Nevada Administrative Code

NAC 687B.265 Notice of modifications to policy or certificate; compliance with certain notice requirements. (NRS 679B.130, 687B.430) 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 …

NAC 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. (NRS 679B.130, 687B.430) 1. An insurer that delivers or issues for delivery in this State: (a) A…

NAC 687B.273 Standards of practice for marketing. (NRS 679B.130, 687B.430) 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 accu…

NAC 687B.275 Compensation of agents and other representatives and producers. (NRS 679B.130, 687B.430) 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 o…

NAC 687B.280 Review of proposed advertising. (NRS 679B.130, 687B.430) 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 …

NAC 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. (NRS 679B.130, 687B.430) 1. If an agent recommends the purchase or replacement of any policy to supplement…

NAC 687B.283 Annual reporting of multiple policies or certificates. (NRS 679B.130, 687B.430) 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 h…

NAC 687B.286 Compliance with certain provisions of Social Security Act regarding notice and payment of claims. (NRS 679B.130, 687B.430) 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…

NAC 687B.288 Open enrollment period: Compliance with requirements relating to compensation of agents and other representatives and producers and recommendations for purchase or replacement of Medicare supplemental policy; list of available policies; prohibition against re-enrollm…

NAC 687B.290 Availability; minimum benefits. (NRS 679B.130, 687B.430) 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…

NAC 687B.295 General requirements. (NRS 679B.130, 687B.430) 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 cove…

NAC 687B.300 Standardized Benefit Plan A. (NRS 679B.130, 687B.430) 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, e…

NAC 687B.302 Standardized Benefit Plan B. (NRS 679B.130, 687B.430) 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 …

NAC 687B.304 Standardized Benefit Plan C. (NRS 679B.130, 687B.430) 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 …

NAC 687B.306 Standardized Benefit Plan D. (NRS 679B.130, 687B.430) 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 …

NAC 687B.308 Standardized Benefit Plan E. (NRS 679B.130, 687B.430) 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 …

NAC 687B.311 Standardized Benefit Plan F or High Deductible Benefit Plan F. (NRS 679B.130, 687B.430) 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…

NAC 687B.313 Standardized Benefit Plan G. (NRS 679B.130, 687B.430) 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 …

NAC 687B.315 Standardized Benefit Plan H. (NRS 679B.130, 687B.430) 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 …

NAC 687B.317 Standardized Benefit Plan I. (NRS 679B.130, 687B.430) 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 …

NAC 687B.319 Standardized Benefit Plan J or High Deductible Benefit Plan J. (NRS 679B.130, 687B.430) 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…

NAC 687B.320 Standardized Benefit Plan K. (NRS 679B.130, 687B.430) 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 …

NAC 687B.321 Standardized Benefit Plan L. (NRS 679B.130, 687B.430) 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 …

NAC 687B.322 Standards for policies to supplement Medicare or certificates effective on or after June 1, 2010. (NRS 679B.130, 687B.430) 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 N…

NAC 687B.323 Requirements regarding policies to supplement Medicare or certificates effective on or after June 1, 2010. (NRS 679B.130, 687B.430) 1. In addition to the standards set forth in NAC 687B.322, the standards provided for in this section are: (a) Except as otherwise prov…

NAC 687B.324 Standards for 2020 standardized benefit plan. (NRS 679B.130, 687B.430) 1. The standards set forth in this section are applicable to every 2020 standardized benefit plan to supplement Medicare. 2. Except as otherwise provided in subsection 3, a 2020 standardized benef…

NAC 687B.325 Coverage for short-term services provided to person recovering at home. (NRS 679B.130, 687B.430) 1. For a 1990 standardized benefit plan, coverage for short-term services provided to a person recovering from an illness, injury or surgery in his or her home must compl…

NAC 687B.330 Provision of new or innovative benefits. (NRS 679B.130, 687B.430) 1. An issuer may, with the prior approval of the Commissioner, offer a policy to supplement Medicare or a certificate with new or innovative benefits in addition to the benefits required by NAC 687B.29…

NAC 687B.340 Definitions. (NRS 679B.130, 687B.430) As used in NAC 687B.340 to 687B.376, inclusive, unless the context otherwise requires, the words and terms defined in NAC 687B.342 to 687B.354, inclusive, have the meanings ascribed to them in those sections. (Added to NAC by Com…

NAC 687B.342 “Complaint” defined. (NRS 679B.130, 687B.430) “Complaint” means any dissatisfaction with a Medicare select issuer or a network provider expressed by a holder of a Medicare select policy or certificate. (Added to NAC by Comm’r of Insurance, eff. 5-13-96)

NAC 687B.344 “Grievance” defined. (NRS 679B.130, 687B.430) “Grievance” means any dissatisfaction with the administration, claims practices or provision of services of a Medicare select issuer or a network provider that is expressed in writing by a holder of a Medicare select poli…

NAC 687B.346 “Medicare select issuer” defined. (NRS 679B.130, 687B.430) “Medicare select issuer” means an issuer who is offering or seeking to offer a Medicare select policy or certificate. (Added to NAC by Comm’r of Insurance, eff. 5-13-96)

NAC 687B.348 “Medicare select policy” and “Medicare select certificate” defined. (NRS 679B.130, 687B.430) “Medicare select policy” or “Medicare select certificate” means a policy or certificate to supplement Medicare that contains a provision for a restricted network. (Added to N…

NAC 687B.350 “Network provider” defined. (NRS 679B.130, 687B.430) “Network provider” means a provider of health care or a group of providers of health care that has entered into a written agreement with a Medicare select issuer to provide benefits insured under a Medicare select …

NAC 687B.352 “Provision for a restricted network” defined. (NRS 679B.130, 687B.430) “Provision for a restricted network” means a provision of a policy or certificate to supplement Medicare that conditions the payment of benefits, in whole or in part, on the use of network provide…

NAC 687B.354 “Service area” defined. (NRS 679B.130, 687B.430) “Service area” means the geographic area approved by the Commissioner within which a Medicare select issuer is authorized to offer a Medicare select policy. (Added to NAC by Comm’r of Insurance, eff. 5-13-96)

NAC 687B.356 Compliance with regulations required before advertising. (NRS 679B.130, 687B.430) No policy or certificate may be advertised as a Medicare select policy or certificate unless it meets the requirements of NAC 687B.200 to 687B.376. (Added to NAC by Comm’r of Insurance,…

NAC 687B.358 Authorization to offer and approval to issue. (NRS 679B.130, 687B.430) 1. The Commissioner may authorize an issuer to offer a Medicare select policy or certificate, pursuant to NAC 687B.340 to 687B.376, inclusive, and section 4358 of the Omnibus Budget Reconciliation…

NAC 687B.360 Filing and contents of proposed plan of operation. (NRS 679B.130, 687B.430) A Medicare select issuer shall file a proposed plan of operation with the Commissioner which must include: 1. Evidence that all services covered under the policy that are subject to a provisi…

NAC 687B.362 Proposed changes to plan of operation; update of list of network providers. (NRS 679B.130, 687B.430) 1. A Medicare select issuer shall file any proposed changes to the plan of operation, other than changes to the list of network providers, with the Commissioner befor…

NAC 687B.364 Payment for covered services provided by persons other than network providers. (NRS 679B.130, 687B.430) A Medicare select policy or certificate must not restrict payment for services covered under the policy that are provided by persons other than network providers i…

NAC 687B.366 Full payment required for covered services not available through network provider. (NRS 679B.130, 687B.430) A Medicare select policy or certificate must provide full payment for services covered under the policy that are not available through a network provider. (Add…

NAC 687B.368 Written disclosure of provisions, restrictions and limitations. (NRS 679B.130, 687B.430) 1. A Medicare select issuer shall disclose in writing the provisions, restrictions and limitations of the Medicare select policy or certificate to each applicant. The disclosure …

NAC 687B.370 Procedures for hearing complaints and resolving grievances; annual report regarding grievance procedure. (NRS 679B.130, 687B.430) 1. A Medicare select issuer shall have written procedures for hearing complaints and resolving written grievances made by policyholders a…

NAC 687B.372 Availability of certain policies and certificates offered by Medicare select issuer. (NRS 679B.130, 687B.430) 1. A Medicare select issuer shall offer to each applicant for a Medicare select policy or certificate, at the time of initial purchase, the opportunity to pu…

NAC 687B.374 Provision for continuation of coverage; availability of policies to supplement Medicare as continuation of coverage. (NRS 679B.130, 687B.430) 1. Medicare select policies and certificates must provide for continuation of coverage in the event the Secretary of Health a…

NAC 687B.376 Compliance with requests for data for evaluation of Medicare select program. (NRS 679B.130, 687B.430) A Medicare select issuer shall comply with reasonable requests for data made by state or federal agencies, including the United States Department of Health and Human…