reglab/housing_qa huggingface dataset:
NV Rev Stat § 689A.750 (2021)
2021 Nevada Revised Statutes|Chapter 689A - Individual Health Insurance|NRS 689A.750 - Annual report; insurer to maintain records of complaints concerning something other than health care services.

  1. Each insurer that issues a policy of health insurance in this State shall submit to the Commissioner an annual report regarding its system for resolving complaints established pursuant to subsection 1 of NRS 689A.745 on a form prescribed by the Commissioner which includes, without limitation:  (a) A description of the procedures used for resolving any complaints of an insured;  (b) The total number of complaints and appeals handled through the system for resolving complaints since the last report and a compilation of the causes underlying the complaints filed;  (c) The current status of each complaint and appeal filed; and  (d) The average amount of time that was needed to resolve a complaint and an appeal, if any.  2. Each insurer shall maintain records of complaints filed with it which concern something other than health care services and shall submit to the Commissioner a report summarizing such complaints at such times and in such format as the Commissioner may require.  (Added to NRS by 1997, 308; A 2003, 774; 2017, 2365)
NV Rev Stat § 689A.755 (2021)
2021 Nevada Revised Statutes|Chapter 689A - Individual Health Insurance|NRS 689A.755 - Written notice to insured explaining right to file complaint; notice to insured required when insurer denies coverage of health care service.

  1. Following approval by the Commissioner, each insurer that issues a policy of health insurance in this State shall provide written notice to an insured, in clear and comprehensible language that is understandable to an ordinary layperson, explaining the right of the insured to file a written complaint. Such notice must be provided to an insured:  (a) At the time the insured receives his or her evidence of coverage;  (b) Any time that the insurer denies coverage of a health care service or limits coverage of a health care service to an insured; and  (c) Any other time deemed necessary by the Commissioner.  2. Any time that an insurer denies coverage of a health care service to an insured, including, without limitation, denying a claim relating to a policy of health insurance pursuant to NRS 689A.410, it shall notify the insured in writing within 10 working days after it denies coverage of the health care service of:  (a) The reason for denying coverage of the service;  (b) The criteria by which the insurer determines whether to authorize or deny coverage of the health care service; and  (c) The right of the insured to file a written complaint and the procedure for filing such a complaint.  3. A written notice which is approved by the Commissioner shall be deemed to be in clear and comprehensible language that is understandable to an ordinary layperson.  (Added to NRS by 1997, 308; A 1999, 3082)
NV Rev Stat § 689B.010 (2021)
2021 Nevada Revised Statutes|Chapter 689B - Group and Blanket Health Insurance|NRS 689B.010 - Short title; scope.

  1. This chapter may be cited as the Group or Blanket Health Insurance Law.  2. This chapter applies only to group health insurance contracts and to blanket accident and health insurance contracts as provided in this chapter.  (Added to NRS by 1971, 1767; A 2001, 2220)
NV Rev Stat § 689B.015 (2021)
2021 Nevada Revised Statutes|Chapter 689B - Group and Blanket Health Insurance|NRS 689B.015 - Contracts between insurer and provider of health care: Prohibiting insurer from charging provider of health care fee for inclusion on list of providers given to insureds; form to obtain information on provider of health care; modification; schedule of fees.

  1. An insurer that issues a policy of group health insurance shall not charge a provider of health care a fee to include the name of the provider on a list of providers of health care given by the insurer to its insureds.  2. An insurer specified in subsection 1 shall not contract with a provider of health care to provide health care to an insured unless the insurer uses the form prescribed by the Commissioner pursuant to NRS 629.095 to obtain any information related to the credentials of the provider of health care.  3. A contract between an insurer specified in subsection 1 and a provider of health care may be modified:  (a) At any time pursuant to a written agreement executed by both parties.  (b) Except as otherwise provided in this paragraph, by the insurer upon giving to the provider 45 days’ written notice of the modification of the insurer’s schedule of payments, including any changes to the fee schedule applicable to the provider’s practice. If the provider fails to object in writing to the modification within the 45-day period, the modification becomes effective at the end of that period. If the provider objects in writing to the modification within the 45-day period, the modification must not become effective unless agreed to by both parties as described in paragraph (a).  4. If an insurer specified in subsection 1 contracts with a provider of health care to provide health care to an insured, the insurer shall:  (a) If requested by the provider of health care at the time the contract is made, submit to the provider of health care the schedule of payments applicable to the provider of health care; or  (b) If requested by the provider of health care at any other time, submit to the provider of health care the schedule of payments, including any changes to the fee schedule applicable to the provider’s practice, specified in paragraph (a) within 7 days after receiving the request.  5. As used in this section, "provider of health care" means a provider of health care who is licensed pursuant to chapter 630, 631, 632 or 633 of NRS.  (Added to NRS by 1999, 1648; A 2001, 2730; 2003, 3357; 2011, 2533)
NV Rev Stat § 689B.020 (2021)
2021 Nevada Revised Statutes|Chapter 689B - Group and Blanket Health Insurance|NRS 689B.020 - "Group health insurance" defined; eligible groups and benefits.

  1. "Group health insurance" is hereby declared to be that form of health insurance covering groups of two or more persons, formed for a purpose other than obtaining insurance.  2. Any group health policy which contains provisions for the payment by the insurer of benefits for expenses incurred on account of hospital, nursing, medical, dental or surgical services, home health care or health supportive services for members of the family or dependents of a person in the insured group may provide for the continuation of such benefit provisions, or any part or parts thereof, after the death of the person in the insured group.  3. The Commissioner may, in the discretion of the Commissioner, require the form of each certificate proposed to be delivered in this state under a group health policy not made under the laws of this state to be filed with the Commissioner by the insurer for informational purposes only.  (Added to NRS by 1971, 1767; A 1971, 1954; 1975, 447)
NV Rev Stat § 689B.026 (2021)
2021 Nevada Revised Statutes|Chapter 689B - Group and Blanket Health Insurance|NRS 689B.026 - Delivery of policy to group formed to purchase health insurance prohibited; exception.

  1. Except as otherwise provided in this section, no policy of group health insurance may be delivered or issued for delivery in this state to a group which was formed for the purpose of purchasing one or more policies of group health insurance.  2. A policy of group health insurance may be delivered to a group described in subsection 1 if the Commissioner approves the issuance. The Commissioner shall not grant approval unless the Commissioner finds that:  (a) The benefits of the policy are reasonable in relation to the premiums charged;  (b) The group to which the policy is issued is organized and operated in a fiscally sound manner; and  (c) All policy rates and forms are filed with and approved by the Division before marketing to a resident or employer in this State.  3. The Commissioner shall use the provisions of this chapter and chapter 689C of NRS to review insurance products marketed to employers in this State. The Commissioner shall use the provisions of chapter 689A of NRS to review insurance products marketed to natural persons in this State.  4. The provisions of this section apply to the offering in this state of a policy issued in another state.  (Added to NRS by 1985, 1060; A 1995, 1628; 2011, 3381)
NV Rev Stat § 689B.0283 (2021)
2021 Nevada Revised Statutes|Chapter 689B - Group and Blanket Health Insurance|NRS 689B.0283 - Coverage for prescription drugs: Provision of notice and information regarding use of formulary.

  1. An insurer that offers or issues a policy of group health insurance which provides coverage for prescription drugs shall include with any summary, certificate or evidence of that coverage provided to an insured, notice of whether a formulary is used and, if so, of the opportunity to secure information regarding the formulary from the insurer 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 insurer for making a request for information regarding the formulary pursuant to subsection 2.  2. If an insurer offers or issues a policy of group health insurance which provides coverage for prescription drugs and a formulary is used, the insurer shall:  (a) Provide to any insured 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 insurer 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, 857)
NV Rev Stat § 689B.0285 (2021)
2021 Nevada Revised Statutes|Chapter 689B - Group and Blanket Health Insurance|NRS 689B.0285 - System for resolving complaints: Approval; requirements; examination.

  1. Except as otherwise provided in subsection 4, each insurer that issues a policy of group health insurance in this State shall establish a system for resolving any complaints of an insured concerning health care services covered under the policy. The system must be approved by the Commissioner.  2. A system for resolving complaints established pursuant to subsection 1 must include an initial investigation, a review of the complaint by a review board and a procedure for appealing a determination regarding the complaint. The majority of the members on a review board must be insureds who receive health care services pursuant to a policy of group health insurance issued by the insurer.  3. The Commissioner may examine the system for resolving complaints established pursuant to subsection 1 at such times as the Commissioner deems necessary or appropriate.  4. Each insurer that issues a policy of group health insurance in this State 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 insured concerning the health care services that complies with the provisions of NRS 695G.200 to 695G.310, inclusive.  (Added to NRS by 1997, 309; A 2003, 775; 2011, 3382; 2017, 2365)
NV Rev Stat § 689B.029 (2021)
2021 Nevada Revised Statutes|Chapter 689B - Group and Blanket Health Insurance|NRS 689B.029 - Annual report regarding system for resolving complaints; insurer to maintain records of complaints concerning something other than health care services.

  1. Each insurer that issues a policy of group health insurance in this State shall submit to the Commissioner an annual report regarding its system for resolving complaints established pursuant to subsection 1 of NRS 689B.0285 on a form prescribed by the Commissioner which includes, without limitation:  (a) A description of the procedures used for resolving any complaints of an insured;  (b) The total number of complaints and appeals handled through the system for resolving complaints since the last report and a compilation of the causes underlying the complaints filed;  (c) The current status of each complaint and appeal filed; and  (d) The average amount of time that was needed to resolve a complaint and an appeal, if any.  2. Each insurer shall maintain records of complaints filed with it which concern something other than health care services and shall submit to the Commissioner a report summarizing such complaints at such times and in such format as the Commissioner may require.  (Added to NRS by 1997, 309; A 2003, 775; 2017, 2366)
NV Rev Stat § 689B.0295 (2021)
2021 Nevada Revised Statutes|Chapter 689B - Group and Blanket Health Insurance|NRS 689B.0295 - Written notice to insured explaining right to file complaint; notice to insured required when insurer denies coverage of health care service.

  1. Following approval by the Commissioner, each insurer that issues a policy of group health insurance in this State shall provide written notice to an insured, in clear and comprehensible language that is understandable to an ordinary layperson, explaining the right of the insured to file a written complaint. Such notice must be provided to an insured:  (a) At the time the insured receives his or her certificate of coverage or evidence of coverage;  (b) Any time that the insurer denies coverage of a health care service or limits coverage of a health care service to an insured; and  (c) Any other time deemed necessary by the Commissioner.  2. Any time that an insurer denies coverage of a health care service, including, without limitation, denying a claim relating to a policy of group health insurance or blanket insurance pursuant to NRS 689B.255, to an insured it shall notify the insured in writing within 10 working days after it denies coverage of the health care service of:  (a) The reason for denying coverage of the service;  (b) The criteria by which the insurer determines whether to authorize or deny coverage of the health care service; and  (c) The right of the insured to file a written complaint and the procedure for filing such a complaint.  3. A written notice which is approved by the Commissioner shall be deemed to be in clear and comprehensible language that is understandable to an ordinary layperson.  (Added to NRS by 1997, 309; A 1999, 3084)
NV Rev Stat § 689B.030 (2021)
2021 Nevada Revised Statutes|Chapter 689B - Group and Blanket Health Insurance|NRS 689B.030 - Required provisions.

Each group health insurance policy must contain in substance the following provisions:  1. A provision that, in the absence of fraud, all statements made by applicants or the policyholders or by an insured person are representations and not warranties, and that no statement made for the purpose of effecting insurance voids the insurance or reduces its benefits unless the statement is contained in a written instrument signed by the policyholder or the insured person, a copy of which has been furnished to the policyholder or insured person or a beneficiary of the policyholder or insured person.  2. A provision that the insurer will furnish to the policyholder for delivery to each employee or member of the insured group a statement in summary form of the essential features of the insurance coverage of that employee or member and to whom benefits thereunder are payable. If dependents are included in the coverage, only one statement need be issued for each family.  3. A provision that to the group originally insured may be added from time to time eligible new employees or members or dependents, as the case may be, in accordance with the terms of the policy.  4. A provision for benefits for expense arising from care at home or health supportive services if the care or service was prescribed by a physician and would have been covered by the policy if performed in a medical facility or facility for the dependent as defined in chapter 449 of NRS.  5. A provision for benefits for expenses arising from hospice care.  (Added to NRS by 1971, 1767; A 1975, 448, 1850; 1979, 1178; 1983, 1934, 2037; 1985, 1774; 1989, 1032; 2009, 1810)
NV Rev Stat § 689B.0303 (2021)
2021 Nevada Revised Statutes|Chapter 689B - Group and Blanket Health Insurance|NRS 689B.0303 - Required provision concerning coverage for continued medical treatment.

  1. The provisions of this section apply to a policy of group health insurance offered or issued by an insurer if an insured covered by the policy receives health care through a defined set of providers of health care who are under contract with the insurer.  2. Except as otherwise provided in this section, if an insured who is covered by a policy described in subsection 1 is receiving medical treatment for a medical condition from a provider of health care whose contract with the insurer is terminated during the course of the medical treatment, the policy must provide that:  (a) The insured may continue to obtain medical treatment for the medical condition from the provider of health care pursuant to this section, if:  (1) The insured is actively undergoing a medically necessary course of treatment; and  (2) The provider of health care and the insured agree that the continuity of care is desirable.  (b) The provider of health care is entitled to receive reimbursement from the insurer for the medical treatment the provider of health care provides to the insured pursuant to this section, if the provider of health care agrees:  (1) To provide medical treatment under the terms of the contract between the provider of health care and the insurer with regard to the insured, including, without limitation, the rates of payment for providing medical service, as those terms existed before the termination of the contract between the provider of health care and the insurer; and  (2) Not to seek payment from the insured for any medical service provided by the provider of health care that the provider of health care could not have received from the insured were the provider of health care still under contract with the insurer.  3. The coverage required by subsection 2 must be provided until the later of:  (a) The 120th day after the date the contract is terminated; or  (b) If the medical condition is pregnancy, the 45th day after:  (1) The date of delivery; or  (2) If the pregnancy does not end in delivery, the date of the end of the pregnancy.  4. The requirements of this section do not apply to a provider of health care if:  (a) The provider of health care was under contract with the insurer and the insurer terminated that contract because of the medical incompetence or professional misconduct of the provider of health care; and  (b) The insurer did not enter into another contract with the provider of health care after the contract was terminated pursuant to paragraph (a).  5. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2003, has the legal effect of including the coverage required by this section, and any provision of the policy or renewal thereof that is in conflict with this section is void.  6. The Commissioner shall adopt regulations to carry out the provisions of this section.  (Added to NRS by 2003, 3356)
NV Rev Stat § 689B.031 (2021)
2021 Nevada Revised Statutes|Chapter 689B - Group and Blanket Health Insurance|NRS 689B.031 - Required provision concerning coverage of certain gynecological or obstetrical services without authorization or referral from primary care physician.

  1. A policy of group health insurance must include a provision authorizing a woman covered by the policy to obtain covered gynecological or obstetrical services without first receiving authorization or a referral from her primary care physician.  2. The provisions of this section do not authorize a woman covered by a policy of group health insurance to designate an obstetrician or gynecologist as her primary care physician.  3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1999, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void.  4. As used in this section, "primary care physician" has the meaning ascribed to it in NRS 695G.060.  (Added to NRS by 1999, 1944)
NV Rev Stat § 689B.0317 (2021)
2021 Nevada Revised Statutes|Chapter 689B - Group and Blanket Health Insurance|NRS 689B.0317 - Required provision concerning coverage for prostate cancer screening.

  1. A policy of group health insurance that provides coverage for the treatment of prostate cancer must provide coverage for prostate cancer screening in accordance with:  (a) The guidelines concerning prostate cancer screening which are published by the American Cancer Society; or  (b) Other guidelines or reports concerning prostate cancer screening which are published by nationally recognized professional organizations and which include current or prevailing supporting scientific data.  2. A policy of group health insurance that provides coverage for the treatment of prostate cancer must not require an insured to obtain prior authorization for any service provided pursuant to subsection 1.  3. A policy of group health insurance that provides coverage for the treatment of prostate cancer which is delivered, issued for delivery or renewed on or after July 1, 2007, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with subsection 1 is void.  (Added to NRS by 2007, 3238)