Excepted Benefits in Health Insurance Law and Legal Definition

According to 42 USCS § 300gg-91 (Title 42; The Public Health and Welfare; Chapter 6A; The Public Health Service Requirements Relating to Health Insurance Coverage Definitions; Miscellaneous Provisions), the term "excepted benefits" means “benefits under one or more (or any combination thereof) of the following:

(1) Benefits not subject to requirements.

(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.

(2) Benefits not subject to requirements if offered separately.

(A) Limited scope dental or vision benefits.

(B) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof.

(C) Such other similar, limited benefits as are specified in regulations.

(3) Benefits not subject to requirements if offered as independent, noncoordinated benefits.

(A) Coverage only for a specified disease or illness.

(B) Hospital indemnity or other fixed indemnity insurance.

(4) Benefits not subject to requirements if offered as separate insurance policy.

Medicare supplemental health insurance (as defined under section 1882(g)(1) of the Social Security Act [42 USCS § 1395ss(g)(1)]), coverage supplemental to the coverage provided under chapter 55 of title 10, United States Code [10 USCS §§ 1071 et seq.], and similar supplemental coverage provided to coverage under a group health plan.”