reglab/statecodes huggingface dataset:
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.324 - Standards for 2020 standardized benefit plan

Current through June 11, 2024
1. The
				standards set forth in this section are applicable to every 2020 standardized
				benefit plan to supplement Medicare.
2. Except as otherwise provided in subsection
				3, a 2020 standardized benefit plan to supplement Medicare must comply with the
				requirements applicable to a 2010 standardized benefit plan to supplement
				Medicare, as set forth in NAC
				687B.200 to
				687B.330, inclusive, including,
				without limitation, NAC
				687B.2057,
				687B.206,
				687B.2062,
				687B.250,
				687B.322 and
				687B.323.
3. For the purposes of a 2020 standardized
				benefit plan to supplement Medicare:
(a) In
				NAC 687B.2057,
				687B.206 and
				687B.2062:
(1) The references to Standardized Benefit
				Plan C, Plan C or C policy shall be deemed to be references to Standardized
				Benefit Plan D, Plan D or D policy, as applicable;
(2) The references to Standardized Benefit
				Plan F, Plan F or F policy shall be deemed to be references to Standardized
				Benefit Plan G, Plan G or G policy, as applicable; and
(3) The references to Standardized Benefit
				Plan F with a high deductible, Plan F with a high deductible or F with a high
				deductible policy shall be deemed to be references to Standardized Benefit Plan
				G with a high deductible, Plan G with a high deductible or G with a high
				deductible policy, as applicable.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.325 - Coverage for short-term services provided to person recovering at home

Current through June 11, 2024
1. For a 1990 standardized benefit plan,
				coverage for short-term services provided to a person recovering from an
				illness, injury or surgery in his or her home must comply with the following
				requirements:
(a) The insured's attending
				physician must certify that the specific type and frequency of recovery
				services provided at home are necessary because of a condition for which a plan
				of treatment provided at home was approved by Medicare.
(b) Coverage must be limited to:
(1) No more than the number and type of
				recovery visits certified as necessary by the insured's attending physician.
				The total number of recovery visits may not exceed the number of visits
				approved by Medicare pursuant to a plan of treatment provided at home that has
				been approved by Medicare.
(2) The
				actual charges for each recovery visit not to exceed a maximum reimbursement of
				$40 per visit.
(3) A maximum
				reimbursement of $1,600 per calendar year.
(4) Seven visits in any 1 week.
(5) Care furnished on a visiting basis in the
				insured's home.
(6) Services
				provided by a provider of health care.
(7) Recovery visits received:
(I) While the insured is covered under the
				policy to supplement Medicare or the certificate and not otherwise
				excluded.
(II) During the period
				the insured is receiving services at home which are approved by Medicare or no
				later than 8 weeks after the date of the last recovery visit approved by
				Medicare.
(c)
				Coverage must be excluded for:
(1) Recovery
				visits paid for by Medicare or another governmental program.
(2) Care provided by members of the insured's
				family, unpaid volunteers or other persons who are not providers of health
				care.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.330 - Provision of new or innovative benefits

Current through June 11, 2024
1. An issuer may,
				with the prior approval of the Commissioner, offer a policy to supplement
				Medicare or a certificate with new or innovative benefits in addition to the
				benefits required by NAC 687B.290 to 687B.321, inclusive. The new or innovative
				benefits may include benefits that are:
(a)
				Appropriate to supplement Medicare;
(b) Not otherwise available;
(c) Cost-effective; and
(d) Offered in a manner that is consistent
				with the goal of simplifying policies to supplement Medicare.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.340 - Definitions

Current through June 11, 2024
As used in NAC 687B.340 to 687B.376, inclusive, unless the
				  context otherwise requires, the words and terms defined in NAC 687B.342 to
				  687B.354, inclusive, have the meanings ascribed to them in those
				  sections.
Added to NAC by Comm'r
				  of Insurance, eff. 5-13-96
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.342 - "Complaint" defined

Current through June 11, 2024
"Complaint" means any dissatisfaction with a Medicare select
				  issuer or a network provider expressed by a holder of a Medicare select policy
				  or certificate.
Added to NAC by Comm'r
				  of Insurance, eff. 5-13-96
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.344 - "Grievance" defined

Current through June 11, 2024
"Grievance" means any dissatisfaction with the
				  administration, claims practices or provision of services of a Medicare select
				  issuer or a network provider that is expressed in writing by a holder of a
				  Medicare select policy or certificate.
Added to NAC by Comm'r
				  of Insurance, eff. 5-13-96
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.346 - "Medicare select issuer" defined

Current through June 11, 2024
"Medicare select issuer" means an issuer who is offering or
				  seeking to offer a Medicare select policy or certificate.
Added to NAC by Comm'r
				  of Insurance, eff. 5-13-96
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.348 - "Medicare select policy" and "Medicare select certificate" defined

Current through June 11, 2024
"Medicare select policy" or "Medicare select certificate"
				  means a policy or certificate to supplement Medicare that contains a provision
				  for a restricted network.
Added to NAC by Comm'r
				  of Insurance, eff. 5-13-96
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.350 - "Network provider" defined

Current through June 11, 2024
"Network provider" means a provider of health care or a group
				  of providers of health care that has entered into a written agreement with a
				  Medicare select issuer to provide benefits insured under a Medicare select
				  policy.
Added to NAC by Comm'r
				  of Insurance, eff. 5-13-96
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.352 - "Provision for a restricted network" defined

Current through June 11, 2024
"Provision for a restricted network" means a provision of a
				  policy or certificate to supplement Medicare that conditions the payment of
				  benefits, in whole or in part, on the use of network providers.
Added to NAC by Comm'r
				  of Insurance, eff. 5-13-96
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.354 - "Service area" defined

Current through June 11, 2024
"Service area" means the geographic area approved by the
				  Commissioner within which a Medicare select issuer is authorized to offer a
				  Medicare select policy.
Added to NAC by Comm'r
				  of Insurance, eff. 5-13-96
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.356 - Compliance with regulations required before advertising

Current through June 11, 2024
No policy or certificate may be advertised as a Medicare
				  select policy or certificate unless it meets the requirements of NAC 687B.200
				  to 687B.376.
Added to NAC by Comm'r
				  of Insurance, eff. 5-13-96
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.358 - Authorization to offer and approval to issue

Current through June 11, 2024
1. The
				Commissioner may authorize an issuer to offer a Medicare select policy or
				certificate, pursuant to NAC 687B.340 to 687B.376, inclusive, and section 4358
				of the Omnibus Budget Reconciliation Act of 1990,
				42 U.S.C. §
										1395 ss(t), if the Commissioner:
(a) Determines that the issuer has satisfied
				all of the requirements of NAC 687B.200 to 687B.376; and
(b) Approves the issuer's plan of
				operation.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.360 - Filing and contents of proposed plan of operation

Current through June 11, 2024
A Medicare select issuer shall file a proposed plan of
				  operation with the Commissioner which must include:
1. Evidence that all services covered under
				the policy that are subject to a provision for a restricted network are
				available and accessible through network providers, including evidence that:
(a) Such services are available from network
				providers with reasonable promptness with respect to geographic location, hours
				of operation during regular business hours and hours of operation after regular
				business hours. The reasonableness of hours of operation and availability must
				be based on the usual practice in the local area. The reasonableness of the
				geographic location must be based on average travel times within the
				community.
(b) The number of
				network providers in the service area is sufficient in relation to the number
				of current and expected policyholders and certificate holders to:
(1) Deliver adequately services that are
				subject to a provision for a restricted network; or
(2) Make appropriate referrals.
(c) The Medicare select issuer has
				executed written agreements with network providers that describe the specific
				responsibilities of those providers.
(d) Emergency care is available 24 hours a
				day and 7 days a week.
(e) For such
				services that are provided on a prepaid basis, the Medicare select issuer has
				executed written agreements with network providers that prohibit such providers
				from billing or otherwise seeking additional reimbursement or recourse against
				any policyholder or certificate holder, other than seeking collection of
				supplemental charges or coinsurance payments that are required under the
				Medicare select policy or certificate.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.362 - Proposed changes to plan of operation; update of list of network providers

Current through June 11, 2024
1. A Medicare
				select issuer shall file any proposed changes to the plan of operation, other
				than changes to the list of network providers, with the Commissioner before
				implementing the changes. If the Commissioner does not approve or disapprove
				the proposed changes within 30 days after their receipt, the changes shall be
				deemed approved.
2. A Medicare
				select issuer shall file an updated list of network providers with the
				Commissioner every 3 months.
Added to NAC by Comm'r
				  of Insurance, eff. 5-13-96
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.364 - Payment for covered services provided by persons other than network providers

Current through June 11, 2024
A Medicare select policy or certificate must not restrict
				  payment for services covered under the policy that are provided by persons
				  other than network providers if:
1.
				The services were for symptoms requiring emergency care or for symptoms of an
				unforeseen illness or condition requiring immediate attention; or
2. It was not reasonable to obtain the
				services through a network provider.
Added to NAC by Comm'r
				  of Insurance, eff. 5-13-96
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.366 - Full payment required for covered services not available through network provider

Current through June 11, 2024
A Medicare select policy or certificate must provide full
				  payment for services covered under the policy that are not available through a
				  network provider.
Added to NAC by Comm'r
				  of Insurance, eff. 5-13-96
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.368 - Written disclosure of provisions, restrictions and limitations

Current through June 11, 2024
1. A Medicare select issuer shall disclose in
				writing the provisions, restrictions and limitations of the Medicare select
				policy or certificate to each applicant. The disclosure must include:
(a) An outline of coverage sufficient to
				permit the applicant to compare the coverage and premiums of the Medicare
				select policy or certificate with:
(1) Other
				policies or certificates to supplement Medicare offered by the Medicare select
				issuer; and
(2) Other Medicare
				select policies.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.370 - Procedures for hearing complaints and resolving grievances

Current through June 11, 2024
1. A Medicare select issuer shall have
				written procedures for hearing complaints and resolving written grievances made
				by policyholders and certificate holders under a Medicare select policy or
				certificate. The procedures may include the utilization of arbitration if the
				Medicare select issuer and the policyholder or certificate holder or the
				policyholder's or certificate holder's spouse mutually agree to use
				it.
2. The procedure for addressing
				grievances must be described in all policies and certificates and in the
				outline of coverage provided to applicants for coverage pursuant to NAC
				687B.368.
3. The Medicare select issuer shall provide
				detailed information to the policyholder or certificate holder at the time the
				policy or certificate is issued that describes how to file a grievance with the
				Medicare select issuer.
4. The
				Medicare select issuer shall begin evaluating a grievance filed with it within
				10 working days after the filing date by transmitting the grievance to the
				person who has authority to investigate the issue fully and take corrective
				action to address it.
5. If a
				grievance is found to be valid, corrective action must commence within 48 hours
				after the determination or within 72 hours after the determination if a holiday
				occurs within the 48hour period.
6.
				All concerned parties must be notified of the determination made with regard to
				the grievance.
7. The Medicare
				select issuer shall report to the Commissioner on or before May 31 of each year
				regarding its grievance procedure. The report must be submitted in a format
				prescribed by the Commissioner and must contain the number of grievances filed
				in the past year and a summary of the nature and resolution of those
				grievances.
Added to NAC by Comm'r
				  of Insurance, eff. 5-13-96; A by
				  R081-16A,
				  eff. 11/2/2016
NRS
				  679B.130,
				  687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.372 - Availability of certain policies and certificates offered by Medicare select issuer

Current through June 11, 2024
1. A Medicare
				select issuer shall offer to each applicant for a Medicare select policy or
				certificate, at the time of initial purchase, the opportunity to purchase any
				policies or certificates to supplement Medicare that the Medicare select issuer
				offers.
2. Upon request by a
				policyholder or certificate holder, a Medicare select issuer shall make
				available the opportunity to purchase a different policy or certificate to
				supplement Medicare offered by the Medicare select issuer which has comparable
				or lesser benefits and which does not contain a provision for a restricted
				network. The Medicare select issuer shall make such policies or certificates
				available without requiring evidence of insurability if the person has been a
				policyholder or certificate holder for 6 months or more.
3. For the purposes of this section, a policy
				or certificate to supplement Medicare will be considered to have comparable or
				lesser benefits unless it contains one or more significant benefits not
				included in the Medicare select policy or certificate being replaced. For the
				purposes of this subsection, a significant benefit means coverage for the
				Medicare Part A deductible, coverage for at-home recovery services or coverage
				for Medicare Part B excess charges.
Added to NAC by Comm'r
				  of Insurance, eff. 5-13-96; A by Div. of Insurance by R078-05, 11-17-2005, eff.
				  9-8-2005 for Plans K and L, and 1-1-2006 for Medicare Part D Prescription Drug
				  Benefit
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.374 - Provision for continuation of coverage; availability of policies to supplement Medicare as continuation of coverage

Current through June 11, 2024
1. Medicare select
				policies and certificates must provide for continuation of coverage in the
				event the Secretary of Health and Human Services determines that Medicare
				select policies and certificates issued pursuant to NAC 687B.340 to 687B.376,
				inclusive, must be discontinued because the Medicare select program has not
				been reauthorized by Congress or because the statutory authority for the
				program has been substantially amended.
2. If the Secretary of Health and Human
				Services makes such a determination, each Medicare select issuer shall make
				available to each policyholder and certificate holder the opportunity to
				purchase any policy to supplement Medicare offered by the Medicare select
				issuer which has comparable or lesser benefits and which does not contain a
				provision for a restricted network. The Medicare select issuer shall make such
				policies and certificates available without requiring evidence of
				insurability.
3. For the purposes
				of this section, a policy to supplement Medicare will be considered to have
				comparable or lesser benefits unless it contains one or more significant
				benefits not included in the Medicare select policy or certificate being
				replaced. For the purpose of this subsection, a significant benefit means
				coverage for the Medicare Part A deductible, coverage for at-home recovery
				services or coverage for Part B excess charges.
Added to NAC by Comm'r
				  of Insurance, eff. 5-13-96; A by Div. of Insurance by R078-05, 11-17-2005, eff.
				  9-8-2005 for Plans K and L, and 1-1-2006 for Medicare Part D Prescription Drug
				  Benefit
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Medicare Select Policies and Certificates › Section 687B.376 - Compliance with requests for data for evaluation of Medicare select program

Current through June 11, 2024
A Medicare select issuer shall comply with reasonable
				  requests for data made by state or federal agencies, including the United
				  States Department of Health and Human Services, for the purpose of evaluating
				  the Medicare select program.
Added to NAC by Comm'r
				  of Insurance, eff. 5-13-96
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › REQUIREMENTS FOR DELIVERY › Section 687B.405 - Delivery of certificates to policyholder of group insurance

Current through June 11, 2024
All companies and all resident or nonresident agents or brokers
				doing group life insurance or group accident and health insurance business in
				Nevada must provide for delivery to the policyholder of the individual
				certificates required by NRS
				NRS
				688B.110,
				689B.090
				and 690A.070. Each company, agent and broker shall use his or her best efforts
				to see that policyholders distribute those certificates of insurance to all
				debtors, members or employees afforded coverage under the policy.
Comm'r of Insurance, part
				M-5, eff. 5-13-72-Substituted in revision for NAC
				687B.110
NRS
				  679B.130,
				  688B.110,
				  689B.090
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › REQUIREMENTS FOR DELIVERY › Section 687B.415 - Delivery of other policies, memoranda or certificates of insurance

Current through June 11, 2024
1. Except for policies of group life or group
			 accident and health insurance, all companies and all resident or nonresident
			 agents and brokers shall deliver a copy of the policy or a memorandum or
			 certificate of insurance to each insured person.
2. The memorandum or certificate of insurance
			 must indicate the:
(a) Kind and amount of
			 coverage;
(b) Term of the
			 coverage;
(c) Amount of premium for
			 each coverage provided; and
(d)
			 Name and address of the company issuing the coverage.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CANCELLATION OF POLICIES › Section 687B.520 - Refunds to third parties

Current through June 11, 2024
1. All forms used
			 by an agent broker, solicitor, company or any other person, partnership or
			 corporation, for the purpose of obtaining authorization from an insured to
			 cancel an existing insurance policy or policies, which authorize the payment of
			 the unearned premium to anyone other than the insured, shall state in the
			 heading or title of the form, in 14-point type or larger:
Authorization for Insurance Cancellation and Payment of Return
				Premium to a Third Party.
2. No form may be used for that purpose
			 unless the title calls the attention of the insured to the fact that the
			 insured is signing away his or her interest in the unearned premium to a third
			 person.
Comm'r of Insurance,
				PC-15, eff. 9-23-72
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CANCELLATION OF POLICIES › Section 687B.530 - Notice to agent

Current through June 11, 2024
Each insurer shall also provide a copy of the notice of
				cancellation of a policy to the agent who wrote the policy.
Added to NAC by Comm'r of
				Insurance, eff. 10-30-85
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › NOTICE OF TERMINATION TO EMPLOYEE LEASING COMPANIES › Section 687B.550 - Definitions

Current through June 11, 2024
As used in NAC 687B.550 to 687B.564, inclusive, unless the
				context otherwise requires, the words and terms defined in NAC 687B.552 to
				687B.560, inclusive, have the meanings ascribed to them in those
				sections.
Added to NAC by Comm'r of
				Insurance by R025-04, 7-9-2004, eff. 8-1-2004
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › NOTICE OF TERMINATION TO EMPLOYEE LEASING COMPANIES › Section 687B.552 - "Client company" defined

Current through June 11, 2024
"Client company" has the meaning ascribed to it in NRS NRS NRS
				NRS 616B.670.
Added to NAC by Comm'r of
				Insurance by R025-04, 7-9-2004, eff. 8-1-2004
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › NOTICE OF TERMINATION TO EMPLOYEE LEASING COMPANIES › Section 687B.554 - "Employee leasing company" defined

Current through June 11, 2024
"Employee leasing company" has the meaning ascribed to it in
				NRS 616B.670.
Added to NAC by Comm'r of
				Insurance by R025-04, 7-9-2004, eff. 8-1-2004
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › NOTICE OF TERMINATION TO EMPLOYEE LEASING COMPANIES › Section 687B.556 - "Health maintenance organization" defined

Current through June 11, 2024
"Health maintenance organization" has the meaning ascribed to
				it in
				NRS 695C.030.
Added to NAC by Comm'r of
				Insurance by R025-04, 7-9-2004, eff. 8-1-2004
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › NOTICE OF TERMINATION TO EMPLOYEE LEASING COMPANIES › Section 687B.558 - "Insurer" defined

Current through June 11, 2024
"Insurer" has the meaning ascribed to it in NRS NRS NRS
				NRS
				679A.100.
Added to NAC by Comm'r of
				Insurance by R025-04, 7-9-2004, eff. 8-1-2004
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › NOTICE OF TERMINATION TO EMPLOYEE LEASING COMPANIES › Section 687B.560 - "Producer of insurance" defined

Current through June 11, 2024
"Producer of insurance" has the meaning ascribed to it in NRS
				NRS
				679A.117.
Added to NAC by Comm'r of
				Insurance by R025-04, 7-9-2004, eff. 8-1-2004
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › NOTICE OF TERMINATION TO EMPLOYEE LEASING COMPANIES › Section 687B.562 - Disclosure of names and addresses of client companies; confidentiality

Current through June 11, 2024
1. Employee leasing companies applying for
			 insurance coverage under chapter 688B, 689A, 689B, 689C, 695A, 695B, 695C, 695D
			 or 695F of NRS shall submit the names and addresses of client companies to:
(a) Insurers or health maintenance
			 organizations with their applications; and
(b) Producers of insurance.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › NOTICE OF TERMINATION TO EMPLOYEE LEASING COMPANIES › Section 687B.564 - Notice of cancellation or failure to renew policy or contract

Current through June 11, 2024
1. An insurer or health maintenance
			 organization shall not cancel or fail to renew a policy or contract issued to
			 an employee leasing company pursuant to chapter 688B, 689A, 689B, 689C, 695A,
			 695B, 695C, 695D or 695F of NRS unless notice in writing of the termination is
			 given to:
(a) The employee leasing company;
			 and
(b) The client companies
			 included on the current client company list.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › MISCELLANEOUS POLICIES › Section 687B.610 - Vendor single interest policies: Marking (Repealed)

Current through June 11, 2024
Comm'r of Insurance,
				PC-1, eff. 9-23-72; R by
				R089-17AP,
				eff. 5/16/2018
NRS 679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › MISCELLANEOUS POLICIES › Section 687B.620 - Multiple line packages (Repealed)

Current through June 11, 2024
Comm'r of Insurance,
				PC-11, eff. 9-23-72-Substituted in revision for NAC 687B.410; R by
				R089-17AP,
				eff. 5/16/2018
NRS 679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › MISCELLANEOUS POLICIES › Section 687B.630 - Health policy, contract or plan that includes grace period for payment of premiums

Current through June 11, 2024
1. If an insurer
			 issues a health insurance policy or contract, health care plan, health benefit
			 plan or plan for dental care, whether individual, group or blanket, that
			 includes a grace period:
(a) The insurer shall
			 not require the payment of an additional premium for the grace period. If a
			 premium is not paid by the end of the grace period, the contract of insurance
			 terminates retroactively to the end of the day next preceding the grace
			 period.
(b) Except as otherwise
			 provided in this paragraph, the insurer is not required to pay claims incurred
			 during the grace period while a required premium remains unpaid and may seek
			 reimbursement for any such claim erroneously paid during the grace period. The
			 insurer is liable for any claims incurred during the grace period if the
			 required premium payment is received during the grace period in accordance with
			 the contract of insurance.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › MISCELLANEOUS POLICIES › Section 687B.640 - Medical examination required by insurer; standard set of criteria to be applied consistently to each insured

Current through June 11, 2024
1. Any medical
			 examination required by an insurer pursuant to NRS
			 NRS
			 687B.450 must follow a standard set of
			 criteria established by the insurer for the medical examination. The standard
			 set of criteria for the medical examination must be consistently applied to
			 each insured.
2. As used in this
			 section, "medical examination":
(a) Means an
			 examination completed by a licensed physician or by a provider of health care
			 who is acting within the scope of his or her license and under the direct
			 supervision of a licensed physician; and
(b) Includes, without limitation, a physical,
			 laboratory tests, radiology or imaging tests, completion of a medical history,
			 the taking of physical measurements, including, without limitation, height,
			 weight or blood pressure, or an examination of the heart or other bodily
			 systems or organs.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES THAT DUPLICATE BENEFITS PROVIDED UNDER MEDICARE › Section 687B.700 - Notice of duplication for policy which provides reimbursement upon both expense-incurred and fixed-indemnity basis

Current through June 11, 2024
1. An insurer that
			 delivers or issues for delivery in this State a policy of health insurance
			 which provides reimbursement upon both an expense-incurred and a
			 fixed-indemnity basis and which provides benefits that are provided under
			 Medicare shall provide notice to the insured that the policy contains certain
			 benefits which are also provided under Medicare.
2. The notice must be:
(a) Printed on or attached to the first page
			 of the application for the policy; and
(b) In not less than 12-point type and must
			 not vary from the following form in terms of language or format:
Important Notice to Persons on
							 Medicare
This Insurance Duplicates Some Medicare
							 Benefits
This is not Medicare Supplement Insurance
This insurance pays limited reimbursement for expenses if you
				meet the conditions listed in the policy. It also pays a fixed amount,
				regardless of your expenses, if you meet other policy conditions. It does not
				pay your Medicare deductibles or coinsurance and is not a substitute for
				Medicare Supplement insurance.
This insurance duplicates Medicare benefits when:
* any expenses or services covered by the policy are also
				covered by Medicare; or
* it pays the fixed dollar amount stated in the policy and
				Medicare covers the same event
Medicare generally pays for most or all of these
				expenses.
Medicare pays extensive benefits for medically necessary
				services regardless of the reason you need them. These include:
* hospitalization
* physician services
* hospice care
* outpatient prescription drugs if you are enrolled in Medicare
				Part D
* other approved items and services
Before You Buy This
							 Insurance
Check the coverage in
all
health insurance
				policies you already have.
For more information about Medicare and Medicare Supplement
				insurance, review the
Guide to Health Insurance for People with
				Medicare
, which is available from the insurance company.
For help in understanding your health insurance, contact the
				Commissioner of Insurance or the State Health Insurance Assistance Program
				(SHIP).
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES THAT DUPLICATE BENEFITS PROVIDED UNDER MEDICARE › Section 687B.706 - Notice of duplication for certain policies which provide reimbursement in fixed dollar amounts per day

Current through June 11, 2024
1. An insurer that
			 delivers or issues for delivery in this State an indemnity policy or other
			 policy which provides reimbursement in a fixed dollar amount per day, excluding
			 long-term care policies, and which provides benefits that are provided under
			 Medicare shall provide notice to the insured that the policy contains certain
			 benefits which are also provided under Medicare.
2. The notice must be:
(a) Printed or attached to the first page of
			 the application for the policy; and
(b) In not less than 12-point type and must
			 not vary from the following form in terms of language or format:
Important Notice to Persons on
							 Medicare
This Insurance Duplicates Some Medicare
							 Benefits
This is not Medicare Supplement Insurance
This insurance pays a fixed dollar amount, regardless of your
				expenses, for each day you meet the policy conditions. It does not pay your
				Medicare deductibles or coinsurance and is not a substitute for Medicare
				Supplement insurance.
This insurance duplicates Medicare benefits
				when:
* any expenses or services covered by the policy are also
				covered by Medicare
Medicare generally pays for most or all of these
				expenses.
Medicare pays extensive benefits for medically necessary
				services regardless of the reason you need them. These include:
* hospitalization
* physician services
* outpatient prescription drugs if you are enrolled in Medicare
				Part D
* hospice
* other approved items and services
Before You Buy This
							 Insurance
Check the coverage in
all
health insurance
				policies you already have.
For more information about Medicare and Medicare Supplement
				insurance, review the
Guide to Health Insurance for People with
				Medicare
, available from the insurance company.
For help in understanding your health insurance, contact the
				Commissioner of Insurance or the State Health Insurance Assistance Program
				(SHIP).
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES THAT DUPLICATE BENEFITS PROVIDED UNDER MEDICARE › Section 687B.711 - Notice of duplication for policy which provides reimbursement in fixed dollar amounts for specified diseases or other specified impairments

Current through June 11, 2024
1. An insurer that delivers or issues for
			 delivery in this State a policy of health insurance which provides
			 reimbursement in fixed dollar amounts for specified diseases or other specified
			 impairments and which provides benefits that are provided under Medicare shall
			 provide notice to the insured that the policy contains certain benefits which
			 are also provided under Medicare.
2. The notice must be:
(a) Printed on or attached to the first page
			 of the application for the policy; and
(b) In not less than 12-point type and must
			 not vary from the following form in terms of language or format:
Important Notice to Persons on
							 Medicare
This Insurance Duplicates Some Medicare
							 Benefits
This is not Medicare Supplement Insurance
This insurance pays a fixed amount, regardless of your
				expenses, if you meet the policy conditions, for one of the specific diseases
				or health conditions named in the policy. It does not pay your Medicare
				deductibles or coinsurance and is not a substitute for Medicare Supplement
				insurance.
This insurance duplicates Medicare benefits because
				Medicare generally pays for most of the expenses for the diagnosis and
				treatment of the specific conditions or diagnoses named in the
				policy.
Medicare pays extensive benefits for medically necessary
				services regardless of the reason you need them. These include:
* hospitalization
* physician services
* hospice
* outpatient prescription drugs if you are enrolled in Medicare
				Part D
* other approved items and services
Before You Buy This
							 Insurance
Check the coverage in
all
health insurance
				policies you already have.
For more information about Medicare and Medicare Supplement
				insurance, review the
Guide to Health Insurance for People with
				Medicare
, available from the insurance company.
For help in understanding your health insurance, contact the
				Commissioner of Insurance or the State Health Insurance Assistance Program
				(SHIP).
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES THAT DUPLICATE BENEFITS PROVIDED UNDER MEDICARE › Section 687B.716 - Notice of duplication for policy which provides reimbursement for expenses incurred for accidental injury only

Current through June 11, 2024
1. An insurer that
			 delivers or issues for delivery in this State a policy of health insurance
			 which provides reimbursement for expenses incurred for an accidental injury
			 only and which provides benefits that are provided under Medicare shall provide
			 notice to the insured that the policy contains benefits which are also provided
			 under Medicare.
2. The notice must
			 be:
(a) Printed or attached to the first page
			 of the application for the policy; and
(b) In not less than 12-point type and must
			 not vary from the following form in terms of language or format:
Important Notice to Persons on
							 Medicare
This Insurance Duplicates Some Medicare
							 Benefits
This is not Medicare Supplement Insurance
This insurance provides limited benefits, if you meet the
				policy conditions, for hospital or medical expenses that result from accidental
				injury. It does not pay your Medicare deductibles or coinsurance and is not a
				substitute for Medicare Supplement insurance.
This insurance duplicates Medicare benefits when it pays:
* hospital or medical expenses up to the maximum stated in the
				policy
Medicare generally pays for most or all of these
				expenses.
Medicare pays extensive benefits for medically necessary
				services regardless of the reason you need them. These include:
* hospitalization
* physician services
* outpatient prescription drugs if you are enrolled in Medicare
				Part D
* other approved items and services
Before You Buy This
							 Insurance
Check the coverage in
all
health insurance
				policies you already have.
For more information about Medicare and Medicare Supplement
				insurance, review the
Guide to Health Insurance for People with
				Medicare
, available from the insurance company.
For help in understanding your health insurance, contact the
				Commissioner of Insurance or the State Health Insurance Assistance Program
				(SHIP).
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES THAT DUPLICATE BENEFITS PROVIDED UNDER MEDICARE › Section 687B.720 - Notice of duplication for policy which provides reimbursement for expenses incurred for specified diseases and other specified impairments

Current through June 11, 2024
1. An insurer that delivers or issues for
			 delivery in this State a policy of health insurance which provides
			 reimbursement for expenses incurred for specified diseases and other specified
			 impairments and which provides benefits that are provided under Medicare shall
			 provide notice to the insured that the policy contains certain benefits which
			 are also provided under Medicare.
2. The notice must be:
(a) Printed on or attached to the first page
			 of the application for the policy; and
(b) In not less than 12-point type and must
			 not vary from the following form in terms of language or format:
Important Notice to Persons on
							 Medicare
This Insurance Duplicates Some Medicare
							 Benefits
This is not Medicare Supplement Insurance
This insurance provides limited benefits, if you meet the
				policy conditions, for hospital or medical expenses only when you are treated
				for one of the specific diseases or health conditions listed in the policy. It
				does not pay your Medicare deductibles or coinsurance and is not a substitute
				for Medicare Supplement insurance.
This insurance duplicates Medicare benefits when it
				pays:
* hospital or medical expenses up to the maximum stated in the
				policy
Medicare generally pays for most or all of these
				expenses.
Medicare pays extensive benefits for medically necessary
				services regardless of the reason you need them. These include:
* hospitalization
* physician services
* hospice
* outpatient prescription drugs if you are enrolled in Medicare
				Part D
* other approved items and services
Before You Buy This Insurance
Check the coverage in
all
health insurance
				policies you already have.
For more information about Medicare and Medicare Supplement
				insurance, review the
Guide to Health Insurance for People with
				Medicare
, available from the insurance company.
For help in understanding your health insurance, contact the
				Commissioner of Insurance or the State Health Insurance Assistance Program
				(SHIP).
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES THAT DUPLICATE BENEFITS PROVIDED UNDER MEDICARE › Section 687B.725 - Notice of duplication for policy which provides reimbursement for expenses incurred for specified limited services

Current through June 11, 2024
1. An insurer that
			 delivers or issues for delivery in this State a policy of health insurance
			 which provides reimbursement for expenses incurred for specified limited
			 services and which provides benefits that are provided under Medicare shall
			 provide notice to the insured that the policy contains certain benefits which
			 are also provided under Medicare.
2. The notice must be:
(a) Printed on or attached to the first page
			 of the application for the policy; and
(b) In not less than 12-point type and must
			 not vary from the following form in terms of language or format:
Important Notice to Persons on
							 Medicare
This Insurance Duplicates Some Medicare
							 Benefits
This is not Medicare Supplement Insurance
This insurance provides limited benefits, if you meet the
				policy conditions, for expenses relating to the specific services listed in the
				policy. It does not pay your Medicare deductibles or coinsurance and is not a
				substitute for Medicare Supplement insurance.
This insurance duplicates Medicare benefits when:
* any of the services covered by the policy are also covered by
				Medicare
Medicare pays extensive benefits for medically necessary
				services regardless of the reason you need them. These include:
* hospitalization
* physician services
* outpatient prescription drugs if you are enrolled in Medicare
				Part D
* other approved items and services
Before You Buy This Insurance
Check the coverage in
all
health insurance
				policies you already have.
For more information about Medicare and Medicare Supplement
				insurance, review the
Guide to Health Insurance for People with
				Medicare
, available from the insurance company.
For help in understanding your health insurance, contact the
				Commissioner of Insurance or the State Health Insurance Assistance Program
				(SHIP).
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES THAT DUPLICATE BENEFITS PROVIDED UNDER MEDICARE › Section 687B.730 - Notice of duplication for policy not described in NAC 687B.700 to 687B.725 , inclusive

Current through June 11, 2024
1. An insurer that
			 delivers or issues for delivery in this State a policy of health insurance,
			 other than a policy of insurance described in NAC 687B.700 to 687B.725,
			 inclusive, and which provides benefits that are provided under Medicare shall
			 provide notice to the insured that the policy contains certain benefits which
			 are also provided under Medicare.
2. The notice must be:
(a) Printed on or attached to the first page
			 of the application for the policy; and
(b) In not less than 12-point type and must
			 not vary from the following form in terms of language or format:
Important Notice to Persons on
							 Medicare
This Insurance Duplicates Some Medicare
							 Benefits
This is not Medicare Supplement Insurance
This insurance provides limited benefits if you meet the
				conditions listed in the policy. It does not pay your Medicare deductibles or
				coinsurance and is not a substitute for Medicare Supplement Insurance.
This insurance duplicates Medicare benefits when it
				pays:
* the benefits stated in the policy and coverage for the same
				event is provided by Medicare
Medicare generally pays for most or all of these
				expenses.
Medicare pays extensive benefits for medically necessary
				services regardless of the reason you need them. These include:
* hospitalization
* physician services
* hospice
* outpatient prescription drugs if you are enrolled in Medicare
				Part D
* other approved items and services
Before You Buy This
							 Insurance
Check the coverage in
all
health insurance
				policies you already have.
For more information about Medicare and Medicare Supplement
				insurance, review the
Guide to Health Insurance for People with
				Medicare
, available from the insurance company.
For help in understanding your health insurance, contact the
				Commissioner of Insurance or the State Health Insurance Assistance Program
				(SHIP).
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES THAT DUPLICATE BENEFITS PROVIDED UNDER MEDICARE › Section 687B.735 - Payment of benefits that are covered under other policies

Current through June 11, 2024
A policy of health insurance described in NAC 687B.700,
				687B.720, 687B.725 or 687B.730 which provides benefits that are provided under
				Medicare may not be delivered or issued for delivery in this State unless the
				policy includes a provision that specifically states that the benefits under
				the policy will be provided without regard to any other policy or coverage of
				health insurance, including Medicare.
Added to NAC by Comm'r of
				Insurance, eff. 5-13-96; A by R110-98, 2-23-99
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › ADEQUACY OF NETWORK PLANS › Section 687B.750 - Definitions

Current through June 11, 2024
As used in sections 2 to 18, inclusive, of this regulation,
				unless the context otherwise requires, the words and terms defined in sections
				3 to 8, inclusive, of this regulation have the meanings ascribed to them in
				those sections.
Added to NAC
				by Comm'r of Insurance, by
				R049-14,
				eff. 4/4/2016
NRS
				  679B.130,
				  687B.490,
				  as amended by section 28 of Assembly Bill No. 292, chapter 153, Statutes of
				  Nevada 2015, at page 636
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › ADEQUACY OF NETWORK PLANS › Section 687B.752 - "Carrier" defined

Current through June 11, 2024
"Carrier" means an insurer that makes a network plan available
				for sale in this State pursuant to
				NRS
				687B.490.
Added to NAC
				by Comm'r of Insurance, by
				R049-14,
				eff. 4/4/2016
NRS
				  679B.130,
				  687B.490,
				  as amended by section 28 of Assembly Bill No. 292, chapter 153, Statutes of
				  Nevada 2015, at page 636
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › ADEQUACY OF NETWORK PLANS › Section 687B.754 - "Council" defined

Current through June 11, 2024
"Council" means the Network Adequacy Advisory Council
				established by section 10 of this regulation.
Added to NAC
				by Comm'r of Insurance, by
				R049-14,
				eff. 4/4/2016
NRS
				  679B.130,
				  687B.490,
				  as amended by section 28 of Assembly Bill No. 292, chapter 153, Statutes of
				  Nevada 2015, at page 636