NAC687B.315. Standardized Benefit Plan H.

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)