reglab/statecodes huggingface dataset:
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.1733 - Required provision in certain evidences of coverage concerning coverage for certain drugs and related services for treatment of cancer.

Except as otherwise provided in NRS 695C.1693:
1. No evidence of coverage that provides coverage for a drug approved by the Food and Drug Administration for use in the treatment of an illness, disease or other medical condition may be delivered or issued for delivery in this state unless the evidence of coverage includes coverage for any other use of the drug for the treatment of cancer, if that use is:
(a) Specified in the most recent edition of or supplement to:
(1) The
United States Pharmacopoeia Drug Information
; or
(2) The
American Hospital Formulary Service Drug Information
; or
(b) Supported by at least two articles reporting the results of scientific studies that are published in scientific or medical journals, as defined in 21 C.F.R. § 99.3.
2. The coverage required pursuant to this section:
(a) Includes coverage for any medical services necessary to administer the drug to the enrollee.
(b) Does not include coverage for any:
(1) Experimental drug used for the treatment of cancer if that drug has not been approved by the Food and Drug Administration; or
(2) Use of a drug that is contraindicated by the Food and Drug Administration.
3. Any 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 that conflicts with the provisions of this section is void.
(Added to NRS by 1999, 761; A 2003, 3531)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.17335 - Plan covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy.

1. A health maintenance organization that offers or issues a health care plan which provides coverage for the treatment of cancer through the use of chemotherapy shall not:
(a) Require a copayment, deductible or coinsurance amount for chemotherapy administered orally by means of a prescription drug in a combined amount that is more than $100 per prescription. The limitation on the amount of the deductible that may be required pursuant to this paragraph does not apply to a health benefit plan, as defined in NRS 687B.470, if the health benefit plan is a high deductible health plan, as defined in 26 U.S.C. § 223, and the amount of the annual deductible has not been satisfied.
(b) Make the coverage subject to monetary limits that are less favorable for chemotherapy administered orally by means of a prescription drug than the monetary limits applicable to chemotherapy which is administered by injection or intravenously.
(c) Decrease the monetary limits applicable to such chemotherapy administered orally by means of a prescription drug or to chemotherapy which is administered by injection or intravenously to meet the requirements of this section.
2. Evidence of coverage subject to the provisions of this chapter which provides coverage for the treatment of cancer through the use of chemotherapy and that is delivered, issued for delivery or renewed on or after January 1, 2015, has the legal effect of providing that coverage subject to the requirements of this section, and any provision of the evidence of coverage or the renewal which is in conflict with this section is void.
3. Nothing in this section shall be construed as requiring a health maintenance organization to provide coverage for the treatment of cancer through the use of chemotherapy administered by injection or intravenously or administered orally by means of a prescription drug.
(Added to NRS by 2013, 1999; A 2013, 3659)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.1734 - Evidence of coverage covering prescription drugs prohibited from limiting or excluding coverage for certain prescription drugs previously approved for medical condition of enrollee; exceptions.

1. Except as otherwise provided in this section, evidence of coverage which provides coverage for prescription drugs must not limit or exclude coverage for a drug if the drug:
(a) Had previously been approved for coverage by the health maintenance organization or insurer for a medical condition of an enrollee and the enrollee’s provider of health care determines, after conducting a reasonable investigation, that none of the drugs which are otherwise currently approved for coverage are medically appropriate for the enrollee; and
(b) Is appropriately prescribed and considered safe and effective for treating the medical condition of the enrollee.
2. The provisions of subsection 1 do not:
(a) Apply to coverage for any drug that is prescribed for a use that is different from the use for which that drug has been approved for marketing by the Food and Drug Administration;
(b) Prohibit:
(1) The health maintenance organization or insurer from charging a deductible, copayment or coinsurance for the provision of benefits for prescription drugs to the enrollee or from establishing, by contract, limitations on the maximum coverage for prescription drugs;
(2) A provider of health care from prescribing another drug covered by the evidence of coverage that is medically appropriate for the enrollee; or
(3) The substitution of another drug pursuant to NRS 639.23286 or 639.2583 to 639.2597, inclusive; or
(c) Require any coverage for a drug after the term of the evidence of coverage.
3. Any provision of an evidence of coverage subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2001, which is in conflict with this section is void.
(Added to NRS by 2001, 863; A 2003, 2300; 2017, 639)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.17345 - Required provision in plan covering prescription drugs concerning coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications; prohibited acts; exception.

1. A health maintenance organization that offers or issues a health care plan 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 enrollee’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 enrollee; and
(2) The enrollee 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 health maintenance organization.
(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. An evidence of coverage 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 evidence of coverage 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, 2126)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.17347 - Required provision concerning coverage for screening, genetic counseling and testing related to BRCA gene in certain circumstances.

1. A health maintenance organization that issues a health care plan shall provide coverage for screening, genetic counseling and testing for harmful mutations in the BRCA gene for women under circumstances where such screening, genetic counseling or testing, as applicable, is required by NRS 457.301.
2. A health maintenance organization shall ensure that the benefits required by subsection 1 are made available to an enrollee through a provider of health care who participates in the network plan of the health maintenance organization.
3. A health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2022, has the legal effect of including the coverage required by subsection 1, and any provision of the plan that conflicts with the provisions of this section is void.
4. As used in this section:
(a) "Network plan" means a health care plan offered by a health maintenance organization under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the health maintenance organization. The term does not include an arrangement for the financing of premiums.
(b) "Provider of health care" has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 2021, 783)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.1736 - Required provision concerning coverage for testing, treatment and prevention of sexually transmitted diseases; required provision concerning coverage for condoms for certain insureds.

1. A health maintenance organization that offers or issues a health care plan shall include in the plan:
(a) Coverage of testing for and the treatment and prevention of sexually transmitted diseases, including, without limitation,
Chlamydia trachomatis
, gonorrhea, syphilis, human immunodeficiency virus and hepatitis B and C, for all enrollees, regardless of age. Such coverage must include, without limitation, the coverage required by NRS 695C.1737 and 695C.1743.
(b) Unrestricted coverage of condoms for enrollees who are 13 years of age or older.
2. A health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2024, has the legal effect of including the coverage required by subsection 1, and any provision of the plan that conflicts with the provisions of this section is void.
(Added to NRS by 2023, 3524)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.1737 - Required provision concerning coverage for examination of person who is pregnant for certain diseases.

1. A health maintenance organization that issues a health care plan shall provide coverage for the examination of a person who is pregnant for the discovery of:
(a)
Chlamydia trachomatis
, gonorrhea, hepatitis B and hepatitis C in accordance with NRS 442.013.
(b) Syphilis in accordance with NRS 442.010.
2. The coverage required by this section must be provided:
(a) Regardless of whether the benefits are provided to the enrollee by a provider of health care, facility or medical laboratory that participates in the network plan of the health maintenance organization; and
(b) Without prior authorization.
3. A health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2021, has the legal effect of including the coverage required by subsection 1, and any provision of the plan that conflicts with the provisions of this section is void.
4. As used in this section:
(a) "Medical laboratory" has the meaning ascribed to it in NRS 652.060.
(b) "Network plan" means a health care plan offered by a health maintenance organization under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the health maintenance organization. The term does not include an arrangement for the financing of premiums.
(c) "Provider of health care" has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 2021, 2580)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.1751 - Required provision in plan covering treatment of prostate cancer concerning coverage for prostate cancer screening; prohibited act.

1. A health care plan of a health maintenance organization 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 health care plan of a health maintenance organization 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. Any evidence of coverage for a health care plan of a health maintenance organization 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 evidence of coverage or the renewal which is in conflict with subsection 1 is void.
(Added to NRS by 2007, 3239)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.1755 - Evidence of coverage prohibited from excluding coverage for treatment of temporomandibular joint; exception.

1. Except as otherwise provided in this section, no evidence of coverage may be delivered or issued for delivery in this state if it contains an exclusion of coverage of the treatment of the temporomandibular joint whether by specific language in the evidence of coverage or by a claims settlement practice. An evidence of coverage may exclude coverage of those methods of treatment which are recognized as dental procedures, including, but not limited to, the extraction of teeth and the application of orthodontic devices and splints.
2. The health maintenance organization may limit its liability on the treatment of the temporomandibular joint to:
(a) No more than 50 percent of the usual and customary charges for such treatment actually received by an enrollee, but in no case more than 50 percent of the maximum benefits provided by the evidence of coverage for such treatment; and
(b) Treatment which is medically necessary.
3. Any provision of an evidence of coverage subject to the provisions of this chapter and issued or delivered on or after January 1, 1990, which is in conflict with this section is void.
(Added to NRS by 1989, 2139)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.1757 - Plan covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products.

1. A health maintenance organization which offers or issues a health care plan that provides coverage for prescription drugs shall not deny coverage for a topical ophthalmic product which is otherwise approved for coverage by the health maintenance organization when the enrollee, 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 established by the health care plan.
3. An evidence of coverage 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 evidence of coverage 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, 208)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.1759 - Plan covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by health maintenance organization if insured is person with disability.

1. A health maintenance organization that offers or issues a health care plan that includes coverage for anatomical gifts, organ transplants or treatments or services related to an organ transplant shall not:
(a) Deny, limit or seek reimbursement from an enrollee for care related to an organ transplant because the enrollee is a person with a disability;
(b) Deny a person with a disability eligibility or continued eligibility to enroll or renew coverage to avoid providing coverage in accordance with this section;
(c) Reduce or limit the reimbursement of or otherwise penalize a provider of medical or related services because the provider of medical or related services acted in accordance with NRS 460.160; or
(d) Provide monetary or nonmonetary incentives for a provider of medical or related services to induce the provider of medical or related services to provide care to an enrollee in a manner inconsistent with NRS 460.160.
2. As used in this section:
(a) "Anatomical gift" has the meaning ascribed to it in NRS 451.513.
(b) "Disability" has the meaning ascribed to it in 42 U.S.C. § 12102(1).
(c) "Provider of medical or related services" has the meaning ascribed to it in NRS 460.160.
(Added to NRS by 2021, 1173)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.1765 - Reimbursement for acupuncture.

If any evidence of coverage provides coverage for acupuncture performed by a physician, the insured is entitled to reimbursement for acupuncture performed by a person who is licensed pursuant to chapter 634A of NRS.
(Added to NRS by 1991, 1134)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.177 - Reimbursement for treatments by licensed psychologist.

If any evidence of coverage provides coverage for treatment of an illness which is within the authorized scope of the practice of a qualified psychologist, the insured is entitled to reimbursement for treatments by a licensed psychologist.
(Added to NRS by 1981, 576; A 1989, 1553; 2017, 935)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.1773 - Reimbursement for treatment by licensed marriage and family therapist or licensed clinical professional counselor.

If any evidence of coverage provides coverage for treatment of an illness which is within the authorized scope of practice of a licensed marriage and family therapist or licensed clinical professional counselor, the insured is entitled to reimbursement for treatment by a marriage and family therapist or clinical professional counselor who is licensed pursuant to chapter 641A of NRS.
(Added to NRS by 1987, 2134; A 2007, 3094)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.1775 - Reimbursement for treatment by licensed associate in social work, social worker, master social worker, independent social worker or clinical social worker.

If any evidence of coverage provides coverage for treatment of an illness which is within the authorized scope of the practice of a licensed associate in social work, a social worker, a master social worker, an independent social worker or a clinical social worker, the insured is entitled to reimbursement for treatment by an associate in social work, a social worker, a master social worker, an independent social worker or a clinical social worker who is licensed pursuant to chapter 641B of NRS.
(Added to NRS by 1987, 1123; A 2021, 3508)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.178 - Reimbursement for treatment by chiropractic physician.

1. If any evidence of coverage provides coverage for treatment of an illness which is within the authorized scope of practice of a qualified chiropractic physician, the insured is entitled to reimbursement for treatments by a chiropractic physician who is licensed pursuant to chapter 634 of NRS.
2. The terms of the policy must not limit:
(a) Coverage for treatments by a chiropractic physician to a number less than for treatments by other physicians.
(b) Reimbursement for treatments by a chiropractic physician to an amount less than that charged for similar treatments by other physicians.
(Added to NRS by 1981, 930; A 1983, 328)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.1783 - Reimbursement for treatment by podiatrist.

1. If any evidence of coverage provides coverage for treatment of an illness which is within the authorized scope of practice of a qualified podiatrist, the insured is entitled to reimbursement for treatments by a podiatrist who is licensed pursuant to chapter 635 of NRS.
2. The terms of the policy must not limit:
(a) Coverage for treatments by a podiatrist to a number less than for treatments by other physicians.
(b) Reimbursement for treatments by a podiatrist to an amount less than that reimbursed for similar treatments by other physicians.
(Added to NRS by 2007, 1046)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.1789 - Reimbursement for treatment by licensed clinical alcohol and drug counselor.

If any evidence of coverage provides coverage for treatment of an illness which is within the authorized scope of practice of a licensed clinical alcohol and drug counselor, the insured is entitled to reimbursement for treatment by a clinical alcohol and drug counselor who is licensed pursuant to chapter 641C of NRS unless the clinical alcohol and drug counselor must be directly reimbursed pursuant to:
1. An assignment of benefits described in NRS 687B.409; or
2. Any other applicable assignment of benefits.
(Added to NRS by 2007, 3094; A 2017, 2211)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.179 - Reimbursement for services provided by certain nurses.

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)
2023 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)
2023 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)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.190 - Commissioner authorized to require submission of information necessary to determine approval or disapproval of filing.

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)
2023 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 hospital with certain endorsement for inclusion in network of providers.

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 hospital with an endorsement as a crisis stabilization center pursuant to NRS 449.0915 to include the 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; A 2021, 240)
2023 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)
2023 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)
2023 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)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.203 - Health maintenance organization prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence.

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)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.204 - Health maintenance organization prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression.

A health maintenance organization that issues a health care plan shall not discriminate against any person with respect to participation or coverage under the plan on the basis of actual or perceived gender identity or expression. Prohibited discrimination includes, without limitation:
1. Denying, cancelling, limiting or refusing to issue or renew a health care plan on the basis of the actual or perceived gender identity or expression of a person or a family member of the person;
2. Imposing a payment or premium that is based on the actual or perceived gender identity or expression of an enrollee or a family member of the enrollee;
3. Designating the actual or perceived gender identity or expression of a person or a family member of the person as grounds to deny, cancel or limit participation or coverage; and
4. Denying, cancelling or limiting participation or coverage on the basis of actual or perceived gender identity or expression, including, without limitation, by limiting or denying coverage for health care services that are:
(a) Related to gender transition, provided that there is coverage under the plan for the services when the services are not related to gender transition; or
(b) Ordinarily or exclusively available to persons of any sex.
(Added to NRS by 2023, 2043)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.205 - Health maintenance organization prohibited from denying coverage solely because applicant or insured was intoxicated or under the influence of controlled substance; 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)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.207 - Health maintenance organization prohibited from requiring or using information concerning genetic testing.

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)
2023 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 timely 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)
2023 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)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.230 - Fees; forwarding of premium tax.

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)
2023 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)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.260 - Establishment of system for resolving complaints and system for conducting external review of adverse determinations required.

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)
2023 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 chiropractic physician who is certified to practice in the same field of practice as the primary treating physician, dentist or chiropractic physician 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 chiropractic physician. A certified copy of all reports of findings must be sent to the primary treating physician, dentist or chiropractic physician 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 chiropractic physician.
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 chiropractic physician may not recover any payment from either the insurer, insured person or the patient for services that the primary treating physician, dentist or chiropractic physician 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)
2023 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)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.270 - Surety bond or deposit 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)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.275 - Commissioner required to adopt regulations for licensing of provider-sponsored organizations to extent authorized by federal law.

1. To the extent authorized by federal law, the Commissioner shall adopt regulations for the licensing of provider-sponsored organizations in this State.
2. As used in this section, "provider-sponsored organization" has the meaning ascribed to it in 42 U.S.C. § 1395w-25(d).
(Added to NRS by 1999, 2817)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.280 - Commissioner authorized to adopt regulations for licensing of agents or brokers.

The Commissioner may adopt such reasonable regulations as are necessary to provide for the licensing of agents or brokers. An agent is a person directly or indirectly associated with a health care plan who engages in solicitation or enrollment. A broker is a person who is directly involved with the insured in the manner provided in chapter 683A of NRS.
(Added to NRS by 1973, 1254; A 1981, 107; 1993, 2401)