as a separate insurance policy :             (i)         Medicare supplemental health insurance (as defined under Section 1882(g)(1) of the Social Security Act);             (ii)     , coverage supplement to the coverage provided under Chapter 55, Title 10 of the United States Code ; and             (iii)    similar supplemental coverage under a group health plan .     (6)    'Medicare' means Title XVIII of the Social Security Act, 42 USC 1395, et seq., as amended.     (7)    'Physician' means any practitioner of the healing arts, other than an insured person or a person related to an insured person, who is legally licensed to perform any service for which benefits are provided by the insurance policy issued by the pool.     (8)    'Hospital' means an institution operated pursuant to law under the supervision of a staff of duly licensed physicians which is primarily and continuously engaged in providing or operating, either on its premises or in facilities available to the public on a prearranged basis, medical, diagnostic, and major surgical facilities for the medical care and treatment of sick or injured persons on an inpatient basis for which a charge is made and provides twenty-four - hour nursing service under the supervision of registered nurses.     (9)    'Health maintenance organization' means an organization as defined in section 38-33-20 (7).     (10)    'Plan of operation' means the plan of operation of the pool, including articles, bylaws, and operating rules adopted by the board.     (11)    'Benefits plan' means the coverages to be offered by the pool to eligible persons.     (12)    'Department' means the South Carolina Insurance Department.     (13)    'Director' means the person who is appointed by the Governor upon the advice and consent of the Senate and who is responsible for the operation and management of the Department of Insurance, including all of its divisions. The director may appoint or designate the person or persons who shall serve at the pleasure of the director to carry out the objectives or duties of the department as provided by law. Furthermore, the director may bestow upon his designee or deputy director any duty or function required of him by law in managing or supervising the Insurance Department.     (14)    'Member' means each insurer participating in the pool.     (15)    'Net loss' means the excess of incurred claims plus expenses over the sum of earned premiums, accrued investment income, and other appropriate gains and losses.     (16)    'Affiliation period' means a period which, under the terms of the health insurance coverage offered by a health maintenance organization, must expire before the health insurance coverage becomes effective. The organization is not required to provide health care services or benefits during this period and no premium shall be charged to the participant or beneficiary for any coverage during the period. The period begins on the enrollment date and runs concurrently with any waiting period under the plan.     (17)    'Beneficiary' has the meaning given under Section 3(8) of the Employee Retirement Income Security Act of 1974.     (18)    'COBRA continuation provision' means:         (a)    Part 6 of subtitle B of Title I of the Employee Retirement Income Security Act of 1974, other than Section 609 of the act;         (b)    Section 4908B of the Internal Revenue Code of 1986, other than subsection (f)(1) of the section insofar as it relates to pediatric vaccines; or         (c)    Title XXII of the Public Health Service Act.     (19)    'Church plan' has the meaning given the term under Section 3(33) of the Employee Retirement Income Security Act of 1974.     (20)    'Creditable coverage' means, with respect to an individual, coverage of the individual under any of the following:         (a)    a group health plan;         (b)    health insurance;         (c)    Part A or B of Title XVIII of the Social Security Act;         (d)    Title XIX of the Social Security Act, other than coverage consisting solely of benefits under Section 1928;         (e)    Chapter 55, Title 10 of the United States Code;         (f)    a medical care program of the Indian Health Service or of a tribal organization;         (g)    a state health benefits risk pool, including the South Carolina Health Insurance Pool;         (h)    a health plan offered under Chapter 89, Title 5 of the United States Code;         (i)        a public health plan, as defined in regulations;         (j)        a health benefit plan under Section 5(e) of the Peace Corps Act (22 U.S.C. 2504(e)).     The term does not include coverage consisting solely of those benefits excepted from the definition of health insurance.     A period of creditable coverage shall not be counted if, after such period and before the enrollment date, there was a sixty-three - day period during all of which the individual was not covered under any creditable coverage. However, in determining whether there has been continuous coverage, no period shall be taken into account during which the individual is in a waiting period for any coverage under a group health plan or for group health insurance coverage or is in an affiliation period.     Periods of creditable coverage with respect to an individual shall be established through presentation of certifications as described in Section 38-71-850 (D) or in a manner specified in regulations.     (21)    'Employee' has the meaning given the term under Section 3(6) of the Employee Retirement Income Security Act of 1974.     (22)    'Enrollment date' means, with respect to an individual covered under a group health plan or health insurance coverage, the date of enrollment of the individual in the plan or coverage or, if earlier, the first day of the waiting period for the enrollment.     (23)    'Federally defined eligible individual' means an individual:         (a)    for whom, as of the date on which the individual seeks coverage under this chapter, the aggregate of the periods of creditable coverage is eighteen or more months;         (b)    whose most recent prior creditable coverage was under a group health plan, governmental plan, or church plan or health insurance coverage offered in connection with one of these plans;         (c)    who is not eligible for coverage under a group health plan, part A or part B of Title XVIII of the Social Security Act, or a state plan under Title XIX of the Social Security Act or any successor program and who does not have other health insurance coverage;         (d)    with respect to whom the most recent coverage within the period of aggregate creditable coverage was not terminated based on a factor relating to nonpayment of premiums or fraud;         (e)    who, if offered the option of continuation coverage under a COBRA continuation provision or under a similar state program, elected the coverage; and         (f)    who, if the individual elected the continuation coverage, has exhausted the continuation coverage under the provision or program.     (24)    'Governmental plan' has the meaning given the term under Section 3(32) of the Employee Retirement Income Security Act of 1974 and any governmental plan established or maintained for its employees by the government of the United States or by an agency or instrumentality of the government.     (25)    'Group health insurance coverage' means, in connection with a group health plan, health insurance offered by an insurer in connection with the plan.     (26)    'Group health plan' means an employee welfare benefit plan, as defined in Section 3(1) of the Employee Retirement Income Security Act of 1974, to the extent that the plan provides medical care, including items and services paid for as medical care, to employees or their dependents, as defined under the terms of the plan, directly or through insurance, reimbursement, or otherwise.     (27)    'Individual market' means the market for health insurance coverage offered to individuals other than in connection with a group health plan. The term includes coverage offered in connection with a group health plan that has fewer than two participants as current employees on the first day of the plan year unless the State elects participants as current employees on the first day of the plan year unless the State elects to regulate the coverage as coverage issued to small employers as defined in Section 38-71-1330 .     (28)    'Medical care' means amounts paid for:         (a)    the diagnosis, cure, mitigation, treatment, or prevention of disease, or amounts paid for the purpose of affecting any structure or function of the body;         (b)    amounts paid for transportation primarily for and essential to medical care referred to in subitem (a); and         (c)    amounts paid for insurance covering medical care referred to in subitems (a) and (b).     (29)    'Participant' has the meaning given the term under Section 3(7) of the Employee Retirement Income Security Act of 1974.     (30)    'Preexisting condition exclusion' means, with respect to coverage, a limitation or exclusion of benefits relating to a condition based on the fact that the condition was present before the date of enrollment for the coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before the date. Genetic information may not be treated as a preexisting condition in the absence of a diagnosis of the condition related to the information.     (31)    'Waiting period' means, with respect to a group health plan and an individual who is a potential participant or beneficiary in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan." SECTION    2.    Section 38-74-30 of the 1976 Code is amended to read:     "Section    38-74-30 .        (A)    A person who is a resident of this State for thirty days, except that for a federally defined eligible individual, there shall not be a thirty-day requirement, and his newborn child is eligible for pool coverage:         (1)    upon providing evidence of any of the following actions by an insurer on an application for health insurance comparable to that provided by the pool submitted on behalf of the person:             (a)    a refusal to issue the insurance for health reasons;             (b)    a refusal to issue the insurance except with a reduction or exclusion of coverage for a preexisting health condition for a period exceeding twelve months, unless it is determined that the person voluntarily terminated his or did not seek any health insurance coverage before being refused issuance except with a reduction or exclusion for a preexisting health condition, and then seeks to be eligible for pool coverage after the health condition develops. This determination must be made by the board;             (c)    a refusal to issue insurance coverage comparable to that provided by the pool except at a rate exceeding one hundred fifty percent of the pool rate; or         (2)    if the individual is a federally defined eligible individual, as defined in Section 38-74-10 , who is and continues to be a resident of this State . ; or         (3)     if the individual is covered under Medicare Parts A and B due to disability and is under age sixty-five.     (B)    A person whose health insurance coverage is terminated involuntarily for any reason other than nonpayment of premium may apply for coverage under the plan but shall submit proof of eligibility according to subsection (A) of this section. If proof is supplied and if coverage is applied for within sixty days after the involuntary termination and if premiums are paid for the entire coverage period, the effective date of the coverage is the date of termination of the previous coverage. Waiting period and preexisting condition exclusions are waived to the extent to which similar exclusions, if any, have been satisfied under the prior health insurance coverage. The waiver does not apply to a person whose policy has been terminated or rescinded involuntarily because of a material misrepresentation.     (C)    A person who is paying a premium for health insurance comparable to the pool plan in excess of one hundred fifty percent of the pool rate or who has received notice that the premium for a policy would be in excess of one hundred fifty percent of the pool rate may make application for coverage under the pool. The effective date of coverage is the date of the application, or the date that the premium is paid if later, and any waiting period or preexisting condition exclusion is waived to the extent to which similar exclusions, if any, were satisfied under the prior health insurance plan. Benefits payable under the pool plan are secondary to benefits payable by the previous plan. The board shall require an additional premium for coverage effected under the plan in this manner notwithstanding the premium limitation stated in Section 38-74-60 .     (D)    The waiting period and preexisting condition exclusions are waived for a federally defined eligible individual.     (E)    A person not eligible for pool coverage is one who meets any one of the following criteria:         (1)    a person who has coverage under health insurance comparable to that offered by the pool from an insurer or any other source except a person who would be eligible under subsection (C) of this section;         (2)    a person who is eligible for health insurance comparable to that offered by the pool from an insurer or any other source except a person who would be eligible for pool coverage under Section 38-74-30 (A)(1)(b), 38-74-30 (A)(1)(c), or 38-74-30 (A)(2) , or 38-74-30 (A)(3) ;         (3)    a person who at the time of pool application is eligible for health care benefits under state Medicaid or eligible for health care benefits under Medicare and age sixty-five or older ;         (4)    a person having terminated coverage in the pool unless twelve months have lapsed since termination unless termination was because of ineligibility, except that this item shall not apply with respect to an applicant who is a federally defined eligible individual;         (5)    a person on whose behalf the pool has paid out one million dollars in benefits;         (6)    inmates of public institutions and persons eligible for public programs, except that this item shall not apply with respect to an applicant who is a federally defined eligible individual;         (7)    a person who fails to maintain South Carolina residency.     (F)    A person who ceases to meet the eligibility requirements of this section may be terminated at the end of the policy period." SECTION    3.    Section 38-74-60 of the 1976 Code is amended to read:     "Section 38-74-60 .    (A) (1)     Except as provided in Section 38-74-60 (B), the pool shall offer major medical expense coverage to every eligible person. The coverage to be issued by the pool, its schedule of benefits, exclusions, and other limitations must be established by the board and approved by the director taking into consideration the advice and recommendations of the pool members.     (B) (2)     In establishing and reviewing the pool pool's major medical expense coverage, the board shall take into consideration the levels of health insurance provided in the State and medical and economic factors considered appropriate and promulgate benefit levels, deductibles, coinsurance factors, exclusions, and limitations determined to be generally reflective of and commensurate with health insurance provided through a representative number of large employers in the State. At least one policy form of coverage must be comparable to comprehensive health insurance coverage offered in the individual market in this State or to the standard health insurance plan as defined in Section 38-71-1330 .     (B)     The pool shall offer Medicare supplemental health insurance coverage to every person covered under Medicare Parts A and B due to disability and who is under age sixty-five. The benefit plans to be offered shall include Medicare supplement plan A and plan C.     (C)    The pool shall provide a choice of health insurance coverage to all eligible individuals.     (D)(1)    Premium rates charged for pool coverage may not be unreasonable in relation to the benefits provided, the risk experience, and the reasonable expenses of providing the coverage. Separate schedules of premium rates based on age, sex, and geographical location may apply for individual risks.         (2)    The board shall determine the standard risk rate for major medical expense coverage by taking into account the individual standard rate charged by the five largest insurers offering individual coverages in the State comparable to the pool coverage. If five insurers do not offer comparable coverage, the standard risk rate must be established using reasonable actuarial techniques and must reflect anticipated experience and expenses for coverage. Rates initially established for pool coverage are two hundred percent of rates established as applicable for individual standard risks. Rates subsequently established must provide fully for the expected costs of claims and expenses of operation taking into account investment income and any other cost factors, but may not exceed two hundred percent of rates established as applicable for individual standard risks subject to the limitations described in this section. If the total tax credit provided in Section 38-74-80 exceeds five million dollars in any one year for all members of the pool, the board shall establish a rate for all policies that may exceed, if necessary, the two hundred percent limitation as provided in this subsection so as to assure that the tax credit does not exceed five million dollars in the following year of operation. All rates and rate schedules must be submitted to the director or his designee for approval.         (3)     Premium rates charged for Medicare supplemental insurance coverage may not be unreasonable in relation to the benefits provided, the risk experience, and the reasonable expenses of providing the coverage. Rates established must provide fully for the expected costs of claims and expenses of operation taking into account investment income and any other cost factors.     (E)    Except as provided in Section 38-74-30 (B), (C), and (D), pool coverage excludes charges or expenses incurred during the first six months following the effective date of coverage as to any condition which during the six-month period immediately preceding the effective date of coverage:         (1)    had manifested itself in a manner so as to cause an ordinarily prudent person to seek diagnosis, care, or treatment; or         (2)    for which medical advice, care, or treatment was recommended or received as to the condition.     (F)(1)    A benefit otherwise payable under pool coverage for covered expenses must be reduced by all amounts paid or payable for the same expenses through any other health insurance or health coverage and by all hospital and medical expense benefits paid or payable under any workers' compensation coverage, automobile medical payment, or liability insurance whether provided on the basis of fault or nonfault, and by any hospital or medical benefits paid or payable under or provided pursuant to any state or federal law or program.         (2)    The insurer or the pool has a cause of action against an eligible person for the recovery of the amount of benefits paid which are not for covered expenses. Benefits due from the pool may be reduced or refused as a setoff against any amount recoverable under this paragraph." SECTION    4.    Section 38-74-80 of the 1976 Code is amended to read:     "Section    38-74-80 .        The pool established pursuant to this chapter is exempt from all taxes and assessments. Any member subject to tax liability imposed by any state statute may take credit for any assessment paid to the pool in the previous year against its premium or income tax payable. The tax credit is in addition to any other tax credits to which the member may be entitled pursuant to South Carolina law, but the credit may not reduce the member's tax liability below zero. Any unused credit may be carried forward three years. The credits are subject to the provisions of Section 38-7-120 (c). The members are responsible for any loss of the operation of the pool, including any loss in excess of assessments paid to the pool. This State is not responsible for any loss of the operation of the pool, and no state funds may be used to defray any loss. If the total assessment for all members of the pool exceeds ten million dollars in any one year, the credit for any member shall be limited to the amount determined by multiplying the member's assessment by a fraction, the numerator of which equals ten million dollars and the denominator of which equals the total assessment in the year for all members of the pool. " SECTION    5.    This act takes effect January 1, 2003. ----XX---- This web page was last updated on March 28, 2002 at 10:52 AM

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