reglab/statecodes huggingface dataset:
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.241 - Circumstances under which adverse determination may be subject to external review; exceptions.

Except as otherwise required for an expedited external review pursuant to NRS 695G.271 or 695G.275, for the purposes of NRS 695G.200 to 695G.310, inclusive, an adverse determination may be subject to an external review:
1. If a covered person exhausts all procedures set forth in the health care plan for reviewing the adverse determination within the health carrier and the health carrier fails to render a decision within the period required to render that decision set forth in the health care plan; or
2. If the health carrier allows the covered person to submit the adverse determination to the independent review organization without requiring the covered person to exhaust all procedures set forth in the health care plan for reviewing the adverse determination within the health carrier.
(Added to NRS by 2003, 780; A 2011, 3412)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.243 - Applicability.

1. Except as otherwise provided in subsection 2, the provisions of NRS 695G.200 to 695G.310, inclusive, apply to all health carriers.
2. The provisions of subsection 1 do not apply to:
(a) A policy or certificate that provides only coverage for:
(1) A specified disease or accident;
(2) Accidents;
(3) Credit;
(4) Dental;
(5) Disability income;
(6) Hospital indemnity;
(7) Long-term care insurance;
(8) Vision care; or
(9) Any other limited supplemental benefit;
(b) A Medicare supplement policy of insurance, as defined in regulations adopted by the Commissioner;
(c) Coverage under a plan through Medicare, Medicaid or the Federal Employees Health Benefits Program, FEHBP, 5 U.S.C. §§ 8901 et seq.;
(d) Any coverage issued under the Civilian Health and Medical Program of the Uniformed Services, CHAMPUS, 10 U.S.C. §§ 1071 et seq., and any coverage issued as supplemental to that coverage;
(e) Any coverage issued as supplemental to liability insurance;
(f) Workers’ compensation or similar insurance;
(g) Automobile medical payment insurance; or
(h) Any insurance under which benefits are payable with or without regard to fault, whether written on a group, blanket or individual basis.
(Added to NRS by 2011, 3399)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.247 - Requests for external review to be in writing; exception; form and content.

1. Except for a request for an expedited external review as set forth in NRS 695G.271 or 695G.275, all requests for external review must be made in writing to the Office for Consumer Health Assistance.
2. The Commissioner may prescribe by regulation the form and content of requests for external review required to be submitted pursuant to this section.
3. A covered person or the covered person’s authorized representative may submit a request for an external review of an adverse determination.
(Added to NRS by 2011, 3401)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.251 - Request for review; assignment of independent review organization; provision of documents relating to adverse determination to independent review organization.

1. If a covered person or a physician of a covered person receives notice of an adverse determination from a health carrier concerning the covered person, the covered person, the physician of the covered person or an authorized representative may, within 4 months after receiving notice of the adverse determination, submit a request to the Office for Consumer Health Assistance for an external review of the adverse determination.
2. Within 5 days after receiving a request pursuant to subsection 1, the Office for Consumer Health Assistance shall notify the covered person, the authorized representative or physician of the covered person, the agent who performed utilization review for the health carrier, if any, and the health carrier that the request has been filed with the Office for Consumer Health Assistance.
3. As soon as practicable after receiving a request pursuant to subsection 1, the Office for Consumer Health Assistance shall assign an independent review organization from the list maintained pursuant to NRS 683A.3715. Each assignment made pursuant to this subsection must be completed on a rotating basis.
4. Within 5 days after receiving notification from the Office for Consumer Health Assistance specifying the independent review organization assigned pursuant to subsection 3, the health carrier shall provide to the independent review organization all documents and materials relating to the adverse determination, including, without limitation:
(a) Any medical records of the insured relating to the external review;
(b) A copy of the provisions of the health benefit plan upon which the adverse determination was based;
(c) Any documents used by the health carrier to make the adverse determination;
(d) The reasons for the adverse determination; and
(e) Insofar as practicable, a list that specifies each provider of health care who has provided health care to the covered person and the medical records of the provider of health care relating to the external review.
(Added to NRS by 2003, 780; A 2011, 3412)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.261 - Review of documents by independent review organization; decision of independent review organization.

1. Except as otherwise provided in NRS 695G.271 and 695G.275, upon receipt of a request for an external review pursuant to NRS 695G.251, the independent review organization shall, within 5 days after receiving the request:
(a) Review the request and the documents and materials submitted pursuant to NRS 695G.251; and
(b) Notify the covered person, the physician of the covered person and the health carrier if any additional information is required to conduct a review of the adverse determination. Such additional information must be provided within 5 days after receiving notice that the information is required to conduct a review of the adverse determination. The independent review organization shall forward to the health carrier, within 1 business day after receipt, any information received from a covered person or the physician of a covered person.
2. Except as otherwise provided in NRS 695G.271 and 695G.275, the independent review organization shall approve, modify or reverse the adverse determination within 15 days after it receives the information required to make that determination pursuant to this section. The independent review organization shall submit a copy of its determination, including the reasons therefor, to:
(a) The covered person;
(b) The physician of the covered person;
(c) The authorized representative of the covered person, if any; and
(d) The health carrier.
(Added to NRS by 2003, 781; A 2011, 3413)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.271 - Expedited approval or denial of request.

1. The Office for Consumer Health Assistance shall approve or deny a request for an external review of an adverse determination in an expedited manner not later than 72 hours after it receives proof from the provider of health care of the covered person that:
(a) The adverse determination concerns an admission, availability of care, continued stay or health care service for which the covered person received emergency services but has not been discharged from the facility providing the services or care; or
(b) Failure to proceed in an expedited manner may jeopardize the life or health of the covered person or the ability of the covered person to regain maximum function.
2. If the Office for Consumer Health Assistance approves a request for an external review pursuant to subsection 1, the Office for Consumer Health Assistance shall assign the request to an independent review organization not later than 1 working day after approving the request. Each assignment made by the Office for Consumer Health Assistance pursuant to this section must be completed on a rotating basis.
3. Within 24 hours after receiving notice of the Officer for Consumer Health Assistance assigning the request, the health carrier shall provide to the independent review organization all documents and materials specified in subsection 4 of NRS 695G.251.
4. An independent review organization that is assigned to conduct an external review pursuant to subsection 2 shall, if it accepts the assignment:
(a) Complete its external review not later than 48 hours after receiving the assignment, unless the covered person and the health carrier agree to a longer period;
(b) Not later than 24 hours after completing its external review, notify the covered person, the physician of the covered person, the authorized representative, if any, and the health carrier by telephone of its determination; and
(c) Not later than 48 hours after completing its external review, submit a written decision of its external review to the covered person, the physician of the covered person, the authorized representative, if any, and the health carrier.
(Added to NRS by 2003, 781; A 2011, 3413)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.280 - Basis for decision of independent review organization.

The decision of an independent review organization concerning a request for an external review must be based on:
1. Documentary evidence, including any recommendation of the physician of the insured submitted pursuant to NRS 695G.251;
2. Medical or scientific evidence, including, without limitation:
(a) Professional standards of safety and effectiveness for diagnosis, care and treatment that are generally recognized in the United States;
(b) Any report published in literature that is peer-reviewed;
(c) Evidence-based medicine, including, without limitation, reports and guidelines that are published by professional organizations that are recognized nationally and that include supporting scientific data; and
(d) An opinion of an independent physician who, as determined by the independent review organization, is an expert in the health specialty that is the subject of the independent review; and
3. The terms and conditions for benefits set forth in the evidence of coverage issued to the insured by the health carrier.
(Added to NRS by 2003, 782; A 2011, 3414)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.290 - Decision in favor of covered person binding on health carrier; limitation of liability; cost for independent review organization.

1. If the determination of an independent review organization concerning an external review of an adverse determination is in favor of the covered person, the determination is final, conclusive and binding upon the health carrier.
2. An independent review organization or any clinical peer who conducts or participates in an external review of an adverse determination for the independent review organization is not liable in a civil action for damages relating to a determination made by the independent review organization if the determination is made in good faith and without gross negligence.
3. The cost of conducting an external review of an adverse determination pursuant to NRS 695G.241 to 695G.310, inclusive, must be paid by the health carrier that made the adverse determination.
(Added to NRS by 2003, 782; A 2011, 3415)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.300 - Submission of complaint of covered person to independent review organization.

In lieu of resolving a complaint of a covered person in accordance with a system for resolving complaints established pursuant to the provisions of NRS 695G.200, a health carrier may:
1. Submit the complaint to an independent review organization pursuant to the provisions of NRS 695G.241 to 695G.310, inclusive; or
2. If a federal law or regulation provides a procedure for submitting the complaint for resolution that the Commissioner determines is substantially similar to the procedure for submitting the complaint to an independent review organization pursuant to NRS 695G.241 to 695G.310, inclusive, submit the complaint for resolution in accordance with the federal law or regulation.
(Added to NRS by 2003, 782; A 2011, 3415)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.303 - Independent review organization and health carrier required to maintain written records; submission of report upon request.

1. An independent review organization assigned pursuant to NRS 695G.251, 695G.271 or 695G.275 to conduct an external review shall maintain written records, aggregated for each state and for each health carrier, on all requests for which it conducted an external review during a calendar year and, upon request, submit a report to the Office for Consumer Health Assistance in a format specified by the Commissioner.
2. The report must include, aggregated for each state and for each health carrier:
(a) The total number of requests for external review;
(b) The number of requests for external review resolved and, of those resolved, the number upholding the adverse determination and the number reversing the adverse determination;
(c) The average length of time for resolution;
(d) A summary of the types of coverages or cases for which an external review was sought;
(e) The number of external reviews that were terminated as the result of a reconsideration by the health carrier of its adverse determination after receipt of additional information from the covered person or the covered person’s authorized representative pursuant to subsection 4 of NRS 695G.251 and subsection 32 of NRS 695G.275; and
(f) Any other information the Office for Consumer Health Assistance may request or require.
3. An independent review organization shall retain the written records required pursuant to this section for at least 3 years.
4. Each health carrier shall maintain written records, aggregated for each state and for each type of health benefit plan offered by the health carrier, on all requests for external review for which the health carrier receives notice from the Office for Consumer Health Assistance and, upon request, submit a report to the Office for Consumer Health Assistance in a format specified by the Commissioner.
5. The report must include, aggregated for each state and for each type of health benefit plan:
(a) The total number of requests for external review;
(b) Of the total number of requests for external review, the number of requests determined to be eligible for external review; and
(c) Any other information the Office for Consumer Health Assistance may request or require.
6. A health carrier shall retain the written records required pursuant to this section for at least 3 years.
(Added to NRS by 2011, 3409)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.307 - Health carrier required to provide description of external review procedures; format; contents.

1. A health carrier shall include a description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage or other evidence of coverage it provides to covered persons.
2. The description required by subsection 1 must be in a format prescribed by the Commissioner.
3. The description required by subsection 1 must include a statement that informs the covered person of the right of the covered person to file a request for an external review of an adverse determination with the Office for Consumer Health Assistance. The statement may explain that external review is available when the adverse determination involves an issue of medical necessity, appropriateness, health care setting, level of care or effectiveness. The statement must include the telephone number and address of the Office for Consumer Health Assistance.
4. In addition to the requirements of subsection 3, the statement must inform the covered person that, when filing a request for an external review, the covered person will be required to authorize the release of any medical records of the covered person that may be required to be reviewed for the purpose of reaching a decision on the external review.
(Added to NRS by 2011, 3409)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.310 - Annual report; requirements.

On or before December 31 of each year, each health carrier shall file a written report with the Office for Consumer Health Assistance setting forth the total number of:
1. Requests for an external review of an adverse decision made by the health carrier which were granted by the Office for Consumer Health Assistance during the immediately preceding year; and
2. Adverse determinations of the health carrier that were:
(a) Upheld during the immediately preceding year.
(b) Reversed during the immediately preceding year.
(Added to NRS by 2003, 783; A 2005, 1026; 2011, 3415)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.320 - 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 managed care 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 managed care organization to provide services to recipients of Medicaid or insureds in the Children’s Health Insurance Program, as applicable.
(Added to NRS by 2019, 1927; A 2021, 240)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.325 - 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 managed care 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, 2419)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.330 - Provision of health care services to recipients of Medicaid: Coverage for antipsychotic or anticonvulsant medication that is not on list of preferred prescription drugs required upon failure of drug on list to treat condition.

A managed care organization that provides health care services to recipients of Medicaid under the State Plan for Medicaid pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services shall automatically cover any typical or atypical antipsychotic medication or anticonvulsant medication that is not on the list of preferred prescription drugs developed pursuant to NRS 422.4025 upon the demonstrated therapeutic failure of one drug on that list to adequately treat the condition of a recipient of Medicaid.
(Added to NRS by 2023, 525)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.400 - Managed care organization prohibited from restricting or interfering with certain communications between provider of health care and patient.

A managed care organization shall not restrict or interfere with any communication between a provider of health care and a patient of the provider of health care regarding any information that the provider of health care determines is relevant to the health care of the patient.
(Added to NRS by 1997, 304)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.405 - Managed care 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 managed care organization shall not:
(a) Deny a claim under a health care 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 care 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 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 managed care 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 managed care organization under a health care plan that provides coverage for long-term care or disability income.
(Added to NRS by 2005, 2347; A 2007, 87)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.410 - Managed care organization prohibited from taking certain actions against provider solely because provider advocates on behalf of patient, assists patient or reports violation of law.

A managed care organization shall not terminate a contract with, demote, refuse to contract with or refuse to compensate a provider of health care solely because the provider, in good faith:
1. Advocates in private or in public on behalf of a patient;
2. Assists a patient in seeking reconsideration of a decision by the managed care organization to deny coverage for a health care service; or
3. Reports a violation of law to an appropriate authority.
(Added to NRS by 1997, 304)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.415 - Managed care organization prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression.

A managed care 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 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, 2048)
2023 Nevada Revised Statutes › Chapter 695G - Managed Care › NRS 695G.420 - Managed care organization prohibited from offering or paying financial incentive to provider to deny, reduce, withhold, limit or delay medically necessary services.

1. A managed care organization shall not offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay specific medically necessary health care services to an insured.
2. Nothing in this section prohibits an arrangement for payment between a managed care organization and a provider of health care that uses capitation or other financial incentives, if the arrangement is designed to provide an incentive to the provider of health care to use health care services effectively and consistently in the best interest of the health care of the insured.
(Added to NRS by 1997, 304)
2023 Nevada Revised Statutes › Chapter 695H - Medical Discount Plans › NRS 695H.040 - "Insurer" defined.

"Insurer" means any insurer, fraternal benefit society, nonprofit corporation for hospital, medical and dental services, organization for dental care, health maintenance organization or prepaid limited health service organization authorized pursuant to this title to conduct business in this State.
(Added to NRS by 2005, 2101)
2023 Nevada Revised Statutes › Chapter 695H - Medical Discount Plans › NRS 695H.050 - "Medical discount plan" defined.

"Medical discount plan" means a business arrangement or program evidenced by a membership agreement, contract, card, certificate, device or mechanism in which a person, in exchange for fees, dues, charges or any other form of consideration, offers to provide or provides health care or medical services at a discount from providers of health care who are participating in the business arrangement or program or whom the person advertises as or claims to be participating in the business arrangement or program.
(Added to NRS by 2005, 2101)
2023 Nevada Revised Statutes › Chapter 695H - Medical Discount Plans › NRS 695H.080 - Offering, marketing, selling or engaging in business as medical discount plan without registration unlawful; exceptions.

1. Except as otherwise provided in this section, it is unlawful for any person to offer, market, sell or engage in business as a medical discount plan in this State without first registering the medical discount plan pursuant to the provisions of this chapter.
2. An insurer is not required to register any medical discount plan pursuant to the provisions of this chapter unless the insurer offers, markets or sells the medical discount plan in this State for separate consideration.
3. If an affiliate of an insurer offers, markets, sells or engages in business as a medical discount plan in this State, the affiliate is required to register the medical discount plan pursuant to the provisions of this chapter.
4. The provisions of this chapter do not apply to any medical discount plan that offers or provides discounts only on prescriptions.
(Added to NRS by 2005, 2101)
2023 Nevada Revised Statutes › Chapter 695H - Medical Discount Plans › NRS 695H.090 - Application for registration; renewal of registration; fees; regulations.

1. An application for registration to engage in business as a medical discount plan must be submitted on a form prescribed by the Commissioner. The form must be signed by an officer or an authorized representative of the applicant. Except as otherwise provided in this section, the application must be accompanied by:
(a) A registration fee of $500 and, in addition to any other fee or charge, all applicable fees required pursuant to NRS 680C.110.
(b) A copy of the organizational documents of the applicant, if any.
(c) A list of names, addresses, positions of employment and biographical information of each person who is responsible for conducting the business activities of the medical discount plan of the applicant, including, but not limited to, all members of the board of directors, board of trustees, officers and managers. The list must set forth the extent and nature of any contracts or other agreements between any person who is responsible for conducting the business activities of the applicant and the medical discount plan, including disclosure of any possible conflicts of interest.
(d) A complete biographical statement, on a form prescribed by the Commissioner, describing the facilities, employees and services that will be offered by the applicant.
(e) A copy of all forms used for contracts between the applicant and networks of providers of health care regarding the provision of health care or medical services to members.
(f) A copy of the most recent financial statements of the applicant, audited by an independent certified public accountant.
(g) A description of the method of marketing proposed by the applicant.
(h) A description of the procedures for making a complaint to be established and maintained by the applicant.
(i) Any other information required by the Commissioner.
2. Each person who registers a medical discount plan must renew the registration on or before March 1 of each year. Except as otherwise provided in this section, an application to renew the registration must include:
(a) An annual renewal fee of $500 and, in addition to any other fee or charge, all applicable fees required pursuant to NRS 680C.110; and
(b) Any information set forth in subsection 1 that the Commissioner requires to be included in the application.
3. An administrator or insurer that registers a medical discount plan is not required to pay the fees for registering or renewing the registration of the medical discount plan pursuant to this section.
4. The Commissioner shall, by regulation, designate the provisions of subsection 1 that shall be deemed satisfied by an administrator, insurer or affiliate of an insurer that has complied with substantially similar requirements pursuant to other provisions of this title.
(Added to NRS by 2005, 2101; A 2009, 1821; 2011, 3416)
2023 Nevada Revised Statutes › Chapter 695H - Medical Discount Plans › NRS 695H.100 - Person responsible for conducting business activities of medical discount plan prohibited from engaging in certain acts.

A person who is responsible for conducting the business activities of a medical discount plan may not:
1. Use the word "insurance" or "enrollment" in any advertising or marketing material, brochures or discount cards for the medical discount plan unless approved by the Commissioner;
2. Use in any advertising or marketing material, brochures or discount cards for the medical discount plan the terms "coverage," "copay," "preexisting conditions," "guaranteed issue," "PPO," "preferred provider organization" or any other term that could reasonably mislead a person into believing the medical discount plan is a policy of health insurance;
3. Pay a provider of health care any fee for providing any health care or medical services; or
4. Collect or accept money from a member of the medical discount plan for payment to a provider of health care for specific health care or medical services that the provider has provided or will provide to the member unless the registration for the medical discount plan is held by an administrator or insurer.
(Added to NRS by 2005, 2102)
2023 Nevada Revised Statutes › Chapter 695H - Medical Discount Plans › NRS 695H.105 - Contracts with dentists: Assignments; toll-free telephone number.

1. A medical discount plan that contracts directly with a dentist:
(a) Shall notify the dentist in the contract if the contract may be assigned to a third party;
(b) May assign the contract with the dentist to a third party only if the contract expressly authorizes the medical discount plan to assign the contract; and
(c) Shall maintain a toll-free telephone number for the dentist to obtain information regarding the medical discount plan.
2. A medical discount plan to which a contract with a dentist is assigned shall issue a written notice of inclusion in the medical discount plan to the dentist within 30 days after the assignment of the contract. Such a notice must include:
(a) The approximate number of members in the medical discount plan;
(b) The corporate name of the person offering the medical discount plan;
(c) The location and address of each office for the medical discount plan; and
(d) The telephone number where the dentist may obtain information regarding the medical discount plan.
3. A medical discount plan which fails to provide the notice required by subsection 2 to a dentist may not hold the dentist responsible for performance pursuant to the assigned contract.
(Added to NRS by 2015, 2438)
2023 Nevada Revised Statutes › Chapter 695H - Medical Discount Plans › NRS 695H.110 - Required disclosures.

1. The following disclosures must be made in writing to any prospective member of a medical discount plan and must be in clear language and prominently displayed in any advertisements, marketing materials and brochures relating to a medical discount plan:
(a) That the medical discount plan is not a policy of health insurance;
(b) That the medical discount plan provides discounts from providers of health care who provide health care or medical services to members;
(c) That the medical discount plan does not make payments directly to the providers of health care;
(d) That the member will be required to pay for all health care or medical services but will receive a discount from those providers of health care who have contracted with the medical discount plan;
(e) The corporate name of the person offering the medical discount plan and the location and address of each office for the medical discount plan; and
(f) A telephone number where the member may obtain information and answers to questions or complaints.
2. The disclosures required pursuant to this section may be provided orally or electronically if written disclosures are provided not later than the earlier of:
(a) Ten business days after the prospective member elects to accept the medical discount plan; or
(b) The date on which any other written material is provided by the medical discount plan to the member.
(Added to NRS by 2005, 2103)
2023 Nevada Revised Statutes › Chapter 695H - Medical Discount Plans › NRS 695H.130 - Net worth.

1. Each medical discount plan must at all times maintain a net worth of $100,000.
2. The Commissioner shall not issue a registration or renewal of a registration for a medical discount plan unless the person registering or renewing the registration certifies that the medical discount plan has a net worth of at least $100,000.
(Added to NRS by 2005, 2103)
2023 Nevada Revised Statutes › Chapter 695H - Medical Discount Plans › NRS 695H.140 - Examinations and inspection of accounts, books and records by Commissioner.

1. Except as otherwise provided in this subsection, the Commissioner may conduct examinations to enforce the provisions of this chapter pursuant to the provisions of NRS 679B.230 to 679B.300, inclusive, at such times as the Commissioner deems necessary. For the purposes of this chapter, the Commissioner is not required to comply with the requirement in NRS 679B.230 that insurers be examined not less frequently than every 5 years.
2. A person who is responsible for conducting the business activities of a medical discount plan shall, upon the request of the Commissioner, make available to the Commissioner for inspection any accounts, books and records concerning the medical discount plan which are reasonably necessary to enable the Commissioner to determine whether the medical discount plan is in compliance with the provisions of this chapter.
(Added to NRS by 2005, 2104)
2023 Nevada Revised Statutes › Chapter 695H - Medical Discount Plans › NRS 695H.150 - Records: Maintenance, retention and storage.

1. A medical discount plan must maintain records of the transactions governed by this chapter. The records must include:
(a) A copy of each type of contract that the medical discount plan issues, sells or offers for sale;
(b) The name and address of each member of the medical discount plan;
(c) A copy of each contract that the medical discount plan enters into with providers of health care for purposes of providing members with health care or medical services at a discount; and
(d) A copy of the annual certification of net worth and supporting documentation.
2. Except as otherwise provided in this subsection, each medical discount plan must retain all records for at least 7 years. A medical discount plan which intends to discontinue doing business in this State must provide the Commissioner with satisfactory proof that it has discharged its duties to the members in this State and must not destroy its records without the prior approval of the Commissioner.
3. The records required to be maintained pursuant to this section may be stored on a computer disc or other storage device for a computer from which the records may be readily printed.
(Added to NRS by 2005, 2104)
2023 Nevada Revised Statutes › Chapter 695H - Medical Discount Plans › NRS 695H.170 - Administrative penalty for commission of certain acts; availability of list of participating providers of health care required.

A person is subject to the imposition of an administrative penalty pursuant to this chapter if, in the course of the business of the person, the person:
1. Solicits, markets, advertises, promotes or sells to a person in this State a medical discount plan or a membership in connection with a medical discount plan unless the medical discount plan is registered pursuant to this chapter.
2. Fails to provide any disclosure required pursuant to NRS 695H.110.
3. Fails to make available to an applicant for membership or to a member, through a toll-free telephone number, upon the request of the applicant or member, a complete and accurate list of all participating providers of health care who have contracted with the medical discount plan and who are located in the applicant’s or member’s local area, or within a radius of 50 miles, and a list of the health care or medical services for which the discounts are applicable. The list must be made available, upon the request of the applicant, at the time the applicant purchases a membership and must be updated not less than once every 6 months.
4. Violates subsection 1 or 2 of NRS 695H.100 or otherwise uses advertising or marketing material, brochures or discount cards that are misleading, deceptive or fraudulent.
5. Offers discounted products or services to the applicant or member that are not authorized by a contract with each provider of health care listed in conjunction with the medical discount plan.
6. Fails to allow the applicant or member to cancel the membership in the medical discount plan.
7. If appropriate, fails to refund any required portion of membership fees paid to the medical discount plan by the applicant or member within 30 days after the applicant or member provides timely notification of the cancellation of the membership to the person administering the medical discount plan.
(Added to NRS by 2005, 2103)
2023 Nevada Revised Statutes › Chapter 695H - Medical Discount Plans › NRS 695H.180 - Penalties.

A person who violates any provision of this chapter or an order or regulation of the Commissioner issued or adopted pursuant thereto may be assessed an administrative penalty by the Commissioner of not more than $2,000 for each act or violation.
(Added to NRS by 2005, 2104; A 2011, 3416)
2023 Nevada Revised Statutes › Chapter 695I - Silver State Health Insurance Exchange › NRS 695I.090 - "Qualified individual" defined.

"Qualified individual" means a person, including, without limitation, a minor, who:
1. Is seeking to enroll in a qualified health plan offered to persons through the Exchange;
2. Resides in Nevada;
3. At the time of enrollment is not incarcerated, unless the person is incarcerated pending the disposition of charges; and
4. Is, and is reasonably expected to be, for the entire period for which enrollment is sought, a citizen of the United States or an alien lawfully present in the United States.
(Added to NRS by 2011, 2645)
2023 Nevada Revised Statutes › Chapter 695I - Silver State Health Insurance Exchange › NRS 695I.100 - "Qualified small employer" defined.

"Qualified small employer" means a small employer that chooses to make all of its full-time employees eligible for one or more qualified health plans offered through the Exchange to assist qualified small employers in Nevada in facilitating the enrollment of their employees in qualified health plans offered in the small group market, if the employer:
1. Has its principal place of business in Nevada and chooses to provide coverage through the Exchange to all of its eligible employees, regardless of where those employees are employed; or
2. Regardless of the location of its principal place of business, chooses to provide coverage through the Exchange to all of its eligible employees who are principally employed in Nevada.
(Added to NRS by 2011, 2645)
2023 Nevada Revised Statutes › Chapter 695I - Silver State Health Insurance Exchange › NRS 695I.200 - Establishment; purpose.

The Silver State Health Insurance Exchange is hereby established to:
1. Facilitate the purchase and sale of qualified health plans in the individual market in Nevada;
2. Assist qualified small employers in Nevada in facilitating the enrollment and purchase of coverage and the application for subsidies for small business enrollees;
3. Reduce the number of uninsured persons in Nevada;
4. Provide a transparent marketplace for health insurance and consumer education on matters relating to health insurance; and
5. Assist residents of Nevada with access to programs, premium assistance tax credits and cost-sharing reductions.
(Added to NRS by 2011, 2645)
2023 Nevada Revised Statutes › Chapter 695I - Silver State Health Insurance Exchange › NRS 695I.210 - Powers and duties of Exchange; applicability of state purchasing provisions.

1. The Exchange shall:
(a) Create and administer a health insurance exchange;
(b) Facilitate the purchase and sale of qualified health plans consistent with established patterns of care within the State;
(c) Provide for the establishment of a program to assist qualified small employers in Nevada in facilitating the enrollment of their employees in qualified health plans offered in the small group market;
(d) Except as otherwise authorized by a waiver obtained pursuant to NRS 695I.505, make only qualified health plans available to qualified individuals and qualified small employers; and
(e) Unless the Federal Act is repealed or is held to be unconstitutional or otherwise invalid or unlawful, perform all duties that are required of the Exchange to implement the requirements of the Federal Act.
2. The Exchange may:
(a) Enter into contracts with any person, including, without limitation, a local government, a political subdivision of a local government and a governmental agency, to assist in carrying out the duties and powers of the Exchange or the Board; and
(b) Apply for and accept any gift, donation, bequest, grant or other source of money to carry out the duties and powers of the Exchange or the Board.
3. The Exchange is subject to the provisions of chapter 333 of NRS.
(Added to NRS by 2011, 2646; A 2015, 554; 2019, 1431; 2021, 3626)
2023 Nevada Revised Statutes › Chapter 695I - Silver State Health Insurance Exchange › NRS 695I.300 - Membership of Board.

1. The governing authority of the Exchange is the Board, consisting of seven voting members and three ex officio nonvoting members.
2. Subject to the provisions of subsections 3 to 6, inclusive:
(a) The Governor shall appoint five voting members of the Board;
(b) The Senate Majority Leader shall appoint one voting member of the Board; and
(c) The Speaker of the Assembly shall appoint one voting member of the Board.
3. Each voting member of the Board must have:
(a) Expertise in the sale or marketing of individual or small employer health insurance;
(b) Expertise in health care administration, health care financing, health information technology or health insurance;
(c) Expertise in the administration of health care delivery systems;
(d) Experience as a consumer who would benefit from services provided by the Exchange; or
(e) Experience as a consumer advocate, including, without limitation, experience in consumer outreach and education for those who would benefit from services provided by the Exchange.
4. When making an appointment pursuant to subsection 2, the Governor, the Majority Leader and the Speaker of the Assembly shall consider the collective expertise and experience of the voting members of the Board and shall attempt to make each appointment so that:
(a) The areas of expertise and experience described in subsection 3 are collectively represented by the voting members of the Board; and
(b) The voting members of the Board represent a range and diversity of skills, knowledge, experience and geographic and stakeholder perspectives.
5. When making an appointment pursuant to subsection 2, the Governor, the Majority Leader and the Speaker of the Assembly shall, as vacancies on the Board occur, ensure that not more than two voting members of the Board represent any particular area of expertise or experience described in paragraph (a), (b), (c), (d) or (e) of subsection 3.
6. A voting member of the Board may not be a Legislator or hold any elective office in State Government.
7. The following are ex officio nonvoting members of the Board who shall assist the voting members of the Board by providing advice and expertise:
(a) The Director of the Department of Health and Human Services, or his or her designee;
(b) The Director of the Department of Business and Industry, or his or her designee; and
(c) The Director of the Office of Finance, or his or her designee.
(Added to NRS by 2011, 2646; A 2015, 555)
2023 Nevada Revised Statutes › Chapter 695I - Silver State Health Insurance Exchange › NRS 695I.310 - Terms of office; reappointment; removal; vacancy; expiration of term.

1. After the initial terms, the term of each voting member of the Board is 3 years.
2. A voting member of the Board may be reappointed to the Board.
3. The appointing authority who appoints a voting member of the Board may remove that voting member if the voting member neglects his or her duty or commits misfeasance, malfeasance or nonfeasance in office.
4. A vacancy on the Board in the position of a voting member must be filled in the same manner as the original appointment.
5. Upon the expiration of his or her term of office, a voting member of the Board may continue to serve until he or she is reappointed or a person is appointed as a successor.
(Added to NRS by 2011, 2647)
2023 Nevada Revised Statutes › Chapter 695I - Silver State Health Insurance Exchange › NRS 695I.320 - Chair and Vice Chair: Election; term; vacancy.

1. The Board shall elect a Chair and a Vice Chair from among its members.
2. The terms of the Chair and Vice Chair are 1 year.
3. The Chair and Vice Chair may be reelected to one or more terms.
4. If a vacancy occurs, the members of the Board shall elect a replacement Chair or Vice Chair, as applicable, for the remainder of the unexpired term.
(Added to NRS by 2011, 2647)
2023 Nevada Revised Statutes › Chapter 695I - Silver State Health Insurance Exchange › NRS 695I.330 - Compensation of members; per diem and travel expenses.

1. To the extent that money is available for that purpose, each member of the Board who is not an officer or employee of the State of Nevada or a political subdivision of the State is entitled to receive a salary of not more than $80 per day, as fixed by the Executive Director, for each day or portion of a day spent on the business of the Board.
2. If sufficient money is available from federal grant funds or revenues generated by the Exchange, each member is entitled to receive the per diem allowance and travel expenses provided for state officers and employees generally while attending meetings of the Board or otherwise engaged in the business of the Board.
(Added to NRS by 2011, 2647; A 2015, 556)
2023 Nevada Revised Statutes › Chapter 695I - Silver State Health Insurance Exchange › NRS 695I.340 - Meetings; quorum; voting.

1. The Board shall meet:
(a) At least once each calendar year; and
(b) At other times upon the call of the Chair or a majority of the voting members.
2. A majority of the voting members of the Board constitutes a quorum for the transaction of business.
3. A member of the Board may not vote by proxy.
(Added to NRS by 2011, 2647; A 2015, 556)