NAC687B.700. Notice of duplication for policy which provides reimbursement upon both expense-incurred and fixed-indemnity basis.

     1. An insurer that delivers or issues for delivery in this State a policy of health insurance which provides reimbursement upon both an expense-incurred and a fixed-indemnity basis and which provides benefits that are provided under Medicare shall provide notice to the insured that the policy contains certain benefits which are also provided under Medicare.

     2. The notice must be:

     (a) Printed on or attached to the first page of the application for the policy; and

     (b) In not less than 12-point type and must not vary from the following form in terms of language or format:

Important Notice to Persons on Medicare

This Insurance Duplicates Some Medicare Benefits

This is not Medicare Supplement Insurance

This insurance pays limited reimbursement for expenses if you meet the conditions listed in the policy. It also pays a fixed amount, regardless of your expenses, if you meet other policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when:

· any expenses or services covered by the policy are also covered by Medicare; or

· it pays the fixed dollar amount stated in the policy and Medicare covers the same event

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

· hospitalization

· physician services

· hospice care

· outpatient prescription drugs if you are enrolled in Medicare Part D

· other approved items and services

Before You Buy This Insurance

ü Check the coverage in all health insurance policies you already have.

ü For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, which is available from the insurance company.

ü For help in understanding your health insurance, contact the Commissioner of Insurance or the State Health Insurance Assistance Program (SHIP).

     (Added to NAC by Comm’r of Insurance, eff. 5-13-96; 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)