(H) at-home recovery visits not otherwise excluded; and(I) at-home recovery visits received during the period the insured is receiving Medicare-approved home care services or no more than eight weeks after the service date of the last Medicare-approved home health care visit.
(b) "At-home recovery benefit" does not include:
(i) home care visits paid for by Medicare or other government programs; or
(ii) care provided by family members, unpaid volunteers, or providers who are not care providers.
(5) "At-home recovery visit" means the period of a visit required to provide at-home recovery care, without limit on the duration of the visit, except each consecutive four hours in a 24-hour period of services provided by a care provider is one visit.
(6) "Bankruptcy" means when a Medicare Advantage organization that is not an issuer files, or has had filed against it, a petition for declaration of bankruptcy and has stopped doing business in this state.
(7) "Basic core benefits" means:
(a) coverage of Medicare Part A eligible expenses for hospitalization, to the extent not covered by Medicare, from the 61st day through the 90th day in any Medicare benefit period;
(b) coverage of Medicare Part A eligible expenses incurred for hospitalization, to the extent not covered by Medicare, for each Medicare lifetime inpatient reserve day used;
(c) upon exhaustion of the Medicare Part A hospital inpatient coverage, including the lifetime reserve days, coverage of 100% of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system rate or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days, which the provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance;
(d) coverage under Medicare Part A and B for the reasonable cost of the first three pints of blood, or equivalent quantities of packed red blood cells, as defined under federal regulations, unless replaced in accordance with federal regulations; and
(e) coverage for the coinsurance amount, or in the case of hospital outpatient department services paid under a prospective payment system, the copayment amount, of Medicare eligible expenses under Medicaid Part B regardless of hospital confinement, subject to the Medicare Part B deductible.
(8)(a) "Basic outpatient prescription drug benefit" means coverage for 50% of outpatient prescription drug charges, after a $250 calendar year deductible, to a maximum of $1,250 in benefits received by the insured per calendar year, to the extent not covered by Medicare.
(b) The outpatient prescription drug benefit may be included for sale or issuance in a policy until January 1, 2006.
(9) "Certificate" means a group Medicare supplement insurance certificate.
(10) "Cold lead advertising" means using, directly or indirectly, any method of marketing that fails to disclose in a conspicuous manner that the method of marketing is a solicitation of insurance and that contact will be made by a producer or an issuer.
(11) "Continuous period of creditable coverage" means the period during which an individual was covered by creditable coverage, if during the period of coverage the individual had no breaks in coverage greater than 63 days.
(12) "Employee welfare benefit plan" means a plan, fund, or program of employee benefits as defined in 29 U.S.C. Section 1002, Employee Retirement Income Security Act.
(13)(a) "Extended outpatient prescription drug benefit" means coverage for 50% of outpatient prescription drug charges, after a $250 calendar year deductible to a maximum of $3,000 in benefits received by the insured per calendar year, to the extent not covered by Medicare.
(b) The outpatient prescription drug benefit may be included for sale or issuance in a policy until January 1, 2006.
(14) "High pressure tactics" means using a method of marketing to induce, or tend to induce, the purchase of insurance through force, fright, threat, whether explicit or implied, or undue pressure to purchase or recommend the purchase of insurance.
(15)(a) "Home" means any place used by the insured as a place of residence, provided that the place would qualify as a residence for home health care services covered by Medicare.
(b) "Home" does not mean a hospital or skilled nursing facility.
(16) "Insolvency" means when an issuer licensed to transact the business of insurance in this state has a final order of liquidation entered against it with a finding of insolvency by a court of competent jurisdiction in the issuer's state of domicile.
(17)(a) "Medically necessary emergency care in a foreign country" means:
(i) coverage that, to the extent not covered by Medicare for 80% of the billed charges for Medicare-eligible expenses for medically necessary emergency hospital, physician, and medical care received in a foreign country:
(A) would have been covered by Medicare if provided in the United States; and
(B) began during the first 60 consecutive days of a trip outside the United States; and
(ii) coverage that is subject to a calendar year deductible of $250 and a lifetime maximum benefit of $50,000.
(b) For the purposes of "medically necessary emergency are in a foreign country," "emergency care" means care needed immediately because of an injury or an illness of sudden and unexpected onset.
(18) "Medicare Advantage plan" means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. 1395w-28(b)(1), and includes:
(a) coordinated care plans that provide health care services, including health maintenance organization plans, with or without a point-of-service option, plans offered by provider-sponsored organizations, and preferred provider organization plans;
