reglab/housing_qa huggingface dataset:
NV Rev Stat § 689A.04045 (2021)
2021 Nevada Revised Statutes|Chapter 689A - Individual Health Insurance|NRS 689A.04045 - Coverage for prescription drug previously approved for medical condition of insured.

  1. Except as otherwise provided in this section, a policy of health insurance 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 insurer for a medical condition of an insured and the insured’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 insured; and  (b) Is appropriately prescribed and considered safe and effective for treating the medical condition of the insured.  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 insurer from charging a deductible, copayment or coinsurance for the provision of benefits for prescription drugs to the insured 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 policy that is medically appropriate for the insured; 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 policy.  3. Any provision of a policy 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, 857; A 2003, 2298; 2017, 636)
NV Rev Stat § 689A.04046 (2021)
2021 Nevada Revised Statutes|Chapter 689A - Individual Health Insurance|NRS 689A.04046 - Coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications.

  1. An insurer who offers or issues a policy of health insurance which provides coverage for prescription drugs:  (a) Must authorize coverage for and may apply a copayment and deductible to a prescription that is dispensed by a pharmacy for less than a 30-day supply if, for the purpose of synchronizing the insured’s chronic medications:  (1) The prescriber or pharmacist determines that filling or refilling the prescription in that manner is in the best interest of the insured; and  (2) The insured requests less than a 30-day supply.  (b) May not deny coverage for a prescription described in paragraph (a) which is otherwise approved for coverage by the insurer.  (c) Unless otherwise provided by a contract or other agreement, may not prorate any pharmacy dispensing fees for a prescription described in paragraph (a).  2. A policy subject to the provisions of this chapter which provides coverage for prescription drugs and that is delivered, issued for delivery or renewed on or after January 1, 2017, has the legal effect of providing that coverage subject to the requirements of this section, and any provision of the policy or renewal which is in conflict with this section is void.  3. The provisions of this section do not apply to unit-of-use packaging for which synchronization is not practicable or to a controlled substance.  4. As used in this section:  (a) "Chronic medication" means any drug that is prescribed to treat any disease or other condition which is determined to be permanent, persistent or lasting indefinitely.   (b) "Synchronization" means the alignment of the dispensing of multiple medications by a single contracted pharmacy for the purpose of improving a patient’s adherence to a prescribed course of medication.  (c) "Unit-of-use packaging" means medication that is prepackaged by the manufacturer in blister packs, compliance packs, course-of-therapy packs or any other packaging which is designed and intended to be dispensed directly to the patient without modification by the dispensing pharmacy, except for the addition of a prescription label.  (Added to NRS by 2015, 2123)
NV Rev Stat § 689A.04047 (2021)
2021 Nevada Revised Statutes|Chapter 689A - Individual Health Insurance|NRS 689A.04047 - Coverage for early refills of topical ophthalmic products.

  1. An insurer who offers or issues a policy of health insurance which provides coverage for prescription drugs shall not deny coverage for a topical ophthalmic product which is otherwise approved for coverage by the insurer when the insured, pursuant to NRS 639.2395, receives a refill of the product:  (a) After 21 days or more but before 30 days after receiving any 30-day supply of the product;  (b) After 42 days or more but before 60 days after receiving any 60-day supply of the product; or  (c) After 63 days or more but before 90 days after receiving any 90-day supply of the product.  2. The provisions of this section do not affect any deductibles, copayments or coinsurance authorized or required pursuant to the policy of health insurance.  3. A policy of health insurance subject to the provisions of this chapter which provides coverage for prescription drugs and that is delivered, issued for delivery or renewed on or after January 1, 2016, has the legal effect of including the coverage required by this section, and any provision of the policy or renewal which is in conflict with this section is void.  4. As used in this section, "topical ophthalmic product" means a liquid prescription drug which is applied directly to the eye from a bottle or by means of a dropper.  (Added to NRS by 2015, 206)
NV Rev Stat § 689A.041 (2021)
2021 Nevada Revised Statutes|Chapter 689A - Individual Health Insurance|NRS 689A.041 - Coverage relating to mastectomy.

  1. A policy of health insurance which provides coverage for the surgical procedure known as a mastectomy must also provide commensurate coverage for:  (a) Reconstruction of the breast on which the mastectomy has been performed;  (b) Surgery and reconstruction of the other breast to produce a symmetrical structure; and  (c) Prostheses and physical complications for all stages of mastectomy, including lymphedemas.  2. The provision of services must be determined by the attending physician and the patient.  3. The plan or issuer may require deductibles and coinsurance payments if they are consistent with those established for other benefits.  4. Written notice of the availability of the coverage must be given upon enrollment and annually thereafter. The notice must be sent to all participants:  (a) In the next mailing made by the plan or issuer to the participant or beneficiary; or  (b) As part of any annual information packet sent to the participant or beneficiary,  whichever is earlier.  5. A plan or issuer may not:  (a) Deny eligibility, or continued eligibility, to enroll or renew coverage, in order to avoid the requirements of subsections 1 to 4, inclusive; or  (b) Penalize, or limit reimbursement to, a provider of care, or provide incentives to a provider of care, in order to induce the provider not to provide the care listed in subsections 1 to 4, inclusive.  6. A plan or issuer may negotiate rates of reimbursement with providers of care.  7. If reconstructive surgery is begun within 3 years after a mastectomy, the amount of the benefits for that surgery must equal the amounts provided for in the policy at the time of the mastectomy. If the surgery is begun more than 3 years after the mastectomy, the benefits provided are subject to all of the terms, conditions and exclusions contained in the policy at the time of the reconstructive surgery.  8. A policy subject to the provisions of this chapter which is delivered, issued for delivery or renewed on or after October 1, 2001, 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.  9. For the purposes of this section, "reconstructive surgery" means a surgical procedure performed following a mastectomy on one breast or both breasts to re-establish symmetry between the two breasts. The term includes augmentation mammoplasty, reduction mammoplasty and mastopexy.  (Added to NRS by 1983, 614; A 1989, 1889; 2001, 2218)
NV Rev Stat § 689A.0413 (2021)
2021 Nevada Revised Statutes|Chapter 689A - Individual Health Insurance|NRS 689A.0413 - Coverage for certain gynecological or obstetrical services without authorization or referral from primary care physician.

  1. A policy of 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 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, 1943)
NV Rev Stat § 689A.0415 (2021)
2021 Nevada Revised Statutes|Chapter 689A - Individual Health Insurance|NRS 689A.0415 - Coverage for hormone replacement therapy in certain circumstances; prohibited actions by insurer; exception.

  1. An insurer that offers or issues a policy of health insurance which provides coverage for prescription drugs or devices shall include in the policy coverage for any type of hormone replacement therapy which is lawfully prescribed or ordered and which has been approved by the Food and Drug Administration.  2. An insurer that offers or issues a policy of health insurance that provides coverage for prescription drugs shall not:  (a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition for coverage for a prescription for hormone replacement therapy;  (b) Refuse to issue a policy of health insurance or cancel a policy of health insurance solely because the person applying for or covered by the policy uses or may use in the future hormone replacement therapy;  (c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from accessing hormone replacement therapy;  (d) Penalize a provider of health care who provides hormone replacement therapy to an insured, including, without limitation, reducing the reimbursement of the provider of health care; or  (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay hormone replacement therapy to an insured.  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 subsection 1, and any provision of the policy or the renewal which is in conflict with this section is void.  4. The provisions of this section do not require an insurer to provide coverage for fertility drugs.  5. As used in this section, "provider of health care" has the meaning ascribed to it in NRS 629.031.  (Added to NRS by 1999, 1995; A 2017, 1810, 3934)
NV Rev Stat § 689A.0417 (2021)
2021 Nevada Revised Statutes|Chapter 689A - Individual Health Insurance|NRS 689A.0417 - Coverage for health care services related to hormone replacement therapy in certain circumstances; prohibited actions by insurer.

  1. An insurer that offers or issues a policy of health insurance which provides coverage for outpatient care shall include in the policy coverage for any health care service related to hormone replacement therapy.  2. An insurer that offers or issues a policy of health insurance that provides coverage for outpatient care shall not:  (a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition for coverage for outpatient care related to hormone replacement therapy;  (b) Refuse to issue a policy of health insurance or cancel a policy of health insurance solely because the person applying for or covered by the policy uses or may use in the future hormone replacement therapy;  (c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from accessing hormone replacement therapy;  (d) Penalize a provider of health care who provides hormone replacement therapy to an insured, including, without limitation, reducing the reimbursement of the provider of health care; or  (e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay hormone replacement therapy to an insured.  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 subsection 1, and any provision of the policy or the renewal which is in conflict with this section is void.  4. As used in this section, "provider of health care" has the meaning ascribed to it in NRS 629.031.  (Added to NRS by 1999, 1996; A 2017, 1811, 3935)
NV Rev Stat § 689A.042 (2021)
2021 Nevada Revised Statutes|Chapter 689A - Individual Health Insurance|NRS 689A.042 - Coverage relating to complications of pregnancy.

  1. No health insurance policy may be delivered or issued for delivery in this state if it contains any exclusion, reduction or other limitation of coverage relating to complications of pregnancy, unless the provision applies generally to all benefits payable under the policy.  2. As used in this section, the term "complications of pregnancy" includes any condition which requires hospital confinement for medical treatment and:  (a) If the pregnancy is not terminated, is caused by an injury or sickness not directly related to the pregnancy or by acute nephritis, nephrosis, cardiac decompensation, missed abortion or similar medically diagnosed conditions; or  (b) If the pregnancy is terminated, results in nonelective cesarean section, ectopic pregnancy or spontaneous termination.  3. A policy subject to the provisions of this chapter which is delivered or issued for delivery on or after July 1, 1977, has the legal effect of including the coverage required by this section, and any provision of the policy which is in conflict with this section is void.  (Added to NRS by 1977, 415)
NV Rev Stat § 689A.0423 (2021)
2021 Nevada Revised Statutes|Chapter 689A - Individual Health Insurance|NRS 689A.0423 - Coverage for treatment of certain inherited metabolic diseases.

  1. A policy of health insurance must provide coverage for:  (a) Enteral formulas for use at home that are prescribed or ordered by a physician as medically necessary for the treatment of inherited metabolic diseases characterized by deficient metabolism, or malabsorption originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate or fat; and  (b) At least $2,500 per year for special food products which are prescribed or ordered by a physician as medically necessary for the treatment of a person described in paragraph (a).  2. The coverage required by subsection 1 must be provided whether or not the condition existed when the policy was purchased.  3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 1998, 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:  (a) "Inherited metabolic disease" means a disease caused by an inherited abnormality of the body chemistry of a person.  (b) "Special food product" means a food product that is specially formulated to have less than one gram of protein per serving and is intended to be consumed under the direction of a physician for the dietary treatment of an inherited metabolic disease. The term does not include a food that is naturally low in protein.  (Added to NRS by 1997, 1526)
NV Rev Stat § 689A.0424 (2021)
2021 Nevada Revised Statutes|Chapter 689A - Individual Health Insurance|NRS 689A.0424 - Policy that includes coverage for maternity care must not deny coverage for gestational carrier; status of child in relation to intended parent. [Effective January 1, 2020.]

  1. An insurer that offers or issues a policy of health insurance that includes coverage for maternity care shall not deny, limit or seek reimbursement for maternity care because the insured is acting as a gestational carrier.  2. If an insured acts as a gestational carrier, the child shall be deemed to be a child of the intended parent, as defined in NRS 126.590, for purposes related to the policy of health insurance.  3. As used in this section, "gestational carrier" has the meaning ascribed to it in NRS 126.580.  (Added to NRS by 2019, 1005, effective January 1, 2020)
NV Rev Stat § 689A.0425 (2021)
2021 Nevada Revised Statutes|Chapter 689A - Individual Health Insurance|NRS 689A.0425 - Individual health benefit plan that includes coverage for maternity care and pediatric care: Requirement to allow minimum stay in hospital in connection with childbirth; prohibited acts.

[Replaced in revision by NRS 689A.717.]
NV Rev Stat § 689A.0427 (2021)
2021 Nevada Revised Statutes|Chapter 689A - Individual Health Insurance|NRS 689A.0427 - Coverage for management and treatment of diabetes.

  1. No policy of health insurance that provides coverage for hospital, medical or surgical expenses may be delivered or issued for delivery in this state unless the policy includes coverage for the management and treatment of diabetes, including, without limitation, coverage for the self-management of diabetes.  2. An insurer who delivers or issues for delivery a policy specified in subsection 1:  (a) Shall include in any disclosure of the coverage provided by the policy notice to each policyholder and subscriber under the policy of the availability of the benefits required by this section.  (b) Shall provide the coverage required by this section subject to the same deductible, copayment, coinsurance and other such conditions for coverage that are required under the policy.  3. A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 1998, has the legal effect of including the coverage required by this section, and any provision of the policy that conflicts with this section is void.  4. As used in this section:  (a) "Coverage for the management and treatment of diabetes" includes coverage for medication, equipment, supplies and appliances that are medically necessary for the treatment of diabetes.  (b) "Coverage for the self-management of diabetes" includes:  (1) The training and education provided to an insured person after the insured person is initially diagnosed with diabetes which is medically necessary for the care and management of diabetes, including, without limitation, counseling in nutrition and the proper use of equipment and supplies for the treatment of diabetes;  (2) Training and education which is medically necessary as a result of a subsequent diagnosis that indicates a significant change in the symptoms or condition of the insured person and which requires modification of the insured person’s program of self-management of diabetes; and  (3) Training and education which is medically necessary because of the development of new techniques and treatment for diabetes.  (c) "Diabetes" includes type I, type II and gestational diabetes.  (Added to NRS by 1997, 742; A 2017, 2361)
NV Rev Stat § 689A.0428 (2021)
2021 Nevada Revised Statutes|Chapter 689A - Individual Health Insurance|NRS 689A.0428 - Coverage for management and treatment of sickle cell disease.

  1. An insurer that issues a policy of health insurance shall include in the policy coverage for:  (a) Necessary case management services for an insured diagnosed with sickle cell disease and its variants; and  (b) Medically necessary care for an insured who has been diagnosed with sickle cell disease and its variants.  2. An insurer that issues a policy of health insurance which provides coverage for prescription drugs shall include in the policy coverage for medically necessary prescription drugs to treat sickle cell disease and its variants.  3. An insurer may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.  4. As used in this section:  (a) "Case management services" means medical or other health care management services to assist patients and providers of health care, including, without limitation, identifying and facilitating additional resources and treatments, providing information about treatment options and facilitating communication between providers of services to a patient.  (b) "Medical management technique" means a practice which is used to control the cost or utilization of health care services. The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.  (c) "Medically necessary" has the meaning ascribed to it in NRS 695G.055.  (d) "Sickle cell disease and its variants" has the meaning ascribed to it in NRS 439.4927.  (Added to NRS by 2019, 2169)
NV Rev Stat § 689A.043 (2021)
2021 Nevada Revised Statutes|Chapter 689A - Individual Health Insurance|NRS 689A.043 - Coverage of newly born and adopted children and children placed for adoption.

  1. All individual health insurance policies providing family coverage on an expense-incurred basis must as to family members’ coverage provide that the health benefits applicable for children are payable with respect to:  (a) A newly born child of the insured from the moment of birth;  (b) An adopted child from the date the adoption becomes effective, if the child was not placed in the home before adoption; and  (c) A child placed with the insured for the purpose of adoption from the moment of placement as certified by the public or private agency making the placement. The coverage of such a child ceases if the adoption proceedings are terminated as certified by the public or private agency making the placement.  The policies must provide the coverage specified in subsection 3 and must not exclude premature births.  2. The policy or contract may require that notification of:  (a) The birth of a newly born child;  (b) The effective date of adoption of a child; or  (c) The date of placement of a child for adoption,  and payments of the required premium or fees, if any, must be furnished to the insurer within 31 days after the date of birth, adoption or placement for adoption in order to have the coverage continue beyond the 31-day period.  3. The coverage for newly born and adopted children and children placed for adoption consists of coverage of injury or sickness, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities and, within the limits of the policy, necessary transportation costs from place of birth to the nearest specialized treatment center under major medical policies, and with respect to basic policies to the extent such costs are charged by the treatment center.  (Added to NRS by 1975, 1109; A 1989, 739)