Nevada Rules and Regulations pertinent to Health Only 10% Flashcards
What type of coverage is required in individual and group health insurance that covers family members of the insured.
Newborn child from moment of birth
What is covered for newborn children in health insurance policies?
injury or sickness, including necessary care and treatment of medically diagnosed congenital birth defects and birth abnormalities
What is the time period an insured has to notify the insurance company of the birth of the a newborn including payment of the required premium for coverage to continue beyond period?
within 31 days after date of birth
The same regulation for newborn children also applies to whom?
adopted children, from time of adoption or child placed in home
All health insurance can continue to provide coverage for dependents of the insured beyond the attained age stated for termination of coverage under what circumstances?
1) incapable of self-sustaining employment due to a physical handicap or intellectual disability
2) Dependent of the policyholder for support and maintenance
What are the time limits that an insured has to provide proof to the insurers of child dependency beyond age limit?
within 31 days of reaching age limit
also as often as the insurer requires afterward, no more than once a year beginning 2 years after child reaches age limit
What are the benefits provided by health insurance policies for treatment of alcoholism or drug abuse must consist of?
1) treatment for withdrawal: up to $1,500 per calendar year
2) Inpatient treatment; up to $9,000 per calendar year
3) Counseling for a person, group or family not admitted to a facility; up to $2,500 per calendar year
How are the benefits paid in the Alcohol & Drug abuse coverage?
same manner as policy would pay for any other covered illness
An insurer or other organization providing this type of coverage must comply with the provisions of what act?
Mental Health Parity and Addiction Equity Act of 2008
All health insurance that cover mastectomies must also cover what?
cover prosthetic devices and reconstructive surgery
What happens to benefits if the reconstructive surgery after a mastectomy occurs within or after 3 years?
within 3 years- benefits must equal amount provided for in the policy at the time of the surgery
after 3 years- surgery benefits are subject to current policy terms, conditions, and exclusions
What is Hospice?
facility that provides short-term, continuous care in a home-like setting to terminally ill-people (and their families) with life expenctancies of 6 months or less
Does Hospice care coverage must be included in all health insurance policies in Nevada?
Yes
A policy or certificate may not be advertised, solicited, or issued for delivery in Nevada as a Medicare Supplement policy if it contains what?
limitations or exclusions on coverage that are more restrictive than those of Medicare
Medicare policies cannot do what?
limit or reduce coverage or benefits for specifically named or descried pre-existing disease or physical conditions, and must not contains benefits that duplicate the benefits provided by Medicare
What type of minimum standards are Medicare Supplement policies subject to, as established by the Revised Statues of the Nevada Insurance code?
Some parts of the same standards of Medicare Part A and Part B, as well as Plans K and L
** See chapter for the full list of standards to long to write
In Medicare supplemental policies, noncancellable, guaranteed renewable or noncancellable AND guaranteed renewable policies cannot what?
1) Provide for termination of coverage of a spouse solely because of the occurence of an event for termination of coverage of the insured (other than nonpayment of premiums)
2) Be cancelled or denied renewal by the insurer solely on the grounds of deterioration of health
Issuer cannot cancel or refuse supplement Medicare or a certificate for any other reason except what?
Nonpayment of premiums
Material representations
Each issuer in a Medicare supplemental must provide what, to each applicant at the time application is presented to the applicant?
Outline of coverage
What must the applicant do once they receive the outline of coverage in a Medicare supplement, except in a direct response policy?
applicant must provided an acknowledgment to the issuer
What is issued when the outline of coverage at time of app and policy to supplement Medicare or certificate is issued on basis that would require revision of outline?
issued a substitute outline of coverage properly describing the policy or certificate must accompany the policy or certificate when it is delivered
What statement is contained in the substitute outline is not less than 12-point type, immediately above name of company?
“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”
What must the outline of coverage in Medicare supplement include?
1) cover page
2) Information regarding premiums
3) Disclosure pages
4) Charts displaying the features of each benefit plan offered by the issuer
Every Medicare Supplement Policy must include a noticed that the insured has the right to return the policy within what time frame and be refunded any premium due if dissatisfied for any reason or choose not to purchase the policy?
30 days (free look policy)
In Nevada, what is a Long-Term care insurance (LTC)?
any group or individual policy that is advertised, marketed, or designed to provide coverage for at least 24 months for necessary diagnostic, preventative, therapeutic, rehab or medical care services provided in a setting other than an acute care unite of a hospital
What must be presented to applicant at time of initial solicitation of LTC policies?
outline of coverage
LTC’s must comply with what following provisions?
1) policies cannot terminate for a reason other than nonpayment of required premium
2) insurer cannot impose a new waiting period if the existing coverage is converted to a different coverage within same company
3) Insurer may not limit coverage to a skilled nursing care. Also may not provide significantly more coverage for skilled care provided in a facility than coverage for lower levels of care
4) policy must allow the policyholder a 30 day free look period
All long-term policies must be what?
guaranteed renewable or noncancellable
Every LTC policy must provide that in the case of lapse, insurer will reinstate the policy if insured what?
1) Proves cognitive impairment (deficiency in ability to perceive, think, reason, or remember that prevents a person from meeting daily living needs)
2) asks the insurer to reinstate the policy within 5 months of the date the coverage lapsed
3) pays any past due premiums
What required period of institutional care cannot exceed what period of time in LTC policies?
exceed 30 days
All persons who sell continuous care insurance (workers comp) must be licensed in what and approval of who?
licensed as an accident and health insurance producer and casualty insurance producer
receive approval from the Commissioner
Producers who are licensed as accident and health producers may submit written request to the Commissioner to sell continuous care coverage if they completed what?
8 hours of approved instruction in workers compensation insurance and employers liability insurance
