reglab/housing_qa huggingface dataset:
NV Rev Stat § 695C.179 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.179 - Reimbursement for services provided by certain nurses; prohibited limitations; exceptions.

  1. If any evidence of coverage provides coverage for services which are within the authorized scope of practice of a registered nurse who is authorized pursuant to chapter 632 of NRS to perform additional acts in an emergency or under other special conditions as prescribed by the State Board of Nursing, and which are reimbursed when provided by another provider of health care, the insured is entitled to reimbursement for services provided by such a registered nurse.  2. The terms of the evidence of coverage must not limit:  (a) Coverage for services provided by such a registered nurse to a number of occasions less than for services provided by another provider of health care.  (b) Reimbursement for services provided by such a registered nurse to an amount less than that reimbursed for similar services provided by another provider of health care.  3. An insurer is not required to pay for services provided by such a registered nurse which duplicate services provided by another provider of health care.  (Added to NRS by 1985, 1448)
NV Rev Stat § 695C.1795 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.1795 - Reimbursement to provider of medical transportation.

  1. Except as otherwise provided in subsection 3, every evidence of coverage amended, delivered or issued for delivery in this State after October 1, 1989, that provides coverage for medical transportation, must contain a provision for the direct reimbursement of a provider of medical transportation for covered services if that provider does not receive reimbursement from any other source.  2. The enrollee or the provider may submit the claim for reimbursement. The provider shall not demand payment from the enrollee until after that reimbursement has been granted or denied.  3. Subsection 1 does not apply to any agreement between a health maintenance organization and a provider of medical transportation for the direct payment by the organization for the provider’s services.  (Added to NRS by 1989, 1274)
NV Rev Stat § 695C.187 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.187 - Schedule for payment of claims: Mandatory inclusion in arrangements for provision of health care.

  1. A health maintenance organization shall not:  (a) Enter into any contract or agreement, or make any other arrangements, with a provider for the provision of health care; or  (b) Employ a provider pursuant to a contract, an agreement or any other arrangement to provide health care,  unless the contract, agreement or other arrangement specifically provides that the health maintenance organization and provider agree to the schedule for the payment of claims set forth in NRS 695C.185.  2. Any contract, agreement or other arrangement between a health maintenance organization and a provider that is entered into or renewed on or after October 1, 2001, that does not specifically include a provision concerning the schedule for the payment of claims as required by subsection 1 shall be deemed to conform with the requirements of subsection 1 by operation of law.  (Added to NRS by 2001, 2734)
NV Rev Stat § 695C.190 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.190 - Commissioner may require submission of information.

The Commissioner may require the submission of whatever relevant information the Commissioner deems necessary in determining whether to approve or disapprove a filing made pursuant to NRS 695C.170 to 695C.200, inclusive.  (Added to NRS by 1973, 1252; A 1985, 1448; 1989, 1274)
NV Rev Stat § 695C.194 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.194 - Provision of health care services to recipients of Medicaid or enrollees in Children’s Health Insurance Program: Requirement to contract with psychiatric hospital for inclusion in network of providers. [Effective January 1, 2020.]

A health maintenance organization that provides health care services to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services shall negotiate in good faith to enter into a contract with a psychiatric hospital with an endorsement as a crisis stabilization center pursuant to NRS 449.0915 to include the psychiatric hospital in the network of providers under contract with the health maintenance organization to provide services to recipients of Medicaid or enrollees in the Children’s Health Insurance Program, as applicable.  (Added to NRS by 2019, 1926, effective January 1, 2020)
NV Rev Stat § 695C.200 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.200 - Approval of forms and schedules.

The Commissioner shall within a reasonable period approve any form if the requirements of NRS 695C.170 are met. It is unlawful to issue such form or to use such schedule of charges until approved. If the Commissioner disapproves such filing, the Commissioner shall notify the filer. In the notice, the Commissioner shall specify the reasons for disapproval. A hearing will be granted within 90 days after a request in writing by the person filing.  (Added to NRS by 1973, 1251; A 2013, 3646)
NV Rev Stat § 695C.201 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.201 - Offering policy of health insurance for purposes of establishing health savings account.

A health maintenance organization may, subject to regulation by the Commissioner, offer a policy of health insurance that has a high deductible and is in compliance with 26 U.S.C. § 223 for the purposes of establishing a health savings account.  (Added to NRS by 2005, 2158)
NV Rev Stat § 695C.202 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.202 - Provision of health care services to recipients of Medicaid: Notice to recipients if Department of Health and Human Services obtains waiver to provide dental care to persons with diabetes; coordination to ensure receipt of such care.

If the Department of Health and Human Services obtains a waiver to provide the dental care described in NRS 422.27247, a health maintenance organization that provides health care services through managed care to recipients of Medicaid must:  1. Provide written notice to each such recipient who is diagnosed with diabetes and is eligible to receive dental care pursuant to NRS 422.27247 of his or her eligibility to receive such care; and  2. Coordinate with any entity necessary to ensure that eligible recipients of Medicaid receive the benefits prescribed by that section.  (Added to NRS by 2019, 2418)
NV Rev Stat § 695C.203 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.203 - Denying coverage solely because person was victim of domestic violence prohibited.

A health maintenance organization shall not deny a claim, refuse to issue a policy or cancel a policy solely because the claim involves an act that constitutes domestic violence pursuant to NRS 33.018, or because the person applying for or covered by the policy was the victim of such an act of domestic violence, regardless of whether the insured or applicant contributed to any loss or injury.  (Added to NRS by 1997, 1096)
NV Rev Stat § 695C.205 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.205 - Denying coverage solely because insured was intoxicated or under the influence of controlled substance prohibited; exceptions.

  1. Except as otherwise provided in subsection 2, a health maintenance organization shall not:  (a) Deny a claim under a health care plan solely because the claim involves an injury sustained by an enrollee as a consequence of being intoxicated or under the influence of a controlled substance.  (b) Cancel participation under a health care plan solely because an enrollee has made a claim involving an injury sustained by the enrollee as a consequence of being intoxicated or under the influence of a controlled substance.  (c) Refuse participation under a health care plan to an eligible applicant solely because the applicant has made a claim involving an injury sustained by the applicant as a consequence of being intoxicated or under the influence of a controlled substance.  2. The provisions of subsection 1 do not prohibit a health maintenance organization from enforcing a provision included in a health care plan to:  (a) Deny a claim which involves an injury to which a contributing cause was the insured’s commission of or attempt to commit a felony;  (b) Cancel participation under a health care plan solely because of such a claim; or  (c) Refuse participation under a health care plan to an eligible applicant solely because of such a claim.  3. The provisions of this section do not apply to a health maintenance organization under a health care plan that provides coverage for long-term care or disability income.  (Added to NRS by 2005, 2345; A 2007, 86)
NV Rev Stat § 695C.207 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.207 - Requiring or using information concerning genetic testing. [Effective through December 31, 2019.]

  1. A health maintenance organization shall not:  (a) Require an enrollee or any member of the family of the enrollee to take a genetic test;  (b) Require an enrollee to disclose whether the enrollee or any member of the family of the enrollee has taken a genetic test or the genetic information of the enrollee or a member of the family of the enrollee; or  (c) Determine the rates or any other aspect of the coverage or benefits for health care provided to an enrollee based on:  (1) Whether the enrollee or any member of the family of the enrollee has taken a genetic test; or  (2) Any genetic information of the enrollee or any member of the family of the enrollee.  2. As used in this section:  (a) "Genetic information" means any information that is obtained from a genetic test.  (b) "Genetic test" means a test, including a laboratory test which uses deoxyribonucleic acid extracted from the cells of a person or a diagnostic test, to determine the presence of abnormalities or deficiencies, including carrier status, that:  (1) Are linked to physical or mental disorders or impairments; or  (2) Indicate a susceptibility to illness, disease, impairment or any other disorder, whether physical or mental.  (Added to NRS by 1997, 1461)
NV Rev Stat § 695C.207 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.207 - Requiring or using information concerning genetic testing. [Effective January 1, 2020.]

  1. A health maintenance organization shall not:  (a) Require an enrollee or any member of the family of the enrollee to take a genetic test;  (b) Require an enrollee to disclose whether the enrollee or any member of the family of the enrollee has taken a genetic test or the genetic information of the enrollee or a member of the family of the enrollee; or  (c) Determine the rates or any other aspect of the coverage or benefits for health care provided to an enrollee based on whether the enrollee or any member of the family of the enrollee has taken a genetic test.  2. As used in this section:  (a) "Genetic information" means any information that is obtained from a genetic test.  (b) "Genetic test" means a test, including a laboratory test which uses deoxyribonucleic acid extracted from the cells of a person or a diagnostic test, to determine the presence of abnormalities or deficiencies, including carrier status, that:  (1) Are linked to physical or mental disorders or impairments; or  (2) Indicate a susceptibility to illness, disease, impairment or any other disorder, whether physical or mental.  (Added to NRS by 1997, 1461; A 2019, 310, effective January 1, 2020)
NV Rev Stat § 695C.210 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.210 - Annual report of financial condition and financial statement; quarterly statement; administrative penalty for failure to file report or statement; extension of time.

  1. Every health maintenance organization shall file with the Commissioner on or before March 1 of each year 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 forms prescribed by the Commissioner and must include:  (a) A financial statement of the organization, including its balance sheet and receipts and disbursements for the preceding calendar year;  (b) Any material changes in the information submitted pursuant to NRS 695C.070;  (c) The number of persons enrolled during the year, the number of enrollees as of the end of the year, the number of enrollments terminated during the year and, if requested by the Commissioner, a compilation of the reasons for such terminations;  (d) The number and amount of malpractice claims initiated against the health maintenance organization and any of the providers used by it during the year broken down into claims with and without form of legal process, and the disposition, if any, of each such claim, if requested by the Commissioner;  (e) A summary of information compiled pursuant to paragraph (c) of subsection 1 of NRS 695C.080 in such form as required by the Commissioner; and  (f) Such other information relating to the performance of the health maintenance organization as is necessary to enable the Commissioner to carry out his or her duties pursuant to this chapter.  3. Every health maintenance organization shall file with the Commissioner annually an audited financial statement of the organization in accordance with the provisions of subsection 1 of NRS 680A.265. Upon written request, the Commissioner may grant a 30-day extension.  4. Every health maintenance 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. If an organization fails to file timely a report or financial statement required by this section, it shall pay an administrative penalty of $100 per day until the report or statement is filed, except that the total penalty must not exceed $3,000. The Attorney General shall recover the penalty in the name of the State of Nevada.  6. The Commissioner may grant a reasonable extension of time for filing any report or statement required by this section, if the request for an extension is submitted in writing and shows good cause.  (Added to NRS by 1973, 1252; A 1991, 2204; 1995, 1632, 2681; 2013, 3646; 2019, 1718)
NV Rev Stat § 695C.215 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.215 - Financial statement required to include report of net worth.

A health maintenance organization which has been issued a certificate of authority pursuant to this chapter shall maintain and report on each financial statement filed with the Commissioner pursuant to NRS 695C.210 a net worth in an amount which is not less than the greatest of:  1. One million five hundred thousand dollars;  2. Two percent of the first $150,000,000 earned as revenue from premiums collected in the preceding 12-month period, plus 1 percent of the amount in excess of $150,000,000 earned as revenue from premiums collected in that same period; or  3. The amount of risk-based capital required by regulations adopted by the Commissioner pursuant to NRS 681B.550.  (Added to NRS by 2019, 1717)
NV Rev Stat § 695C.220 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.220 - Applications, filings and reports open to public inspection.

All applications, filings and reports required under this chapter shall be treated as public documents except as otherwise provided in this chapter.  (Added to NRS by 1973, 1258)
NV Rev Stat § 695C.230 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.230 - Fees.

  1. Every health maintenance organization subject to this chapter shall pay to the Commissioner the following fees:  (a) For filing an application for a certificate of authority, $2,450.  (b) For issuance of a certificate of authority, $250.  (c) For an amendment to a certificate of authority, $100.  (d) For the renewal of a certificate of authority, $2,450.  (e) For filing each annual report, $25.  (f) In addition to any other fee or charge, all applicable fees required pursuant to NRS 680C.110.  2. At the time of filing the annual report the health maintenance 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.  3. All fees paid pursuant to this section shall be deemed earned when paid and may not be refunded.  (Added to NRS by 1973, 1257; A 1987, 470; 1991, 1634; 1993, 1923; 2009, 1818)
NV Rev Stat § 695C.240 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.240 - Information required to be available for inspection.

Every health maintenance organization shall have available for inspection the following information:  1. A current statement of financial condition including a balance sheet and summary of receipts and disbursements;  2. A description of the organizational structure and operation of the health maintenance organization and a summary of any material changes since the issuance of the last report;  3. A description of services and information as to where and how to secure them; and  4. A clear and understandable description of the health maintenance organization’s method for resolving enrollee complaints.  (Added to NRS by 1973, 1252)
NV Rev Stat § 695C.260 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.260 - Complaint system.

Each health maintenance organization shall establish:  1. A system for resolving complaints which complies with the provisions of NRS 695G.200 to 695G.230, inclusive; and  2. A system for conducting external reviews of adverse determinations that complies with the provisions of NRS 695G.241 to 695G.310, inclusive.  (Added to NRS by 1973, 1253; A 1997, 311; 2003, 778; 2011, 3395)
NV Rev Stat § 695C.265 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.265 - Required procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations.

  1. If a health maintenance organization, for any final determination of benefits or care, requires an independent evaluation of the medical, dental or chiropractic care of any person for whom such care is provided under the evidence of coverage:  (a) The evidence of coverage must include a procedure for binding arbitration to resolve disputes concerning independent medical evaluations pursuant to the rules of the American Arbitration Association; and  (b) Only a physician, dentist or chiropractor who is certified to practice in the same field of practice as the primary treating physician, dentist or chiropractor or who is formally educated in that field may conduct the independent evaluation.  2. The independent evaluation must include a physical examination of the patient, unless the patient is deceased, and a personal review of all X-rays and reports prepared by the primary treating physician, dentist or chiropractor. A certified copy of all reports of findings must be sent to the primary treating physician, dentist or chiropractor and the insured person within 10 working days after the evaluation. If the insured person disagrees with the finding of the evaluation, the insured person must submit an appeal to the insurer pursuant to the procedure for binding arbitration set forth in the evidence of coverage within 30 days after the insured person receives the finding of the evaluation. Upon its receipt of an appeal, the insurer shall so notify in writing the primary treating physician, dentist or chiropractor.  3. The insurer shall not limit or deny coverage for care related to a disputed claim while the dispute is in arbitration, except that, if the insurer prevails in the arbitration, the primary treating physician, dentist or chiropractor may not recover any payment from either the insurer, insured person or the patient for services that the primary treating physician, dentist or chiropractor provided to the patient after receiving written notice from the insurer pursuant to subsection 2 concerning the appeal of the insured person.  (Added to NRS by 1989, 2116; A 2015, 197)
NV Rev Stat § 695C.267 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.267 - Provision requiring binding arbitration authorized; procedures for arbitration; declaratory relief.

  1. Except as otherwise provided in NRS 695C.265 and subject to the approval of the Commissioner, a health maintenance organization may include in any evidence of coverage issued by the organization a provision which requires an enrollee to whom the evidence of coverage is issued and the health maintenance organization to submit for binding arbitration any dispute between the enrollee and the organization concerning any matter directly or indirectly related to, or associated with, the evidence of coverage or the health care plan or health care services of the health maintenance organization. If such a provision is included in the evidence of coverage:  (a) An enrollee must be given the opportunity to decline to participate in binding arbitration at the time of his or her enrollment.  (b) It must clearly state that the health maintenance organization and an enrollee who has not declined to participate in binding arbitration agree to forego their right to resolve any such dispute in a court of law or equity.  2. Except as otherwise provided in subsection 3, the arbitration must be conducted pursuant to the rules for commercial arbitration established by the American Arbitration Association. The health maintenance organization is responsible for any administrative fees and expenses relating to the arbitration, except that the health maintenance organization is not responsible for attorney’s fees and fees for expert witnesses unless those fees are awarded by the arbitrator.  3. If a dispute required to be submitted to binding arbitration requires an immediate resolution to protect the physical health of an enrollee, any party to the dispute may waive arbitration and seek declaratory relief in a court of competent jurisdiction.  4. If a provision described in subsection 1 is included in any evidence of coverage issued by a health maintenance organization, the provision shall not be deemed unenforceable as an unreasonable contract of adhesion if the provision is included in compliance with the provisions of subsection 1.  (Added to NRS by 1995, 2559)
NV Rev Stat § 695C.270 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.270 - Bond required; waiver.

Each health maintenance organization shall furnish a surety bond in an amount satisfactory to the Commissioner or deposit with the Commissioner cash or securities acceptable to the Commissioner in at least the same amount as a guarantee that the obligations to the enrollees will be performed. The Commissioner may waive this requirement whenever satisfied that the assets of the organization and its contracts with insurers, governments, or other organizations are sufficient to reasonably assure the performance of its obligations.  (Added to NRS by 1973, 1253)