Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.319 - Standardized Benefit Plan J or High Deductible Benefit Plan J

Current through June 11, 2024
1. A 1990 standardized benefit plan to
				supplement Medicare which is designated as Standardized Benefit Plan J or High
				Deductible Benefit Plan J must provide the following benefits:
(a) The benefits required by NAC
				687B.290.
(b) Coverage for all of
				the Medicare Part A inpatient hospital deductible amount per benefit
				period.
(c) For Medicare Part A
				eligible expenses for posthospital care received at a skilled nursing facility,
				coverage for the actual billed charges up to the coinsurance amount from the
				21st day through the 100th day in any Medicare benefit period.
(d) Coverage for all of the Medicare Part B
				deductible amount per calendar year, regardless of whether the insured has been
				confined in a hospital.
(e)
				Coverage for 100 percent of the Medicare Part B excess charge calculated by
				determining the difference between the actual Medicare Part B charge as billed,
				not to exceed any limitation on that charge established by the Medicare program
				or state law, and the Medicare Part B charge that has been approved.
(f) For plans sold or issued before January
				1, 2006, as an extended benefit, coverage is provided for 50 percent of the
				charges for prescription drugs received as an outpatient, after payment of a
				deductible of $250 per calendar year, not to exceed $3,000 in benefits received
				by the insured per calendar year, to the extent not covered by Medicare. This
				paragraph only applies to those persons currently covered by Plan J and who do
				not apply for Medicare Part D.
(g)
				Coverage of Medicare eligible expenses for 80 percent of the billed charges for
				medically necessary emergency care received in a foreign country to the extent
				not covered by Medicare, if such care would have been covered by Medicare if
				provided in the United States and the care began during the first 60
				consecutive days of the trip outside the United States. The benefit is subject
				to the payment of a deductible of $250 per calendar year and a lifetime maximum
				benefit of $50,000. As used in this paragraph, "emergency care" means medical
				care needed immediately because of a sudden and unexpected injury or
				illness.
(h) Coverage for the
				following preventative health services for the actual amount charged for each
				service not to exceed 100 percent of the amount approved by Medicare for that
				service, as identified in the American Medical Association's Current Procedural
				Terminology (AMA CPT) codes, not to exceed $120 per year, to the extent not
				covered by Medicare:
(1) An annual clinical
				medical history and physical examination that may include the tests and
				services set forth in subparagraph (2) and educational services that address
				measures to be taken for preventative health care.
(2) Preventive screening tests or preventive
				services, the selection and frequency of which is determined to be medically
				appropriate by the attending physician.
(i) Coverage for short-term services that
				provide to a person recovering from an illness, injury or surgery in his or her
				home, assistance with daily activities such as bathing, dressing, personal
				hygiene, eating, ambulating, administering prescription drugs and changing
				bandages and other dressings. The coverage must comply with the requirements of
				NAC 687B.325.