reglab/housing_qa huggingface dataset:
NV Rev Stat § 695F.220 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.220 - Contract between organization and provider or subcontractor for provision of services to enrollees.

Each contract between a prepaid limited health service organization and a provider or other person subcontracting for the provision of a limited health service to enrollees on a prepayment basis or any other basis must contain the following terms and conditions:  1. If the prepaid limited health service organization fails to pay for a limited health service for any reason, including, but not limited to, insolvency or breach of this contract, the enrollees are not liable to the provider for any money owed to the provider pursuant to this contract.  2. A provider, agent, trustee or assignee thereof may not maintain an action at law or attempt to collect from an enrollee any money which the prepaid limited health service organization owes to the provider.  3. These provisions do not prohibit the collection of any uncovered charges which an enrollee agreed to pay or the collection of any copayment from an enrollee.  4. These provisions survive the termination of this contract, regardless of the reason for the termination.  5. The termination of this contract does not release the provider from its obligation to complete any procedure on an enrollee who is receiving treatment for a specific condition for a period not to exceed 60 days, at the same schedule of copayment or any other applicable charge in effect when this contract is terminated.  6. Any amendment to the provisions of this contract must be submitted to the Commissioner for approval before the amendment is effective.  (Added to NRS by 1991, 1118)
NV Rev Stat § 695F.230 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.230 - Establishment of system for resolution of complaints.

  1. Each prepaid limited health service organization shall establish a system for the resolution of written complaints submitted by enrollees and providers.  2. The provisions of subsection 1 do not prohibit an enrollee or provider from filing a complaint with the Commissioner or limit the Commissioner’s authority to investigate such a complaint.  3. Each prepaid limited health service organization that issues any evidence of coverage that provides, delivers, arranges for, pays for or reimburses any cost of health care services through managed care shall provide a system for resolving any complaints of an enrollee or subscriber concerning those health care services that complies with the provisions of NRS 695G.200 to 695G.310, inclusive.  (Added to NRS by 1991, 1117; A 2003, 779; 2011, 3397)
NV Rev Stat § 695F.300 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.300 - Regulations of Commissioner.

The Commissioner shall adopt regulations to carry out the provisions of this chapter.  (Added to NRS by 1991, 1121)
NV Rev Stat § 695F.310 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.310 - Examination: Affairs of organization; availability of books and records; exception; assessment of expenses.

  1. The Commissioner may examine the affairs of any prepaid limited health service organization as often as is reasonably necessary to protect the interests of the residents of this State, but not less frequently than once every 3 years.  2. A prepaid limited health service organization shall make its books and records available for examination and cooperate with the Commissioner to facilitate the examination.  3. In lieu of such an examination, the Commissioner may accept the report of an examination conducted by the commissioner of insurance of another state.  4. The reasonable expenses of an examination conducted pursuant to this section must be assessed, billed and paid in accordance with the provisions of NRS 679B.290.  (Added to NRS by 1991, 1117; A 2007, 3331; 2019, 1722)
NV Rev Stat § 695F.320 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.320 - Annual report and financial statement; quarterly statement; imposition of fine and suspension of certificate of authority for failure to file report or statement.

  1. Each prepaid limited health service organization shall file with the Commissioner annually, on or before March 1, a report showing its financial condition on the last day of the preceding calendar year. The report must be verified by at least two principal officers of the organization.  2. The report must be on a form prescribed by the Commissioner and include:  (a) A financial statement of the organization, including its balance sheet and receipts and disbursements for the preceding calendar year;  (b) The number of subscribers at the beginning and the end of the year and the number of enrollments terminated during the year; and  (c) Such other information as the Commissioner may prescribe.  3. Each prepaid limited health service organization shall file with the Commissioner annually an audited financial statement prepared in accordance with the provisions of subsection 1 of NRS 680A.265.  4. Each prepaid limited health service organization shall file with the Commissioner and the National Association of Insurance Commissioners a quarterly statement in the form most recently adopted by the National Association of Insurance Commissioners for that type of insurer. The quarterly statement must be:  (a) Prepared in accordance with the instructions which are applicable to that form, including, without limitation, the required date of submission for the form; and  (b) Filed by electronic means.  5. The Commissioner may require more frequent reports containing such information as is necessary to enable the Commissioner to carry out his or her duties pursuant to this chapter.  6. The Commissioner may:  (a) Assess a fine of not more than $100 per day for each day a report or statement required pursuant to this section is not filed after the report or statement is due, but the fine must not exceed $3,000; and  (b) Suspend the organization’s certificate of authority until the organization files the report or statement, as applicable.  (Added to NRS by 1991, 1119; A 1995, 1634, 2683; 2019, 1723)
NV Rev Stat § 695F.330 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.330 - Payment of tax.

At the time of filing the annual report pursuant to NRS 695F.320 the prepaid limited health service organization shall forward to the Department of Taxation the tax and any penalty for nonpayment or delinquent payment of the tax in accordance with the provisions of chapter 680B of NRS.  (Added to NRS by 1991, 1121; A 1993, 1923)
NV Rev Stat § 695F.340 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.340 - Fees.

Each prepaid limited health service organization shall pay to the Commissioner the following fees: For filing an application for a certificate of authority.................................... $2,450 For issuance of a certificate of authority.............................................................. 283 For the renewal of a certificate of authority...................................................... 2,450 For filing a material change or addition of a limited health service.................. 100 For filing an annual report........................................................................................ 25 For filing periodic reports required by the Commissioner................................... 25 In addition to any other fee or charge, all applicable fees required pursuant to NRS 680C.110.  (Added to NRS by 1991, 1121; A 1993, 2403; 2009, 1821)
NV Rev Stat § 695F.350 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.350 - Suspension or revocation of certificate of authority.

  1. The Commissioner may suspend or revoke the certificate of authority of a prepaid limited health service organization issued pursuant to this chapter if the Commissioner determines that:  (a) The prepaid limited health service organization is operating substantially in violation of its basic organizational document or in a manner contrary to the manner described in and reasonably inferred from any other information submitted pursuant to NRS 695F.110 unless any amendment to its basic organization document or other information has been filed with and approved by the Commissioner;  (b) The prepaid limited health service organization issued an evidence of coverage or used rates or charges which do not comply with the requirements of NRS 695F.150 and 695F.160;  (c) The prepaid limited health service organization is not able to carry out its obligations to provide its limited health service;  (d) The prepaid limited health service organization is not financially responsible and may reasonably be expected to be unable to carry out its obligations to enrollees or prospective enrollees;  (e) The capital of the prepaid limited health service organization is less than the amount required by NRS 695F.200 or the organization has failed to correct any deficiency concerning its capital as required by the Commissioner;  (f) The prepaid limited health service organization has failed to establish and maintain in a reasonable manner the complaint system required by NRS 695F.230;  (g) The continued operation of the prepaid limited health service organization would be hazardous to its enrollees; or  (h) The prepaid limited health service organization has failed to comply with any other provision of this chapter.  2. If the Commissioner has cause to believe that grounds for the suspension or revocation of a certificate of authority of a prepaid limited health service organization exist, the Commissioner shall send written notice to the organization. The notice must include the reason for the suspension or revocation and a time not more than 30 days thereafter for a hearing on the matter. The hearing must be held in the manner set forth in NRS 695F.140.  3. If the certificate of authority of a prepaid limited health service organization is revoked, the organization shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs. The organization shall not:  (a) Conduct any further business unless it is essential for the orderly conclusion of its affairs; and  (b) Engage in any further advertising or solicitation.  4. The Commissioner may, by written order, permit such further operation of the organization as the Commissioner considers necessary to enable the enrollees to obtain limited health services from another organization or provider.  (Added to NRS by 1991, 1119)
NV Rev Stat § 695F.360 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.360 - Violations of chapter: Order to cease and desist; fine.

If the Commissioner, after a hearing held pursuant to NRS 695F.140, finds that a prepaid limited health service organization or other person subject to this chapter has violated a provision of this chapter, the Commissioner may:  1. Issue and cause to be served upon the organization or any other person charged with a violation of this chapter, a copy of the findings of the Commissioner and an order directing the organization or person to cease and desist from engaging in the act or practice which constitutes the violation; and  2. Impose a fine of not more than $1,000 for each violation, not to exceed a total amount of $10,000.  (Added to NRS by 1991, 1120)
NV Rev Stat § 695F.400 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.400 - License required to apply, procure, negotiate or place for another any policy or contract of organization.

A person shall not apply, procure, negotiate or place for another person any policy or contract of a prepaid limited health service organization unless he or she holds a license issued pursuant to chapter 683A of NRS.  (Added to NRS by 1991, 1118)
NV Rev Stat § 695F.410 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.410 - Confidentiality and disclosure of information.

  1. Any information relating to the diagnosis, treatment or health of any enrollee obtained from the enrollee or from any provider by a prepaid limited health service organization and any contract with a provider submitted pursuant to the requirements of this chapter must not be disclosed to any person except:  (a) To the extent that it is necessary to carry out the provisions of this chapter;  (b) Upon the written consent of the enrollee or applicant, provider or prepaid limited health service organization, as appropriate;  (c) Pursuant to a specific statute or court order for the production of evidence or the discovery thereof; or  (d) For a claim or legal action if that data or information is relevant.  2. A prepaid limited health service organization may claim any privilege against disclosure which the provider who furnished the information relating to the diagnosis, treatment or health of an enrollee or applicant to the organization is entitled to claim.  (Added to NRS by 1991, 1121)
NV Rev Stat § 695F.420 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.420 - Certain insurers and organizations may exclude coverage duplicated pursuant to this chapter.

Notwithstanding any other provision of this title, any person who is licensed as an insurer pursuant to chapter 680A of NRS or issued a certificate of authority pursuant to chapter 695A, 695B or 695C of NRS may exclude, in any contract or policy issued to a group, any coverage which would duplicate the coverage of a limited health service, whether for services, supplies or reimbursement, to the extent that the coverage or service is provided in accordance with this chapter pursuant to a contract or policy issued to the same group or to a part of that group by a prepaid limited health service organization or a person who is licensed as an insurer pursuant to chapter 680A of NRS or issued a certificate of authority pursuant to chapter 695A, 695B or 695C of NRS.  (Added to NRS by 1991, 1117)
NV Rev Stat § 695F.430 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.430 - Provision of services excluded from practice of any healing arts; solicitation excluded from statutory provisions regarding solicitation or advertising by practitioner of healing art.

  1. The provision of limited health services by a prepaid limited health service organization or any other person pursuant to this chapter shall not be deemed to be the practice of medicine or any other healing arts.  2. The solicitation by a prepaid limited health service organization to arrange for or provide a limited health service in accordance with this chapter does not violate any statutory provision relating to solicitation or advertising by a practitioner of a healing art.  (Added to NRS by 1991, 1117)
NV Rev Stat § 695F.440 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.440 - Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency.

  1. An organization shall not, when considering eligibility for coverage or making payments under any evidence of coverage, consider the availability of, or eligibility of a person for, medical assistance under Medicaid.  2. To the extent that payment has been made by Medicaid for health care, a prepaid limited health service organization:  (a) Shall treat Medicaid as having a valid and enforceable assignment of benefits due a subscriber or claimant under the subscriber regardless of any exclusion of Medicaid or the absence of a written assignment; and  (b) May, as otherwise allowed by its evidence of coverage or contract and applicable law or regulation concerning subrogation, seek to enforce any rights of a recipient of Medicaid against any other liable party if:  (1) It is so authorized pursuant to a contract with Medicaid for managed care; or  (2) It has reimbursed Medicaid in full for the health care provided by Medicaid to its subscriber.  3. If a state agency is assigned any rights of a person who is:  (a) Eligible for medical assistance under Medicaid; and  (b) Covered by any evidence of coverage,  the prepaid limited health service organization that issued the evidence of coverage shall not impose any requirements upon the state agency except requirements it imposes upon the agents or assignees of other persons covered by any evidence of coverage.  4. If a state agency is assigned any rights of a subscriber who is eligible for medical assistance under Medicaid, a prepaid limited health service organization shall:  (a) Upon request of the state agency, provide to the state agency information regarding the subscriber to determine:  (1) Any period during which the subscriber, the spouse or a dependent of the subscriber may be or may have been covered by the organization; and  (2) The nature of the coverage that is or was provided by the organization, including, without limitation, the name and address of the subscriber and the identifying number of the evidence of coverage;  (b) Respond to any inquiry by the state agency regarding a claim for payment for the provision of any medical item or service not later than 3 years after the date of the provision of the medical item or service; and  (c) Agree not to deny a claim submitted by the state agency solely on the basis of the date of submission of the claim, the type or format of the claim form or failure to present proper documentation at the point of sale that is the basis for the claim if:  (1) The claim is submitted by the state agency not later than 3 years after the date of the provision of the medical item or service; and  (2) Any action by the state agency to enforce its rights with respect to such claim is commenced not later than 6 years after the submission of the claim.  (Added to NRS by 1995, 2437; A 2007, 2407)
NV Rev Stat § 695F.450 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.450 - Organization prohibited from asserting certain grounds to deny enrollment of child pursuant to order if parent is insured.

A prepaid limited health service organization shall not deny the enrollment of a child pursuant to an order for medical coverage under any evidence of coverage pursuant to which a parent of the child is insured on the ground that the child:  1. Was born out of wedlock;  2. Has not been claimed as a dependent on the parent’s federal income tax return; or  3. Does not reside with the parent or within the organization’s geographic area of service.  (Added to NRS by 1995, 2438)
NV Rev Stat § 695F.460 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.460 - Certain accommodations to be made when child is covered under evidence of coverage of noncustodial parent.

If a child has coverage under any evidence of coverage pursuant to which a noncustodial parent of the child is insured, the prepaid limited health service organization issuing that evidence of coverage shall:  1. Provide to the custodial parent such information as necessary for the child to obtain any benefits under that coverage.  2. Allow the custodial parent or, with the approval of the custodial parent, a provider to submit claims for covered services without the approval of the noncustodial parent.  3. Make payments on claims submitted pursuant to subsection 2 directly to the custodial parent, the provider or an agency of this or another state responsible for the administration of Medicaid.  (Added to NRS by 1995, 2438)
NV Rev Stat § 695F.470 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.470 - Organization to authorize enrollment of child of parent who is required by order to provide medical coverage under certain circumstances; termination of coverage of child.

If a parent is required by an order for medical coverage to provide coverage for a child and the parent is eligible for coverage of members of the family of the parent under any evidence of coverage, the prepaid limited health service organization that issued the evidence of coverage:  1. Shall, if the child is otherwise eligible for that coverage, allow the parent to enroll the child in that coverage without regard to any restrictions upon periods for enrollment.  2. Shall, if:  (a) The child is otherwise eligible for that coverage; and  (b) The parent is enrolled in that coverage but fails to apply for enrollment of the child,  enroll the child in that coverage upon application by the other parent of the child, or by an agency of this or another state responsible for the administration of Medicaid or a state program for the enforcement of child support established pursuant to 42 U.S.C. §§ 651 et seq., without regard to any restrictions upon periods for enrollment.  3. Shall not terminate the enrollment of the child in that coverage or otherwise eliminate that coverage of the child unless the prepaid limited health service organization has written proof that:  (a) The order for medical coverage is no longer in effect; or  (b) The child is or will be enrolled in comparable coverage through another insurer on or before the effective date of the termination of enrollment or elimination of coverage.  (Added to NRS by 1995, 2438)
NV Rev Stat § 695F.480 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.480 - Organization prohibited from restricting coverage of child based on preexisting condition if person who is eligible for group coverage adopts or assumes legal obligation for child. [Effective through December 31, 2019.]

  1. If a person:  (a) Adopts a dependent child; or  (b) Assumes and retains a legal obligation for the total or partial support of a dependent child in anticipation of adopting the child,  while the person is eligible for group coverage under any evidence of coverage, the prepaid limited health service organization issuing that evidence of coverage shall not restrict the coverage of the child based solely on a preexisting condition the child has at the time he or she would otherwise become eligible for coverage pursuant to that evidence of coverage. Any provision relating to an exclusion for a preexisting condition must comply with NRS 689B.500 or 689C.190, as appropriate.  2. For the purposes of this section, "child" means a person who is under 18 years of age at the time of his or her adoption or the assumption of a legal obligation for his or her support in anticipation of his or her adoption.  (Added to NRS by 1995, 2439; A 1997, 2960; R 2019, 318, effective January 1, 2020)
NV Rev Stat § 695G.010 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.010 - Definitions.

As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 695G.012 to 695G.085, inclusive, have the meanings ascribed to them in those sections.  (Added to NRS by 1997, 301; A 2003, 783; 2011, 3410)
NV Rev Stat § 695G.012 (2021)
2021 Nevada Revised Statutes|Chapter 695G - Managed Care|NRS 695G.012 - "Adverse determination" defined.

Adverse determination means a determination by a health carrier or utilization review organization that an admission, availability of care, continued stay or other health care service that is a covered benefit has been reviewed and, based upon the information provided, does not meet the health carrier’s requirements for medical necessity, appropriateness, health care setting, level of care or effectiveness, and the requested service or payment for the service is therefore denied, reduced or terminated.  (Added to NRS by 2003, 779; A 2011, 3410)