reglab/statecodes huggingface dataset:
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.230 - Rates: Standards for ratios of loss; filing requirements; adjustments; hearing on certain requested increases

Current through June 11, 2024
1. A policy to
				supplement Medicare or a certificate must not be delivered or issued for
				delivery in this State unless the policy form or certificate form can be
				expected, as estimated for the entire period for which rates are computed to
				provide coverage, to return to the policyholder or certificate holder the
				following amounts in the form of aggregate benefits provided under the policy,
				not including anticipated refunds or credits:
(a) In the case of a group policy, at least
				75 percent of the aggregate amount of premiums earned.
(b) In the case of an individual policy, at
				least 65 percent of the aggregate amount of premiums earned. For the purposes
				of this paragraph, a policy issued as a result of any solicitation made by mail
				or by advertising using the mass media, including any written or broadcasted
				advertisement, shall be deemed to be an individual policy.
The aggregate benefits must be calculated on the basis of
				  incurred claims experience or incurred expenses for health care if coverage is
				  provided by a health maintenance organization on the basis of payments made to
				  the provider of health care rather than reimbursements made to the insured, and
				  must be calculated in accordance with accepted actuarial principles and
				  practices. Incurred health care expenses where coverage is provided by a health
				  maintenance organization must not include:
(1) Home office and overhead costs;
(2) Advertising costs;
(3) Commissions and other acquisition
				costs;
(4) Taxes;
(5) Capital costs;
(6) Administrative costs; and
(7) Claims processing costs.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.235 - Calculation and payment of refunds and credits

Current through June 11, 2024
1. An
				issuer shall collect and file with the Commissioner by May 31 of each year the
				data contained in the reporting form prescribed by the Commissioner for each
				type of policy in a standardized benefit plan to supplement Medicare. The
				appropriate reporting form may be obtained from the Office of the
				Commissioner.
2. If, on the basis
				of the experience reported, the loss ratio since inception, commonly referred
				to as ratio 1, exceeds the loss ratio adjusted for experience incurred since
				inception, commonly referred to as ratio 3, a refund or credit must be
				calculated. The refund must be calculated on a statewide basis for each type of
				policy in a standardized benefit plan to supplement Medicare. To calculate the
				refund or credit, experience incurred for:
(a)
				Policies to supplement Medicare issued within the reporting year must be
				excluded.
(b) All policy forms and
				certificate forms of the same type in a standardized benefit plan to supplement
				Medicare must be combined.
(c) A
				policy form or certificate form assumed pursuant to an agreement to assume
				reinsurance must not be combined with the experience incurred for other
				forms.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.240 - Provision for renewal or continuation; acceptance of riders and endorsements; prohibited standards for payment of benefits; disclosure and dissemination of information

Current through June 11, 2024
1. Each policy to
				supplement Medicare or certificate must include a renewal or continuation
				provision. The language or specifications of the provision must be consistent
				with the type of contract issued. The provision must:
(a) Be captioned appropriately;
(b) Appear on the first page of the
				policy;
(c) Include any reservation
				by the issuer to change premiums; and
(d) Include any automatic increases in
				premiums at the time of renewal which are based on the age of the
				policyholder.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.243 - Lapse of policy to supplement Medicare or certificate for nonpayment of premium: Notice required before termination of policy or certificate

Current through June 11, 2024
1. An issuer may not terminate a policy to
				supplement Medicare or certificate advertised, solicited or issued for delivery
				in this State based on the lack of payment of the premium on or before the date
				the premium is required to be paid, unless the insured and each person
				designated by the insured pursuant to NAC 687B.245 has received a notice sent
				by the issuer stating that the policy has lapsed and may be terminated for
				nonpayment of the premium.
2. For
				the purposes of this section, the notice:
(a)
				Must be sent by first-class mail, postage prepaid, and addressed to the person
				at his or her last known address.
(b) Shall be deemed to have been received by
				the insured or the person designated by the insured pursuant to NAC 687B.245 on
				the fifth day after the date on which the issuer mails the notice.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.245 - Lapse of policy to supplement Medicare or certificate for nonpayment of premium: Designation of person to receive notice of lapse or waiver of designation

Current through June 11, 2024
1. An issuer shall
				not issue a policy to supplement Medicare or certificate advertised, solicited
				or issued for delivery in this State until the issuer has received from the
				applicant a designation of one or more persons to receive notice of lapse or a
				waiver pursuant to subsection 2.
2.
				Each applicant shall submit to the issuer of the policy to supplement Medicare
				or the certificate:
(a) A written designation
				of one or more persons other than the applicant to receive notice from the
				issuer that the policy to supplement Medicare or the certificate has lapsed and
				may be terminated for nonpayment of a premium; or
(b) A written waiver which is dated and
				signed by the applicant and which:
(1)
				Indicates that the applicant does not wish to designate any person other than
				the applicant to receive notice that the policy to supplement Medicare or the
				certificate has lapsed and may be terminated for nonpayment of a premium;
				and
(2) Includes the statement
				required pursuant to subsection 4.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.247 - Lapse of policy to supplement Medicare or certificate for nonpayment of premium: Provision for reinstatement of coverage

Current through June 11, 2024
A policy to supplement Medicare or certificate advertised,
				  solicited or issued for delivery in this State must include a provision which
				  provides that, in the event of a lapse in coverage of the policy or certificate
				  for nonpayment of a premium, coverage will be reinstated if:
1. Reinstatement is requested within 2 months
				after the date of lapse of coverage; and
2. Proof of cognitive impairment or loss of
				functional capacity of the insured before the lapse of coverage or the
				expiration of any grace period contained in the policy to supplement Medicare
				or the certificate is provided to the issuer.
Added to NAC by Comm'r
				  of Insurance by R027-04, eff. 8-2-2004
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.250 - Outline of coverage; assistance in understanding health insurance

Current through June 11, 2024
1. Each issuer shall provide an outline of
				coverage to each applicant at the time the application is presented to the
				applicant and, except in the case of a direct response policy, shall obtain an
				acknowledgment from the applicant that he or she has received the
				outline.
2. If an outline of
				coverage is provided at the time of application and the policy to supplement
				Medicare or the certificate is issued on a basis that would require revision of
				the outline, a substitute outline of coverage properly describing the policy or
				certificate must accompany the policy or certificate when it is delivered. The
				substitute outline must contain the following statement, in not less than
				12-point type, immediately above the name of the company:
NOTICE: Read this outline of coverage carefully. It is not
				  identical to the outline of coverage provided upon application, and the
				  coverage originally applied for has not been issued.
3. The outline of coverage provided to the
				applicant must consist of:
(a) A cover
				page;
(b) Information regarding
				premiums;
(c) Disclosure pages;
				and
(d) Charts displaying the
				features of each benefit plan offered by the issuer as set forth in subsection
				7.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.258 - Replacement of existing coverage: Limitations on time periods for preexisting conditions, waiting periods, elimination periods and probationary periods

Current through June 11, 2024
1. If a policy to supplement Medicare or a
				certificate replaces another policy to supplement Medicare or certificate, the
				replacing issuer shall waive any time periods for preexisting conditions,
				waiting periods, elimination periods and probationary periods in the new policy
				or certificate for similar benefits to the extent that such time was spent
				under the original policy.
2. If a
				policy to supplement Medicare or a certificate replaces another policy to
				supplement Medicare or certificate which has been in effect for at least 6
				months, the replacing policy or certificate must not provide any time period
				for preexisting conditions, waiting periods, elimination periods or
				probationary periods for benefits similar to those contained in the original
				policy or certificate.
Added to NAC by Comm'r
				  of Insurance, eff. 11-16-90; A 7-16-92, eff.
				  7-30-92
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.260 - Policy to supplement Medicare or certificate issued before January 1, 1992: Replacement with standardized benefit plan

Current through June 11, 2024
1. Except as
				otherwise provided in subsection 2, an issuer shall, at the request of an
				insured, replace a policy to supplement Medicare which was issued before
				January 1, 1992, or a certificate which was issued before January 1, 1992, with
				any standardized benefit plan offered by the issuer. An insured may submit a
				request to replace a policy to supplement Medicare or certificate pursuant to
				this subsection not more than once.
2. An issuer may refuse a request made
				pursuant to subsection 1 for the issuance of a standardized benefit plan to
				replace a policy to supplement Medicare or certificate which was issued before
				January 1, 1992, if:
(a) The standardized
				benefit plan includes coverage for prescription drugs; or
(b) The insured does not otherwise qualify
				for the standardized benefit plan.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.263 - Termination and replacement of coverage under group policy

Current through June 11, 2024
1. If a group policy to supplement Medicare
				or a certificate is terminated by the group policyholder or certificate holder
				and is not replaced as provided in subsection 3, the issuer shall offer each
				certificate holder an individual policy to supplement Medicare or a
				certificate. The issuer shall offer the certificate holder an individual policy
				that provides for the continuation of the benefits contained in the group
				policy.
2. If a certificate holder
				is provided coverage under a group policy to supplement Medicare or a
				certificate and the certificate holder terminates his or her membership in the
				group, the issuer shall:
(a) Offer the
				certificate holder an individual policy to supplement Medicare pursuant to
				subsection 1; or
(b) At the request
				of the group policyholder, continue coverage for the certificate holder under
				the group policy to supplement Medicare.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.265 - Notice of modifications to policy or certificate; compliance with certain notice requirements

Current through June 11, 2024
1. As soon as
				practicable, but not later than 30 days before the annual effective date of any
				changes in Medicare benefits, an issuer shall notify each policyholder and
				certificate holder of any modifications it has made to the policy to supplement
				Medicare or the certificate. The notice must:
(a) Include a description of any revisions to
				the Medicare program and a description of each modification made to the
				coverage provided under the policy or certificate.
(b) Inform each policyholder or certificate
				holder of the date on which any adjustment of premiums is to be made because of
				changes in Medicare.
(c) Be in
				outline form and in clear and simple terms so as to facilitate
				comprehension.
(d) Be in a format
				which is acceptable to the Commissioner.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.269 - Notice required that certain policies of insurance are not supplementary to Medicare; disclosure of extent to which policy or certificate duplicates coverage of Medicare

Current through June 11, 2024
1. An insurer that
				delivers or issues for delivery in this State:
(a) An insurance policy that provides
				coverage for accidents or sickness, including a policy to provide income in
				case of a disability, other than a policy to supplement Medicare;
(b) A policy of insurance issued pursuant to
				a contract under section 1876 of the Social Security Act,
				42 U.S.C. §§
											1395 et seq.; or
(c) A policy of insurance identified in
				subsection 2 of NAC 687B.205,
to a person who is eligible for Medicare shall give notice to
				  the insureds under the policy that the policy is not a policy to supplement
				  Medicare.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.273 - Standards of practice for marketing

Current through June 11, 2024
1. An issuer,
				directly or through its producers, shall:
(a)
				Establish marketing procedures to ensure that any comparison of policies to
				supplement Medicare by its agents or other producers is fair and
				accurate.
(b) Establish marketing
				procedures to ensure that excessive insurance is not sold or issued.
(c) Establish marketing procedures which set
				forth a mechanism or formula for determining whether a replacement policy or
				certificate contains benefits clearly and substantially greater than the
				benefits under the replaced policy.
(d) Display prominently by type, stamp or
				other appropriate means, on the first page of the policy to supplement Medicare
				the following notice:
"Notice to buyer: This policy may not cover all of your
				  medical expenses."
(e)
				Inquire and otherwise make every reasonable effort to determine whether a
				prospective applicant or person enrolled for a policy to supplement Medicare
				has accident and sickness insurance and identify the types and amounts of any
				such insurance.
(f) Establish
				procedures that may be audited for verifying compliance with this
				section.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.275 - Compensation of agents and other representatives and producers

Current through June 11, 2024
1. An issuer or other entity may provide a
				commission or other compensation to an agent or other representative for the
				sale of a policy to supplement Medicare or a certificate only if the commission
				or other compensation for the first year is no more than 200 percent of the
				commission or other compensation paid for selling or servicing the policy or
				certificate in the second year or period.
2. The commission or other compensation
				provided in a subsequent renewal year must be:
(a) The same as that provided in the second
				year or period; and
(b) Provided
				for not less than 5 renewal years.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.280 - Review of proposed advertising

Current through June 11, 2024
Each issuer shall furnish the Division, for its review, with
				  a copy of any advertisement for a policy to supplement Medicare which is
				  intended for use in this State, including any written, radio, television or
				  newspaper advertisement.
Added to NAC by Comm'r
				  of Insurance, 2-21-89, eff. 3-15-89; A 5-27-92; 7-16-92, eff.
				  7-30-92
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › General Provisions › Section 687B.282 - Recommendations for purchase or replacement; sale of multiple policies or certificates; issuance of policy or certificate to person enrolled in Medicare Part C

Current through June 11, 2024
1. If an agent
				recommends the purchase or replacement of any policy to supplement Medicare or
				certificate, the agent shall make reasonable efforts to determine the
				appropriateness of the recommended purchase or replacement.
2. Any sale of a policy to supplement
				Medicare or a certificate that provides a person with more than one policy to
				supplement Medicare or certificate is prohibited.
3. An issuer shall not issue a policy to
				supplement Medicare or certificate to a person enrolled in Medicare Part C
				unless the effective date of the coverage is after the termination date of the
				person's Part C coverage.
Added to NAC by Comm'r
				  of Insurance, eff. 11-16-90; A 7-16-92, eff. 7-30-92; 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.283 - Reporting of multiple policies or certificates

Current through June 11, 2024
1. On or
				before May 31 of each year, an issuer shall report the number of the policy,
				the certificate number and the date of issuance for each resident of this State
				for whom the issuer has in force more than one policy to supplement Medicare or
				certificate. The report must include all this information for each individual
				policyholder in a format prescribed by the Commissioner.
2. The provisions of this section apply to an
				issuer of a policy to supplement Medicare delivered or issued for delivery in
				this State, regardless of the date the policy was delivered or issued for
				delivery.
Added to NAC by Comm'r
				  of Insurance, eff. 11-16-90; A 7-16-92, eff. 7-30-92; 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 › General Provisions › Section 687B.286 - Compliance with certain provisions of Social Security Act regarding notice and payment of claims

Current through June 11, 2024
1. An issuer shall
				comply with the provisions of section 1882(c)(3) of the Social Security Act,
				42 U.S.C. §§
										1395 et seq., as enacted by section
				4081(b)(2)(c) of the Omnibus Budget Reconciliation Act of 1987, Public Law No.
				100-203, by:
(a) Accepting a notice from a
				Medicare carrier on an assigned claim submitted by a participating physician or
				supplier as a claim for benefits in lieu of any other claim form otherwise
				required;
(b) Making a
				determination for payment on the basis of the information contained in that
				notice;
(c) Notifying the
				participating physician or supplier and the beneficiary of the determination
				for payment;
(d) Paying the
				participating physician or supplier directly;
(e) Furnishing each enrollee, at the time of
				enrollment, with a card listing the name and number of the policy and a central
				mailing address to which notices from a Medicare carrier may be sent;
(f) Paying the user fees for claim notices
				that are transmitted electronically or otherwise; and
(g) Providing to the Secretary of Health and
				Human Services, at least annually, a central mailing address to which all
				claims may be sent by Medicare carriers.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.290 - Availability; minimum benefits

Current through June 11, 2024
1. An issuer who
				delivers or issues for delivery in this State a policy to supplement Medicare
				or a certificate on or after July 30, 1992, and with an effective date for
				coverage before June 1, 2010, shall make available to each prospective insured
				a policy or certificate that provides only the following benefits:
(a) Coverage of Medicare Part A eligible
				expenses for hospitalization to the extent they are not covered by Medicare
				from the 61st day through the 90th day in any Medicare benefit
				period.
(b) Coverage of Medicare
				Part A eligible expenses incurred for hospitalization to the extent they are
				not covered by Medicare for each Medicare lifetime inpatient reserve day
				used.
(c) Upon exhaustion of the
				Medicare hospital inpatient coverage, including the lifetime reserve days,
				coverage of 100 percent of the Medicare Part A eligible expenses for
				hospitalization paid at the applicable prospective payment system (PPS) rate,
				or other appropriate Medicare standard of payment, subject to a lifetime
				maximum benefit of an additional 365 days.
(d) Plans A to J, inclusive, provide coverage
				under Medicare Parts A and B for the reasonable cost of the first 3 pints of
				blood, or an equivalent quantity of packed red blood cells, as defined by
				federal regulations, unless replaced in accordance with federal regulations.
				Plans K and L provide for 50 percent and 75 percent, respectively, of the
				reasonable cost for the first 3 pints of blood.
(e) Coverage for the coinsurance amount of
				Medicare eligible expenses under Part B regardless of confinement in a
				hospital, subject to the Medicare Part B deductible.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.295 - General requirements

Current through June 11, 2024
1. Except as
				otherwise provided in NAC 687B.330, a standardized benefit plan to supplement
				Medicare may not be delivered or issued for delivery in this State on or after
				July 30, 1992, and with an effective date for coverage before June 1, 2010,
				unless it complies with the provisions of NAC 687B.300 to 687B.323,
				inclusive.
2. Except as otherwise
				provided in subsection 4, a 1990 standardized benefit plan must:
(a) Have the same style, arrangement, overall
				content and designation as the 1990 standardized benefit plans set forth in NAC
				687B.300 to 687B.323, inclusive.
(b) Conform to the definitions set forth in
				NAC 687B.2002 to 687B.2045, inclusive.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.300 - Standardized Benefit Plan A

Current through June 11, 2024
A 1990 standardized benefit plan to supplement Medicare which
				  is designated as Standardized Benefit Plan A must be limited to the benefits
				  required by NAC 687B.290.
Added to NAC by Comm'r
				  of Insurance, 7-16-92, eff. 7-30-92; A by R049-09,
				  10-27-2009
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.302 - Standardized Benefit Plan B

Current through June 11, 2024
A 1990 standardized benefit plan to supplement Medicare which
				  is designated as Standardized Benefit Plan B must provide the following
				  benefits:
1. The benefits required by
				NAC 687B.290.
2. Coverage for all
				of the Medicare Part A inpatient hospital deductible amount per benefit
				period.
Added to NAC by Comm'r
				  of Insurance, 7-16-92, eff. 7-30-92; A by R049-09,
				  10-27-2009
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.304 - Standardized Benefit Plan C

Current through June 11, 2024
A 1990 standardized benefit plan to supplement Medicare which
				  is designated as Standardized Benefit Plan C must provide the following
				  benefits:
1. The benefits required by
				NAC 687B.290.
2. Coverage for all
				of the Medicare Part A inpatient hospital deductible amount per benefit
				period.
3. 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.
4. Coverage for all of the Medicare Part B
				deductible amount per calendar year, regardless of whether the insured has been
				confined in a hospital.
5. 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 subsection, "emergency care" means medical
				care needed immediately because of a sudden and unexpected injury or
				illness.
Added to NAC by Comm'r
				  of Insurance, 7-16-92, eff. 7-30-92; A by R049-09,
				  10-27-2009
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.306 - Standardized Benefit Plan D

Current through June 11, 2024
A 1990 standardized benefit plan to supplement Medicare which
				  is designated as Standardized Benefit Plan D must provide the following
				  benefits:
1. The benefits required by
				NAC 687B.290.
2. Coverage for all
				of the Medicare Part A inpatient hospital deductible amount per benefit
				period.
3. 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.
4. 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
				subsection, "emergency care" means medical care needed immediately because of a
				sudden and unexpected injury or illness.
5. 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.
Added to NAC by Comm'r
				  of Insurance, 7-16-92, eff. 7-30-92; A by R049-09,
				  10-27-2009
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.308 - Standardized Benefit Plan E

Current through June 11, 2024
A 1990 standardized benefit plan to supplement Medicare which
				  is designated as Standardized Benefit Plan E must provide the following
				  benefits:
1. The benefits required by
				NAC 687B.290.
2. Coverage for all
				of the Medicare Part A inpatient hospital deductible amount per benefit
				period.
3. 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.
4. 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
				subsection, "emergency care" means medical care needed immediately because of a
				sudden and unexpected injury or illness.
5. 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, and to the extent not covered by Medicare:
(a) An annual clinical medical history and
				physical examination that may include the tests and services set forth in
				paragraph (b) and educational services that address measures to be taken for
				preventative health care.
(b)
				Preventive screening tests or preventive services, the selection and frequency
				of which is determined to be medically appropriate by the attending
				physician.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.311 - Standardized Benefit Plan F or High Deductible Benefit Plan F

Current through June 11, 2024
1. A 1990 standardized benefit plan to
				supplement Medicare which is designated as Standardized Benefit Plan F or High
				Deductible Benefit Plan F 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) 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.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.313 - Standardized Benefit Plan G

Current through June 11, 2024
A 1990 standardized benefit plan to supplement Medicare which
				  is designated as Standardized Benefit Plan G must provide the following
				  benefits:
1. The benefits required by
				NAC 687B.290.
2. Coverage for all
				of the Medicare Part A inpatient hospital deductible amount per benefit
				period.
3. 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.
4. Coverage for 80 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.
5.
				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 subsection, "emergency care" means medical
				care needed immediately because of a sudden and unexpected injury or
				illness.
6. 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.
Added to NAC by Comm'r
				  of Insurance, 7-16-92, eff. 7-30-92; A by R049-09,
				  10-27-2009
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.315 - Standardized Benefit Plan H

Current through June 11, 2024
A 1990 standardized benefit plan to supplement Medicare which
				  is designated as Standardized Benefit Plan H must provide the following
				  benefits:
1. The benefits required by
				NAC 687B.290.
2. Coverage for all
				of the Medicare Part A inpatient hospital deductible amount per benefit
				period.
3. 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.
4. For plans sold or issued before January 1,
				2006, as a basic 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 $1,250 in benefits received by the
				insured per calendar year, and to the extent not covered by Medicare. This
				subsection only applies to those persons currently covered by Plan H and who do
				not apply for Medicare Part D.
5.
				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 subsection, "emergency care" means medical
				care needed immediately because of a sudden and unexpected injury or
				illness.
Added to NAC by Comm'r
				  of Insurance, 7-16-92, eff. 7-30-92; 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
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.317 - Standardized Benefit Plan I

Current through June 11, 2024
A 1990 standardized benefit plan to supplement Medicare which
				  is designated as Standardized Benefit Plan I must provide the following
				  benefits:
1. The benefits required by
				NAC 687B.290.
2. Coverage for all
				of the Medicare Part A inpatient hospital deductible amount per benefit
				period.
3. 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.
4. 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.
5.
				For plans sold or issued before January 1, 2006, as a basic 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 $1,250 in benefits received by the insured per calendar year, to the
				extent not covered by Medicare. This subsection only applies to those persons
				currently covered by Plan I and who do not apply for Medicare Part D.
6. 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
				subsection, "emergency care" means medical care needed immediately because of a
				sudden and unexpected injury or illness.
7. 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.
Added to NAC by Comm'r
				  of Insurance, 7-16-92, eff. 7-30-92; 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
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.320 - Standardized Benefit Plan K

Current through June 11, 2024
A 1990 standardized benefit plan to supplement Medicare which
				  is designated as Standardized Benefit Plan K must provide the following
				  benefits:
1. The benefits required by
				NAC 687B.290.
2. Coverage for 50
				percent of the Medicare Part A inpatient hospital deductible amount per benefit
				period until the out-of-pocket limitation is met as described in subsection
				8.
3. Coverage for 50 percent of
				the coinsurance amount for each day used from the 21st day through the 100th
				day in a Medicare benefit period for posthospital skilled nursing facility care
				eligible under Medicare Part A until the out-of-pocket limitation is met as
				described in subsection 8.
4.
				Coverage for 50 percent of cost sharing for all Medicare Part A eligible
				expenses and respite care until the out-of-pocket limitation is met as
				described in subsection 8.
5.
				Coverage for 50 percent, under Medicare Part A or B, of the reasonable cost of
				the first 3 pints of blood, or equivalent quantities of packed red blood cells,
				as defined under federal regulations, unless replaced in accordance with
				federal regulations, until the out-of-pocket limitation is met as described in
				subsection 8.
6. Except for
				coverage provided in subsection 8, coverage for 50 percent of the cost sharing
				otherwise applicable under Medicare Part B after the policyholder pays the Part
				B deductible until the out-of-pocket limitation is met as described in
				subsection 8.
7. Coverage of 100
				percent of the cost sharing for Medicare Part B preventive services after the
				policyholder pays the Part B deductible.
8. Coverage of 100 percent of all cost
				sharing under Medicare Parts A and B for the balance of the calendar year after
				the person has reached the out-of-pocket limitation on annual expenditures
				under Medicare Parts A and B of $4,000 in 2006, indexed each year by the
				appropriate inflation adjustment specified by the Secretary of Health and Human
				Services.
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; A by Comm'r of Insurance by
				  R049-09, 10-27-2009
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.321 - Standardized Benefit Plan L

Current through June 11, 2024
A 1990 standardized benefit plan to supplement Medicare which
				  is designated as Standardized Benefit Plan L must provide the following
				  benefits:
1. The benefits required by
				NAC 687B.290.
2. Coverage for 75
				percent of the Medicare Part A inpatient hospital deductible amount per benefit
				period until the out-of-pocket limitation is met as described in subsection
				8.
3. Coverage for 75 percent of
				the coinsurance amount for each day used from the 21st day through the 100th
				day in a Medicare benefit period for posthospital skilled nursing facility care
				eligible under Medicare Part A until the out-of-pocket limitation is met as
				described in subsection 8.
4.
				Coverage for 75 percent of cost sharing for all Medicare Part A eligible
				expenses and respite care until the out-of-pocket limitation is met as
				described in subsection 8.
5.
				Coverage for 75 percent, under Medicare Part A or B, of the reasonable cost of
				the first 3 pints of blood, or equivalent quantities of packed red blood cells,
				as defined under federal regulations, unless replaced in accordance with
				federal regulations, until the out-of-pocket limitation is met as described in
				subsection 8.
6. Except for
				coverage provided in subsection 8, coverage for 75 percent of the cost sharing
				otherwise applicable under Medicare Part B after the policyholder pays the Part
				B deductible until the out-of-pocket limitation is met as described in
				subsection 8.
7. Coverage of 100
				percent of the cost sharing for Medicare Part B preventive services after the
				policyholder pays the Part B deductible.
8. Coverage of 100 percent of all cost
				sharing under Medicare Parts A and B for the balance of the calendar year after
				the person has reached the out-of-pocket limitation on annual expenditures
				under Medicare Parts A and B of $2,000 in 2006, indexed each year by the
				appropriate inflation adjustment specified by the Secretary of Health and Human
				Services.
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; A by Comm'r of Insurance by
				  R049-09, 10-27-2009
NRS
					 679B.130,
					 687B.430
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.322 - Standards for policies to supplement Medicare or certificates effective on or after June 1, 2010

Current through June 11, 2024
1. In addition to
				the standards set forth in NAC
				687B.323, the standards provided
				for in this section are:
(a) Except as
				otherwise provided in section 6 of this regulation, applicable to all policies
				to supplement Medicare or certificates delivered or issued for delivery in this
				State with an effective date for coverage on or after June 1, 2010;
				and
(b) Not applicable to policies
				to supplement Medicare or certificates delivered or issued for delivery in this
				State with an effective date for coverage before June 1, 2010.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › POLICIES SUPPLEMENTARY TO MEDICARE › Standardized Benefit Plans › Section 687B.323 - Requirements regarding policies to supplement Medicare or certificates effective on or after June 1, 2010

Current through June 11, 2024
1. In addition to
				the standards set forth in NAC
				687B.322, the standards provided
				for in this section are:
(a) Except as
				otherwise provided in section 6 of this regulation, applicable to all policies
				to supplement Medicare or certificates delivered or issued for delivery in this
				State with an effective date for coverage on or after June 1, 2010;
				and
(b) Not applicable to policies
				to supplement Medicare or certificates delivered or issued for delivery in this
				State with an effective date for coverage before June 1, 2010.