reglab/housing_qa huggingface dataset:
NV Rev Stat § 695C.1703 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.1703 - Coverage for prescription drugs: Provision of notice and information regarding use of formulary.

  1. A health maintenance organization or insurer that offers or issues evidence of coverage which provides coverage for prescription drugs shall include with any evidence of that coverage provided to an enrollee, notice of whether a formulary is used and, if so, of the opportunity to secure information regarding the formulary from the organization or 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 organization or insurer for making a request for information regarding the formulary pursuant to subsection 2.  2. If a health maintenance organization or insurer offers or issues evidence of coverage which provides coverage for prescription drugs and a formulary is used, the organization or insurer 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 or 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, 863)
NV Rev Stat § 695C.1705 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.1705 - Group health care plan issued to replace discontinued policy or coverage: Requirements; notice of reduction of benefits; statement of benefits; applicability to self-insured employer.

Except as otherwise provided in the provisions of NRS 689B.340 to 689B.580, inclusive, and chapter 689C of NRS relating to the portability and accountability of health insurance:  1. A group health care plan issued by a health maintenance organization to replace any discontinued policy or coverage for group health insurance must:  (a) Provide coverage for all persons who were covered under the previous policy or coverage on the date it was discontinued; and  (b) Except as otherwise provided in subsection 2, provide benefits which are at least as extensive as the benefits provided by the previous policy or coverage, except that benefits may be reduced or excluded to the extent that such a reduction or exclusion was permissible under the terms of the previous policy or coverage,  if that plan is issued within 60 days after the date on which the previous policy or coverage was discontinued.  2. If an employer obtains a replacement plan pursuant to subsection 1 to cover the employees of the employer, any benefits provided by the previous policy or coverage may be reduced if notice of the reduction is given to the employees pursuant to NRS 608.1577.  3. Any health maintenance organization which issues a replacement plan pursuant to subsection 1 may submit a written request to the insurer which provided the previous policy or coverage for a statement of benefits which were provided under that policy or coverage. Upon receiving such a request, the insurer shall give a written statement to the organization indicating what benefits were provided and what exclusions or reductions were in effect under the previous policy or coverage.  4. If an employee or enrollee was a recipient of benefits under the coverage provided pursuant to NRS 695C.1709, the employee or enrollee is not entitled to have issued to him or her by a health maintenance organization a replacement plan unless the employee or enrollee has reported for his or her normal employment for a period of 90 consecutive days after last being eligible to receive any benefits under the coverage provided pursuant to NRS 695C.1709.  5. The provisions of this section apply to a self-insured employer who provides health benefits to the employees of the self-insured employer and replaces those benefits with a group health care plan issued by a health maintenance organization.  (Added to NRS by 1987, 850; A 1989, 1253; 1997, 2958; 2013, 3644)
NV Rev Stat § 695C.1708 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.1708 - Required provision concerning coverage for services provided through telehealth.

  1. A health care plan of a health maintenance organization must include coverage for services provided to an enrollee through telehealth to the same extent as though provided in person or by other means.   2. A health maintenance organization shall not:  (a) Require an enrollee to establish a relationship in person with a provider of health care or provide any additional consent to or reason for obtaining services through telehealth as a condition to providing the coverage described in subsection 1;   (b) Require a provider of health care to demonstrate that it is necessary to provide services to an enrollee through telehealth or receive any additional type of certification or license to provide services through telehealth as a condition to providing the coverage described in subsection 1;  (c) Refuse to provide the coverage described in subsection 1 because of the distant site from which a provider of health care provides services through telehealth or the originating site at which an enrollee receives services through telehealth; or  (d) Require covered services to be provided through telehealth as a condition to providing coverage for such services.  3. A health care plan of a health maintenance organization must not require an enrollee to obtain prior authorization for any service provided through telehealth that is not required for the service when provided in person. Such a health care plan may require prior authorization for a service provided through telehealth if such prior authorization would be required if the service were provided in person or by other means.  4. The provisions of this section do not require a health maintenance organization to:  (a) Ensure that covered services are available to an enrollee through telehealth at a particular originating site;  (b) Provide coverage for a service that is not a covered service or that is not provided by a covered provider of health care; or  (c) Enter into a contract with any provider of health care or cover any service if the health maintenance organization is not otherwise required by law to do so.  5. Evidence of coverage subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2015, has the legal effect of including the coverage required by this section, and any provision of the plan or the renewal which is in conflict with this section is void.  6. As used in this section:  (a) "Distant site" has the meaning ascribed to it in NRS 629.515.  (b) "Originating site" has the meaning ascribed to it in NRS 629.515.  (c) "Provider of health care" has the meaning ascribed to it in NRS 439.820.  (d) "Telehealth" has the meaning ascribed to it in NRS 629.515.  (Added to NRS by 2015, 643)
NV Rev Stat § 695C.1709 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.1709 - Required provision concerning coverage for enrollee on leave without pay as result of total disability.

  1. As used in this section, "total disability" and "totally disabled" mean the continuing inability of the enrollee, because of an injury or illness, to perform substantially the duties related to his or her employment for which the enrollee is otherwise qualified.  2. No policy of group insurance to which an enrollee is entitled under a health care plan provided by a health maintenance organization may be delivered or issued for delivery in this state unless it provides continuing coverage for an enrollee and dependents of the enrollee who are otherwise covered by the policy while the enrollee is on leave without pay as a result of a total disability. The coverage must be for any injury or illness suffered by the enrollee which is not related to the total disability or for any injury or illness suffered by a dependent of the enrollee. The coverage must be equal to or greater than the coverage otherwise provided by the policy.  3. The coverage required pursuant to subsection 2 must continue until:  (a) The date on which the employment of the enrollee is terminated;  (b) The date on which the enrollee obtains another policy of health insurance;  (c) The date on which the policy of group insurance is terminated; or  (d) After a period of 12 months in which benefits under such coverage are provided to the enrollee,  whichever occurs first.  (Added to NRS by 1989, 1253)
NV Rev Stat § 695C.171 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.171 - Required provision concerning coverage relating to mastectomy.

  1. A health maintenance plan 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 those 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, but is not limited to, augmentation mammoplasty, reduction mammoplasty and mastopexy.  (Added to NRS by 1983, 615; A 1989, 1891; 2001, 2250)
NV Rev Stat § 695C.1712 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.1712 - Health care plan 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. A health maintenance organization that offers or issues a health care plan that includes coverage for maternity care shall not deny, limit or seek reimbursement for maternity care because the enrollee is acting as a gestational carrier.  2. If an enrollee 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 health care plan.  3. As used in this section, "gestational carrier" has the meaning ascribed to it in NRS 126.580.  (Added to NRS by 2019, 1007, effective January 1, 2020)
NV Rev Stat § 695C.1713 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.1713 - Required provision concerning coverage of certain gynecological and obstetrical services without authorization or referral from primary care physician.

  1. A health care plan must include a provision authorizing a woman covered by the plan 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 health care plan to designate an obstetrician or gynecologist as her primary care physician.  3. An evidence of coverage 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 evidence of coverage 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 § 695C.172 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.172 - Required provision concerning coverage relating to complications of pregnancy.

  1. No health maintenance organization may issue evidence of coverage under a health care plan to any enrollee 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 and complies with the provisions of NRS 689B.340 to 689B.580, inclusive, and chapter 689C of NRS relating to the portability and accountability of health insurance.  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. Evidence of coverage under a health care plan subject to the provisions of this chapter which is issued on or after July 1, 1977, has the legal effect of including the coverage required by this section, and any provision which is in conflict with this section is void.  (Added to NRS by 1977, 416; A 1997, 2959; 2013, 3644)
NV Rev Stat § 695C.1723 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.1723 - Required provision concerning coverage for treatment of certain inherited metabolic diseases.

  1. A health maintenance plan 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 health maintenance plan was purchased.  3. Any evidence of coverage 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 evidence of coverage 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, 1527)
NV Rev Stat § 695C.1727 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.1727 - Required provision concerning coverage for management and treatment of diabetes.

  1. No evidence of coverage that provides coverage for hospital, medical or surgical expenses may be delivered or issued for delivery in this state unless the evidence of coverage 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 an evidence of coverage specified in subsection 1 shall provide the coverage required by this section subject to the same deductible, copayment, coinsurance and other such conditions for the evidence of coverage that are required under the evidence of coverage.  3. Evidence of coverage 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 evidence of coverage 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 the enrollee after the enrollee 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 enrollee and which requires modification of the enrollee’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, 745; A 2013, 3645)
NV Rev Stat § 695C.1728 (2021)
2021 Nevada Revised Statutes|Chapter 695C - Health Maintenance Organizations|NRS 695C.1728 - Required provision concerning coverage for management and treatment of sickle cell disease.

  1. A health maintenance organization that issues a health care plan shall include in the plan coverage for:  (a) Necessary case management services for an enrollee who has been diagnosed with sickle cell disease and its variants; and  (b) Medically necessary care for an enrollee who has been diagnosed with sickle cell disease and its variants.  2. A health maintenance organization that issues a health care plan which provides coverage for prescription drugs shall include in the plan coverage for medically necessary prescription drugs to treat sickle cell disease and its variants.  3. A health maintenance organization shall establish a plan for each enrollee under 18 years of age who has been diagnosed with sickle cell disease and its variants to transition the enrollee from pediatric care to adult care when the enrollee reaches 18 years of age.  4. A health maintenance organization 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.  5. 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, 2172)