Nevada Administrative Code

NAC 687B.2004 “2020 standardized benefit plan to supplement Medicare” defined. (NRS 679B.130, 687B.430) “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 …

NAC 687B.201 “Applicant” defined. (NRS 679B.130, 687B.430) “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 …

NAC 687B.2014 “Certificate” defined. (NRS 679B.130, 687B.430) “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)

NAC 687B.2015 “Creditable coverage” defined. (NRS 679B.130, 687B.430) “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 Dr…

NAC 687B.2018 “Eligible organization” defined. (NRS 679B.130, 687B.430) “Eligible organization” has the meaning ascribed to it in section 1876(b) of the Social Security Act, 42 U.S.C. § 1395mm(b). (Added to NAC by Comm’r of Insurance by R110-98, eff. 2-23-99)

NAC 687B.202 “Employee welfare benefit plan” defined. (NRS 679B.130, 687B.430) “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-…

NAC 687B.2024 “Issuer” defined. (NRS 679B.130, 687B.430) “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…

NAC 687B.2028 “Medicare” defined. (NRS 679B.130, 687B.430) “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…

NAC 687B.203 “Medicare Advantage organization” defined. (NRS 679B.130, 687B.430) “Medicare Advantage organization” has the meaning ascribed to it in section 1859(a)(1) of the Social Security Act, 42 U.S.C. § 1395w-28(a)(1). (Added to NAC by Comm’r of Insurance by R110-98, eff. 2-…

NAC 687B.2034 “Medicare Advantage plan” defined. (NRS 679B.130, 687B.430) “Medicare Advantage plan” means a plan of coverage for health benefits under Medicare Part C, as defined in 42 U.S.C. §§ 1395w-28(b)(1), and includes: 1. Coordinated care plans that provide health care serv…

NAC 687B.2036 “Medicare Part D” defined. (NRS 679B.130, 687B.430) “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…

NAC 687B.2037 “Medicare select issuer” defined. (NRS 679B.130, 687B.430) “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)

NAC 687B.2038 “Newly eligible on or after January 1, 2020” defined. (NRS 679B.130, 687B.430) “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…

NAC 687B.2039 “PACE program” defined. (NRS 679B.130, 687B.430) “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. § 1395eee. (Added to NAC by Comm’r of Insurance by R075-02, eff. 9-20-2…

NAC 687B.204 “Policy to supplement Medicare” defined. (NRS 679B.130, 687B.430) “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. § 13…

NAC 687B.2045 “Standardized benefit plan” defined. (NRS 679B.130, 687B.430) “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, a…

NAC 687B.205 Applicability of provisions. (NRS 679B.130, 687B.430) 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 J…

NAC 687B.2053 Eligible persons: Description; prohibited actions by insurers. (NRS 679B.130, 687B.430) 1. Eligible persons are those persons described in subsection 3 who seek to enroll under the policy during the period specified in NAC 687B.2056, and who submit evidence of the d…

NAC 687B.2054 Eligible persons: Subsequent enrollment deemed to be initial enrollment under certain circumstances. (NRS 679B.130, 687B.430) 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 subsec…

NAC 687B.2055 Eligible persons: Notification required upon occurrence of certain events. (NRS 679B.130, 687B.430) 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…

NAC 687B.2056 Guaranteed issue periods for eligible persons; special enrollment period. (NRS 679B.130, 687B.430) 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 rec…

NAC 687B.2057 Policies to supplement Medicare to which eligible persons are entitled. (NRS 679B.130, 687B.430) Except as otherwise provided in NAC 687B.324, the policy to supplement Medicare to which eligible persons are entitled: 1. Under paragraphs (a), (b), (c) and (d) of subs…

NAC 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. (NRS 679B.130, 687B.430) 1. A person is eligible…

NAC 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. (NRS 679B.130, 687B.430) 1. A person is eligi…

NAC 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. (NRS 679B.130, 687B.430) 1. A person is eligible for a polic…

NAC 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. (NRS 679B…

NAC 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. (NRS 679B.130, 687B.430) 1. If an application for a p…

NAC 687B.209 Termination of or disenrollment from plan, certificate or policy to supplement Medicare: Requirements for written notification. (NRS 679B.130, 687B.430) 1. Any time a plan, certificate or policy to supplement Medicare is terminated or a person disenrolls from a plan,…

NAC 687B.212 Filing and approval of policy forms and certificate forms. (NRS 679B.130, 687B.120, 687B.430) 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…

NAC 687B.213 Availability and discontinuance of policy forms and certificate forms. (NRS 679B.130, 687B.120, 687B.430) 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 …

NAC 687B.215 Definitions and terms used in policy or certificate. (NRS 679B.130, 687B.430) 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 sect…

NAC 687B.220 Exclusions from and limitations on coverage and benefits; duplication of benefits provided by Medicare; benefits for outpatient prescription drugs. (NRS 679B.130, 687B.430) 1. Except as otherwise provided in paragraphs (a) and (b) of subsection 2 of NAC 687B.226 and …

NAC 687B.223 Prohibitions regarding genetic information and genetic testing. (NRS 679B.130, 687B.430) 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 l…

NAC 687B.225 Minimum standards for coverage: Policy or certificate advertised, solicited or issued for delivery before July 16, 1992. (NRS 679B.130, 687B.430) 1. A policy of insurance or subscriber contract must not be advertised, solicited or issued for delivery in this State as…

NAC 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. (NRS 679B.130, 687B.430) 1. A policy or certificate must not be advertised, solicited, original…

NAC 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. (NRS 679B.130, 687B.430) 1. A policy or certificate must not be advertised, solicited, origina…

NAC 687B.2273 Policy or certificate advertised, solicited, delivered or issued for delivery on or after June 1, 2010: General requirements. (NRS 679B.130, 687B.430) 1. Except as otherwise provided in NAC 687B.324, on or after June 1, 2010, no policy or certificate may be advertis…

NAC 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; is…

NAC 687B.229 Filing and approval of rates, rating schedule and supporting documentation required. (NRS 679B.130, 687B.430) 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 doc…

NAC 687B.230 Rates: Calculation of aggregate benefits; standards for ratios of loss; filing requirements; adjustments; hearing on certain requested increases. (NRS 679B.130, 687B.120, 687B.430) 1. A policy to supplement Medicare or a certificate must not be delivered or issued fo…

NAC 687B.235 Calculation and payment of refunds and credits. (NRS 679B.130, 687B.430) 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…

NAC 687B.240 Provision for renewal or continuation; acceptance of riders and endorsements; prohibited standards for payment of benefits; disclosure and dissemination of information. (NRS 679B.130, 687B.430) 1. Each policy to supplement Medicare or certificate must include a renew…

NAC 687B.243 Lapse of policy to supplement Medicare or certificate for nonpayment of premium: Notice required before termination of policy or certificate. (NRS 679B.130, 687B.430) 1. An issuer may not terminate a policy to supplement Medicare or certificate advertised, solicited …

NAC 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. (NRS 679B.130, 687B.430) 1. An issuer shall not issue a policy to supplement Medicare or certificate advertised…

NAC 687B.247 Lapse of policy to supplement Medicare or certificate for nonpayment of premium: Provision for reinstatement of coverage. (NRS 679B.130, 687B.430) A policy to supplement Medicare or certificate advertised, solicited or issued for delivery in this State must include a…

NAC 687B.250 Outline of coverage; assistance in understanding health insurance. (NRS 679B.130, 687B.430) 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 po…

NAC 687B.255 Elicitation and dissemination of information regarding existing coverage and its replacement; inclusion of certain statements and questions in application. (NRS 679B.130, 687B.430) 1. An application for a policy to supplement Medicare must include questions designed …