reglab/statecodes huggingface dataset:
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.169 - Coverage for severe mental illness required under group health insurance policy.

1. A policy of group health insurance delivered or issued for delivery in this State pursuant to this chapter must provide coverage for the treatment of conditions relating to severe mental illness.
2. As used in this section, "severe mental illness" means any of the following mental illnesses that are biologically based and for which diagnostic criteria are prescribed in the latest edition of the
Diagnostic and Statistical Manual of Mental Disorders
, published by the American Psychiatric Association:
(a) Schizophrenia.
(b) Schizoaffective disorder.
(c) Bipolar disorder.
(d) Major depressive disorders.
(e) Panic disorder.
(f) Obsessive-compulsive disorder.
(Added to NRS by 2009, 1811; A 2013, 3627)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.170 - Authorized variation of minimum participation and contributions; denial of coverage based on industry prohibited.

1. A carrier serving small employers may vary the application of requirements for minimum participation of eligible employees and minimum employer’s contributions only by the size of the small employer’s group or the product offered.
2. In applying requirements for minimum participation with respect to a small employer, a carrier shall not consider employees or dependents who have creditable coverage when determining whether the applicable percentage of participation is met, but may consider employees or dependents who have coverage under another health benefit plan that is sponsored by the employer.
3. A carrier shall not deny an application for coverage solely because the applicant works in a certain industry.
4. After a small employer has been accepted for coverage, a carrier shall not increase any requirement for minimum employee participation or modify any requirement for minimum employer contribution applicable to the small employer.
(Added to NRS by 1995, 980; A 1997, 2942; 2007, 3327)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.180 - Carrier to offer same coverage to all eligible employees; denial of coverage to otherwise eligible employee.

1. If a carrier serving small employers offers coverage to a small employer, the carrier shall offer the same coverage to all of the eligible employees of the small employer and their dependents. A carrier shall not offer coverage to only certain members of a small employer’s group or to only part of the group, but may exclude an otherwise eligible employee, or a dependent of the eligible employee, who requests enrollment in a health benefit plan after the end of the initial period during which the employee or dependent is entitled to enroll under the terms of the plan, if the initial period is at least 30 days.
2. A carrier shall not exclude an eligible employee or dependent if:
(a) The employee or dependent:
(1) Was covered under other creditable coverage at the time of the initial period for enrollment;
(2) Lost coverage under the other creditable coverage as a result of termination of employment or eligibility, the involuntary termination of the creditable coverage, the death of a spouse or divorce; and
(3) Requests enrollment within 30 days after termination of the other creditable coverage;
(b) The employee is employed by an employer that offers multiple health benefit plans and elects a different plan during an open period for enrollment; or
(c) A court has ordered that coverage be provided for a dependent under a covered employee’s health benefit plan and the request for enrollment is made within 30 days after issuance of the court order.
(Added to NRS by 1995, 981; A 1997, 2942)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.183 - Plan and carrier required to permit employee or dependent of employee to enroll for coverage under certain circumstances.

A health benefit plan and a carrier offering such a plan shall permit an employee or a dependent of an employee covered by the health benefit plan who is eligible, but not enrolled, for coverage in connection with the health benefit plan to enroll for coverage under the terms of the health benefit plan if:
1. The employee or dependent was covered under a different health benefit plan or had other health insurance coverage at the time coverage was previously offered to the employee or dependent;
2. The employee stated in writing at that time that the other coverage was the reason for declining enrollment, but only if the plan sponsor or carrier required such a written statement and informed the employee of that requirement and the consequences of the requirement; and
3. The employee or dependent:
(a) Was covered under any provision of the Consolidated Omnibus Budget Reconciliation Act of 1985 relating to the continuation of coverage and such continuation of coverage was exhausted; or
(b) Was not covered under such a provision and his or her insurance coverage was lost as a result of cessation of contributions by his or her employer, termination of employment or eligibility, reduction in the number of hours of employment, or the death of, or divorce or legal separation from, a covered spouse.
(Added to NRS by 1997, 2921)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.187 - Manner and period for enrolling dependent of covered employee; period of special enrollment.

1. A health benefit plan and a carrier of such a plan that makes coverage available to the dependent of a covered employee shall permit the employee to enroll a dependent after the close of a period of open enrollment if:
(a) The employee is a participant in the health benefit plan, or has met any waiting period applicable to becoming a participant and is eligible to be enrolled under the plan, except for a failure to enroll during a previous period of open enrollment; and
(b) The person to be enrolled became a dependent of the employee through marriage, birth, adoption or placement for adoption.
2. The health benefit plan or carrier shall provide a period of special enrollment for the enrollment of a dependent of an employee pursuant to this section. Such a period must be not less than 30 days and must begin on:
(a) The date specified by the health benefit plan or carrier for the period of special enrollment; or
(b) The date of the marriage, birth, adoption or placement for adoption, as appropriate.
3. If an employee seeks to enroll a dependent during the first 30 days of the period for special enrollment provided pursuant to subsection 2, the coverage of the dependent becomes effective:
(a) In the case of a marriage, not later than the first day of the first month beginning after the date on which the completed request for enrollment is received;
(b) In the case of a birth, on the date of the birth; and
(c) In the case of an adoption or placement for adoption, on the date of the adoption or the placement for adoption.
4. In the case of a birth, an adoption or a placement for adoption of a child of an employee, the spouse of the employee may be enrolled as a dependent pursuant to this section if the spouse is otherwise eligible for coverage under the health benefit plan.
(Added to NRS by 1997, 2922)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.190 - Carrier required to offer and issue plan regardless of health status of employees; prohibited acts; authority to include wellness program in plan that offers discounts based on health status under certain circumstances.

1. A carrier that issues a health benefit plan shall offer and issue a health benefit plan to any small employer regardless of the health status of the employees of the small employer. Such health status includes, without limitation:
(a) Any preexisting medical condition of an insured, including, without limitation, any physical or mental illness;
(b) The claims history of the insured, including, without limitation, any prior health care services received by the insured;
(c) Genetic information relating to the insured; and
(d) Any increased risk for illness, injury or any other medical condition of the insured, including, without limitation, any medical condition caused by an act of domestic violence.
2. A carrier that offers or issues a health benefit plan shall not:
(a) Deny, limit or exclude a covered benefit based on the health status of an insured; or
(b) Require an insured, as a condition of enrollment or renewal, to pay a premium, deductible, copay or coinsurance based on his or her health status which is greater than the premium, deductible, copay or coinsurance charged to a similarly situated insured who does not have such a health status.
3. A carrier that offers or issues a health benefit plan shall not adjust a premium, deductible, copay or coinsurance for any insured on the basis of genetic information relating to the insured or the covered dependent of the insured.
4. A carrier that offers or issues a health benefit plan may include in the plan a wellness program that reduces a premium, deductible or copayment based on health status if:
(a) An insured who is eligible to participate in the wellness program is given the opportunity to qualify for the discount at least once each year;
(b) The amount of all discounts provided pursuant to such a wellness program does not exceed 30 percent, or if the program is designed to prevent or reduce tobacco use, 50 percent, of the cost of coverage for an insured or an insured and his or her dependents, as applicable, under the plan;
(c) The wellness program is reasonably designed to promote health or prevent disease;
(d) The carrier ensures that the full discount under the wellness program is available to all similarly situated insureds by providing a reasonable alternative standard by which an insured may qualify for the discount which, if based on health status, must accommodate the recommendations of the physician of the insured; and
(e) The plan discloses in all plan materials describing the terms of the wellness program, and in any disclosure that an insured did not satisfy the initial standard to be eligible for the discount, the availability of a reasonable alternative standard described in paragraph (d).
(Added to NRS by 1995, 981; A 1997, 2943; 2013, 3628; 2019, 302)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.191 - Determination of applicable creditable coverage of person; determining period of creditable coverage of person; required statement for certain election by carrier; applicability.

1. In determining the applicable creditable coverage of a person, a period of creditable coverage must not be included if, after the expiration of that period but before the enrollment date, there was a 63-day period during all of which the person was not covered under any creditable coverage. To establish a period of creditable coverage, an eligible employee must present any certificates of coverage provided to the eligible employee in accordance with NRS 689C.192 and such other evidence of coverage as required by regulations adopted by the Commissioner. For the purposes of this subsection, any waiting period for coverage or an affiliation period must not be considered in determining the applicable period of creditable coverage.
2. In determining the period of creditable coverage of a person, a carrier shall include each applicable period of creditable coverage without regard to the specific benefits covered during that period, except that the carrier may elect to include applicable periods of creditable coverage based on coverage of specific benefits as specified by the United States Department of Health and Human Services by regulation, if such an election is made on a uniform basis for all participants and beneficiaries of the health benefit plan or coverage. Pursuant to such an election, the carrier shall include each applicable period of creditable coverage with respect to any class or category of benefits if any level of benefits is covered within that class or category, as specified by those regulations.
3. Regardless of whether coverage is actually provided, if a carrier elects in accordance with subsection 2 to determine creditable coverage based on specified benefits, a statement that such an election has been made and a description of the effect of the election must be:
(a) Included prominently in any disclosure statement concerning the health benefit plan; and
(b) Provided to each eligible employee at the time of enrollment in the health benefit plan.
4. The provisions of this section apply only to grandfathered plans.
(Added to NRS by 1997, 2926; A 2013, 3630)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.192 - Written certification of coverage required for purpose of determining period of creditable coverage accumulated by person.

1. For the purposes of determining the period of creditable coverage of a person accumulated under a health benefit plan or group health insurance, the insurer shall provide written certification of coverage on a form prescribed by the Commissioner to the person which certifies the length of:
(a) The period of creditable coverage that the person accumulated under the plan and any coverage under any provision of the Consolidated Omnibus Budget Reconciliation Act of 1985, as that act existed on July 16, 1997, relating to the continuation of coverage; and
(b) Any waiting and affiliation period imposed on the person pursuant to that coverage.
2. The certification of coverage must be provided to the person who was insured:
(a) At the time that the person ceases to be covered under the plan, if the person does not otherwise become covered under any provision of the Consolidated Omnibus Budget Reconciliation Act of 1985, as that act existed on July 16, 1997, relating to the continuation of coverage;
(b) If the person becomes covered under such a provision, at the time that the person ceases to be covered by that provision; and
(c) Upon request, if the request is made not later than 24 months after the date on which the person ceased to be covered as described in paragraphs (a) and (b).
(Added to NRS by 1997, 2927)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.193 - Carrier prohibited from imposing restriction on being participant of or beneficiary of plan inconsistent with certain provisions; restrictions on rules of eligibility that may be established.

1. A carrier shall not place any restriction on a small employer or an eligible employee or a dependent of the eligible employee as a condition of being a participant in or a beneficiary of a health benefit plan that is inconsistent with NRS 689C.015 to 689C.355, inclusive.
2. A carrier that offers health insurance coverage to small employers pursuant to this chapter shall not establish rules of eligibility which conflict with the provisions of NRS 689B.550, including, but not limited to, rules which define applicable waiting periods, for the initial or continued enrollment under a health benefit plan offered by the carrier that are based on the following factors relating to the eligible employee or a dependent of the eligible employee:
(a) Health status.
(b) Medical condition, including physical and mental illnesses, or both.
(c) Claims experience.
(d) Receipt of health care.
(e) Medical history.
(f) Genetic information.
(g) Evidence of insurability, including conditions which arise out of acts of domestic violence.
(h) Disability.
3. Except as otherwise provided in NRS 689C.190, the provisions of subsection 1 do not require a carrier to provide particular benefits other than those that would otherwise be provided under the terms of the health benefit plan or coverage.
4. Nothing in this section:
(a) Restricts the amount that a small employer may be charged for coverage by a carrier;
(b) Prevents a carrier from establishing premium discounts or rebates or from modifying otherwise applicable copayments or deductibles in return for adherence by the insured person to programs of health promotion and disease prevention; or
(c) Precludes a carrier from establishing rules relating to employer contribution or group participation when offering health insurance coverage to small employers in this State.
5. As used in this section:
(a) "Contribution" means the minimum employer contribution toward the premium for enrollment of participants and beneficiaries in a health benefit plan.
(b) "Group participation" means the minimum number of participants or beneficiaries that must be enrolled in a health benefit plan in relation to a specified percentage or number of eligible persons or employees of the employer.
(Added to NRS by 1997, 2925; A 2013, 3630; 2019, 303)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.1945 - Plan covering maternity care: Prohibited acts by carrier if insured is acting as gestational carrier; child deemed child of intended parent for purposes of plan.

1. A carrier that offers or issues a health benefit plan 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 health benefit plan.
3. As used in this section, "gestational carrier" has the meaning ascribed to it in NRS 126.580.
(Added to NRS by 2019, 1006)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.1947 - Plan covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by carrier if insured is person with disability.

1. A carrier that offers or issues a health benefit 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 insured for care related to an organ transplant because the insured 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 insured 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, 1171)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.196 - Insurer prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence.

An insurer shall not deny a claim, refuse to issue a health benefit plan or cancel a health benefit plan 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 health benefit plan 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 689C - Health Insurance for Small Employers › NRS 689C.197 - Carrier prohibited from denying coverage because applicant or insured was intoxicated or under influence of controlled substance; exceptions.

1. Except as otherwise provided in subsection 2, a carrier shall not:
(a) Deny a claim under a health benefit plan solely because the claim involves an injury sustained by an insured as a consequence of being intoxicated or under the influence of a controlled substance.
(b) Cancel participation under a health benefit plan solely because an insured has made a claim involving an injury sustained by the insured as a consequence of being intoxicated or under the influence of a controlled substance.
(c) Refuse participation under a health benefit 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 carrier from enforcing a provision included in a health benefit 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 in a health benefit plan solely because of such a claim; or
(c) Refuse participation in a health benefit plan to an eligible applicant solely because of such a claim.
3. The provisions of this section do not apply to a carrier under a health benefit plan that provides coverage for long-term care or disability income.
(Added to NRS by 2005, 2344; A 2007, 85)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.1975 - Carrier prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression.

A carrier that issues a health benefit 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 benefit 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 insured or a family member of the insured;
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, 2035)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.198 - Insurer prohibited from requiring or using information concerning genetic testing; exceptions.

1. Except as otherwise provided in subsection 2, a carrier serving small employers shall not:
(a) Require an insured person or any member of the family of the insured person to take a genetic test;
(b) Require an insured person to disclose whether the insured person or any member of the family of the insured person has taken a genetic test or any genetic information of the insured person or a member of the family of the insured person; or
(c) Determine the rates or any other aspect of the coverage or benefits for health care provided to an insured person based on whether the insured person or any member of the family of the insured person has taken a genetic test.
2. The provisions of this section do not apply to a carrier serving small employers who issues a policy of health insurance that provides coverage for long-term care or disability income.
3. 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 that 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, 1460; A 2019, 304)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.200 - Circumstances in which carrier is not required to offer coverage.

A carrier serving small employers is not required to accept applications from or offer coverage to:
1. A small employer if the employer is not physically located in the carrier’s geographic service area; or
2. An employee if the employee does not work or reside within the carrier’s geographic service area.
(Added to NRS by 1995, 982; A 1997, 2946; 2013, 3631)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.203 - Requirement for denial of application for coverage from small employer; regulations setting standards for fair marketing and broad availability of plans.

1. A denial by a carrier of an application for coverage from a small employer must be in writing and must state the reason for the denial.
2. The Commissioner may adopt regulations that set forth standards to provide for the fair marketing and broad availability of health benefit plans to small employers in this state.
(Added to NRS by 1997, 2924)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.207 - Regulations concerning reissuance of health benefit plan.

The Commissioner may adopt regulations to require a carrier, as a condition of transacting insurance with small employers in this state after July 16, 1997, to reissue a health benefit plan to any small employer whose health benefit plan has been terminated or not renewed by the carrier after July 1, 1997. The Commissioner may prescribe such terms for the reissue of coverage as the Commissioner finds are reasonable and necessary to provide continuity of coverage to small employers.
(Added to NRS by 1997, 2924)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.220 - Adjustment in rates required to be applied uniformly.

A carrier serving small employers shall not charge adjustments in rates for duration of coverage or any reason prohibited by NRS 689C.190 to individual employees or dependents. Any such adjustment must be applied uniformly to the rates charged for all employees and dependents of a small employer.
(Added to NRS by 1995, 984; A 2019, 305)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.265 - Carrier authorized to modify coverage for insurance product under certain circumstances.

A carrier may modify the health insurance coverage for a product offered to small employers pursuant to a group health plan if, for coverage that is available in that market other than through one or more bona fide associations, the modification is consistent with the provisions of this title and is effective on a uniform basis among such group health plans.
(Added to NRS by 1997, 2927)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.281 - Plan covering prescription drugs: Provision of notice and information regarding use of formulary.

1. A carrier that offers or issues a health benefit plan which provides coverage for prescription drugs shall include with any summary, certificate or evidence of that coverage provided to an insured, notice of whether a formulary is used and, if so, of the opportunity to secure information regarding the formulary from the carrier 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 carrier for making a request for information regarding the formulary pursuant to subsection 2.
2. If a carrier offers or issues a health benefit plan which provides coverage for prescription drugs and a formulary is used, the carrier shall:
(a) Provide to any insured or participating provider of health care, upon request:
(1) Information regarding whether a specific drug is included in the formulary.
(2) Access to the most current list of prescription drugs in the formulary, organized by major therapeutic category, with an indication of whether any listed drugs are preferred over other listed drugs. If more than one formulary is maintained, the carrier 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, 858)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.320 - Required notification when carrier discontinues transacting insurance in this State or particular geographic service area of state; restrictions on carrier that discontinues transacting insurance.

1. A carrier that discontinues transacting insurance in this State or in a particular geographic service area of this State shall:
(a) Notify the Commissioner and the chief regulatory officer for insurance in each state in which the carrier is licensed to transact insurance at least 60 days before a notice of cancellation or nonrenewal is delivered or mailed to the affected small employers pursuant to paragraph (b).
(b) Notify the Commissioner and each small employer affected not less than 180 days before the expiration of any policy or contract of insurance under any health benefit plan issued to a small employer pursuant to this chapter.
2. A carrier that cancels any health benefit plan because it has discontinued transacting insurance in this State or in a particular geographic service area of this State:
(a) Shall discontinue the issuance and delivery for issuance of all health benefit plans pursuant to this chapter in this State and not renew coverage under any health benefit plan issued to a small employer; and
(b) May not issue any health benefit plans pursuant to this chapter in this State or in the particular geographic service area for 5 years after it gives notice to the Commissioner pursuant to paragraph (b) of subsection 1.
(Added to NRS by 1995, 986; A 1997, 2949; 2013, 3633)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.325 - Coverage offered through network plan not required to be offered to eligible employee who does not reside or work in geographic service area or if carrier lacks capacity to deliver adequate service to additional employers and employees.

A carrier that offers coverage through a network plan is not required to offer coverage to or accept any applications for coverage from the eligible employees of a small employer pursuant to NRS 689C.310 and 689C.320 if:
1. The eligible employees do not reside or work in the geographic service area of the network plan.
2. For a small employer whose eligible employees reside or work in the geographic service area of the network plan, the carrier demonstrates to the satisfaction of the Commissioner that the carrier does not have the capacity to deliver adequate service to additional small employers and eligible employees because of the existing obligations of the carrier. If a carrier is authorized by the Commissioner not to offer coverage pursuant to this subsection, the carrier shall not thereafter offer coverage to additional small employers and eligible employees within that geographic service area until the carrier demonstrates to the satisfaction of the Commissioner that it has regained the capacity to deliver adequate service to additional small employers and eligible employees within that service area.
(Added to NRS by 1997, 2921; A 2013, 3633)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.350 - Health benefit plan which offers difference of payment between preferred providers of health care and providers who are not preferred: Limitations on deductibles and copayments; circumstances in which service is deemed to be provided by preferred provider.

A health benefit plan which offers a difference of payment between preferred providers of health care and providers of health care who are not preferred:
1. Must require that the deductible and payment for coinsurance paid by the insured to a preferred provider of health care be applied to the negotiated reduced rates of that provider.
2. Must provide that if there is a particular service which a preferred provider of health care does not provide and the provider of health care who is treating the insured requests the service and the insurer determines that the use of the service is necessary for the health of the insured, the service shall be deemed to be provided by the preferred provider of health care.
(Added to NRS by 1995, 987; A 2013, 3634; 2017, 2374)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.355 - Prohibited acts of carrier or producer related to encouraging or directing small employer to take certain actions; exceptions; prohibited acts by carrier related to contract or agreement with producer; violation may constitute unfair trade practice; applicability.

1. Except as otherwise provided in this section, a carrier or a producer shall not, directly or indirectly:
(a) Encourage or direct a small employer to refrain from filing an application for coverage with the carrier because of the health status, claims experience, industry, occupation or geographic location of the small employer.
(b) Encourage or direct a small employer to seek coverage from another carrier because of the health status, claims experience, industry, occupation or geographic location of the small employer.
2. The provisions of subsection 1 do not apply to information provided to a small employer by a carrier or a producer relating to the geographic service area or a provision for a restricted network of the carrier.
3. A carrier shall not, directly or indirectly, enter into any contract, agreement or arrangement with a producer if the contract, agreement or arrangement provides for or results in a variation to the compensation that is paid to a producer for the sale of a health benefit plan because of the health status, claims experience, industry, occupation or geographic location of the small employer at the time that the health benefit plan is issued to or renewed by the small employer.
4. A carrier shall not terminate, fail to renew, or limit its contract or agreement of representation with a producer for any reason related to the health status, claims experience, occupation or geographic location of a small employer at the time that the health benefit plan is issued to or renewed by the small employer placed by the producer with the carrier.
5. A carrier or producer shall not induce or otherwise encourage a small employer to separate or otherwise exclude an employee or a dependent of the employee from health coverage or benefits provided in connection with the employment of the employee.
6. A violation of any provision of this section by a carrier may constitute an unfair trade practice for the purposes of chapter 686A of NRS.
7. The provisions of this section apply to a third-party administrator if the third-party administrator enters into a contract, agreement or other arrangement with a carrier to provide administrative, marketing or other services related to the offering of a health benefit plan to small employers in this state.
8. Nothing in this section interferes with the right and responsibility of a producer to advise and represent the best interests of a small employer who is seeking health insurance coverage from a small employer carrier.
(Added to NRS by 1997, 2923; A 2013, 3634)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.360 - Definitions.

As used in NRS 689C.360 to 689C.600, inclusive, unless the context otherwise requires, the words and terms defined in NRS 689C.380 and 689C.390 have the meanings ascribed to them in those sections.
(Added to NRS by 1995, 2677; A 1997, 2951)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.380 - "Contract" defined.

"Contract" means a policy or certificate for hospital or medical expenses, a contract for dental, hospital or medical services, or a health care plan of a health maintenance organization available for use by or offered or sold to a small employer. The term does not include coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, automobile medical payment insurance, coverage for a specified disease, hospital confinement indemnity or limited-benefit health insurance.
(Added to NRS by 1995, 2677)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.390 - "Dependent" defined.

"Dependent" means a spouse, a domestic partner as defined in NRS 122A.030, or a child on or before the last day of the month in which the child attains 26 years of age.
(Added to NRS by 1995, 2677; A 2013, 3635)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.425 - Applicability of other provisions.

A voluntary purchasing group and any contract issued to such a group pursuant to NRS 689C.360 to 689C.600, inclusive, are subject to the provisions of NRS 689C.015 to 689C.355, inclusive, to the extent applicable and not in conflict with the express provisions of NRS 687B.408 and 689C.360 to 689C.600, inclusive.
(Added to NRS by 1997, 2929; A 2001, 860; 2009, 1812; 2015, 207, 641, 2125; 2017, 1828, 3943; 2019, 1006, 2171; 2021, 782, 825, 1172, 1935, 2579, 2665, 3209; 2023, 812, 1784, 2035, 2217, 2374, 3518)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.430 - Entities which are authorized to offer contracts to voluntary purchasing groups; compliance with provisions required.

Every insurer, fraternal benefit society, corporation providing hospital or medical services or health maintenance organization, whose policies or activities relating to health insurance are governed by the provisions of chapter 689B, 695A, 695B or 695C of NRS, may offer contracts to voluntary purchasing groups and, if it does so, shall comply with the provisions of NRS 689C.360 to 689C.600, inclusive.
(Added to NRS by 1995, 2677)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.455 - Coverage for prescription drugs: Provision of notice and information regarding use of formulary.

1. A carrier that offers or issues a contract which provides coverage for prescription drugs shall include with any summary, certificate or evidence of that coverage provided to an insured, notice of whether a formulary is used and, if so, of the opportunity to secure information regarding the formulary from the carrier 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 carrier for making a request for information regarding the formulary pursuant to subsection 2.
2. If a carrier offers or issues a contract which provides coverage for prescription drugs and a formulary is used, the carrier shall:
(a) Provide to any insured or participating provider of health care, upon request:
(1) Information regarding whether a specific drug is included in the formulary.
(2) Access to the most current list of prescription drugs in the formulary, organized by major therapeutic category, with an indication of whether any listed drugs are preferred over other listed drugs. If more than one formulary is maintained, the carrier 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, 859)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.460 - Carrier to offer same coverage to all eligible employees; denial of coverage to otherwise eligible employee.

1. If a carrier offers a contract to a voluntary purchasing group, the carrier shall offer the same coverage to all of the eligible employees of the small employers that are members of the voluntary purchasing group and their dependents. A carrier shall not offer coverage to only certain members of that group or to only part of that group, but may exclude an otherwise eligible employee, or a dependent of the otherwise eligible employee, who requests enrollment in the contract after the end of the initial period during which the employee or dependent is entitled to enroll under the terms of the contract, if the initial period is at least 30 days.
2. A carrier shall not exclude an eligible employee or dependent if:
(a) The employee or dependent:
(1) Was covered under other creditable coverage at the time of the initial period for enrollment;
(2) Lost coverage under the other creditable coverage as a result of termination of employment or eligibility, the involuntary termination of the creditable coverage, the death of a spouse or divorce; and
(3) Requests enrollment within 30 days after termination of the other creditable coverage;
(b) The employee is employed by an employer that offers multiple contracts and elects a different contract during an open period for enrollment; or
(c) A court has ordered that coverage be provided for a dependent under a covered employee’s contract and the request for enrollment is made within 30 days after issuance of the court order.
(Added to NRS by 1995, 2678; A 1997, 2951)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.480 - Required notification when carrier ceases to renew all contracts; restrictions on carrier that ceases to renew all contracts.

1. A carrier may cease to renew all contracts covering voluntary purchasing groups and discontinue issuing and delivering for issuance any such contracts. The carrier shall provide notice:
(a) At least 60 days before the notice of termination is provided pursuant to paragraph (b), to the Commissioner and the chief regulatory officer for insurance of each state in which the carrier is licensed to transact insurance; and
(b) At least 180 days before termination of coverage to holders of all affected contracts and to the Commissioner and the chief regulatory officer for insurance in each state in which an affected insured person is known to reside.
2. A carrier that exercises its right to cease to renew all contracts covering voluntary purchasing groups shall not transfer or otherwise provide coverage to any of the insureds from a nonrenewed voluntary purchasing group unless the carrier offers to transfer or provide coverage to all affected employers and eligible employees and dependents without regard to characteristics of the insured, experience as to claims, health or duration of coverage.
3. A carrier that decides to terminate its contracts and to discontinue issuing and delivering for issuance any contracts pursuant to this section:
(a) Shall discontinue issuance and delivery for issuance all health benefit plans pursuant to this chapter in this state and, except as otherwise provided in this section, not renew any such contracts; and
(b) Shall not enter into any new contract with a voluntary purchasing group for 5 years after the date on which the carrier terminated its contracts with voluntary purchasing groups.
(Added to NRS by 1995, 2679; A 1997, 2953)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.490 - Formation of voluntary purchasing group by small employers; requirements when affiliate of group ceases to qualify as small employer.

1. A small employer may, in accordance with the provisions of NRS 689C.490 to 689C.600, inclusive, choose to affiliate voluntarily with other small employers as a voluntary purchasing group to purchase health benefits for eligible employees and their dependents.
2. An employer who affiliates with a voluntary purchasing group shall notify the carrier for that group when the employer has less than 2 or more than 50 employees. The carrier shall:
(a) Upon receiving such a notification, inform the employer of the provisions of paragraph (b).
(b) If the employer ceases to be a small employer, refuse to renew the coverage of that employer and employees of that employer and their dependents under any contract provided through the voluntary purchasing group.
(Added to NRS by 1995, 2679; A 1997, 2953)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.500 - Registration: Requirements; application.

1. An organization seeking to be registered as a voluntary purchasing group:
(a) Must be incorporated as a Nevada corporation not for profit for the purpose of securing health benefits for its members and their eligible employees and dependents;
(b) Shall file articles of incorporation with the Secretary of State and provide a copy of the articles to the Commissioner in such a form as the Commissioner may require; and
(c) Must apply to the Commissioner for and obtain a certificate of registration to operate as a voluntary purchasing group.
2. The contents of the application must be established by the Commissioner and include at least:
(a) The name of the voluntary purchasing group and any agent for service of process;
(b) Provisions to govern the business and affairs of the group, including the management and organizational structure;
(c) An affidavit by an officer of the organization that the group is in compliance with the requirements of NRS 689C.490 to 689C.600, inclusive; and
(d) The names of managing personnel of the voluntary purchasing group.
(Added to NRS by 1995, 2680)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.510 - Registration: Fee for application; response to application; regulations.

1. The application must be accompanied by a fee in an amount to be established by the Commissioner by regulation to cover the direct costs of examining the qualifications of an applicant.
2. The Commissioner shall respond to each application for a certificate of registration within 30 days after receipt. The Commissioner shall either approve the application or shall inform the organization of specific changes to the application necessary to permit approval.
(Added to NRS by 1995, 2680)