reglab/housing_qa huggingface dataset:
NV Rev Stat § 695F.010 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.010 - Definitions.

As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 695F.020 to 695F.070, inclusive, have the meanings ascribed to them in those sections.  (Added to NRS by 1991, 1113; A 1995, 2439)
NV Rev Stat § 695F.020 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.020 - "Enrollee" defined.

Enrollee means a person, including the dependents of the person, who is entitled to a limited health service pursuant to a contract with a person authorized to provide or arrange for that service pursuant to this chapter.  (Added to NRS by 1991, 1113)
NV Rev Stat § 695F.030 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.030 - "Evidence of coverage" defined.

Evidence of coverage means any certificate, agreement or contract issued to an enrollee which sets forth the coverage the enrollee is entitled to receive.  (Added to NRS by 1991, 1113)
NV Rev Stat § 695F.040 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.040 - "Limited health service" defined.

Limited health service means:  1. Chiropractic, dental, hospital, medical, optometric, pharmaceutical, podiatric or surgical care;  2. Treatment relating to mental health or alcohol or substance use disorder; or  3. Such other care or treatment as may be determined by the Commissioner to be a limited health service.  (Added to NRS by 1991, 1113; A 1993, 2402)
NV Rev Stat § 695F.043 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.043 - "Medicaid" defined.

Medicaid means a program established in any state pursuant to Title XIX of the Social Security Act (42 U.S.C. §§ 1396 et seq.) to provide assistance for part or all of the cost of medical care rendered on behalf of indigent persons.  (Added to NRS by 1995, 2437)
NV Rev Stat § 695F.047 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.047 - "Order for medical coverage" defined.

Order for medical coverage means an order of a court or administrative tribunal to provide medical coverage to a child pursuant to the provisions of 42 U.S.C. § 1396g-1.  (Added to NRS by 1995, 2437)
NV Rev Stat § 695F.050 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.050 - "Prepaid limited health service organization" defined.

  1. "Prepaid limited health service organization" means any person who, in return for a prepayment, agrees to provide or arrange for the provision of one or more limited health services to enrollees.  2. The term does not include:  (a) A person otherwise authorized pursuant to the laws of this state to provide a limited health service on a prepayment basis or any other basis or to indemnify for any limited health service;  (b) A person who complies with the requirements of NRS 695F.130; or  (c) A provider who provides or arranges for the provision of a limited health service pursuant to a contract with a prepaid limited health service organization or person described in paragraph (a) or (b).  (Added to NRS by 1991, 1113)
NV Rev Stat § 695F.060 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.060 - "Provider" defined.

Provider means any physician, dentist or any other person who is licensed or otherwise authorized in this state to provide a limited health service.  (Added to NRS by 1991, 1114)
NV Rev Stat § 695F.070 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.070 - "Subscriber" defined.

Subscriber means a person whose employment or other status, except for family dependency, is the basis for his or her entitlement to receive a limited health service pursuant to a contract with a person authorized to provide or arrange for that service pursuant to this chapter.  (Added to NRS by 1991, 1114)
NV Rev Stat § 695F.080 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.080 - General applicability of title 57 of NRS.

Except as otherwise provided in this chapter or in specific provisions of this title, the provisions of this title are not applicable to any prepaid limited health service organization granted a certificate of authority pursuant to this chapter. This section does not apply to an insurer licensed and regulated pursuant to this title except with respect to its activities as a prepaid limited health service organization authorized and regulated pursuant to this chapter.  (Added to NRS by 1991, 1114)
NV Rev Stat § 695F.090 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.090 - Applicable statutory provisions.

  1. Prepaid limited health service organizations are subject to the provisions of this chapter and to the following provisions, to the extent reasonably applicable:  (a) NRS 687B.310 to 687B.420, inclusive, concerning cancellation and nonrenewal of policies.  (b) NRS 687B.122 to 687B.128, inclusive, concerning readability of policies.  (c) The requirements of NRS 679B.152.  (d) The fees imposed pursuant to NRS 449.465.  (e) NRS 686A.010 to 686A.310, inclusive, concerning trade practices and frauds.  (f) The assessment imposed pursuant to NRS 679B.700.  (g) Chapter 683A of NRS.  (h) To the extent applicable, the provisions of NRS 689B.340 to 689B.580, inclusive, and chapter 689C of NRS relating to the portability and availability of health insurance.  (i) NRS 689A.035, 689A.0463, 689A.410, 689A.413 and 689A.415.  (j) NRS 680B.025 to 680B.039, inclusive, concerning premium tax, premium tax rate, annual report and estimated quarterly tax payments. For the purposes of this subsection, unless the context otherwise requires that a section apply only to insurers, any reference in those sections to "insurer" must be replaced by a reference to "prepaid limited health service organization."  (k) Chapter 692C of NRS, concerning holding companies.  (l) NRS 689A.637, concerning health centers.  2. For the purposes of this section and the provisions set forth in subsection 1, a prepaid limited health service organization is included in the meaning of the term "insurer."  (Added to NRS by 1991, 1121; A 1993, 2402; 1997, 1097, 2960, 2962, 3036; 1999, 631, 1652; 2001, 480, 1924; 2005, 2346; 2013, 3458, 3650; 2015, 646; 2017, 2399)
NV Rev Stat § 695F.100 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.100 - Certificate required.

A person shall not operate a prepaid limited health service organization in this state unless the person has been issued a certificate of authority by the Commissioner pursuant to this chapter.  (Added to NRS by 1991, 1114)
NV Rev Stat § 695F.120 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.120 - Review of application; issuance of certificate.

  1. The Commissioner shall review each application and notify the applicant of any deficiency contained in the application.  2. The Commissioner shall issue a certificate of authority to an applicant if:  (a) The applicant has complied with the requirements set forth in NRS 695F.110;  (b) The persons responsible for conducting the applicant’s affairs are competent, trustworthy and possess good reputations, and have the appropriate experience, training or education;  (c) The applicant is financially responsible and may reasonably be expected to carry out its obligations to enrollees and prospective enrollees; and  (d) The agreements with providers for the limited health service include the provisions required by NRS 695F.220.  3. The Commissioner may, when determining whether an applicant complies with the requirements of paragraph (c) of subsection 2, consider:  (a) The financial soundness of the applicant’s arrangements for the provision of a limited health service and the schedule of rates, deductibles, copayments and other charges used in connection therewith;  (b) The adequacy of working capital, any other sources of funding and any provisions for contingencies;  (c) Any agreement for paying the cost of a limited health service or for alternative coverage if the prepaid limited health service organization becomes insolvent; and  (d) The applicant’s manner of compliance with the requirements of NRS 695F.200.  (Added to NRS by 1991, 1115)
NV Rev Stat § 695F.130 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.130 - Application of person who is licensed as insurer or holds another certificate of authority.

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 submit an application to the Commissioner for a certificate of authority to provide a limited health service in this state. The application must include the information requested by subsections 4, 5, 7, 8, 10, 11, 12 and 15 of NRS 695F.110 and any subsequent material changes or additions thereto.  (Added to NRS by 1991, 1116)
NV Rev Stat § 695F.140 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.140 - Denial of application; hearing.

  1. If the Commissioner denies an application for a certificate of authority of a person who files an application pursuant to NRS 695F.120 or 695F.130, the Commissioner shall send a written notice to the applicant. The notice must include the reason for the denial of the certificate.  2. The applicant may, within 30 days after it receives the notice, submit to the Commissioner a written request for a hearing on the matter. The Commissioner shall hold a hearing within 30 days after the Commissioner receives the request.  3. The hearing must be held in the manner set forth in NRS 679B.310 to 679B.370, inclusive. The decision of the Commissioner is a final decision for the purpose of judicial review.  (Added to NRS by 1991, 1116)
NV Rev Stat § 695F.150 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.150 - Evidence of coverage: Issuance; contents; amendment.

  1. A prepaid limited health service organization shall issue evidence of coverage to each subscriber. Each evidence of coverage must contain a clear and complete statement of:  (a) The limited health service which the enrollee is entitled to receive;  (b) Any limitation of that service, type of service or benefits to be provided, and exclusions, including any deductible, copayment or other charges;  (c) Where and in what manner information is available concerning the location of and manner in which the limited health service may be obtained; and  (d) The method established for the resolution of complaints submitted by enrollees concerning the provision of the limited health service.  2. A prepaid limited health service organization may provide to a subscriber any amendment to the evidence of coverage in a separate document.  (Added to NRS by 1991, 1116)
NV Rev Stat § 695F.153 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.153 - Coverage for prescription drugs: Provision of notice and information regarding use of formulary.

  1. A prepaid limited health service organization that offers or issues evidence of coverage which provides coverage for prescription drugs shall include with any evidence of that coverage provided to a subscriber, notice of whether a formulary is used and, if so, of the opportunity to secure information regarding the formulary from the organization pursuant to subsection 2. The notice required by this subsection must:  (a) Be in a language that is easily understood and in a format that is easy to understand;  (b) Include an explanation of what a formulary is; and  (c) If a formulary is used, include:  (1) An explanation of:  (I) How often the contents of the formulary are reviewed; and  (II) The procedure and criteria for determining which prescription drugs are included in and excluded from the formulary; and  (2) The telephone number of the organization for making a request for information regarding the formulary pursuant to subsection 2.  2. If a prepaid limited health service organization offers or issues evidence of coverage which provides coverage for prescription drugs and a formulary is used, the organization shall:  (a) Provide to any enrollee or participating provider of health care, upon request:  (1) Information regarding whether a specific drug is included in the formulary.  (2) Access to the most current list of prescription drugs in the formulary, organized by major therapeutic category, with an indication of whether any listed drugs are preferred over other listed drugs. If more than one formulary is maintained, the organization shall notify the requester that a choice of formulary lists is available.  (b) Notify each person who requests information regarding the formulary, that the inclusion of a drug in the formulary does not guarantee that a provider of health care will prescribe that drug for a particular medical condition.  (Added to NRS by 2001, 864)
NV Rev Stat § 695F.156 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.156 - Coverage for prescription drug previously approved for medical condition of enrollee.

  1. Except as otherwise provided in this section, evidence of coverage which provides coverage for prescription drugs must not limit or exclude coverage for a drug if the drug:  (a) Had previously been approved for coverage by the prepaid limited health service organization for a medical condition of an enrollee and the enrollee’s provider of health care determines, after conducting a reasonable investigation, that none of the drugs which are otherwise currently approved for coverage are medically appropriate for the enrollee; and  (b) Is appropriately prescribed and considered safe and effective for treating the medical condition of the enrollee.  2. The provisions of subsection 1 do not:  (a) Apply to coverage for any drug that is prescribed for a use that is different from the use for which that drug has been approved for marketing by the Food and Drug Administration;  (b) Prohibit:  (1) The organization from charging a deductible, copayment or coinsurance for the provision of benefits for prescription drugs to the enrollee or from establishing, by contract, limitations on the maximum coverage for prescription drugs;  (2) A provider of health care from prescribing another drug covered by the evidence of coverage that is medically appropriate for the enrollee; or  (3) The substitution of another drug pursuant to NRS 639.23286 or 639.2583 to 639.2597, inclusive; or  (c) Require any coverage for a drug after the term of the evidence of coverage.  3. Any provision of an evidence of coverage subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2001, which is in conflict with this section is void.  (Added to NRS by 2001, 865; A 2003, 2301; 2017, 640)
NV Rev Stat § 695F.160 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.160 - Rates and charges: Reasonableness.

The rates and charges for a limited health service must be reasonable. The commissioner may request information from the prepaid limited health service organization to determine the reasonableness of those rates and charges.  (Added to NRS by 1991, 1117)
NV Rev Stat § 695F.170 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.170 - Procedure for modification of rates, charges, benefits, organization, operations, documents or services.

  1. A prepaid limited health service organization shall file with the Commissioner a notice of any change in the rates, charges, benefits or any material change of any matter or document furnished pursuant to NRS 695F.110. The organization shall submit any proof necessary to justify the change. No such change is effective unless it is approved by the Commissioner. If the Commissioner does not disapprove of the change within 60 days after the notice is filed, the change shall be deemed approved.  2. If a prepaid limited health service organization wishes to add a limited health service, it shall submit:  (a) An application to the Commissioner;  (b) The information required by NRS 695F.110, if the information is different from the information filed with the prepaid limited health service organization’s application; and  (c) Proof of compliance with NRS 695F.200, 695F.220 and 695F.340.  A prepaid limited health service organization may not add a limited health service if the Commissioner determines that adding the service would qualify the organization as a health maintenance organization pursuant to chapter 695C of NRS or as an offeror of a health care plan for which a certificate of authority is required by any other provisions of this title.  3. If the Commissioner does not deny the application within 60 days after it is filed, the application shall be deemed approved.  4. If the application is denied, the Commissioner shall send a written notice to the prepaid limited health service organization. The notice must include the reason for the denial. The prepaid limited health service organization may request a hearing in the manner set forth in NRS 695F.140.  (Added to NRS by 1991, 1116; A 1993, 2402)
NV Rev Stat § 695F.180 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.180 - Investments.

The money of the prepaid limited health service organization must be invested in accordance with the guidelines established by the National Association of Insurance Commissioners for investments by health maintenance organizations.  (Added to NRS by 1991, 1118)
NV Rev Stat § 695F.190 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.190 - Requirements for reserve.

  1. A prepaid limited health service organization shall set aside a reserve equal to 3 percent of the premiums collected from its enrollees in an amount not to exceed $500,000. The reserve is in addition to the bond or deposit filed with the Commissioner.  2. The reserve:  (a) Must be deposited in a trust account in a financial institution which is located in this state and which is federally insured or insured by a private insurer approved pursuant to NRS 672.755. The income earned on money in the account must be paid to the organization and used for its operations.  (b) Is in addition to the reserve established by the organization according to good business and accounting practices for incurred but unreported claims and other similar claims.  (Added to NRS by 1991, 1118; A 1999, 1554)
NV Rev Stat § 695F.200 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.200 - Maintenance of capital account, surety bond or deposit and risk-based capital; determination of amount of increase by Commissioner.

  1. Except as otherwise provided in this section, each prepaid limited health service organization which receives a certificate of authority shall maintain all of the following:  (a) A capital account with a net worth of not less than $500,000 unless a lesser amount is permitted in writing by the Commissioner. The account must not be obligated for any accrued liabilities and must consist of cash, securities or a combination thereof which is acceptable to the Commissioner.  (b) A surety bond or deposit of cash or securities for the protection of enrollees of not less than $500,000.  (c) The amount of risk-based capital required by regulations adopted by the Commissioner pursuant to NRS 681B.550.  2. The Commissioner may increase the required amount of the organization’s capital account, surety bond or deposit and capital maintained pursuant to paragraph (c) of subsection 1 to any amount the Commissioner determines to be appropriate pursuant to subsection 3 if the Commissioner determines that such an increase is necessary to:  (a) Assist the Commissioner in the performance of his or her regulatory duties;  (b) Ensure that the organization complies with the requirements of this Code; or  (c) Ensure the solvency of the organization.  3. When determining the appropriate amount of an increase pursuant to subsection 2, the Commissioner must base his or her determination on the type, volume and nature of premiums written and premiums assumed by the organization.  4. The amount of the organization’s capital account, surety bond or deposit and capital maintained pursuant to paragraph (c) of subsection 1, as required pursuant to subsections 1 and 2:  (a) Is in addition to any reserve required by this chapter and any reserve established by the organization according to good business and accounting practices for incurred but unreported claims and other similar claims; and   (b) May increase the amount of risk-based capital required pursuant to NRS 681B.550.   5. The amount of the organization’s surety bond or deposit and capital maintained pursuant to paragraph (c) of subsection 1, as required pursuant to subsections 1 and 2 may increase the amount of net worth required pursuant to subsections 1 and 2.  (Added to NRS by 1991, 1118; A 2017, 2400; 2019, 1722)
NV Rev Stat § 695F.210 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.210 - Maintenance of fidelity bond or deposit in lieu of bond.

  1. A prepaid limited health service organization shall maintain in force a fidelity bond in its own name on its officers and employees in an amount not less than $1,000,000 or in any other amount prescribed by the Commissioner.  2. Except as otherwise provided in subsection 3, the bond must be issued by an insurer licensed to do business in this State.  3. If the fidelity bond is not available from an insurer licensed to do business in this State, a prepaid limited health service organization may procure a fidelity bond from a surplus lines broker licensed pursuant to chapter 685A of NRS.  4. In lieu of the bond required pursuant to subsection 1, a prepaid limited health service organization may deposit with the Commissioner cash, securities or other investments described in NRS 695F.180. The deposit must be maintained in joint custody with the Commissioner in the amount and subject to the same conditions required for a bond pursuant to this subsection.  (Added to NRS by 1991, 1119)
NV Rev Stat § 695F.212 (2021)
2021 Nevada Revised Statutes|Chapter 695F - Prepaid Limited Health Service Organizations|NRS 695F.212 - Hazardous financial condition: Regulations; determination; powers of Commissioner.

  1. The Commissioner may adopt regulations to define when a prepaid limited health service organization is considered to be in a hazardous financial condition and to set forth the standards to be considered by the Commissioner in determining whether the continued operation of a prepaid limited health service organization transacting business in this State may be considered to be hazardous to its enrollees or creditors or to the general public.  2. If the Commissioner determines after a hearing that any prepaid limited health service organization is in a hazardous financial condition, the Commissioner may, instead of suspending or revoking the prepaid limited health service organization’s certificate of authority, limit the certificate of authority of the prepaid limited health service organization as the Commissioner deems reasonably necessary to correct, eliminate or remedy any conduct, condition or ground that is deemed to be a cause of the hazardous financial condition.  3. An order or decision of the Commissioner under this section is subject to review in accordance with NRS 679B.310 to 679B.370, inclusive, at the request of any party to the proceedings whose interests are substantially affected.  (Added to NRS by 2017, 2399)