S.B. 292
- *SB292*
SENATE BILL NO. 292–SENATOR LANGE
MARCH 6, 2025
____________
Referred to Committee on Commerce and Labor
SUMMARY—Revises provisions relating to Medicare
supplemental policies. (BDR 57-1069)
FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: Yes.
CONTAINS UNFUNDED MANDATE (§ 8)
(NOT REQUESTED BY AFFECTED LOCAL GOVERNMENT)
~
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
AN ACT relating to insurance; requiring certain insurers to allow
certain persons who are less than 65 years of age to
purchase a Medicare supplemental policy that the insurer
makes available for purchase to new insureds who are 65
years of age or older; imposing certain restrictions on the
limitations, terms and conditions such an insurer may
impose and the premiums such an insurer may charge for
such policies to persons who are less than 65 years of age;
requiring such an insurer to establish certain open
enrollment periods for the purchase of a Medicare
supplemental policy; prohibiting an insurer from
imposing an exclusion of certain benefits with respect to a
Medicare supplemental policy issued during an open
enrollment period; and providing other matters properly
relating thereto.
Legislative Counsel’s Digest:
Existing federal law establishes the Medicare program, which is a public health 1
insurance program for persons 65 years of age or older and specified persons with 2
disabilities or end-stage renal disease who are less than 65 years of age. (42 U.S.C. 3
§§ 1395 et seq.) Existing federal law defines the term “Medicare supplemental 4
policy” to mean a policy offered by a private insurer that is primarily designed to 5
pay expenses not reimbursed under Medicare because of certain limitations under 6
Medicare. Existing federal law requires the issuance of a Medicare supplemental 7
policy under certain circumstances but does not require a private insurer to sell or 8
issue a Medicare supplemental policy to a person who is less than 65 years of age 9
– 2 –
- *SB292*
and enrolled in Medicare on the basis of a disability or end-stage renal disease. (42 10
U.S.C. § 1395ss) 11
Section 4 of this bill requires an insurer that offers a Medicare supplemental 12
policy in this State, including an insurer that provides coverage to state and local 13
government employees, to allow a person who is less than 65 years of age and 14
enrolled in Medicare on the basis of a disability or end-stage renal disease to 15
purchase any Medicare supplemental policy that the insurer offers to new insureds 16
in this State who are 65 years of age or older. Section 4 requires such an insurer to 17
offer a Medicare supplemental policy to such persons at the same premium rate as 18
is charged when the Medicare supplemental policy is offered to a person who is 65 19
years of age without additional limitations, terms or conditions. 20
Existing law requires an insurer offering a Medicare supplemental policy to 21
annually offer an open enrollment period for persons currently covered by a 22
Medicare supplemental policy, during which the insurer is prohibited from taking 23
certain actions with respect to the issuance or effectiveness of, or price charged for, 24
a policy offered to a person during the open enrollment period. (NRS 687B.352) 25
Section 4 requires an insurer to establish a similar open enrollment period which 26
allows an eligible person who is less than 65 years of age to purchase a Medicare 27
supplemental policy during a 6-month period commencing on the first day of the 28
first month during which the person enrolled in coverage under Part B of Medicare, 29
which provides coverage for certain medically necessary services provided outside 30
of a hospital. During that open enrollment period, section 4 prohibits an insurer 31
from taking certain actions with respect to the issuance or effectiveness of, or price 32
charged for, a policy offered to the person. Section 4 also prohibits an insurer from 33
imposing an exclusion of benefits under a Medicare supplemental policy during 34
that open enrollment period based on a preexisting condition. Section 6 of this bill 35
adds a similar prohibition with regard to the open enrollment period established 36
under existing law which will apply to both persons who are 65 years of age or 37
older and persons who are less than 65 years of age and suffering from a disability 38
or end-stage renal disease. Section 10 of this bill requires an insurer to establish a 39
similar open enrollment period, which commences on October 1, 2025, and remains 40
open through April 1, 2026, for persons who are: (1) less than 65 years of age; (2) 41
suffering from a disability or end-stage renal disease; and (3) enrolled in coverage 42
under Part B of Medicare as of October 1, 2025, on the basis of the disability or 43
end-stage renal disease. 44
Sections 7-9 of this bill establish the applicability of section 4 to: (1) a hospital 45
or medical services corporation; and (2) state and local governments that offer 46
insurance to employees. Section 3 of this bill defines the term “Medicare 47
supplemental policy” to have the same meaning as is ascribed to it in federal 48
regulations, and section 2 of this bill establishes the applicability of that definition. 49
Sections 5 and 6 of this bill make conforming changes to remove duplicative 50
language from other existing provisions. 51
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 687B of NRS is hereby amended by adding 1
thereto the provisions set forth as sections 2, 3 and 4 of this act. 2
Sec. 2. As used in this chapter, unless the context otherwise 3
requires, the words and terms defined in NRS 687B.015 and 4
section 3 of this act have the meanings ascribed to them in those 5
sections. 6
– 3 –
- *SB292*
Sec. 3. “Medicare supplemental policy” has the meaning 1
ascribed to it in 42 C.F.R. § 403.205. 2
Sec. 4. 1. An insurer that offers any Medicare 3
supplemental policy for delivery in this State shall allow a person 4
who is less than 65 years of age and eligible for and enrolled in 5
Medicare on the basis of a disability or end-stage renal disease to 6
purchase any Medicare supplemental policy that the insurer offers 7
to new insureds in this State who are 65 years of age or older. 8
2. An insurer shall not impose any limitation, term or 9
condition relating to coverage, benefits, protections, policies or 10
procedures with respect to a Medicare supplemental policy issued 11
to a person who is less than 65 years of age pursuant to subsection 12
1 if the limitation, term or condition is not imposed with respect to 13
a Medicare supplemental policy offered by the insurer to a person 14
who is 65 years of age or older. 15
3. An insurer must offer a Medicare supplemental policy to a 16
person eligible to purchase the policy pursuant to subsection 1 at 17
the same premium rate that the insurer would charge for the 18
Medicare supplemental policy to a person who is exactly 65 years 19
of age. 20
4. An insurer shall offer to a person who is less than 65 years 21
of age and eligible to purchase a Medicare supplemental policy 22
pursuant to subsection 1 an open enrollment period commencing 23
on the first day of the first month that the person enrolled in 24
coverage pursuant to Medicare Part B, 42 U.S.C. §§ 1395j et seq., 25
and remaining open for at least 6 months thereafter, during which 26
the person may purchase any Medicare supplemental policy made 27
available by the insurer to new insureds in this State. 28
5. During the open enrollment period offered pursuant to 29
subsection 4, an insurer shall not: 30
(a) Deny or condition the issuance or effectiveness, or 31
discriminate in the price of coverage, of a Medicare supplemental 32
policy based on the health status, claims experience, receipt of 33
health care or medical condition of a person described in 34
subsection 4; or 35
(b) Impose an exclusion of benefits provided under the 36
Medicare supplemental policy based on a preexisting medical 37
condition of a person described in subsection 4. 38
Sec. 5. NRS 687B.015 is hereby amended to read as follows: 39
687B.015 [As used in this chapter, unless the context otherwise 40
requires, “binder”] “Binder” means an oral or written contract for 41
temporary insurance which is used when a policy is not immediately 42
issued to evidence that the coverage attaches at a specified time and 43
continues until the policy is issued or the risk is declined. 44
– 4 –
- *SB292*
Sec. 6. NRS 687B.352 is hereby amended to read as follows: 1
687B.352 1. An insurer that issues a Medicare supplemental 2
policy shall offer to a person currently insured under any such 3
policy an annual open enrollment period commencing with the first 4
day of the birthday month of the person and remaining open for at 5
least 60 days thereafter, during which the person may purchase any 6
Medicare supplemental policy made available by the insurer in this 7
State that includes the same or lesser benefits. Innovative benefits, 8
as described in 42 U.S.C. § 1395ss(p)(4)(B), must not be considered 9
when determining whether a Medicare supplemental policy includes 10
the same benefits as or lesser benefits than another such policy. 11
2. During the open enrollment period offered pursuant to 12
subsection 1, an insurer shall not [deny] : 13
(a) Deny or condition the issuance or effectiveness, or 14
discriminate in the price of coverage, of a Medicare supplemental 15
policy based on the health status, claims experience, receipt of 16
health care or medical condition of a person described in subsection 17
1 [.] ; or 18
(b) Impose an exclusion of benefits provided under the 19
Medicare supplemental policy based on a preexisting medical 20
condition of a person described in subsection 1. 21
3. At least 30 days before the beginning of the open enrollment 22
period offered pursuant to subsection 1 but not more than 60 days 23
before the beginning of that period, an insurer that issues a Medicare 24
supplemental policy shall notify each person to whom the open 25
enrollment period applies of: 26
(a) The dates on which the open enrollment period begins and 27
ends and the rights of the person established by the provisions of 28
this section; and 29
(b) Any modification to the benefits provided by the policy 30
under which the person is currently insured or adjustment to the 31
premiums charged for that policy. 32
4. An insurer or other person or entity shall not vary the 33
commission associated with the purchase of Medicare supplemental 34
policies during the open enrollment period offered pursuant to 35
subsection 1, pay differential commissions associated with the 36
purchase of Medicare supplemental policies during that open 37
enrollment period or otherwise treat Medicare supplemental policies 38
purchased during that open enrollment period differently for the 39
purposes of commission for any reason, including, without 40
limitation: 41
(a) Because the Medicare supplemental policy was purchased 42
during the open enrollment period offered pursuant to subsection 1; 43
– 5 –
- *SB292*
(b) Because the Medicare supplemental policy is classified as 1
guaranteed issue under 42 U.S.C. § 1395ss or any other applicable 2
federal or state law or regulations; or 3
(c) Because of the health status, claims experience, receipt of 4
health care or medical condition of the insured. 5
5. An insurer or other person or entity must treat the purchase 6
of a Medicare supplemental policy during the open enrollment 7
period offered pursuant to subsection 1 in the same manner as the 8
renewal of a Medicare supplemental policy for all purposes relating 9
to the payment of a commission. 10
[6. As used in this section, “Medicare supplemental policy” has 11
the meaning ascribed to it in 42 C.F.R. § 403.205 and additionally 12
includes policies offered by public entities that otherwise meet the 13
requirements of that section.] 14
Sec. 7. NRS 695B.320 is hereby amended to read as follows: 15
695B.320 1. Nonprofit hospital and medical or dental service 16
corporations are subject to the provisions of this chapter, and to the 17
provisions of chapters 679A and 679B of NRS, subsections 2, 4, 17, 18
18 and 30 of NRS 680B.010, NRS 680B.025 to 680B.060, 19
inclusive, chapter 681B of NRS, NRS 686A.010 to 686A.315, 20
inclusive, 686B.010 to 686B.175, inclusive, 687B.010 to 21
687B.040, inclusive, 687B.070 to 687B.140, inclusive, 687B.150, 22
687B.160, 687B.180, 687B.200 to 687B.255, inclusive, 687B.270, 23
687B.310 to 687B.380, inclusive, and section 4 of this act, 24
687B.410, 687B.420, 687B.430, 687B.500 and chapters 692B, 25
692C, 693A and 696B of NRS, to the extent applicable and not in 26
conflict with the express provisions of this chapter. 27
2. For the purposes of this section and the provisions set forth 28
in subsection 1, a nonprofit hospital and medical or dental service 29
corporation is included in the meaning of the term “insurer.” 30
Sec. 8. NRS 287.010 is hereby amended to read as follows: 31
287.010 1. The governing body of any county, school 32
district, municipal corporation, political subdivision, public 33
corporation or other local governmental agency of the State of 34
Nevada may: 35
(a) Adopt and carry into effect a system of group life, accident 36
or health insurance, or any combination thereof, for the benefit of its 37
officers and employees, and the dependents of officers and 38
employees who elect to accept the insurance and who, where 39
necessary, have authorized the governing body to make deductions 40
from their compensation for the payment of premiums on the 41
insurance. 42
(b) Purchase group policies of life, accident or health insurance, 43
or any combination thereof, for the benefit of such officers and 44
employees, and the dependents of such officers and employees, as 45
– 6 –
- *SB292*
have authorized the purchase, from insurance companies authorized 1
to transact the business of such insurance in the State of Nevada, 2
and, where necessary, deduct from the compensation of officers and 3
employees the premiums upon insurance and pay the deductions 4
upon the premiums. 5
(c) Provide group life, accident or health coverage through a 6
self-insurance reserve fund and, where necessary, deduct 7
contributions to the maintenance of the fund from the compensation 8
of officers and employees and pay the deductions into the fund. The 9
money accumulated for this purpose through deductions from the 10
compensation of officers and employees and contributions of the 11
governing body must be maintained as an internal service fund as 12
defined by NRS 354.543. The money must be deposited in a state or 13
national bank or credit union authorized to transact business in the 14
State of Nevada. Any independent administrator of a fund created 15
under this section is subject to the licensing requirements of chapter 16
683A of NRS, and must be a resident of this State. Any contract 17
with an independent administrator must be approved by the 18
Commissioner of Insurance as to the reasonableness of 19
administrative charges in relation to contributions collected and 20
benefits provided. The provisions of NRS 439.581 to 439.597, 21
inclusive, 686A.135, 687B.352, 687B.408, 687B.692, 687B.723, 22
687B.725, 687B.805, 689B.030 to 689B.0317, inclusive, paragraphs 23
(b) and (c) of subsection 1 of NRS 689B.0319, subsections 2, 4, 6 24
and 7 of NRS 689B.0319, 689B.033 to 689B.0369, inclusive, 25
689B.0375 to 689B.050, inclusive, 689B.0675, 689B.265, 689B.287 26
and 689B.500 and section 4 of this act apply to coverage provided 27
pursuant to this paragraph, except that the provisions of NRS 28
689B.0378, 689B.03785 and 689B.500 only apply to coverage for 29
active officers and employees of the governing body, or the 30
dependents of such officers and employees. 31
(d) Defray part or all of the cost of maintenance of a self-32
insurance fund or of the premiums upon insurance. The money for 33
contributions must be budgeted for in accordance with the laws 34
governing the county, school district, municipal corporation, 35
political subdivision, public corporation or other local governmental 36
agency of the State of Nevada. 37
2. If a school district offers group insurance to its officers and 38
employees pursuant to this section, members of the board of trustees 39
of the school district must not be excluded from participating in the 40
group insurance. If the amount of the deductions from compensation 41
required to pay for the group insurance exceeds the compensation to 42
which a trustee is entitled, the difference must be paid by the trustee. 43
3. In any county in which a legal services organization exists, 44
the governing body of the county, or of any school district, 45
– 7 –
- *SB292*
municipal corporation, political subdivision, public corporation or 1
other local governmental agency of the State of Nevada in the 2
county, may enter into a contract with the legal services 3
organization pursuant to which the officers and employees of the 4
legal services organization, and the dependents of those officers and 5
employees, are eligible for any life, accident or health insurance 6
provided pursuant to this section to the officers and employees, and 7
the dependents of the officers and employees, of the county, school 8
district, municipal corporation, political subdivision, public 9
corporation or other local governmental agency. 10
4. If a contract is entered into pursuant to subsection 3, the 11
officers and employees of the legal services organization: 12
(a) Shall be deemed, solely for the purposes of this section, to be 13
officers and employees of the county, school district, municipal 14
corporation, political subdivision, public corporation or other local 15
governmental agency with which the legal services organization has 16
contracted; and 17
(b) Must be required by the contract to pay the premiums or 18
contributions for all insurance which they elect to accept or of which 19
they authorize the purchase. 20
5. A contract that is entered into pursuant to subsection 3: 21
(a) Must be submitted to the Commissioner of Insurance for 22
approval not less than 30 days before the date on which the contract 23
is to become effective. 24
(b) Does not become effective unless approved by the 25
Commissioner. 26
(c) Shall be deemed to be approved if not disapproved by the 27
Commissioner within 30 days after its submission. 28
6. As used in this section, “legal services organization” means 29
an organization that operates a program for legal aid and receives 30
money pursuant to NRS 19.031. 31
Sec. 9. NRS 287.04335 is hereby amended to read as follows: 32
287.04335 If the Board provides health insurance through a 33
plan of self-insurance, it shall comply with the provisions of NRS 34
439.581 to 439.597, inclusive, 686A.135, 687B.352, 687B.409, 35
687B.692, 687B.723, 687B.725, 687B.805, 689B.0353, 689B.255, 36
695C.1723, 695G.150, 695G.155, 695G.160, 695G.162, 37
695G.1635, 695G.164, 695G.1645, 695G.1665, 695G.167, 38
695G.1675, 695G.170 to 695G.1712, inclusive, 695G.1714 to 39
695G.174, inclusive, 695G.176, 695G.177, 695G.200 to 695G.230, 40
inclusive, 695G.241 to 695G.310, inclusive, 695G.405 and 41
695G.415, and section 4 of this act, in the same manner as an 42
insurer that is licensed pursuant to title 57 of NRS is required to 43
comply with those provisions. 44
– 8 –
- *SB292*
Sec. 10. 1. In addition to the open enrollment period 1
described in subsection 4 of section 4 of this act, an insurer that 2
offers any Medicare supplemental policy for delivery in this State as 3
of October 1, 2025, shall offer to a person who is less than 65 years 4
of age and is eligible for and enrolled in coverage pursuant to 5
Medicare Part B, 42 U.S.C. §§ 1395j et seq., on October 1, 2025, on 6
the basis of a disability or end-stage renal disease, an open 7
enrollment period commencing on October 1, 2025, and remaining 8
open through April 1, 2026. 9
2. During the open enrollment period offered pursuant to 10
subsection 1, an insurer shall not: 11
(a) Deny or condition the issuance or effectiveness, or 12
discriminate in the price of coverage, of a Medicare supplemental 13
policy based on the health status, claims experience, receipt of 14
health care or medical condition of a person described in subsection 15
1; or 16
(b) Impose an exclusion of benefits provided under the Medicare 17
supplemental policy based on a preexisting medical condition of a 18
person described in subsection 1. 19
3. As used in this section: 20
(a) “Insurer” has the meaning ascribed to it in NRS 679A.100 21
and additionally includes: 22
(1) A governing body of any county, school district, 23
municipal corporation, political subdivision, public corporation or 24
other local governmental agency of the State of Nevada that 25
provides Medicare supplemental policies through a self-insurance 26
reserve fund pursuant to NRS 287.010; and 27
(2) The Public Employees’ Benefits Program. 28
(b) “Medicare supplemental policy” has the meaning ascribed to 29
it in 42 C.F.R. § 403.205. 30
Sec. 11. The provisions of NRS 354.599 do not apply to any 31
additional expenses of a local government that are related to the 32
provisions of this act. 33
H