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2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.290 - Insurance company authorized to establish or contract with health maintenance organization.

1. An insurance company licensed in this State may either directly or through a subsidiary or affiliate organize and operate a health maintenance organization under the provisions of this chapter. Notwithstanding any other law which may be inconsistent herewith, any two or more such insurance companies or subsidiaries or affiliates thereof may jointly organize and operate a health maintenance organization. The business of insurance is deemed to include the providing of health care by a health maintenance organization owned or operated by an insurer or a subsidiary thereof.
2. An insurer may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of the failure of the health maintenance organization to meet its obligations. Among other things, under such contracts the insurer may make benefit payments to health maintenance organizations for health care services rendered by providers pursuant to the health care plan.
(Added to NRS by 1973, 1254)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.300 - Prohibited practices.

1. No health maintenance organization or representative thereof may cause or knowingly permit the use of advertising which is untrue or misleading, solicitation which is untrue or misleading or any form of evidence of coverage which is deceptive. For purposes of this chapter:
(a) A statement or item of information shall be deemed to be untrue if it does not conform to fact in any respect which is or may be significant to an enrollee of, or person considering enrollment in, a health care plan.
(b) A statement or item of information shall be deemed to be misleading, whether or not it may be literally untrue if, in the total context in which such statement is made or such item of information is communicated, such statement or item of information may be reasonably understood by a reasonable person not possessing special knowledge regarding health care coverage, as indicating any benefit or advantage or the absence of any exclusion, limitation or disadvantage of possible significance to an enrollee of, or person considering enrollment in, a health care plan if such benefit or advantage or absence of limitation, exclusion or disadvantage does not in fact exist.
(c) An evidence of coverage shall be deemed to be deceptive if the evidence of coverage taken as a whole, and with consideration given to typography and format as well as language, shall be such as to cause a reasonable person not possessing special knowledge regarding health care plans and evidences of coverage therefor to expect benefits, services, charges or other advantages which the evidence of coverage does not provide or which the health care plan issuing such evidence of coverage does not regularly make available for enrollees covered under such evidence of coverage.
2. NRS 686A.010 to 686A.310, inclusive, shall be construed to apply to health maintenance organizations, health care plans and evidences of coverage except to the extent that the nature of health maintenance organizations, health care plans and evidences of coverage render the sections therein clearly inappropriate.
3. An enrollee may not be cancelled or not renewed except for the failure to pay the charge for such coverage or for cause as determined in the master contract.
4. No health maintenance organization, unless licensed as an insurer, may use in its name, contracts, or literature any of the words "insurance," "casualty," "surety," "mutual" or any other words descriptive of the insurance, casualty or surety business or deceptively similar to the name or description of any insurance or surety corporation doing business in this State.
5. No person not certificated under this chapter shall use in its name, contracts or literature the phrase "health maintenance organization" or the initials "HMO."
(Added to NRS by 1973, 1253; A 2021, 901; 2023, 21)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.311 - Examinations by Commissioner: Financial condition of health maintenance organization; application for initial certificate of authority; exception.

1. For the purpose of determining its financial condition, fulfillment of its contractual obligations and compliance with law, the Commissioner shall, as often as the Commissioner deems advisable, examine the affairs, transactions, accounts, records and assets of a health maintenance organization and of any person as to any matter relevant to the financial affairs of the health maintenance organization or to the examination. Except as otherwise provided in this Code, the Commissioner shall examine each health maintenance organization at least once every 3 years.
2. The Commissioner shall examine each health maintenance organization applying for an initial certificate of authority.
3. In lieu of making his or her own examination, the Commissioner may, in the discretion of the Commissioner, accept a full report of the last recent examination of a foreign or alien health maintenance organization, certified to by the supervisory officer of insurance of another state.
4. To the extent that it is practical, the examination of a foreign or alien health maintenance organization must be made in cooperation with the insurance supervisory officers of other states in which the organization transacts business.
(Added to NRS by 1991, 2035)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.313 - Financial examination: Procedure; appointment of examiner; maintenance and use of records; penalty for obstruction or interference.

1. If the Commissioner determines to examine a health maintenance organization pursuant to NRS 695C.311, the Commissioner shall designate one or more examiners and instruct them as to the scope of the examination. The examiner shall, upon demand, exhibit his or her official credentials to the health maintenance organization being examined.
2. The Commissioner shall conduct each examination in an expeditious, fair and impartial manner.
3. The Commissioner, or the examiner if the examiner is authorized in writing by the Commissioner, may administer oaths and examine under oath any person concerning any matter relevant to the examination.
4. Every health maintenance organization and its officers, attorneys, employees, agents and representatives shall make available to the Commissioner or the examiners of the Commissioner the accounts, records, documents, files, information, assets and matters of the health maintenance organization in his or her possession or control relating to the subject of the examination and shall facilitate the examination.
5. If the Commissioner or examiner finds any accounts or records to be inadequate or inadequately kept or posted, he or she shall so notify the health maintenance organization and give the health maintenance organization a reasonable opportunity to reconstruct, rewrite, post or balance the account or record. If the health maintenance organization fails to maintain, complete or correct the records or accounting after the Commissioner or examiner has given the health maintenance organization written notice and a reasonable opportunity to do so, the Commissioner may employ experts to reconstruct, rewrite, post or balance the account or record at the expense of the health maintenance organization being examined.
6. The Commissioner or an examiner shall not remove any record, account, document, file or other property of the health maintenance organization being examined from the office or place of business of the health maintenance organization unless the Commissioner or examiner has the written consent of an officer of the health maintenance organization before the removal or pursuant to an order of court. This provision does not prohibit the Commissioner or examiner from making or removing copies or abstracts of a record, account, document or file.
7. Any person who, without just cause, refuses to be examined under oath or who willfully obstructs or interferes with an examiner in the exercise of his or her authority is guilty of a misdemeanor.
(Added to NRS by 1991, 2035)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.315 - Financial examination: Payment of expense.

1. The health maintenance organization being examined shall pay the expense of an examination. The expenses to be paid include only the reasonable and proper travel and lodging expenses of the Commissioner and the examiners and assistants of the Commissioner, including expert assistance, reasonable compensation to the examiners and assistants and incidental expenses as necessarily incurred in the examination. The Commissioner shall consider the scales and limitations recommended by the National Association of Insurance Commissioners regarding the expense and compensation for an examination.
2. The health maintenance organization shall promptly pay to the Commissioner the expenses of the examination upon presentation by the Commissioner of a reasonably detailed written statement thereof.
(Added to NRS by 1991, 2036)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.317 - Procedures required for examination and hearing.

The Commissioner shall use the procedures required by:
1. NRS 679B.230 to 679B.290, inclusive, when conducting an examination of a health maintenance organization.
2. NRS 679B.310 to 679B.370, inclusive, when conducting a hearing involving a health maintenance organization.
(Added to NRS by 1991, 2036)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.318 - Insolvency; determination of financial condition; actions by Commissioner; review; regulations.

1. A health maintenance organization shall be deemed to be insolvent if:
(a) The health maintenance organization fails to meet its obligations as they mature; and
(b) The assets of the health maintenance organization are less than the sum of its liabilities and the minimum surplus required to be maintained by the health maintenance organization under this Code for authority to transact business in this State.
2. In addition to the provisions of subsection 1, a health maintenance organization shall be deemed to be insolvent as otherwise expressly provided in this Code.
3. A health maintenance organization shall be deemed to be impaired if the assets of the health maintenance organization are less than the sum of its liabilities and the minimum surplus required to be maintained by the health maintenance organization under this Code for authority to transact business in this State.
4. The Commissioner may adopt regulations to define when a health maintenance organization is considered to be in a hazardous financial condition and to set forth the standards to be considered by the Commissioner in determining whether the continued operation of a health maintenance organization transacting business in this State may be considered to be hazardous to its enrollees or creditors or to the general public.
5. If the Commissioner determines after a hearing that any health maintenance organization is in a hazardous financial condition, the Commissioner may, instead of suspending or revoking the certificate of authority of the health maintenance organization, limit the certificate of authority as the Commissioner deems reasonably necessary to correct, eliminate or remedy any conduct, condition or ground that is deemed to be a cause of the hazardous financial condition.
6. An order or decision of the Commissioner under this section is subject to review in accordance with NRS 679B.310 to 679B.370, inclusive, at the request of any party to the proceedings whose interests are substantially affected.
(Added to NRS by 2017, 2392)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.319 - Power of Commissioner to order corrective action for hazardous operation or violation of law; regulations.

1. If the Commissioner determines that, because of the financial condition of a health maintenance organization, the continued operation of the health maintenance organization is or may be hazardous to its enrollees or creditors or to the general public, or that the health maintenance organization has violated any law of this State to which the health maintenance organization is subject, the Commissioner may, after notice and a hearing, order the health maintenance organization to take any action the Commissioner deems reasonably necessary to correct, eliminate or remedy the condition or violation, including, without limitation:
(a) Reducing the total amount of the present and potential liability of the health maintenance organization for benefits by reinsurance or any other method acceptable to the Commissioner;
(b) Suspending, limiting or reducing the volume of new business being written or accepted by the health maintenance organization for any period of time specified by the Commissioner;
(c) Reducing the expenses of the health maintenance organization by any method acceptable to the Commissioner; and
(d) Increasing the capital and surplus of the health maintenance organization by contribution.
2. The Commissioner may adopt regulations to:
(a) Set standards and criteria for early warning that the continued operation of a health maintenance organization may be hazardous to its enrollees or creditors or to the general public; and
(b) For the purposes of subsection 1, set standards for evaluating the financial condition of a health maintenance organization.
3. The authority conferred upon the Commissioner pursuant to this section is in addition to the authority of the Commissioner pursuant to chapter 696B of NRS. Any order issued by the Commissioner pursuant to this section may, at the discretion of the Commissioner, be in addition to any order issued by the Commissioner pursuant to chapter 696B of NRS.
(Added to NRS by 2017, 2393)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.3195 - Conservation, rehabilitation or liquidation of health maintenance organization: Powers of Commissioner; claims of enrollees; distribution of general assets.

1. Any conservation, rehabilitation or liquidation of a health maintenance organization shall be deemed to be the conservation, rehabilitation or liquidation of an insurer and must be conducted under the supervision of the Commissioner pursuant to chapter 696B of NRS.
2. The Commissioner may apply to a court of competent jurisdiction for an order directing the Commissioner to conserve, rehabilitate or liquidate a health maintenance organization:
(a) Upon any ground provided in chapter 696B of NRS; or
(b) If, as determined by the Commissioner, the continued operation of the health maintenance organization is or may be hazardous to its enrollees or creditors or to the general public.
3. In the event of a rehabilitation or liquidation of a health maintenance organization, a claim of an enrollee or of a beneficiary of an enrollee shall be deemed to have the same priority as would be provided to a claim of a policyholder or insured of an insurer, or of a beneficiary of such a policyholder or insured, in the event of the rehabilitation or liquidation of the insurer.
4. In the event of a distribution of the general assets of a health maintenance organization:
(a) If an enrollee is liable to a provider for health care services provided pursuant to and covered by the applicable health care plan, that liability shall be deemed to be a claim of the enrollee for distribution of the general assets of the health maintenance organization.
(b) A provider under contract with the health maintenance organization who is obligated by law or contract to hold an enrollee harmless from liability for health care services provided pursuant to and covered by the applicable health care plan shall be deemed to have a priority for distribution of the general assets of the health maintenance organization immediately following that of an enrollee as described in this section and immediately preceding any other priority for distribution which, pursuant to this section and chapter 696B of NRS, would follow that of an enrollee.
(Added to NRS by 2017, 2393)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.320 - Rehabilitation, liquidation or conservation: Conduct.

Any rehabilitation, liquidation or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation or conservation of an insurance company and shall be conducted under the supervision of the Commissioner pursuant to the law governing the rehabilitation, liquidation, or conservation of insurance companies.
(Added to NRS by 1973, 1256)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.325 - Offering health care plan to certain small employers for purposes of establishing medical savings accounts.

A health maintenance organization may offer to a small employer who has not less than 2 and not more than 50 employees, a health care plan that has a high deductible and that is in compliance with 26 U.S.C. § 220 for the purposes of establishing medical savings accounts for any person insured by the health care plan.
(Added to NRS by 1997, 2957)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.329 - Penalty for failure of health maintenance organization to comply with certain requirements for electronic maintenance, transmittal and exchange of health information. [Effective July 1, 2024.]

1. If the Commissioner receives notification from the Department of Health and Human Services pursuant to NRS 439.5895 that a health maintenance organization is not in compliance with the requirements of subsection 4 of NRS 439.589, the Commissioner may, after notice and the opportunity for a hearing in accordance with the provisions of this chapter, require corrective action or impose an administrative fine in the amount prescribed by NRS 695C.350.
2. The Commissioner shall not suspend or revoke the certificate of authority of a health maintenance organization for failure to comply with the requirements of subsection 4 of NRS 439.589.
(Added to NRS by 2023, 1856, effective July 1, 2024)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.340 - Disciplinary proceedings: Notice; hearing; judicial review.

1. When the Commissioner has cause to believe that grounds for the denial of an application for a certificate of authority exist, or that grounds for the suspension or revocation of a certificate of authority exist, the Commissioner shall notify the health maintenance organization in writing specifically stating the grounds for denial, suspension or revocation and fixing a time at least 30 days thereafter for a hearing on the matter.
2. After the hearing, or upon the failure of the health maintenance organization to appear at the hearing, the Commissioner shall take action as is deemed advisable on written findings which must be mailed to the health maintenance organization. The action of the Commissioner is subject to review by the First Judicial District Court of the State of Nevada in and for Carson City. The court may, in disposing of the issue before it, modify, affirm or reverse the order of the Commissioner in whole or in part.
(Added to NRS by 1973, 1256; A 1981, 107; 2013, 3649)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.350 - Violations: Remedies; penalties.

1. The Commissioner may, in lieu of suspension or revocation of a certificate of authority under NRS 695C.330, levy an administrative penalty in an amount not more than $2,500 for each act or violation, if reasonable notice in writing is given of the intent to levy the penalty.
2. Any person who violates the provisions of this chapter is guilty of a misdemeanor.
3. If the Commissioner for any reason has cause to believe that any violation of this chapter has occurred or is threatened, the Commissioner may give notice to the health maintenance organization and to the representatives, or other persons who appear to be involved in the suspected violation, to arrange a conference with the alleged violators or their authorized representatives to attempt to determine the facts relating to the suspected violation, and, if it appears that any violation has occurred or is threatened, to arrive at an adequate and effective means of correcting or preventing the violation.
4. The proceedings conducted pursuant to the provisions of subsection 3 must not be governed by any formal procedural requirements, and may be conducted in such manner as the Commissioner may deem appropriate under the circumstances.
5. The Commissioner may issue an order directing a health maintenance organization or a representative of a health maintenance organization to cease and desist from engaging in any act or practice in violation of the provisions of this chapter.
6. Within 30 days after service of the order to cease and desist, the respondent may request a hearing on the question of whether acts or practices in violation of this chapter have occurred. The hearing must be conducted pursuant to the provisions of chapter 233B of NRS and judicial review must be available as provided therein.
7. In the case of any violation of the provisions of this chapter, if the Commissioner elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order issued pursuant to subsection 5, the Commissioner may institute a proceeding to obtain injunctive relief, or seek other appropriate relief in the district court of the judicial district of the county in which the violator resides.
(Added to NRS by 1973, 1257; A 1999, 2817; 2013, 3649)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.010 - Definitions.

As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 695D.012 to 695D.080, inclusive, have the meanings ascribed to them in those sections.
(Added to NRS by 1983, 2021; A 2021, 3529)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.030 - "Dental care" defined.

"Dental care" means the services ordinarily provided by dentists and includes appliances, drugs, medicines, supplies, prosthetic appliances, orthodontic appliances, and metal, ceramic or other restorations customarily used or provided by a dentist.
(Added to NRS by 1983, 2021)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.070 - "Plan for dental care" defined.

"Plan for dental care" means any agreement in which a person agrees to provide or arrange for dental care or pay for or reimburse any part of the cost of that care and the member agrees to prepay, make periodic payments or pay through insurance for that care.
(Added to NRS by 1983, 2021; A 1985, 2098)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.090 - Applicability of title to organizations for dental care; applicability of chapter.

1. Except as otherwise specifically provided in this chapter or elsewhere in this title, the provisions of this title other than this chapter do not apply to organizations for dental care. This exemption does not apply to any insurer authorized pursuant to any other provision of this title except with respect to those activities authorized and regulated by this chapter.
2. The provisions of this chapter do not apply to:
(a) Any person, corporation or organization which must be authorized by the Commissioner to transact the business of insurance pursuant to chapter 680A, 695B or 695C of NRS.
(b) Any plan established to provide health and welfare benefits to employees pursuant to a collective bargaining agreement.
(Added to NRS by 1983, 2021)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.095 - Applicability of chapter and certain other provisions to organizations for dental care.

1. An organization for dental care is subject to the provisions of this chapter and to the provisions set forth in this section, to the extent reasonably applicable. Organizations for dental care are subject to the provisions of NRS 449.465, 679B.700, subsections 7 and 8 of NRS 680A.270, subsections 2, 4, 17, 18 and 30 of NRS 680B.010, NRS 680B.020 to 680B.060, inclusive, chapters 681B and 686A of NRS, NRS 686B.010 to 686B.175, inclusive, and chapters 687B, 692C and 695G of NRS.
2. For the purposes of this section and the provisions set forth in subsection 1, an organization for dental care is included in the meaning of the term "insurer."
(Added to NRS by 1987, 470; A 2017, 2397; 2021, 2995; 2023, 2643)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.102 - Summary of coverage: Contents of disclosure; approval by Commissioner; regulations.

1. The Commissioner shall adopt regulations which require an organization for dental care to file with the Commissioner, for approval by the Commissioner, a disclosure summarizing the coverage provided by each plan for dental care offered by the organization for dental care. The disclosure must include:
(a) Any significant exception, reduction or limitation that applies to the plan; and
(b) Any other information,
that the Commissioner finds necessary to provide for full and fair disclosure of the provisions of the plan.
2. The disclosure must be written in language which is easily understood and must include a statement that the disclosure is a summary of the policy only, and that the policy itself should be read to determine the governing contractual provisions.
3. The Commissioner shall not approve any proposed disclosure submitted to the Commissioner pursuant to this section which does not comply with the requirements of this section and the applicable regulations.
(Added to NRS by 1989, 1254)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.104 - Summary of coverage: Copy required to be provided to group policyholder before issuance of policy; organization prohibited from offering plan unless disclosure approved by Commissioner.

An organization for dental care shall provide to the group policyholder to whom it offers a plan for dental care a copy of the disclosure approved for that plan pursuant to NRS 695D.102 before the policy is issued. An organization for dental care shall not offer a plan for dental care unless the disclosure for that plan has been approved by the Commissioner.
(Added to NRS by 1989, 1254)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.110 - Certificate of authority: Required for establishing, operating, acting as administrator of, selling or offering to sell plan for dental care.

No person may establish or operate a plan for dental care, act as an administrator of such a plan or sell or offer to sell such a plan without first obtaining a certificate of authority from the Commissioner.
(Added to NRS by 1983, 2022)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.120 - Certificate of authority: Application.

Each application for a certificate of authority must be filed with the Commissioner on a form prescribed by the Commissioner, must be verified by an officer or authorized representative of the organization for dental care and must include:
1. A copy of any organizational document for the organization and all amendments to that document.
2. A copy of any bylaws, rules or regulations governing the internal affairs of the organization.
3. A list of the names, addresses and official positions of the persons responsible for operating the organization, including the members of the board of directors, board of trustees, executive committee, principal officers or partners.
4. A copy of the contracts made or proposed to be made between the applicant and those persons listed in subsection 3 and the dentists.
5. A statement describing the applicant’s plan for dental care, its facilities and personnel.
6. A copy of the policy to be issued to its members.
7. A copy of any contract for groups to be issued to employers, unions, trustees or other organizations.
8. Certified financial statements showing the applicant’s assets, liabilities and sources of support. A copy of the applicant’s most recent certified financial statement satisfies this requirement unless the Commissioner requests additional information from the applicant.
9. A description of the method to be used to market the plan for dental care, including a financial statement, a projection for the initial 5 years of operation of the plan and a statement of the sources of capital for the organization.
10. A power of attorney executed by the applicant or its officers, which appoints the Commissioner as the attorney for the applicant upon whom service of process may be made in this State.
11. A statement describing the geographic area or areas to be served by the applicant.
12. A statement indicating that all the dentists for the plan are licensed pursuant to chapter 631 of NRS.
13. Any other information requested by the Commissioner.
(Added to NRS by 1983, 2022)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.130 - Certificate of authority: Issuance; fees.

The Commissioner shall issue a certificate of authority to an organization for dental care after the organization has paid an application fee of $2,450 and, in addition to any other fee or charge, all applicable fees required pursuant to NRS 680C.110, and the Commissioner is satisfied that:
1. The persons responsible for operating the organization are competent, trustworthy, have not been convicted of a felony and have good reputations.
2. The plan for dental care includes care which is appropriate for the plan and the plan is appropriate for providing that care.
3. The organization is financially responsible and may reasonably be expected to meet its obligations to its members. To determine financial responsibility the Commissioner may consider:
(a) The organization’s arrangements for dental care and the schedule of charges to be used;
(b) The agreements with an insurer, government or any other organizations for ensuring payment for the dental care;
(c) Any provisions for alternative coverage if the plan for dental care is discontinued; and
(d) The agreements with the dentists providing dental care to the organization’s members.
4. The appropriate deposits or bonds have been filed with the Commissioner by the organization and its officers.
(Added to NRS by 1983, 2023; A 1991, 1634; 2009, 1819)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.140 - Certificate of authority: Notice of change of information; application for amendment; fee; approval.

1. Except as otherwise provided in subsection 2, every organization issued a certificate of authority by the Commissioner shall notify the Commissioner of any change in the information provided to obtain its certificate of authority within 10 days after the change.
2. Every such organization that wishes to make a change in the geographic areas which it serves, or to make any other material modification of the operations described in the information required by NRS 695D.120, shall file with the Commissioner an application for the amendment of the certificate of authority and pay to the Commissioner an application fee of $100. If the Commissioner does not disapprove the application within 30 days after filing, it shall be deemed approved.
(Added to NRS by 1983, 2023; A 1991, 2205)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.150 - Certificate of authority: Expiration; renewal; fees.

A certificate of authority expires at midnight on March 1 following the date it was issued or previously renewed. The Commissioner shall renew the certificate of any organization for dental care which:
1. Continues to comply with the provisions of this chapter; and
2. Pays the fee for renewal of $2,450 and, in addition to any other fee or charge, all applicable fees required pursuant to NRS 680C.110.
(Added to NRS by 1983, 2023; A 1987, 470; 1991, 1635; 1993, 614; 2009, 1819)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.153 - Capital account: Minimum amount; requirements.

1. Each organization for dental care which receives a certificate of authority shall maintain a capital account with a net worth of not less than $500,000 unless a lesser amount is permitted in writing by the Commissioner.
2. An organization for dental care which has been issued a certificate of authority pursuant to this chapter shall maintain a capital account with a net worth in an amount which is not less than the greater of:
(a) The amount of risk-based capital required by regulations adopted by the Commissioner pursuant to NRS 681B.550; or
(b) The following applicable amount, according to the number of members in the organization:
Number of members Net worth
Less than 2,500............................................................................................... $50,000
At least 2,500 but not more than 5,000......................................................... 75,000
More than 5,000.............................................................................................. 125,000
3. The account must not be obligated for any accrued liabilities and must consist of cash, securities or a combination thereof which is acceptable to the Commissioner.
(Added to NRS by 2017, 2397; A 2019, 1720)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.157 - Hazardous financial condition: Regulations; determination; powers of Commissioner.

1. The Commissioner may adopt regulations to define when an organization for dental care is considered to be in a hazardous financial condition and to set forth the standards to be considered by the Commissioner in determining whether the continued operation of an organization for dental care transacting business in this State may be considered to be hazardous to its members or creditors or to the general public.
2. If the Commissioner determines after a hearing that any organization for dental care is in a hazardous financial condition, the Commissioner may, instead of suspending or revoking the certificate of authority of the organization, limit the certificate of authority as the Commissioner deems reasonably necessary to correct, eliminate or remedy any conduct, condition or ground that is deemed to be a cause of the hazardous financial condition.
3. An order or decision of the Commissioner under this section is subject to review in accordance with NRS 679B.310 to 679B.370, inclusive, at the request of any party to the proceedings whose interests are substantially affected.
(Added to NRS by 2017, 2397)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.160 - Composition of board of directors for organization for dental care that is corporation.

If an organization for dental care is a corporation, its board of directors must include:
1. Dentists who have contracted with the organization to provide dental care to its members; and
2. Members of the plan for dental care, who must comprise at least one-third of the membership of the board by the end of its first year of operation.
(Added to NRS by 1983, 2023)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.190 - Certain persons in organization for dental care in fiduciary relationship to members; dentist subject to disciplinary action for breaches of fiduciary or contractual obligations.

Any director, officer, partner or employee of an organization for dental care who receives, collects, disburses or invests money in connection with the activities of that organization is responsible for that money and has a fiduciary duty and relationship to the members of the organization. Any dentist who breaches this fiduciary duty or fails to satisfy his or her contractual obligation to the organization or the members thereof is subject to disciplinary action pursuant to NRS 631.350.
(Added to NRS by 1983, 2024)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.200 - Policy: Review by prospective members at meeting; provision of copy to members; approval by Commissioner; form and contents; notice of change.

1. An organization for dental care shall:
(a) Hold a meeting for all prospective members to review fully the policy being offered and describe the coverage under the plan for dental care before any contract is executed between the parties.
(b) Provide to each member a copy of the policy describing his or her coverage under the plan for dental care.
2. The Commissioner must approve every policy and amendment to it before they are distributed to the members or any other person. If the Commissioner does not disapprove the policy within 30 days after it is filed with the Commissioner, it shall be deemed to be approved. If the Commissioner disapproves a policy, the Commissioner shall notify the organization of the reasons for disapproval. The Commissioner shall grant a hearing on any disapproval of a policy or amendment within 15 days after the organization requests, in writing, a hearing on the matter.
3. A policy must contain a clear and complete statement of the contract between the parties or a summary of the contract which describes:
(a) The dental care and other benefits to which the member is entitled;
(b) Any limitations on the care to be provided, including any deductibles or copayments to be paid by a member;
(c) Where information is available and how dental care may be obtained; and
(d) The member’s obligations for payment under the plan for dental care.
4. The organization must give notice to the Commissioner and every member 30 days before any change is made in the member’s policy.
(Added to NRS by 1983, 2025)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.203 - Group plan issued to replace discontinued policy or coverage: Requirements; notice of reduction of benefits; statement of benefits; applicability to self-insured employer.

1. A group plan for dental care issued by an organization for dental care to replace any discontinued policy or coverage for dental care must:
(a) Provide coverage for all persons who were covered under the previous policy or coverage on the date it was discontinued; and
(b) Except as otherwise provided in subsection 2, provide benefits which are at least as extensive as the benefits provided by the previous policy or coverage, except that benefits may be reduced or excluded to the extent that such a reduction or exclusion was permissible under the terms of the previous policy or coverage,
if that plan is issued within 60 days after the date on which the previous policy or coverage was discontinued.
2. If an employer obtains a replacement plan pursuant to subsection 1 to cover the employees of the employer, any benefits provided by the previous policy or coverage may be reduced if notice of the reduction is given to the employees pursuant to NRS 608.1577.
3. Any organization for dental care which issues a replacement plan pursuant to subsection 1 may submit a written request to the insurer which provided the previous policy or coverage for a statement of benefits which were provided under that policy or coverage. Upon receiving such a request, the insurer shall give a written statement to the organization indicating what benefits were provided and what exclusions or reductions were in effect under the previous policy or coverage.
4. The provisions of this section apply to a self-insured employer who provides benefits to the employees of the self-insured employer for dental care and replaces those benefits with a group plan for dental care.
(Added to NRS by 1987, 851)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.205 - Copayments and deductibles: Reasonableness; approval of Commissioner; regulations.

1. Each copayment and deductible required to be paid by a member must be reasonable and reasonably related to the cost of the particular service.
2. Every organization for dental care shall submit to the Commissioner for approval any proposal for copayment or deductible before it is imposed on the members. The Commissioner shall approve or disapprove the proposal within 30 days after it is submitted to the Commissioner. If the Commissioner disapproves a copayment or deductible, the Commissioner shall notify the organization of the reasons for disapproval. The Commissioner shall grant a hearing on any such disapproval within 15 days after the organization requests, in writing, a hearing on the matter.
3. The Commissioner may adopt regulations to define:
(a) "Reasonable" as it relates to copayments and deductibles; and
(b) A "reasonable relationship" between the cost of particular services and the amount of related copayments and deductibles.
(Added to NRS by 1987, 1783)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.210 - Policy covering dependent of member required to include coverage for member’s newly born and adopted children and children placed with member for adoption to same extent as other dependents.

1. Any policy which provides coverage for a dependent of a member must provide that benefits for children are payable for a member’s newly born child, adopted child or child placed with the member for the purpose of adoption to the same extent that the coverage applies to other dependents.
2. The policy may require that to have coverage for the newly born child, adopted child or child placed for adoption continued beyond 31 days after the child’s birth, adoption or placement, the member must notify the organization for dental care within 31 days after the birth, adoption or placement.
3. For covered services provided to the child, the organization for dental care shall reimburse noncontracted providers of health care to an amount equal to the average amount of payment for which the organization has agreements, contracts or arrangements for those covered services.
(Added to NRS by 1983, 2025; A 1989, 742)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.215 - Claims: Approval or denial; request for additional information; payment; interest on unpaid claim.

1. Except as otherwise provided in subsection 2, an organization for dental care shall approve or deny a claim relating to a plan for dental care within 30 days after the organization for dental care receives the claim. If the claim is approved, the organization for dental care shall pay the claim within 30 days after it is approved. If the approved claim is not paid within that period, the organization for dental care shall pay interest on the claim at the rate of interest established pursuant to NRS 99.040. The interest must be calculated from the date the payment is due until the claim is paid.
2. If the organization for dental care requires additional information to determine whether to approve or deny the claim, it shall notify the claimant of its request for the additional information within 20 days after it receives the claim. The organization for dental care shall notify the provider of dental care of the reason for the delay in approving or denying the claim. The organization for dental care shall approve or deny the claim within 30 days after receiving the additional information. If the claim is approved, the organization for dental care shall pay the claim within 30 days after it receives the additional information. If the approved claim is not paid within that period, the organization for dental care shall pay interest on the claim in the manner prescribed in subsection 1.
(Added to NRS by 1991, 1332)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.2157 - Recovery of overpayments: Notice; procedures for challenging attempted recovery; limitation of period for recovery; exception.

1. An organization for dental care or an administrator who recovers overpayments under a plan for dental care shall provide written notice to a dentist of any attempt to recover an overpayment, other than a duplicate payment. The notice must include, without limitation:
(a) A description of the error that justifies the recovery; and
(b) The date on which the dental care for which the overpayment was made was provided and the name of the member to whom the dental care was provided.
2. An organization for dental care or an administrator who recovers overpayments under a plan for dental care shall establish written procedures by which a dentist may challenge an attempt to recover an overpayment. Those procedures must include, without limitation, procedures for sharing information concerning a disputed claim with the dentist.
3. Except as otherwise provided in this subsection, an organization for dental care or an administrator who recovers overpayments under a plan for dental care shall not attempt to recover an overpayment more than 12 months after the date of the overpayment. This subsection does not apply to an attempt to recover an overpayment that is:
(a) Based on a reasonable belief that the overpayment involved fraud, abuse or other intentional misconduct; or
(b) Initiated by or at the request of a self-insured employer.
4. Any provision of a contract that conflicts with this section is against public policy, void and unenforceable.
(Added to NRS by 2021, 3528)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.217 - Organization for dental care prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence.

An organization for dental care shall not deny a claim, refuse to issue a policy or cancel a policy solely because the claim involves an act that constitutes domestic violence pursuant to NRS 33.018, or because the person applying for or covered by the policy was the victim of such an act of domestic violence, regardless of whether the insured or applicant contributed to any loss or injury.
(Added to NRS by 1997, 1097)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.219 - Organization for dental care prohibited from denying coverage solely because applicant or member was intoxicated or under the influence of controlled substance; exceptions.

1. Except as otherwise provided in subsection 2, an organization for dental care shall not:
(a) Deny a claim under a plan for dental care solely because the claim involves an injury sustained by a member as a consequence of being intoxicated or under the influence of a controlled substance.
(b) Cancel participation under a plan for dental care solely because a member has made a claim involving an injury sustained by the member as a consequence of being intoxicated or under the influence of a controlled substance.
(c) Refuse participation under a plan for dental care 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 this section do not prohibit an organization for dental care from enforcing a provision included in a plan for dental care 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 plan for dental care solely because of such a claim; or
(c) Refuse participation under a plan for dental care to an eligible applicant solely because of such a claim.
(Added to NRS by 2005, 2346)
2023 Nevada Revised Statutes › Chapter 695D - Plans for Dental Care › NRS 695D.220 - Licensing of agents.

1. The provisions of chapter 683A of NRS apply to the licensing of agents for an organization for dental care.
2. As used in this section, "agent" means any person who is associated, directly or indirectly, with the organization and engages in soliciting or enrolling members.
(Added to NRS by 1983, 2027)