689B.275 Ā Contents, approval and provision of summary of coverage; provision of information about guaranteed availability of certain plans for benefits.

1. Ā An insurer shall provide to each policyholder, or producer of insurance acting on behalf of a policyholder, on a form approved by the Commissioner, a summary of the coverage provided by each policy of group or blanket health insurance offered by the insurer. The summary must disclose any:

(a) Significant exception, reduction or limitation that applies to the policy;

(b) Restriction on payment for care in an emergency, including related definitions of emergency and medical necessity;

(c) Right of the insurer to change the rate of premium and the factors, other than claims experienced, which affect changes in rate;

(d) Provisions relating to renewability;

(e) Provisions relating to preexisting conditions; and

(f) Other information that the Commissioner finds necessary for full and fair disclosure of the provisions of the policy.

2. Ā The language of the disclosure must be easily understood. The disclosure must state that it is only a summary of the policy and that the policy should be read to ascertain the governing contractual provisions.

3. Ā The Commissioner shall not approve a proposed disclosure that does not satisfy the requirements of this section and of applicable regulations.

4. Ā In addition to the disclosure, the insurer shall provide information about guaranteed availability of basic and standard plans for benefits to an eligible person.

5. Ā The insurer shall provide the summary before the policy is issued.

(Added to NRS by 2001, 2219)