reglab/statecodes huggingface dataset:
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.122 - General requirements for converted policy

Current through June 11, 2024
1. A
			 written application by an insured for a converted policy must be made, and the
			 first premium due, if any, must be paid as directed by the insurer within 31
			 days of the date of termination of coverage under a group long-term care
			 insurance contract. The converted policy must be issued effective on the day
			 following the termination of coverage under the group long-term care insurance
			 contract and must be renewable annually.
2. Unless the group long-term care insurance
			 contract from which conversion is made replaced previous group coverage, the
			 premium for the converted policy must be calculated on the basis of the
			 insured's age at inception of coverage under the group long-term care insurance
			 contract from which conversion is made. If the group long-term care insurance
			 contract from which conversion is made replaced previous group coverage, the
			 premium for the converted policy must be calculated on the basis of the
			 insured's age at inception of coverage under the initial group long-term care
			 insurance contract that was replaced.
3. Upon termination of coverage under a group
			 long-term care insurance contract, the insurer shall provide each insured
			 continuation of coverage or shall issue each insured a converted policy unless:
(a) Termination of group coverage resulted
			 from the failure to make any required payment of premium or contribution when
			 due; or
(b) Within 31 days from the
			 date of termination of coverage, the long-term care insurance contract is
			 replaced by a group long-term care insurance contract:
(1) Effective on the day following the date
			 of termination of coverage.
(2) The
			 premium for which is calculated as set forth in subsection 2.
(3) Providing benefits identical to, or
			 benefits determined by the Commissioner to be substantially equivalent to, or
			 in excess of, those provided by the previous long-term care insurance
			 contract.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.125 - Replacement of contract: Questions on applications

Current through June 11, 2024
Application forms for individual long-term care insurance
				contracts must include the following questions designed to elicit information
				as to whether the proposed long-term care insurance contract is intended to
				replace any other contract for accident and sickness or long-term care
				insurance contract presently in force:
TO BE COMPLETED BY THE APPLICANT
1. Do you currently have another contract or
			 certificate of long-term care insurance in force (including a contract for
			 health care services or a contract with a health maintenance
			 organization)?
2. Have you had
			 another contract or certificate of long-term care insurance in force during the
			 last 12 months? If so, please answer questions (a) and (b).
(a) With what company was your contract or
			 certificate?
(b) If your contract
			 or certificate lapsed, when did it lapse?
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.130 - Replacement of contract: Notice from insurer not using direct-response solicitation

Current through June 11, 2024
1. Upon determining
			 that a sale will involve the replacement of a long-term care insurance
			 contract, an insurer, other than an insurer using direct-response solicitation
			 methods, or its agent, shall furnish the applicant, before the issuance or
			 delivery of the individual long-term care insurance contract, a notice
			 regarding the replacement of the policy for accident and sickness or long-term
			 care coverage. One copy of the notice must be retained by the applicant, and an
			 additional copy signed by the applicant must be retained by the
			 insurer.
2. The notice required by
			 subsection 1 must be provided using form NDOI-954, which is available from the
			 Division, or a similar form approved by the Commissioner.
Added to NAC by Comm'r of
				Insurance, eff. 11-21-88; A 12-15-94; R028-10, 12-16-2010, eff.
				10-1-2011
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.135 - Replacement of policy: Notice from insurer using direct-response solicitation

Current through June 11, 2024
1. Insurers using a
			 direct-response solicitation shall deliver a notice regarding the replacement
			 of a policy for accident and sickness or a long-term care insurance contract to
			 the applicant upon issuance of the long-term care insurance contract.
2. The notice required by subsection 1 must
			 be provided using form NDOI-955, which is available from the Division, or a
			 similar form approved by the Commissioner.
3. The insurer shall collect and retain
			 signed copies of the notice from the applicant. The Commissioner may waive the
			 requirements of this subsection in certain situations, including, but not
			 limited to, electronic enrollment.
Added to NAC by Comm'r of
				Insurance, eff. 11-21-88; A 12-1-94; R028-10, 12-16-2010, eff.
				10-1-2011
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.140 - Replacement of contract: Restrictions concerning group policies for long-term care

Current through June 11, 2024
If a group long-term care insurance contract is replaced by
				another group long-term care insurance contract issued to the same
				policyholder, the succeeding insurer shall offer coverage to all persons
				covered under the previous group long-term care insurance contract on its date
				of termination. Coverage provided or offered to an individual by the insurer
				and the premium charged to persons under the new group long-term care insurance
				contract must not:
1. Result in an
			 exclusion for preexisting conditions that would have been covered under the
			 group long-term care insurance contract being replaced; or
2. Vary or otherwise depend on the status of
			 a person's health or disability, experience with claims or use of services
			 related to long-term care.
Added to NAC by Comm'r of
				Insurance, eff. 12-15-94; A by R028-10, 12-16-2010, eff.
				10-1-2011
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.Sec. 1 - NEW

Current through June 11, 2024
1. An agent, issuer or other entity shall
				comply with the requirements of subsection 3 of NAC
				687B.275 and NAC
				687B.282 when the agent, issuer
				or other entity works with a person to purchase a Medicare supplemental policy
				during the open enrollment period offered pursuant to
				NRS
				687B.352.
2. The Division shall publish on its Internet
				website a current and accurate document that lists each policy that is
				available to the holder of a Medicare supplemental policy based on the policy
				that he or she currently holds during the open enrollment period offered
				pursuant to NRS
				687B.352.
3. During the open enrollment period offered
				pursuant to NRS
				687B.352, the holder of a Medicare
				supplemental policy may not re-enroll in the same policy in which he or she is
				currently enrolled that is issued by the same insurer that issued the policy in
				which he or she is currently enrolled for the purpose of lowering his or her
				rate.
4. As used in this section,
				"Medicare supplemental policy" has the meaning ascribed to it in
				NRS
				687B.352.
Added to NAC by Comm'r of Insurance by
				  R163-22A,
				  eff. 12/7/2022
NRS 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.200 - Definitions

Current through June 11, 2024
As used in NAC
				  687B.200 to
				  687B.330, inclusive, and section
				  1, unless the context otherwise requires, the words and terms defined in NAC
				  687B.2002 to
				  687B.2045, inclusive, have the
				  meanings ascribed to them in those sections.
Added to NAC by Comm'r
				  of Insurance, 2-21-89, eff. 3-15-89; A 11-16-90; 7-16-92, eff. 7-30-92; 8-2-94;
				  5-13-96; R110-98, 2-23-99; R075-02, 9-20-2002; R027-04, 8-2-2004; 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; A by Comm'r of Insurance by
				  R049-09, 10-27-2009; A by
				  R041-17A,
				  eff. 6/26/2019; A by
				  R163-22A,
				  eff. 12/7/2022
NRS 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2002 - "1990 standardized benefit plan to supplement Medicare" or "1990 standardized benefit plan" defined

Current through June 11, 2024
"1990 standardized benefit plan to supplement Medicare" or
				  "1990 standardized benefit plan" means a policy to supplement Medicare issued
				  on or after January 1, 1992, and with an effective date for coverage before
				  June 1, 2010, and includes policies to supplement Medicare and certificates
				  renewed on or after that date which are not replaced by the issuer at the
				  request of the insured.
Added to NAC by Comm'r
				  of Insurance by R049-09, eff. 10-27-2009
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2003 - "2010 standardized benefit plan to supplement Medicare" or "2010 standardized benefit plan" defined

Current through June 11, 2024
"2010 standardized benefit plan to supplement Medicare" or
				  "2010 standardized benefit plan" means a policy to supplement Medicare issued
				  with an effective date for coverage on or after June 1, 2010, and which is not
				  issued to an individual who is newly eligible on or after January 1,
				  2020.
Added to NAC by Comm'r
				  of Insurance by R049-09, eff. 10-27-2009; A by
				  R041-17A,
				  eff. 6/26/2019
NRS
				  679B.130 and
				  687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2004 - "2020 standardized benefit plan to supplement Medicare" defined

Current through June 11, 2024
"2020 standardized benefit plan to supplement Medicare" means
				  a policy to supplement Medicare issued to an individual who is newly eligible
				  on or after January 1, 2020.
Added to
				  NAC by Comm'r of Insurance by
				  R041-17A,
				  eff. 6/26/2019
NRS
				  679B.130 and
				  687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.201 - "Applicant" defined

Current through June 11, 2024
"Applicant" means:
1. In the case of an individual policy to
				supplement Medicare, the person who seeks to contract for insurance
				benefits.
2. In the case of a group
				policy to supplement Medicare, the proposed certificate holder.
Added to NAC by Comm'r
				  of Insurance by R110-98, eff. 2-23-99
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2014 - "Certificate" defined

Current through June 11, 2024
"Certificate" means any certificate delivered or issued for
				  delivery in this State under a group policy to supplement Medicare.
Added to NAC by Comm'r
				  of Insurance by R110-98, eff. 2-23-99
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2015 - "Creditable coverage" defined

Current through June 11, 2024
"Creditable coverage" has the meaning ascribed to it in
				  NRS
				  689A.505.
Added to NAC 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 › General Provisions › Section 687B.2018 - "Eligible organization" defined

Current through June 11, 2024
"Eligible organization" has the meaning ascribed to it in
				  section 1876(b) of the Social Security Act,
				  42 U.S.C. §
										1395 mm(b).
Added to NAC by Comm'r
				  of Insurance by R110-98, eff. 2-23-99
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.202 - "Employee welfare benefit plan" defined

Current through June 11, 2024
"Employee welfare benefit plan" has the meaning ascribed to
				  it in section 3(1) of the Employee Retirement Income Security Act of 1974,
				  29
				  U.S.C. §
										1002(1).
Added to NAC by Comm'r
				  of Insurance by R110-98, eff. 2-23-99
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2024 - "Issuer" defined

Current through June 11, 2024
"Issuer" means any insurance company, fraternal benefit
				  society, nonprofit corporation for hospital, medical and dental services or
				  health maintenance organization offering a policy to supplement Medicare which
				  is delivered or issued for delivery in this State.
Added to NAC by Comm'r
				  of Insurance by R110-98, eff. 2-23-99
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2028 - "Medicare" defined

Current through June 11, 2024
"Medicare" means the program of health insurance for aged and
				  disabled persons established pursuant to Title XVIII of the Social Security
				  Act,
				  42 U.S.C. §§
										1395 et seq.
Added to NAC by Comm'r
				  of Insurance by R110-98, eff. 2-23-99
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.203 - "Medicare Advantage organization" defined

Current through June 11, 2024
"Medicare Advantage organization" has the meaning ascribed to
				  it in section 1859(a)(1) of the Social Security Act,
				  42 U.S.C. §
										1395 w - 28(a)(1).
Added to NAC by Comm'r
				  of Insurance by R110-98, eff. 2-23-99; 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 › General Provisions › Section 687B.2034 - "Medicare Advantage plan" defined

Current through June 11, 2024
"Medicare Advantage plan" means a plan of coverage for health
				  benefits under Medicare Part C, as defined in
				  42 U.S.C. §§
										1395 w - 28(b)(1), and includes:
1. Coordinated care plans that provide health
				care services, including, without limitation:
(a) Health maintenance organization plans,
				with or without a point-of-service provider;
(b) Plans offered by provider-sponsored
				organizations; and
(c) Preferred
				provider organization plans;
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2036 - "Medicare Part D" defined

Current through June 11, 2024
"Medicare Part D" means the prescription drug benefit created
				  by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003,
				  Public Law
				  108-173, 117 Stat. 2066, December 8, 2003,
				  beginning January 1, 2006.
Added to NAC 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 › General Provisions › Section 687B.2037 - "Medicare select issuer" defined

Current through June 11, 2024
"Medicare select issuer" has the meaning ascribed to it in
				  NAC 687B.346.
Added to NAC by Comm'r
				  of Insurance by R110-98, eff. 2-23-99
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2038 - "Newly eligible on or after January 1, 2020" defined

Current through June 11, 2024
"Newly eligible on or after January 1, 2020" means an
				  individual who:
1. Becomes 65 years of
				age on or after January 1, 2020; or
2. First becomes eligible for Medicare
				benefits because of age, disability or end-stage renal disease on or after
				January 1, 2020.
Added to
				  NAC by Comm'r of Insurance by
				  R041-17A,
				  eff. 6/26/2019
NRS
				  679B.130 and
				  687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2039 - "PACE program" defined

Current through June 11, 2024
"PACE program" means the program of all-inclusive care for
				  the elderly established pursuant to section 1894 of the Social Security Act,
				  42 U.S.C. §
										1395 eee.
Added to NAC by Comm'r
				  of Insurance by R075-02, eff. 9-20-2002
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.204 - "Policy to supplement Medicare" defined

Current through June 11, 2024
"Policy to supplement Medicare" means a group or individual
				  policy of insurance, or a subscriber contract, other than a policy issued
				  pursuant to section 1876 of the Social Security Act,
				  42 U.S.C. §
										1395 mm, or pursuant to a demonstration
				  project that is advertised, marketed or designed primarily as a supplement to
				  the reimbursements provided under Medicare for the hospital, medical or
				  surgical expenses of persons eligible for Medicare. The term does not include
				  Medicare Advantage plans established under Medicare Part C, Outpatient
				  Prescription Drug plans established under Medicare Part D, or any Health Care
				  Prepayment Plan (HCPP) that provides benefits pursuant to an agreement under
				  section 1833(a)(1)(A) of the Social Security Act,
				  42 U.S.C. §
										1395 l(a)(1)(A).
Added to NAC by Comm'r
				  of Insurance by R110-98, eff. 2-23-99; 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 › General Provisions › Section 687B.2045 - "Standardized benefit plan" defined

Current through June 11, 2024
"Standardized benefit plan" means, as applicable, a benefit
				  plan to supplement Medicare that is designated as Standardized Benefit Plan A
				  through N, inclusive, or High Deductible Benefit Plan F, G or J, as set forth
				  in NAC 687B.300 to
				  687B.323, inclusive, and section
				  6 of this regulation.
Added to NAC by Comm'r
				  of Insurance by R110-98, eff. 2-23-99; 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; A by Comm'r of Insurance by R049-09, 10-27-2009; A
				  by
				  R041-17A,
				  eff. 6/26/2019
NRS
				  679B.130 and
				  687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.205 - Applicability of provisions

Current through June 11, 2024
1. Except as
				otherwise provided in NAC 687B.200 to 687B.330, inclusive, the provisions of
				those sections apply to any:
(a) Policy to
				supplement Medicare delivered or issued for delivery in this State on or after
				July 30, 1992.
(b)
				Certificate.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2054 - Eligible persons: Subsequent enrollment deemed to be initial enrollment under certain circumstances

Current through June 11, 2024
1. In the case of a
				person described in paragraph (e) of subsection 3 of NAC 687B.2053, or deemed
				to be so described pursuant to this subsection, whose enrollment with an
				organization or provider described in paragraph (e) of subsection 3 of NAC
				687B.2053 is involuntarily terminated within the first 12 months of enrollment,
				and who, without an intervening enrollment, enrolls with another such
				organization or provider, the subsequent enrollment shall be deemed to be an
				initial enrollment described in paragraph (e) of subsection 3 of NAC
				687B.2053.
2. In the case of a
				person described in paragraph (f) of subsection 3 of NAC 687B.2053, or deemed
				to be so described pursuant to this subsection, whose enrollment with a plan or
				in a program described in paragraph (f) of subsection 3 of NAC 687B.2053 is
				involuntarily terminated within the first 12 months of enrollment, and who,
				without an intervening enrollment, enrolls in another such plan or program, the
				subsequent enrollment shall be deemed to be an initial enrollment described in
				paragraph (f) of subsection 3 of NAC 687B.2053.
3. For purposes of paragraphs (e) and (f) of
				subsection 3 of NAC 687B.2053, no enrollment of a person with an organization
				or provider described in paragraph (e) of subsection 3 of NAC 687B.2053, or
				with a plan or in a program described in paragraph (f) of subsection 3 of NAC
				687B.2053, may be deemed to be an initial enrollment under this subsection
				after the 2-year period beginning on the date on which the person first
				enrolled with such an organization, provider, plan or program.
Added to NAC 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 › General Provisions › Section 687B.2055 - Eligible persons: Notification required upon occurrence of certain events

Current through June 11, 2024
1. At the time of
				an event described in subsection 3 of NAC 687B.2053 because of which a person
				loses coverage or benefits because of the termination of a contract or
				agreement, policy or plan, the organization that terminates the contract or
				agreement, the issuer terminating the policy or the administrator of the plan
				being terminated, respectively, shall notify the person of his or her rights
				under NAC 687B.2053 to 687B.2057, inclusive, and of the obligations of issuers
				of policies to supplement Medicare under subsections 1 and 2 of NAC 687B.2053.
				Such notice must be communicated contemporaneously with the notification of
				termination.
2. At the time of an
				event described in subsection 3 of NAC 687B.2053 because of which a person
				ceases enrollment under a contract or agreement, policy or plan, the
				organization that offers the contract or agreement, regardless of the basis for
				the cessation of enrollment, the issuer offering the policy or the
				administrator of the plan, respectively, shall notify the person of his or her
				rights under NAC 687B.2053 to 687B.2057, inclusive, and of the obligations of
				issuers of policies to supplement Medicare under subsections 1 and 2 of NAC
				687B.2053. Such notice must be communicated within 10 working days of the
				issuer receiving notification of disenrollment.
Added to NAC 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 › General Provisions › Section 687B.2056 - Guaranteed issue periods for eligible persons; special enrollment period

Current through June 11, 2024
1. In the case of a person described in
				paragraph (a) of subsection 3 of NAC 687B.2053, the guaranteed issue period
				begins on the later of:
(a) The date the
				person receives a notice of termination or cessation of all supplemental health
				benefits or, if a notice is not received, notice that a claim has been denied
				because of a termination or cessation; or
(b) The date that the applicable coverage
				terminates or ceases, and ends 63 days thereafter.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2057 - Policies to supplement Medicare to which eligible persons are entitled

Current through June 11, 2024
Except as otherwise provided in section 6 of this regulation,
				  the policy to supplement Medicare to which eligible persons are
				  entitled:
1. Under paragraphs (a),
				(b), (c) and (d) of subsection 3 of NAC
				687B.2053 is a policy to
				supplement Medicare that has a benefit package classified as Plan A, B, C, F
				(including F with a high deductible), K or L offered by any issuer;
2. Subject to paragraph (e) of subsection 3
				of NAC 687B.2053 is the same policy to
				supplement Medicare in which the person was most recently and previously
				enrolled, if available from the same issuer or, if not so available, a policy
				described in subsection 1;
3. After
				December 31, 2005, if the person was most recently enrolled in a policy to
				supplement Medicare with an outpatient prescription drug benefit, a policy to
				supplement Medicare described in this subsection is:
(a) The policy available from the same issuer
				but modified to remove outpatient prescription drug coverage; or
(b) At the election of the policyholder, an
				A, B, C, F (including F with a high deductible), K or L policy that is offered
				by any issuer;
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.206 - Eligibility for policy to supplement Medicare offered to new enrollees or for certificate offered to new enrollees following certain disenrollment; required policy or certificate; outpatient prescription drug coverage

Current through June 11, 2024
1. A person is eligible for a policy to
				supplement Medicare that is offered to new enrollees or for a certificate that
				is offered to new enrollees if the person provides evidence that he or she
				disenrolled within the previous 63 days from:
(a) An employee welfare benefit plan that:
(1) Provided health benefits to supplement
				the benefits provided under Medicare; and
(2) Discontinued providing substantially all
				such supplemental health benefits to the person.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2062 - Eligibility for policy to supplement Medicare offered to new enrollees or for certificate offered to new enrollees following certain disenrollment, enrollment and subsequent disenrollment; required policy or certificate

Current through June 11, 2024
1. A person is eligible for a policy to
				supplement Medicare that is offered to new enrollees or for a certificate that
				is offered to new enrollees if the person provides evidence that he or she:
(a) Disenrolled from such a policy or
				certificate;
(b) Subsequently
				enrolled for the first time in:
(1) A Medicare
				Advantage plan offered by a Medicare Advantage organization pursuant to
				Medicare Part C;
(2) A plan offered
				by an eligible organization, insurer or a Medicare select issuer listed in
				paragraph (e) of subsection 1 of NAC
				687B.206; or
(3) Any PACE program; and
(c) Disenrolled within the
				previous 63 days from the subsequent plan within 12 months after the person's
				enrollment as authorized pursuant to section 1851(e) of the Social Security
				Act,
				42 U.S.C. §
											1395w-21(e).
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2064 - Eligibility for policy to supplement Medicare offered to new enrollees or for certificate offered to new enrollees following certain enrollment and subsequent disenrollment; required policy or certificate

Current through June 11, 2024
1. A person is eligible for a policy to
				supplement Medicare that is offered to new enrollees or for a certificate that
				is offered to new enrollees if the person provides evidence that he or she has
				disenrolled within the previous 63 days from a Medicare Advantage plan offered
				by a Medicare Advantage organization pursuant to Medicare Part C, or from a
				PACE program, if he or she:
(a) Enrolled in
				that plan or program during the first 6-month period during which the person
				was both 65 years of age or older and was enrolled for benefits under Medicare
				Part B; and
(b) Disenrolled from
				the plan or program not later than 12 months after the effective date of
				enrollment.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2068 - Policy to supplement Medicare offered to new enrollees or certificate offered to new enrollees: Prohibition against denial of application, placement of condition on issuance or effectiveness, or discrimination in pricing under certain conditions by issuer

Current through June 11, 2024
If an application for a policy to supplement Medicare that is
				  offered to new enrollees or for a certificate that is offered to new enrollees
				  is submitted to an issuer by a person who is eligible for such a policy or
				  certificate pursuant to NAC 687B.206, 687B.2062 or 687B.2064, the issuer shall
				  not deny or condition the issuance or effectiveness of the policy or
				  certificate or discriminate in the pricing of the policy or certificate on the
				  basis of:
1. The health status of the
				applicant;
2. The claims experience
				of the applicant;
3. The receipt of
				health care by the applicant;
4.
				The medical condition of the applicant; or
5. A preexisting condition of the
				applicant.
Added to NAC by Comm'r
				  of Insurance by R110-98, eff. 2-23-99
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.207 - Coverage if application is submitted before or during first 6-month period in which person is both 65 years of age or older and enrolled under Medicare Part B; availability of coverage to all qualified applicants

Current through June 11, 2024
1. If an application for a policy to
				supplement Medicare or a certificate is submitted to an issuer before or during
				the first 6-month period during which a person is both 65 years of age or older
				and is enrolled for benefits under Medicare Part B, the issuer may not deny or
				condition the issuance or effectiveness of the policy or certificate or
				discriminate in the pricing of the policy or certificate on the basis of:
(a) The health status of the
				applicant;
(b) The claims
				experience of the applicant;
(c)
				The receipt of health care by the applicant; or
(d) The medical condition of the
				applicant.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.209 - Termination of or disenrollment from plan, certificate or policy to supplement Medicare: Requirements for written notification

Current through June 11, 2024
1. Any
				time a plan, certificate or policy to supplement Medicare is terminated or a
				person disenrolls from a plan, certificate or policy to supplement Medicare,
				the issuer, insurer, Medicare Advantage organization, eligible organization or
				Medicare select issuer that offered the plan, certificate or policy shall
				provide written notification informing the person that:
(a) The person may be entitled to obtain a
				certificate or a policy to supplement Medicare pursuant to NAC 687B.206,
				687B.2062 or 687B.2064; and
(b) The
				issuer of such a certificate or policy must comply with the provisions of NAC
				687B.2068.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.212 - Filing and approval of policy forms and certificate forms

Current through June 11, 2024
1. An issuer shall not deliver or issue for
				delivery in this State a policy to supplement Medicare or a certificate unless
				the policy form or certificate form has been filed with and approved by the
				Commissioner pursuant to NRS
				NRS
				687B.120.
2. An issuer shall file any riders or
				amendments to policy forms or certificate forms to delete outpatient
				prescription drug benefits as required by the Medicare Prescription Drug,
				Improvement, and Modernization Act of 2003,
				Public Law
				108-173, 117 Stat. 2066, December 8, 2003, with
				the commissioner in the state in which the policy or certificate was
				issued.
3. Except as otherwise
				provided in this subsection, an issuer shall not file for approval more than
				one policy form or certificate form for each type of policy in a standardized
				benefit plan to supplement Medicare. An issuer may offer, with the approval of
				the Commissioner, not more than four additional forms for the same type of
				policy in a standardized benefit plan to supplement Medicare:
(a) For the inclusion of new or innovative
				benefits;
(b) For the addition of a
				direct-response or agent-marketing method;
(c) For the addition of guaranteed issue or
				underwritten coverage; or
(d) To
				offer coverage to persons eligible for Medicare because of a
				disability.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.213 - Availability and discontinuance of policy forms and certificate forms

Current through June 11, 2024
1. Except as otherwise provided in subsection
				2, an issuer shall make available for sale on or after July 30, 1992, any
				policy form or certificate form that has been previously approved by the
				Commissioner. A form shall be deemed available for purchase if the issuer has
				actively offered it for sale in the previous 12 months.
2. An issuer may discontinue a policy form or
				certificate form if he or she notifies the Commissioner in writing at least 30
				days before he or she intends to discontinue the form. The issuer may not offer
				the form for sale in this State after the notice is received by the
				Commissioner.
3. If an issuer
				discontinues a policy form or certificate form, he or she may not file for
				approval a new form of the same type as the discontinued form for the same
				standardized benefit plan to supplement Medicare for 5 years after notice is
				given to the Commissioner pursuant to subsection 2, unless the Commissioner
				reduces the period of discontinuance.
4. For the purposes of this section:
(a) The sale or transfer of an issuer's
				business for supplementing Medicare to another issuer shall be deemed a
				discontinuance of a policy form or certificate form.
(b) A change in the rating structure for a
				policy to supplement Medicare or a certificate shall be deemed a discontinuance
				of the form for that policy or certificate unless the issuer:
(1) Files with the Commissioner, in a form
				and manner prescribed by the Commissioner, an actuarial memorandum describing
				the manner in which the revised rating structure and resultant rates differ
				from the existing structure and existing rates; and
(2) Does not subsequently put into effect a
				change of rates or rating factors that cause the percentage differential
				between the discontinued rates and the new rates as described in the memorandum
				to change. The Commissioner may approve a change to a percentage differential
				which is in the public interest.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.215 - Definitions and terms used in policy or certificate

Current through June 11, 2024
1. Each policy to supplement Medicare or
				certificate advertised, solicited or issued for delivery in this State must
				contain definitions or terms conforming to the requirements of this
				section.
2. "Accident," "accidental
				injury" or "accidental means" must be defined to employ "result" language and
				may not include words that establish an accidental means test or use words such
				as "external," "violent," "visible wounds" or similar words of description or
				characterization. The definition:
(a) May not
				define the terms more restrictively than as the direct result of an accident,
				independent of disease or bodily infirmity or any other cause, that occurs
				while insurance coverage is in force.
(b) Unless prohibited by law, may provide
				that the terms do not include any injury for benefits which are provided or
				available under any workers' compensation, employer's liability or similar law,
				or motor vehicle no-fault plan.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.220 - Exclusions from and limitations on coverage and benefits; duplication of benefits provided by Medicare; benefits for outpatient prescription drugs

Current through June 11, 2024
1. Except as otherwise provided in paragraphs
				(a) and (b) of subsection 2 of NAC 687B.226 and paragraphs (a) and (b) of
				subsection 2 of NAC 687B.227, and subparagraphs (1) and (2) of paragraph (a) of
				subsection 2 of NAC 687B.322, a policy or certificate may not be advertised,
				solicited or issued for delivery in this State as a policy to supplement
				Medicare if the policy or certificate contains limitations or exclusions on
				coverage that are more restrictive than those of Medicare.
2. A policy to supplement Medicare or a
				certificate must not use a waiver to exclude, limit or reduce coverage or
				benefits for specifically named or described preexisting diseases or physical
				conditions.
3. A policy to
				supplement Medicare or a certificate must not contain benefits that duplicate
				the benefits provided by Medicare.
4. A policy to supplement Medicare with
				benefits for outpatient prescription drugs in existence before January 1, 2006,
				must be renewed for current policyholders who do not enroll in Medicare Part D
				at the option of the policyholder.
5. A policy to supplement Medicare with
				benefits for outpatient prescription drugs must not be issued after December
				31, 2005.
6. After December 31,
				2005, a policy to supplement Medicare with benefits for outpatient prescription
				drugs may not be renewed after the policyholder enrolls in Medicare Part D
				unless:
(a) The policy is modified to
				eliminate outpatient prescription drug coverage for expenses of outpatient
				prescription drugs incurred after the effective date of the person's coverage
				under a Medicare Part D plan; and
(b) Premiums are adjusted to reflect the
				elimination of outpatient prescription drug coverage at the time of Medicare
				Part D enrollment, accounting for any claims paid, if applicable.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.223 - Prohibitions regarding genetic information and genetic testing

Current through June 11, 2024
1. An issuer of a policy to supplement
				Medicare or a certificate:
(a) Shall not deny
				or condition the issuance or effectiveness of the policy or certificate,
				including, without limitation, the imposition of any exclusion of benefits
				under the policy based on a preexisting condition, on the basis of the genetic
				information of a person; and
(b)
				Shall not discriminate in the pricing of the policy or certificate, including,
				without limitation, the adjustment of the premium rates, of a person on the
				basis of the genetic information of the person.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.225 - Minimum standards for coverage: Policy or certificate advertised, solicited or issued for delivery before July 16, 1992

Current through June 11, 2024
1. A
				policy of insurance or subscriber contract must not be advertised, solicited or
				issued for delivery in this State as a policy or certificate to supplement
				Medicare before July 16, 1992, if it fails to meet the standards established by
				this section. These are minimum standards and do not preclude the inclusion of
				other provisions or benefits that are not inconsistent with these
				standards.
2. A policy to
				supplement Medicare or a certificate issued for delivery in this State before
				July 16, 1992, must not:
(a) Deny a claim for
				losses incurred more than 6 months after the effective date of coverage for a
				preexisting condition.
(b) Define a
				preexisting condition more restrictively than as a condition for which medical
				advice was given or treatment was recommended by or received from a physician
				within 6 months before the effective date of coverage.
(c) Indemnify against any loss resulting from
				sickness on a different basis than for a loss resulting from an
				accident.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.226 - Minimum standards for coverage: Policy or certificate advertised, solicited, delivered, issued for delivery or renewed on or after July 16, 1992, and before July 30, 1992

Current through June 11, 2024
1. A policy or
				certificate must not be advertised, solicited, originally delivered or issued
				for delivery, or renewed in this State as a policy or certificate to supplement
				Medicare on or after July 16, 1992, and before July 30, 1992, if it fails to
				meet or exceed the minimum standards established by this section. These
				standards do not preclude the inclusion of other provisions or benefits that
				are not inconsistent with these standards.
2. A policy to supplement Medicare or a
				certificate originally delivered or issued for delivery, or renewed, in this
				State on or after July 16, 1992, and before July 30, 1992, must not:
(a) Exclude or limit benefits for losses
				incurred more than 6 months after the effective date of coverage because of a
				preexisting condition.
(b) Define a
				preexisting condition more restrictively than as a condition for which medical
				advice was given or treatment was recommended by or received from a physician
				within 6 months before the effective date of coverage.
(c) Indemnify against any loss resulting from
				sickness on a different basis than for a loss resulting from an
				accident.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.227 - Policy or certificate advertised, solicited, delivered or issued for delivery or renewed on or after July 30, 1992, and effective before June 1, 2010: General requirements

Current through June 11, 2024
1. A policy or
				certificate must not be advertised, solicited, originally delivered or issued
				for delivery, or renewed in this State as a policy or certificate to supplement
				Medicare on or after July 30, 1992, and with an effective date for coverage
				before June 1, 2010, if it fails to comply with the requirements set forth in
				this section.
2. A policy to
				supplement Medicare or a certificate originally delivered or issued for
				delivery, or renewed, in this State on or after July 30, 1992, and with an
				effective date for coverage before June 1, 2010, must not:
(a) Exclude or limit benefits for losses
				incurred more than 6 months after the effective date of coverage because of a
				preexisting condition.
(b) Define a
				preexisting condition more restrictively than as a condition for which medical
				advice was given or treatment recommended by or received from a physician
				during the 6 months immediately preceding the effective date of
				coverage.
(c) Indemnify against any
				loss resulting from sickness on a different basis than for a loss resulting
				from an accident.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2273 - Policy or certificate advertised, solicited, delivered or issued for delivery on or after June 1, 2010: General requirements

Current through June 11, 2024
1.
				Except as otherwise provided in section 6 of this regulation, on or after June
				1, 2010, no policy or certificate may be advertised, solicited, delivered or
				issued for delivery in this State as a policy to supplement Medicare or a
				certificate unless it complies with the standards provided for in NAC
				687B.322 and
				687B.323.
2. No issuer may offer any 1990 standardized
				benefit plan to supplement Medicare for sale on or after June 1,
				2010.
3. Benefit standards
				applicable to a policy to supplement Medicare or a certificate issued with an
				effective date for coverage before June 1, 2010, remain subject to the
				requirements of NAC
				687B.225,
				687B.226,
				687B.227,
				687B.290 and
				687B.295.
Added to NAC by Comm'r
				  of Insurance by R049-09, eff. 10-27-2009; A by
				  R041-17A,
				  eff. 6/26/2019
NRS
				  679B.130 and
				  687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.2275 - Prohibition on issuance or provision of certain policies, plans and benefits to persons newly eligible on or after January 1, 2020; general requirements for policy or certificate advertised, solicited, delivered or issued for delivery on or after January 1, 2020; issuance of High Deductible Plan G to certain persons

Current through June 11, 2024
1. An issuer shall
				not advertise, solicit, deliver or issue for delivery in this State to an
				individual who is newly eligible on or after January 1, 2020, a:
(a) Standardized Benefit Plan C;
(b) Standardized Benefit Plan F; or
(c) High Deductible Benefit Plan F.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.229 - Filing and approval of rates, rating schedule and supporting documentation required

Current through June 11, 2024
An issuer shall not use or change the premium rates for a
				  policy to supplement Medicare or a certificate unless the rates, rating
				  schedule and supporting documentation have been filed with and approved by the
				  Commissioner.
Added to NAC by Comm'r
				  of Insurance, 7-16-92, eff. 7-30-92
NRS
					 679B.130,
					 687B.430