reglab/statecodes huggingface dataset:
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.0403 - Procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations.

1. Each policy of health insurance must include a procedure for binding arbitration to resolve disputes concerning independent medical evaluations pursuant to the rules of the American Arbitration Association.
2. If an insurer, for any final determination of benefits or care, requires an independent evaluation of the medical, dental or chiropractic care of any person for whom such care is covered under the terms of the contract of insurance, only a physician, dentist or chiropractic physician who is certified to practice in the same field of practice as the primary treating physician, dentist or chiropractic physician or who is formally educated in that field may conduct the independent evaluation.
3. The independent evaluation must include a physical examination of the patient, unless the patient is deceased, and a personal review of all X-rays and reports prepared by the primary treating physician, dentist or chiropractic physician. A certified copy of all reports of findings must be sent to the primary treating physician, dentist or chiropractic physician and the insured person within 10 working days after the evaluation. If the insured person disagrees with the finding of the evaluation, the insured person must submit an appeal to the insurer pursuant to the procedure for binding arbitration set forth in the policy of insurance within 30 days after the insured person receives the finding of the evaluation. Upon its receipt of an appeal, the insurer shall so notify in writing the primary treating physician, dentist or chiropractic physician.
4. The insurer shall not limit or deny coverage for care related to a disputed claim while the dispute is in arbitration, except that, if the insurer prevails in the arbitration, the primary treating physician, dentist or chiropractic physician may not recover any payment from either the insurer, insured person or the patient for services that the primary treating physician, dentist or chiropractic physician provided to the patient after receiving written notice from the insurer pursuant to subsection 3 concerning the appeal of the insured person.
(Added to NRS by 1989, 2114; A 2015, 195)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.04036 - Coverage for continued medical treatment required in certain policies; exceptions; regulations.

1. The provisions of this section apply to a policy of health insurance offered or issued by an insurer if an insured covered by the policy receives health care through a defined set of providers of health care who are under contract with the insurer.
2. Except as otherwise provided in this section, if an insured who is covered by a policy described in subsection 1 is receiving medical treatment for a medical condition from a provider of health care whose contract with the insurer is terminated during the course of the medical treatment, the policy must provide that:
(a) The insured may continue to obtain medical treatment for the medical condition from the provider of health care pursuant to this section, if:
(1) The insured is actively undergoing a medically necessary course of treatment; and
(2) The provider of health care and the insured agree that the continuity of care is desirable.
(b) The provider of health care is entitled to receive reimbursement from the insurer for the medical treatment the provider of health care provides to the insured pursuant to this section, if the provider of health care agrees:
(1) To provide medical treatment under the terms of the contract between the provider of health care and the insurer with regard to the insured, including, without limitation, the rates of payment for providing medical service, as those terms existed before the termination of the contract between the provider of health care and the insurer; and
(2) Not to seek payment from the insured for any medical service provided by the provider of health care that the provider of health care could not have received from the insured were the provider of health care still under contract with the insurer.
3. The coverage required by subsection 2 must be provided until the later of:
(a) The 120th day after the date the contract is terminated; or
(b) If the medical condition is pregnancy, the 45th day after:
(1) The date of delivery; or
(2) If the pregnancy does not end in delivery, the date of the end of the pregnancy.
4. The requirements of this section do not apply to a provider of health care if:
(a) The provider of health care was under contract with the insurer and the insurer terminated that contract because of the medical incompetence or professional misconduct of the provider of health care; and
(b) The insurer did not enter into another contract with the provider of health care after the contract was terminated pursuant to paragraph (a).
5. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2003, has the legal effect of including the coverage required by this section, and any provision of the policy or renewal thereof that is in conflict with this section is void.
6. The Commissioner shall adopt regulations to carry out the provisions of this section.
(Added to NRS by 2003, 3354)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.0404 - Coverage for use of certain drugs and related services for treatment of cancer required in certain policies.

Except as otherwise provided in NRS 689A.04033:
1. No policy of health insurance that provides coverage for a drug approved by the Food and Drug Administration for use in the treatment of an illness, disease or other medical condition may be delivered or issued for delivery in this state unless the policy includes coverage for any other use of the drug for the treatment of cancer, if that use is:
(a) Specified in the most recent edition of or supplement to:
(1) The
United States Pharmacopoeia Drug Information
; or
(2) The
American Hospital Formulary Service Drug Information
; or
(b) Supported by at least two articles reporting the results of scientific studies that are published in scientific or medical journals, as defined in 21 C.F.R. § 99.3.
2. The coverage required pursuant to this section:
(a) Includes coverage for any medical services necessary to administer the drug to the insured.
(b) Does not include coverage for any:
(1) Experimental drug used for the treatment of cancer if that drug has not been approved by the Food and Drug Administration; or
(2) Use of a drug that is contraindicated by the Food and Drug Administration.
3. A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1999, has the legal effect of including the coverage required by this section, and any provision of the policy that conflicts with the provisions of this section is void.
(Added to NRS by 1999, 759; A 2003, 3522)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.04042 - Coverage for colorectal cancer screening required in policy covering treatment of colorectal cancer.

1. A policy of health insurance that provides coverage for the treatment of colorectal cancer must provide coverage for colorectal cancer screening in accordance with:
(a) The guidelines concerning colorectal cancer screening which are published by the American Cancer Society; or
(b) Other guidelines or reports concerning colorectal cancer screening which are published by nationally recognized professional organizations and which include current or prevailing supporting scientific data.
2. A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2003, has the legal effect of including the coverage required by this section, and any provision of the policy that conflicts with the provisions of this section is void.
(Added to NRS by 2003, 1334)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.04044 - Policy covering prescription drugs: Required actions by insurer related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared.

1. If the Governor or the Legislature proclaims the existence of a state of emergency or issues a declaration of disaster pursuant to NRS 414.070, an insurer who has issued a policy of health insurance which provides coverage for prescription drugs shall, notwithstanding any provision of the policy to the contrary:
(a) Waive any provision of the policy restricting the time within which an insured may refill a covered prescription if the insured:
(1) Has not exceeded the number of refills authorized by the prescribing practitioner;
(2) Resides in the area for which the emergency or disaster has been declared; and
(3) Requests the refill not later than the end of the state of emergency or disaster or 30 days after the issuance of the proclamation or declaration, whichever is later; and
(b) Authorize payment for, and may apply a copayment, coinsurance or deductible to, a supply of a covered prescription drug for up to 30 days for an insured who resides in the area for which the emergency or disaster has been declared.
2. The Commissioner may extend the time periods prescribed by subsection 1 in increments of 15 or 30 days as he or she determines to be necessary.
3. As used in this section, "practitioner" has the meaning ascribed to it in NRS 639.0125.
(Added to NRS by 2021, 823)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.04045 - Policy covering prescription drugs prohibited from limiting or excluding coverage for prescription drug previously approved for medical condition of insured; exception.

1. Except as otherwise provided in this section, a policy of health insurance which provides coverage for prescription drugs must not limit or exclude coverage for a drug if the drug:
(a) Had previously been approved for coverage by the insurer for a medical condition of an insured and the insured’s provider of health care determines, after conducting a reasonable investigation, that none of the drugs which are otherwise currently approved for coverage are medically appropriate for the insured; and
(b) Is appropriately prescribed and considered safe and effective for treating the medical condition of the insured.
2. The provisions of subsection 1 do not:
(a) Apply to coverage for any drug that is prescribed for a use that is different from the use for which that drug has been approved for marketing by the Food and Drug Administration;
(b) Prohibit:
(1) The insurer from charging a deductible, copayment or coinsurance for the provision of benefits for prescription drugs to the insured or from establishing, by contract, limitations on the maximum coverage for prescription drugs;
(2) A provider of health care from prescribing another drug covered by the policy that is medically appropriate for the insured; or
(3) The substitution of another drug pursuant to NRS 639.23286 or 639.2583 to 639.2597, inclusive; or
(c) Require any coverage for a drug after the term of the policy.
3. Any provision of a policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2001, which is in conflict with this section is void.
(Added to NRS by 2001, 857; A 2003, 2298; 2017, 636)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.04046 - Coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications required in policy covering prescription drugs; prohibited acts; exception.

1. An insurer who offers or issues a policy of health insurance which provides coverage for prescription drugs:
(a) Must authorize coverage for and may apply a copayment and deductible to a prescription that is dispensed by a pharmacy for less than a 30-day supply if, for the purpose of synchronizing the insured’s chronic medications:
(1) The prescriber or pharmacist determines that filling or refilling the prescription in that manner is in the best interest of the insured; and
(2) The insured requests less than a 30-day supply.
(b) May not deny coverage for a prescription described in paragraph (a) which is otherwise approved for coverage by the insurer.
(c) Unless otherwise provided by a contract or other agreement, may not prorate any pharmacy dispensing fees for a prescription described in paragraph (a).
2. A policy subject to the provisions of this chapter which provides coverage for prescription drugs and that is delivered, issued for delivery or renewed on or after January 1, 2017, has the legal effect of providing that coverage subject to the requirements of this section, and any provision of the policy or renewal which is in conflict with this section is void.
3. The provisions of this section do not apply to unit-of-use packaging for which synchronization is not practicable or to a controlled substance.
4. As used in this section:
(a) "Chronic medication" means any drug that is prescribed to treat any disease or other condition which is determined to be permanent, persistent or lasting indefinitely.
(b) "Synchronization" means the alignment of the dispensing of multiple medications by a single contracted pharmacy for the purpose of improving a patient’s adherence to a prescribed course of medication.
(c) "Unit-of-use packaging" means medication that is prepackaged by the manufacturer in blister packs, compliance packs, course-of-therapy packs or any other packaging which is designed and intended to be dispensed directly to the patient without modification by the dispensing pharmacy, except for the addition of a prescription label.
(Added to NRS by 2015, 2123)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.04047 - Policy covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products.

1. An insurer who offers or issues a policy of health insurance which provides coverage for prescription drugs shall not deny coverage for a topical ophthalmic product which is otherwise approved for coverage by the insurer when the insured, pursuant to NRS 639.2395, receives a refill of the product:
(a) After 21 days or more but before 30 days after receiving any 30-day supply of the product;
(b) After 42 days or more but before 60 days after receiving any 60-day supply of the product; or
(c) After 63 days or more but before 90 days after receiving any 90-day supply of the product.
2. The provisions of this section do not affect any deductibles, copayments or coinsurance authorized or required pursuant to the policy of health insurance.
3. A policy of health insurance subject to the provisions of this chapter which provides coverage for prescription drugs and that is delivered, issued for delivery or renewed on or after January 1, 2016, has the legal effect of including the coverage required by this section, and any provision of the policy or renewal which is in conflict with this section is void.
4. As used in this section, "topical ophthalmic product" means a liquid prescription drug which is applied directly to the eye from a bottle or by means of a dropper.
(Added to NRS by 2015, 206)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.04048 - Policy covering prescription drugs: Submission to step therapy protocol for drug to treat psychiatric condition prohibited in certain circumstances.

1. A policy of health insurance which provides coverage for prescription drugs must not require an insured to submit to a step therapy protocol before covering a drug approved by the Food and Drug Administration that is prescribed to treat a psychiatric condition of the insured, if:
(a) The drug has been approved by the Food and Drug Administration with indications for the psychiatric condition of the insured or the use of the drug to treat that psychiatric condition is otherwise supported by medical or scientific evidence;
(b) The drug is prescribed by:
(1) A psychiatrist;
(2) A physician assistant under the supervision of a psychiatrist;
(3) An advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120; or
(4) A primary care provider that is providing care to an insured in consultation with a practitioner listed in subparagraph (1), (2) or (3), if the closest practitioner listed in subparagraph (1), (2) or (3) who participates in the network plan of the insurer is located 60 miles or more from the residence of the insured; and
(c) The practitioner listed in paragraph (b) who prescribed the drug knows, based on the medical history of the insured, or reasonably expects each alternative drug that is required to be used earlier in the step therapy protocol to be ineffective at treating the psychiatric condition.
2. Any provision of a policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2023, which is in conflict with this section is void.
3. As used in this section:
(a) "Medical or scientific evidence" has the meaning ascribed to it in NRS 695G.053.
(b) "Network plan" means a policy of health insurance offered by an insurer under which the financing and delivery of medical care is provided, in whole or in part, through a defined set of providers under contract with the insurer. The term does not include an arrangement for the financing of premiums.
(c) "Step therapy protocol" means a procedure that requires an insured to use a prescription drug or sequence of prescription drugs other than a drug that a practitioner recommends for treatment of a psychiatric condition of the insured before his or her policy of health insurance provides coverage for the recommended drug.
(Added to NRS by 2023, 1782)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.04049 - Coverage for screening, genetic counseling and testing related to BRCA gene required in certain circumstances.

1. An insurer that issues a policy of health insurance shall provide coverage for screening, genetic counseling and testing for harmful mutations in the BRCA gene for women under circumstances where such screening, genetic counseling or testing, as applicable, is required by NRS 457.301.
2. An insurer shall ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the insurer.
3. A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2022, has the legal effect of including the coverage required by subsection 1, and any provision of the policy that conflicts with the provisions of this section is void.
4. As used in this section:
(a) "Network plan" means a policy of health insurance offered by an insurer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the insurer. The term does not include an arrangement for the financing of premiums.
(b) "Provider of health care" has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 2021, 780)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.041 - Coverage relating to mastectomy required in policy covering mastectomies; prohibited acts.

1. A policy of health insurance which provides coverage for the surgical procedure known as a mastectomy must also provide commensurate coverage for:
(a) Reconstruction of the breast on which the mastectomy has been performed;
(b) Surgery and reconstruction of the other breast to produce a symmetrical structure; and
(c) Prostheses and physical complications for all stages of mastectomy, including lymphedemas.
2. The provision of services must be determined by the attending physician and the patient.
3. The plan or issuer may require deductibles and coinsurance payments if they are consistent with those established for other benefits.
4. Written notice of the availability of the coverage must be given upon enrollment and annually thereafter. The notice must be sent to all participants:
(a) In the next mailing made by the plan or issuer to the participant or beneficiary; or
(b) As part of any annual information packet sent to the participant or beneficiary,
whichever is earlier.
5. A plan or issuer may not:
(a) Deny eligibility, or continued eligibility, to enroll or renew coverage, in order to avoid the requirements of subsections 1 to 4, inclusive; or
(b) Penalize, or limit reimbursement to, a provider of care, or provide incentives to a provider of care, in order to induce the provider not to provide the care listed in subsections 1 to 4, inclusive.
6. A plan or issuer may negotiate rates of reimbursement with providers of care.
7. If reconstructive surgery is begun within 3 years after a mastectomy, the amount of the benefits for that surgery must equal the amounts provided for in the policy at the time of the mastectomy. If the surgery is begun more than 3 years after the mastectomy, the benefits provided are subject to all of the terms, conditions and exclusions contained in the policy at the time of the reconstructive surgery.
8. A policy subject to the provisions of this chapter which is delivered, issued for delivery or renewed on or after October 1, 2001, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void.
9. For the purposes of this section, "reconstructive surgery" means a surgical procedure performed following a mastectomy on one breast or both breasts to re-establish symmetry between the two breasts. The term includes augmentation mammoplasty, reduction mammoplasty and mastopexy.
(Added to NRS by 1983, 614; A 1989, 1889; 2001, 2218)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.0412 - Coverage for examination of person who is pregnant for certain diseases required.

1. An insurer that issues a policy of health insurance shall provide coverage for the examination of a person who is pregnant for the discovery of:
(a)
Chlamydia trachomatis
, gonorrhea, hepatitis B and hepatitis C in accordance with NRS 442.013.
(b) Syphilis in accordance with NRS 442.010.
2. The coverage required by this section must be provided:
(a) Regardless of whether the benefits are provided to the insured by a provider of health care, facility or medical laboratory that participates in the network plan of the insurer; and
(b) Without prior authorization.
3. A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2021, has the legal effect of including the coverage required by subsection 1, and any provision of the policy that conflicts with the provisions of this section is void.
4. As used in this section:
(a) "Medical laboratory" has the meaning ascribed to it in NRS 652.060.
(b) "Network plan" means a policy of health insurance offered by an insurer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the insurer. The term does not include an arrangement for the financing of premiums.
(c) "Provider of health care" has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 2021, 2577)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.0413 - Coverage for certain gynecological or obstetrical services without authorization or referral from primary care physician required.

1. A policy of health insurance must include a provision authorizing a woman covered by the policy to obtain covered gynecological or obstetrical services without first receiving authorization or a referral from her primary care physician.
2. The provisions of this section do not authorize a woman covered by a policy of health insurance to designate an obstetrician or gynecologist as her primary care physician.
3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1999, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void.
4. As used in this section, "primary care physician" has the meaning ascribed to it in NRS 695G.060.
(Added to NRS by 1999, 1943)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.0415 - Coverage for hormone replacement therapy in certain circumstances required in policy covering prescription drugs or devices; prohibited acts; exception.

1. An insurer that offers or issues a policy of health insurance which provides coverage for prescription drugs or devices shall include in the policy coverage for any type of hormone replacement therapy which is lawfully prescribed or ordered and which has been approved by the Food and Drug Administration.
2. An insurer that offers or issues a policy of health insurance that provides coverage for prescription drugs shall not:
(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition for coverage for a prescription for hormone replacement therapy;
(b) Refuse to issue a policy of health insurance or cancel a policy of health insurance solely because the person applying for or covered by the policy uses or may use in the future hormone replacement therapy;
(c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from accessing hormone replacement therapy;
(d) Penalize a provider of health care who provides hormone replacement therapy to an insured, including, without limitation, reducing the reimbursement of the provider of health care; or
(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay hormone replacement therapy to an insured.
3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1999, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with this section is void.
4. The provisions of this section do not require an insurer to provide coverage for fertility drugs.
5. As used in this section, "provider of health care" has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 1999, 1995; A 2017, 1810, 3934)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.0417 - Coverage for health care services related to hormone replacement therapy required in policy covering outpatient care; prohibited acts.

1. An insurer that offers or issues a policy of health insurance which provides coverage for outpatient care shall include in the policy coverage for any health care service related to hormone replacement therapy.
2. An insurer that offers or issues a policy of health insurance that provides coverage for outpatient care shall not:
(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition for coverage for outpatient care related to hormone replacement therapy;
(b) Refuse to issue a policy of health insurance or cancel a policy of health insurance solely because the person applying for or covered by the policy uses or may use in the future hormone replacement therapy;
(c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from accessing hormone replacement therapy;
(d) Penalize a provider of health care who provides hormone replacement therapy to an insured, including, without limitation, reducing the reimbursement of the provider of health care; or
(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay hormone replacement therapy to an insured.
3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1999, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with this section is void.
4. As used in this section, "provider of health care" has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 1999, 1996; A 2017, 1811, 3935)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.042 - Policy containing exclusion, reduction or limitation of coverage relating to complications of pregnancy prohibited; exception.

1. No health insurance policy may be delivered or issued for delivery in this state if it contains any exclusion, reduction or other limitation of coverage relating to complications of pregnancy, unless the provision applies generally to all benefits payable under the policy.
2. As used in this section, the term "complications of pregnancy" includes any condition which requires hospital confinement for medical treatment and:
(a) If the pregnancy is not terminated, is caused by an injury or sickness not directly related to the pregnancy or by acute nephritis, nephrosis, cardiac decompensation, missed abortion or similar medically diagnosed conditions; or
(b) If the pregnancy is terminated, results in nonelective cesarean section, ectopic pregnancy or spontaneous termination.
3. A policy subject to the provisions of this chapter which is delivered or issued for delivery on or after July 1, 1977, has the legal effect of including the coverage required by this section, and any provision of the policy which is in conflict with this section is void.
(Added to NRS by 1977, 415)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.0423 - Coverage for treatment of certain inherited metabolic diseases required.

1. A policy of health insurance must provide coverage for:
(a) Enteral formulas for use at home that are prescribed or ordered by a physician as medically necessary for the treatment of inherited metabolic diseases characterized by deficient metabolism, or malabsorption originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate or fat; and
(b) At least $2,500 per year for special food products which are prescribed or ordered by a physician as medically necessary for the treatment of a person described in paragraph (a).
2. The coverage required by subsection 1 must be provided whether or not the condition existed when the policy was purchased.
3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2021, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void.
4. As used in this section:
(a) "Enteral formula" includes, without limitation, a formula that is ingested orally.
(b) "Inherited metabolic disease" means a disease caused by an inherited abnormality of the body chemistry of a person.
(c) "Special food product" means a food product that is specially formulated to have less than one gram of protein per serving and is intended to be consumed under the direction of a physician for the dietary treatment of an inherited metabolic disease. The term does not include a food that is naturally low in protein.
(Added to NRS by 1997, 1526; A 2021, 3623)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.0424 - Policy covering maternity care: Prohibited acts by insurer if insured is acting as gestational carrier; child deemed child of intended parent for purposes of policy.

1. An insurer that offers or issues a policy of health insurance that includes coverage for maternity care shall not deny, limit or seek reimbursement for maternity care because the insured is acting as a gestational carrier.
2. If an insured acts as a gestational carrier, the child shall be deemed to be a child of the intended parent, as defined in NRS 126.590, for purposes related to the policy of health insurance.
3. As used in this section, "gestational carrier" has the meaning ascribed to it in NRS 126.580.
(Added to NRS by 2019, 1005)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.0427 - Coverage for management and treatment of diabetes required in policy covering hospital, medical or surgical expenses.

1. No policy of health insurance that provides coverage for hospital, medical or surgical expenses may be delivered or issued for delivery in this state unless the policy includes coverage for the management and treatment of diabetes, including, without limitation, coverage for the self-management of diabetes.
2. An insurer who delivers or issues for delivery a policy specified in subsection 1:
(a) Shall include in any disclosure of the coverage provided by the policy notice to each policyholder and subscriber under the policy of the availability of the benefits required by this section.
(b) Shall provide the coverage required by this section subject to the same deductible, copayment, coinsurance and other such conditions for coverage that are required under the policy.
3. A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 1998, has the legal effect of including the coverage required by this section, and any provision of the policy that conflicts with this section is void.
4. As used in this section:
(a) "Coverage for the management and treatment of diabetes" includes coverage for medication, equipment, supplies and appliances that are medically necessary for the treatment of diabetes.
(b) "Coverage for the self-management of diabetes" includes:
(1) The training and education provided to an insured person after the insured person is initially diagnosed with diabetes which is medically necessary for the care and management of diabetes, including, without limitation, counseling in nutrition and the proper use of equipment and supplies for the treatment of diabetes;
(2) Training and education which is medically necessary as a result of a subsequent diagnosis that indicates a significant change in the symptoms or condition of the insured person and which requires modification of the insured person’s program of self-management of diabetes; and
(3) Training and education which is medically necessary because of the development of new techniques and treatment for diabetes.
(c) "Diabetes" includes type I, type II and gestational diabetes.
(Added to NRS by 1997, 742; A 2017, 2361)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.0428 - Coverage for management and treatment of sickle cell disease and its variants required; coverage for medically necessary prescription drugs to treat sickle cell disease and its variants required by plan covering prescription drugs.

1. An insurer that issues a policy of health insurance shall include in the policy coverage for:
(a) Necessary case management services for an insured diagnosed with sickle cell disease and its variants; and
(b) Medically necessary care for an insured who has been diagnosed with sickle cell disease and its variants.
2. An insurer that issues a policy of health insurance which provides coverage for prescription drugs shall include in the policy coverage for medically necessary prescription drugs to treat sickle cell disease and its variants.
3. An insurer may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.
4. As used in this section:
(a) "Case management services" means medical or other health care management services to assist patients and providers of health care, including, without limitation, identifying and facilitating additional resources and treatments, providing information about treatment options and facilitating communication between providers of services to a patient.
(b) "Medical management technique" means a practice which is used to control the cost or utilization of health care services. The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.
(c) "Medically necessary" has the meaning ascribed to it in NRS 695G.055.
(d) "Sickle cell disease and its variants" has the meaning ascribed to it in NRS 439.4927.
(Added to NRS by 2019, 2169)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.043 - Policy covering family on expense-incurred basis required to include certain coverage for insured’s newly born and adopted children and children placed with insured for adoption.

1. All individual health insurance policies providing family coverage on an expense-incurred basis must as to family members’ coverage provide that the health benefits applicable for children are payable with respect to:
(a) A newly born child of the insured from the moment of birth;
(b) An adopted child from the date the adoption becomes effective, if the child was not placed in the home before adoption; and
(c) A child placed with the insured for the purpose of adoption from the moment of placement as certified by the public or private agency making the placement. The coverage of such a child ceases if the adoption proceedings are terminated as certified by the public or private agency making the placement.
The policies must provide the coverage specified in subsection 3 and must not exclude premature births.
2. The policy or contract may require that notification of:
(a) The birth of a newly born child;
(b) The effective date of adoption of a child; or
(c) The date of placement of a child for adoption,
and payments of the required premium or fees, if any, must be furnished to the insurer within 31 days after the date of birth, adoption or placement for adoption in order to have the coverage continue beyond the 31-day period.
3. The coverage for newly born and adopted children and children placed for adoption consists of coverage of injury or sickness, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities and, within the limits of the policy, necessary transportation costs from place of birth to the nearest specialized treatment center under major medical policies, and with respect to basic policies to the extent such costs are charged by the treatment center.
(Added to NRS by 1975, 1109; A 1989, 739)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.0438 - Coverage for testing, treatment and prevention of sexually transmitted diseases required; coverage for condoms for certain insureds required.

1. An insurer that offers or issues a policy of health insurance shall include in the policy:
(a) Coverage of testing for and the treatment and prevention of sexually transmitted diseases, including, without limitation,
Chlamydia trachomatis
, gonorrhea, syphilis, human immunodeficiency virus and hepatitis B and C, for all insureds, regardless of age. Such coverage must include, without limitation, the coverage required by NRS 689A.0412 and 689A.0437.
(b) Unrestricted coverage of condoms for insureds who are 13 years of age or older.
2. A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2024, has the legal effect of including the coverage required by subsection 1, and any provision of the policy that conflicts with the provisions of this section is void.
(Added to NRS by 2023, 3509)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.0445 - Coverage for prostate cancer screening.

1. A policy of health insurance that provides coverage for the treatment of prostate cancer must provide coverage for prostate cancer screening in accordance with:
(a) The guidelines concerning prostate cancer screening which are published by the American Cancer Society; or
(b) Other guidelines or reports concerning prostate cancer screening which are published by nationally recognized professional organizations and which include current or prevailing supporting scientific data.
2. A policy of health insurance that provides coverage for the treatment of prostate cancer must not require an insured to obtain prior authorization for any service provided pursuant to subsection 1.
3. A policy of health insurance that provides coverage for the treatment of prostate cancer which is delivered, issued for delivery or renewed on or after July 1, 2007, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with subsection 1 is void.
(Added to NRS by 2007, 3236)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.0447 - Policy covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy.

1. An insurer that offers or issues a policy of health insurance which provides coverage for the treatment of cancer through the use of chemotherapy shall not:
(a) Require a copayment, deductible or coinsurance amount for chemotherapy administered orally by means of a prescription drug in a combined amount that is more than $100 per prescription. The limitation on the amount of the deductible that may be required pursuant to this paragraph does not apply to a health benefit plan, as defined in NRS 687B.470, if the health benefit plan is a high deductible health plan, as defined in 26 U.S.C. § 223, and the amount of the annual deductible has not been satisfied.
(b) Make the coverage subject to monetary limits that are less favorable for chemotherapy administered orally by means of a prescription drug than the monetary limits applicable to chemotherapy which is administered by injection or intravenously.
(c) Decrease the monetary limits applicable to chemotherapy administered orally by means of a prescription drug or to chemotherapy which is administered by injection or intravenously to meet the requirements of this section.
2. A policy subject to the provisions of this chapter which provides coverage for the treatment of cancer through the use of chemotherapy and that is delivered, issued for delivery or renewed on or after January 1, 2015, has the legal effect of providing that coverage subject to the requirements of this section, and any provision of the policy or renewal which is in conflict with this section is void.
3. Nothing in this section shall be construed as requiring an insurer to provide coverage for the treatment of cancer through the use of chemotherapy administered by injection or intravenously or administered orally by means of a prescription drug.
(Added to NRS by 2013, 1997; A 2013, 3657)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.0455 - Coverage for treatment of conditions relating to severe mental illness required.

1. A policy of 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 most recent 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 1999, 3100; A 2013, 3610)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.046 - Benefits for treatment of alcohol or substance use disorder required.

1. In addition to the benefits required by NRS 689A.0459, the benefits provided by a policy for health insurance for treatment of alcohol or substance use disorder must include, without limitation:
(a) Treatment for withdrawal from the physiological effect of alcohol or drugs, with a minimum benefit of $1,500 per calendar year.
(b) Treatment for a patient admitted to a facility, with a minimum benefit of $9,000 per calendar year.
(c) Counseling for a person, group or family who is not admitted to a facility, with a minimum benefit of $2,500 per calendar year.
2. Except as otherwise provided in NRS 687B.409, these benefits must be paid in the same manner as benefits for any other illness covered by a similar policy are paid.
3. The insured person is entitled to these benefits if treatment is received in any:
(a) Facility for the treatment of alcohol or substance use disorder which is certified by the Division of Public and Behavioral Health of the Department of Health and Human Services.
(b) Hospital or other medical facility or facility for the dependent which is licensed by the Division of Public and Behavioral Health of the Department of Health and Human Services, accredited by The Joint Commission or CARF International and provides a program for the treatment of alcohol or substance use disorder as part of its accredited activities.
(Added to NRS by 1979, 1176; A 1983, 2036; 1985, 1569, 1773; 1993, 1918; 1997, 1301; 1999, 1888; 2001, 438; 2017, 2209; 2023, 2372, 3512)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.0464 - Policy covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by insurer if insured is person with disability.

1. An insurer that offers or issues a policy of health insurance 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, 1170)