28 TAC §21.1101 — what it says, and how the exam tests it

28 TAC §21.1101. The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise. (1) Affiliation period--A period of time that under the terms of the coverage offered by an HMO, must expire before the coverage becomes effective. During an affiliation period an HMO is not required to provide health care services or benefits to the participant or beneficiary and a premium may not be charged to the participant or beneficiary. (2) COBRA--Title X of the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended (29 USC Section 1161, et seq.). (3) COBRA continuation coverage--Coverage that satisfies an applicable COBRA continuation provision. (4) Commissioner--The Commissioner of Insurance. (5) Creditable coverage-- (A) An individual's coverage is creditable if the coverage is provided under: (i) a self-funded or self-insured employee welfare benefit plan that provides health benefits and that is established in accordance with the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.); (ii) a group health benefit plan provided by a health insurance carrier or an HMO; (iii) an individual health insurance policy or evidence of coverage; (iv) Part A or Part B of Title XVIII of the Social Security Act (42 U.S.C. Section 1395c et seq.); (v) Title XIX of the Social Security Act (42 U.S.C. Section 1396 et seq.), other than coverage consisting solely of benefits under Section 1928 of that Act (42 U.S.C. Section 1396s); (vi) Chapter 55 of Title 10, United States Code (10 U.S.C. Section 1071 et seq.); (vii) a medical care program of the Indian Health Service or of a tribal organization; (viii) a state or political subdivision health benefits risk pool; (ix) a health plan offered under Chapter 89 of Title 5, United States Code (5 U.S.C. Section 8901 et seq.); (x) a public health plan as defined in this section; (xi) a health benefit plan under Section 5(e) of the Peace Corps Act (22 U.S.C. Section 2504(e)); and (xii) short-term limited duration insurance as defined in this section. (B) Creditable coverage does not include: (i) accident-only, disability income insurance, or a combination of accident-only and disability income insurance; (ii) coverage issued as a supplement to liability insurance; (iii) liability insurance, including general liability insurance and…