reglab/statecodes huggingface dataset:
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.2565 - Renewal of converted contract: Request for information on sources of other benefits; grounds for refusal to renew; notice concerning cancellation of other coverage.

1. A converted contract issued under NRS 695B.251 may include a provision permitting the medical service corporation to request from the applicant, in advance of any premium due date, information as to whether the applicant is covered for similar benefits under any of the sources listed in NRS 695B.253.
2. The medical service corporation may not refuse to renew the contract or the coverage of any person unless:
(a) Benefits provided under the sources listed in subsection 1 of NRS 695B.253, together with the benefits provided by the converted contract would result in overinsurance according to the medical service corporation’s standards;
(b) The holder of the converted contract has refused to provide requested information as to such sources; or
(c) Fraud was committed in applying for any benefits under the converted contract.
3. Before refusing to renew a converted contract because of overinsurance, the medical service corporation shall notify the subscriber that the converted contract will be renewed only if the other coverage is cancelled.
(Added to NRS by 1979, 1088)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.257 - Notice of conversion privilege.

A notification of the conversion privilege must be included in each certificate of coverage. A written notice of the existence of the conversion privilege must also be given to the employee or member at least 15 days before the expiration of the 31 days permitted a person to make a written application for the converted contract. If written notice of the right to convert is not given as required under this section, an additional period must be allowed the person to apply for the converted contract. The additional period expires 15 days after written notice of the conversion privilege has been given, or 60 days after the expiration of the 31-day period, whichever is earlier.
(Added to NRS by 1979, 1089)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.2575 - Converted contract delivered outside Nevada: Form.

A converted contract which is to be delivered outside this state must be in such form as would be deliverable in the other jurisdiction as a converted contract if the group contract had been issued in that jurisdiction.
(Added to NRS by 1979, 1089)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.258 - Extension of coverage under existing group contract.

The medical service corporation may elect to extend coverage of a subscriber under the existing group contract for a period not to exceed 6 months following the day of the person’s eligibility for a converted contract if the conversion privilege is offered upon termination of the extended coverage under the group contract.
(Added to NRS by 1979, 1089)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.259 - Continuation of identical coverage in lieu of converted contract.

The medical service corporation may continue coverage identical to that provided under the group contract instead of issuing a converted contract. Coverage may be offered by amending the group certificate or by issuing an individual contract and must otherwise comply with every requirement of NRS 695B.251 to 695B.259, inclusive.
(Added to NRS by 1979, 1089; A 1987, 2235; 2013, 3638)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.260 - Suspension or revocation of permission to provide coverage before approval of forms.

The Commissioner may suspend or revoke the permission granted by NRS 695B.240 if, after notice and hearing, the Commissioner finds that the corporation has:
1. Misrepresented the conditional nature of the coverage.
2. Neglected or refused either to cancel or otherwise terminate such coverage within the time required by such section.
3. Delivered any such memorandum which did not comply with such section.
4. Shown a lack of diligence in making revisions in the contract or certificate necessary to obtain its approval by the Commissioner.
5. Failed so often in so many important respects in drafting any such contract or certificate to conform to the applicable requirements of the insurance laws that a conclusion of lack of good faith or competency in drafting is reasonably justified.
6. Circulated announcements of coverage to individual subscribers which failed to advise them of the conditional nature of the coverage.
7. In any other manner so negligently or carelessly handled the effecting of group hospital or group medical or dental service coverage under NRS 695B.240 or the administration thereof that the subscriber or the persons covered by the contract or certificate have been misled or exposed to the danger of loss.
(Added to NRS by 1971, 1873)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.270 - Disapproval of forms; issuance unlawful.

If the Commissioner notifies the corporation, in writing, that the filed form does not comply with the requirements of law, specifying the reasons for his or her opinion, it is unlawful for the corporation thereafter to issue any contract in such form.
(Added to NRS by 1971, 1874)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.280 - Regulations; limitations.

The Commissioner may adopt such reasonable regulations, not inconsistent with the provisions of this chapter, relating to the substance, form and issuance of any contract covering the furnishing of hospital or medical or dental services and required to be approved by the Commissioner as are necessary or desirable. The regulations may not prohibit the use in any such contract or agreement of:
1. The word "subscriber" as a designation of the obligee.
2. The phrase "a family member" as a designation for the members of the family of the obligee.
3. The word "contract" or "agreement" as a designation for the undertakings of the hospital or medical or dental service corporation.
4. The phrases "furnishing of service" or "payment of benefits" as a designation for the commitments of the hospital or medical or dental service corporation.
5. The phrase "the service" as a designation for the corporate obligor in any such contract or agreement.
(Added to NRS by 1971, 1874; A 1981, 107)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.290 - Agent’s license required.

Any agent of a nonprofit hospital or medical or dental service corporation who acts as such in the solicitation, negotiation, procurement or making of a hospital service or medical or dental care contract shall be qualified, examined and licensed in the same manner and pay the same fees as provided for a producer of insurance in NRS 680B.010 (fee schedule), chapter 683A of NRS and, in addition to any other fee or charge, all applicable fees required pursuant to NRS 680C.110.
(Added to NRS by 1971, 1874; A 2009, 1817; 2017, 2390)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.300 - Contracts with agencies or political subdivisions of United States or State of Nevada; acceptance of money; subcontracts.

Any nonprofit hospital or medical or dental service corporation organized and created under the provisions of this chapter and engaged in the operation of a hospital or medical or dental service plan may contract, without regard to the limitations in respect to contracts imposed by this chapter, with any agency, instrumentality or political subdivision of the United States of America or of the State of Nevada for the furnishing of hospital or medical or dental service and care and, in aid or furtherance of such contract, may accept, receive and administer, in trust, funds directly or indirectly made available by such agency, instrumentality or political subdivision. Any such nonprofit hospital or medical or dental service corporation may subcontract with any organization which has contracted with any agency, instrumentality or political subdivision of the United States of America or of the State of Nevada for the furnishing of medical, dental and hospital services, by which subcontract such hospital or medical or dental service corporation undertakes to furnish the hospital or medical or dental services required by the basic contract.
(Added to NRS by 1971, 1874)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.310 - Corporation subject to same taxes, licenses, fees and supervision as domestic mutual insurer.

Any nonprofit hospital or medical or dental service corporation subject to the provisions of this chapter shall be subject to the same taxes, licenses, fees and, to the extent not regulated by the provisions of this chapter, the same supervision as a mutual insurer organized under the laws of the State of Nevada.
(Added to NRS by 1971, 1875)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.315 - Provision of information regarding claims by policyholder for renewal of insurance policy required upon request; fee; regulations.

1. If a policyholder requests information for the renewal of the policy of the policyholder, an insurer shall provide to the policyholder information regarding claims paid on behalf of the policyholder. The information must be provided within 30 working days after the insurer receives a written request from the policyholder. The insurer may charge the policyholder a reasonable fee for the information.
2. The Commissioner may adopt regulations to carry out the provisions of subsection 1.
(Added to NRS by 1993, 2400)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.316 - Corporation prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence.

A corporation shall not deny a claim, refuse to issue a contract for hospital, medical or dental services or cancel a contract for hospital, medical or dental services 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 contract was the victim of such an act of domestic violence, regardless of whether the insured or applicant contributed to any loss or injury.
(Added to NRS by 1997, 1096)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.3165 - Corporation prohibited from denying coverage solely because applicant or insured was intoxicated or under the influence of controlled substance; exceptions.

1. Except as otherwise provided in subsection 2, a medical services corporation that issues contracts for hospital, medical or dental services shall not:
(a) Deny a claim under such a contract solely because the claim involves an injury sustained by an insured as a consequence of being intoxicated or under the influence of a controlled substance.
(b) Cancel such a contract solely because an insured has made a claim involving an injury sustained by the insured as a consequence of being intoxicated or under the influence of a controlled substance.
(c) Refuse to issue such a contract to an eligible applicant solely because the applicant has made a claim involving an injury sustained by the applicant as a consequence of being intoxicated or under the influence of a controlled substance.
2. The provisions of subsection 1 do not prohibit a medical services corporation from enforcing a provision included in a contract for hospital, medical or dental services 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 such a contract solely because of such a claim; or
(c) Refuse to issue such a contract to an eligible applicant solely because of such a claim.
3. The provisions of this section do not apply to a medical services corporation under a contract for hospital, medical or dental services that provides coverage for long-term care or disability income.
(Added to NRS by 2005, 2345; A 2007, 86)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.3167 - Corporation prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression.

A hospital or medical services corporation that issues a policy of health insurance shall not discriminate against any person with respect to participation or coverage under the policy on the basis of actual or perceived gender identity or expression. Prohibited discrimination includes, without limitation:
1. Denying, cancelling, limiting or refusing to issue or renew a policy of health insurance on the basis of the actual or perceived gender identity or expression of a person or a family member of the person;
2. Imposing a payment or premium that is based on the actual or perceived gender identity or expression of an insured or a family member of the insured;
3. Designating the actual or perceived gender identity or expression of a person or a family member of the person as grounds to deny, cancel or limit participation or coverage; and
4. Denying, cancelling or limiting participation or coverage on the basis of actual or perceived gender identity or expression, including, without limitation, by limiting or denying coverage for health care services that are:
(a) Related to gender transition, provided that there is coverage under the policy for the services when the services are not related to gender transition; or
(b) Ordinarily or exclusively available to persons of any sex.
(Added to NRS by 2023, 2040)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.317 - Corporation that provides health insurance prohibited from requiring or using information concerning genetic testing; exceptions.

1. Except as otherwise provided in subsection 2, a corporation that provides health insurance shall not:
(a) Require an insured person or any member of the family of the insured person to take a genetic test;
(b) Require an insured person to disclose whether the insured person or any member of the family of the insured person has taken a genetic test or any genetic information of the insured person or a member of the family of the insured person; or
(c) Determine the rates or any other aspect of the coverage or benefits for health care provided to an insured person based on whether the insured person or any member of the family of the insured person has taken a genetic test.
2. The provisions of this section do not apply to a corporation that issues a policy of health insurance that provides coverage for long-term care or disability income.
3. As used in this section:
(a) "Genetic information" means any information that is obtained from a genetic test.
(b) "Genetic test" means a test, including a laboratory test that uses deoxyribonucleic acid extracted from the cells of a person or a diagnostic test, to determine the presence of abnormalities or deficiencies, including carrier status, that:
(1) Are linked to physical or mental disorders or impairments; or
(2) Indicate a susceptibility to illness, disease, impairment or any other disorder, whether physical or mental.
(Added to NRS by 1997, 1461; A 2019, 307)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.318 - Applicability of certain provisions concerning portability and availability of health insurance.

1. Nonprofit hospital, medical or dental service corporations are subject to the provisions of NRS 689B.340 to 689B.580, inclusive, and chapter 689C of NRS relating to the portability and availability of health insurance offered by such organizations. If there is a conflict between the provisions of this chapter and the provisions of NRS 689B.340 to 689B.580, inclusive, and chapter 689C of NRS, the provisions of NRS 689B.340 to 689B.580, inclusive, and chapter 689C of NRS control.
2. For the purposes of subsection 1, unless the context requires that a provision apply only to a group health plan or a carrier that provides coverage under a group health plan, any reference in those sections to:
(a) "Carrier" must be replaced by "corporation."
(b) "Group health plan" must be replaced by "group contract for hospital, medical or dental services."
(Added to NRS by 1997, 2954; A 2001, 1924; 2013, 3638)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.319 - Offering policy of health insurance for purposes of establishing health savings account.

A corporation may, subject to regulation by the Commissioner, offer a policy of health insurance that has a high deductible and is in compliance with 26 U.S.C. § 223 for the purposes of establishing a health savings account.
(Added to NRS by 2005, 2158)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.320 - Applicability of other provisions.

1. Nonprofit hospital and medical or dental service corporations are subject to the provisions of this chapter, and to the provisions of chapters 679A and 679B of NRS, subsections 2, 4, 17, 18 and 30 of NRS 680B.010, NRS 680B.025 to 680B.060, inclusive, chapter 681B of NRS, NRS 686A.010 to 686A.315, inclusive, 686B.010 to 686B.175, inclusive, 687B.010 to 687B.040, inclusive, 687B.070 to 687B.140, inclusive, 687B.150, 687B.160, 687B.180, 687B.200 to 687B.255, inclusive, 687B.270, 687B.310 to 687B.380, inclusive, 687B.410, 687B.420, 687B.430, 687B.500 and chapters 692B, 692C, 693A and 696B of NRS, to the extent applicable and not in conflict with the express provisions of this chapter.
2. For the purposes of this section and the provisions set forth in subsection 1, a nonprofit hospital and medical or dental service corporation is included in the meaning of the term "insurer."
(Added to NRS by 1971, 1875; A 1995, 988, 1631, 1636; 1997, 2957, 3036; 1999, 631; 2013, 3638; 2017, 2390; 2021, 880, 901, 2994; 2023, 21, 2643)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.330 - Definitions.

As used in NRS 695B.330 to 695B.370, inclusive, unless the context otherwise requires:
1. "Contract" means a contract for hospital, medical or dental services issued pursuant to this chapter.
2. "Corporation" means a corporation organized pursuant to this chapter.
3. "Medicaid" means a program established in any state pursuant to Title XIX of the Social Security Act (42 U.S.C. §§ 1396 et seq.) to provide assistance for part or all of the cost of medical care rendered on behalf of indigent persons.
4. "Order for medical coverage" means an order of a court or administrative tribunal to provide coverage under a contract to a child pursuant to the provisions of 42 U.S.C. § 1396g-1.
(Added to NRS by 1995, 2433)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.340 - Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency.

1. A corporation shall not, when considering eligibility for coverage or making payments under a contract, consider the availability of, or any eligibility of a person for, medical assistance under Medicaid.
2. To the extent that payment has been made by Medicaid for health care, a corporation:
(a) Shall treat Medicaid as having a valid and enforceable assignment of benefits of a subscriber or policyholder or claimant under the subscriber or policyholder regardless of any exclusion of Medicaid or the absence of a written assignment; and
(b) May, as otherwise allowed by the policy, evidence of coverage or contract and applicable law or regulation concerning subrogation, seek to enforce any rights of a recipient of Medicaid against any other liable party if:
(1) It is so authorized pursuant to a contract with Medicaid for managed care; or
(2) It has reimbursed Medicaid in full for the health care provided by Medicaid to its subscriber or policyholder.
3. If a state agency is assigned any rights of a person who is:
(a) Eligible for medical assistance under Medicaid; and
(b) Covered by a contract,
the corporation that issued the contract shall not impose any requirements upon the state agency except requirements it imposes upon the agents or assignees of other persons covered by the same contract.
4. If a state agency is assigned any rights of a subscriber or policyholder who is eligible for medical assistance under Medicaid, a corporation shall:
(a) Upon request of the state agency, provide to the state agency information regarding the subscriber or policyholder to determine:
(1) Any period during which the subscriber or policyholder, the spouse or a dependent of the subscriber or policyholder may be or may have been covered by a contract; and
(2) The nature of the coverage that is or was provided by the corporation, including, without limitation, the name and address of the subscriber or policyholder and the identifying number of the contract;
(b) Respond to any inquiry by the state agency regarding a claim for payment for the provision of any medical item or service not later than 3 years after the date of the provision of the medical item or service; and
(c) Agree not to deny a claim submitted by the state agency solely on the basis of the date of submission of the claim, the type or format of the claim form or failure to present proper documentation at the point of sale that is the basis for the claim if:
(1) The claim is submitted by the state agency not later than 3 years after the date of the provision of the medical item or service; and
(2) Any action by the state agency to enforce its rights with respect to such claim is commenced not later than 6 years after the submission of the claim.
(Added to NRS by 1995, 2433; A 2007, 2405)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.350 - Corporation prohibited from asserting certain grounds to deny enrollment of child of insured pursuant to order.

A corporation shall not deny the enrollment of a child pursuant to an order for medical coverage under a contract pursuant to which a parent of the child is insured, on the ground that the child:
1. Was born out of wedlock;
2. Has not been claimed as a dependent on the parent’s federal income tax return; or
3. Does not reside with the parent or within the corporation’s geographic area of service.
(Added to NRS by 1995, 2433)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.360 - Certain accommodations required to be made when child is covered under policy of noncustodial parent.

If a child has coverage under a contract pursuant to which a noncustodial parent of the child is insured, the corporation issuing that contract shall:
1. Provide to the custodial parent such information as necessary for the child to obtain any benefits under that coverage.
2. Allow the custodial parent or, with the approval of the custodial parent, a provider of health care to submit claims for covered services without the approval of the noncustodial parent.
3. Make payments on claims submitted pursuant to subsection 2 directly to the custodial parent, the provider of health care or an agency of this or another state responsible for the administration of Medicaid.
(Added to NRS by 1995, 2433)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.370 - Corporation required to authorize enrollment of child of parent who is required by order to provide medical coverage under certain circumstances; termination of coverage of child.

If a parent is required by an order for medical coverage to provide coverage for a child and the parent is eligible for family coverage under a contract, the corporation that issued the contract:
1. Shall, if the child is otherwise eligible for that coverage, allow the parent to enroll the child in that coverage without regard to any restrictions upon periods for enrollment.
2. Shall, if:
(a) The child is otherwise eligible for that coverage; and
(b) The parent is enrolled in that coverage but fails to apply for enrollment of the child,
enroll the child in that coverage upon application by the other parent of the child, or by an agency of this or another state responsible for the administration of Medicaid or a state program for the enforcement of child support established pursuant to 42 U.S.C. §§ 651 et seq., without regard to any restrictions upon periods for enrollment.
3. Shall not terminate the enrollment of the child in that coverage or otherwise eliminate that coverage of the child unless the corporation has written proof that:
(a) The order for medical coverage is no longer in effect; or
(b) The child is or will be enrolled in comparable coverage through another insurer on or before the effective date of the termination of enrollment or elimination of coverage.
(Added to NRS by 1995, 2434)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.380 - Establishment; approval; requirements; examination.

1. Except as otherwise provided in subsection 4, each insurer that issues a contract for hospital or medical services in this State shall establish a system for resolving any complaints of an insured concerning health care services covered under the policy. The system must be approved by the Commissioner.
2. A system for resolving complaints established pursuant to subsection 1 must include an initial investigation, a review of the complaint by a review board and a procedure for appealing a determination regarding the complaint. The majority of the members on a review board must be insureds who receive health care services pursuant to a contract for hospital or medical services issued by the insurer.
3. The Commissioner may examine the system for resolving complaints established pursuant to subsection 1 at such times as the Commissioner deems necessary or appropriate.
4. Each insurer that issues a contract specified in subsection 1 shall, if the contract provides, delivers, arranges for, pays for or reimburses any cost of health care services through managed care, provide a system for resolving any complaints of an insured concerning those health care services that complies with the provisions of NRS 695G.200 to 695G.310, inclusive.
(Added to NRS by 1997, 310; A 2003, 776; 2011, 3395; 2017, 2390)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.390 - Annual report; insurer required to maintain records of complaints concerning something other than health care services.

1. Each insurer that issues a contract for hospital or medical services in this State shall submit to the Commissioner an annual report regarding its system for resolving complaints established pursuant to subsection 1 of NRS 695B.380 on a form prescribed by the Commissioner which includes, without limitation:
(a) A description of the procedures used for resolving any complaints of an insured;
(b) The total number of complaints and appeals handled through the system for resolving complaints since the last report and a compilation of the causes underlying the complaints filed;
(c) The current status of each complaint and appeal filed; and
(d) The average amount of time that was needed to resolve a complaint and an appeal, if any.
2. Each insurer shall maintain records of complaints filed with it which concern something other than health care services and shall submit to the Commissioner a report summarizing such complaints at such times and in such format as the Commissioner may require.
(Added to NRS by 1997, 310; A 2003, 776; 2017, 2390)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.400 - Written notice to insured required to be provided by insurer explaining right to file complaint; written notice to insured required when insurer denies coverage of health care service.

1. Following approval by the Commissioner, each insurer that issues a contract for hospital or medical services in this State shall provide written notice to an insured, in clear and comprehensible language that is understandable to an ordinary layperson, explaining the right of the insured to file a written complaint. Such notice must be provided to an insured:
(a) At the time the insured receives a certificate of coverage or evidence of coverage;
(b) Any time that the insurer denies coverage of a health care service or limits coverage of a health care service to an insured; and
(c) Any other time deemed necessary by the Commissioner.
2. Any time that an insurer denies coverage of a health care service to a beneficiary or subscriber, including, without limitation, denying a claim relating to a contract for dental, hospital or medical services pursuant to NRS 695B.2505, it shall notify the beneficiary or subscriber in writing within 10 working days after it denies coverage of the health care service of:
(a) The reason for denying coverage of the service;
(b) The criteria by which the insurer determines whether to authorize or deny coverage of the health care service; and
(c) The right of the beneficiary or subscriber to file a written complaint and the procedure for filing such a complaint.
3. A written notice which is approved by the Commissioner shall be deemed to be in clear and comprehensible language that is understandable to an ordinary layperson.
(Added to NRS by 1997, 310; A 1999, 3093)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.020 - Legislative declaration.

The Legislature hereby declares that the rising cost of health services in recent years has led government agencies, private organizations, and legislative bodies to seek alternatives to the traditional medical delivery system which would provide improved health care and would provide such health care at a lower cost. The health maintenance organization is a concept which has received much attention as one means through which an improvement in delivery might be achieved. The Legislature therefore enacts this chapter to carry out this objective.
(Added to NRS by 1973, 1246)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.030 - Definitions.

As used in this chapter, unless the context otherwise requires:
1. "Comprehensive health care services" means medical services, dentistry, drugs, psychiatric and optometric and all other care necessary for the delivery of services to the consumer.
2. "Enrollee" means a natural person who has been voluntarily enrolled in a health care plan.
3. "Evidence of coverage" means any certificate, agreement or contract issued to an enrollee setting forth the coverage to which the enrollee is entitled.
4. "Health care plan" means any arrangement whereby any person undertakes to provide, arrange for, pay for or reimburse any part of the cost of any health care services and at least part of the arrangement consists of arranging for or the provision of health care services paid for by or on behalf of the enrollee on a periodic prepaid basis.
5. "Health care services" means any services included in the furnishing to any natural person of medical or dental care or hospitalization or incident to the furnishing of such care or hospitalization, as well as the furnishing to any person of any other services for the purpose of preventing, alleviating, curing or healing human illness or injury.
6. "Health maintenance organization" means any person which provides or arranges for provision of a health care service or services and is responsible for the availability and accessibility of such service or services to its enrollees, which services are paid for or on behalf of the enrollees on a periodic prepaid basis without regard to the dates health services are rendered and without regard to the extent of services actually furnished to the enrollees, except that supplementing the fixed prepayments by nominal additional payments for services in accordance with regulations adopted by the Commissioner shall not be deemed to render the arrangement not to be on a prepaid basis. A health maintenance organization, in addition to offering health care services, may offer indemnity or service benefits provided through insurers or otherwise.
7. "Provider" means any physician, hospital or other person who is licensed or otherwise authorized in this state to furnish health care services.
(Added to NRS by 1973, 1246; A 1985, 538; 1997, 1629)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.055 - Applicability of certain other provisions.

1. The provisions of NRS 449.465, 679A.200, 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, 687B.122 to 687B.128, inclusive, 687B.310 to 687B.420, inclusive, and 687B.500 and chapters 692C and 695G of NRS apply to a health maintenance organization.
2. For the purposes of subsection 1, unless the context requires that a provision apply only to insurers, any reference in those sections to "insurer" must be replaced by "health maintenance organization."
(Added to NRS by 1987, 469; A 1995, 472, 988; 1997, 299, 311, 2958, 2962; 2001, 2735; 2003, 3333, 3367; 2013, 3458, 3639; 2017, 2394; 2019, 1718, 3038; 2021, 2995; 2023, 2643)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.057 - Applicability of certain provisions concerning portability and availability of health insurance.

1. A health maintenance organization is subject to the provisions of NRS 689A.470 to 689A.740, inclusive, 689B.340 to 689B.580, inclusive, and chapter 689C of NRS relating to the portability and availability of health insurance offered by such organizations. If there is a conflict between the provisions of this chapter and the provisions of NRS 689A.470 to 689A.740, inclusive, 689B.340 to 689B.580, inclusive, and chapter 689C of NRS, the provisions of NRS 689A.470 to 689A.740, inclusive, 689B.340 to 689B.580, inclusive, and chapter 689C of NRS control.
2. For the purposes of subsection 1, unless the context requires that a provision apply only to a group health plan or a carrier that provides coverage under a group health plan, any reference in those sections to "group health plan" or "carrier" must be replaced by "health maintenance organization."
(Added to NRS by 1997, 2957; A 2013, 3639; 2019, 1718)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.060 - Establishment of health maintenance organization.

1. Any person may apply to the Commissioner for and obtain a certificate of authority to establish and operate a health maintenance organization in compliance with this chapter. No person shall operate a health maintenance organization without obtaining a certificate of authority under this chapter. A foreign corporation may qualify under this chapter, subject to its qualification to do business in this state as a foreign corporation.
2. No person shall be certified to establish or operate a health maintenance organization in this state, nor sell or offer to sell, or solicit offers to purchase or receive advance or periodic consideration in conjunction with health care plans unless such health maintenance organization provides or arranges for the provision of comprehensive health care services.
3. Every health maintenance organization or person operating a health maintenance organization shall submit an application for a certificate of authority under NRS 695C.070 within 30 days after July 1, 1973. Each such applicant may continue to operate until the Commissioner acts upon the application. In the event that an application is denied under NRS 695C.090 and 695C.100, the applicant shall thereafter be treated as a health maintenance organization whose certificate of authority has been revoked. For purposes of this subsection, a health maintenance organization shall be deemed to be in operation only if health care services are being provided to the public generally or to some group or groups thereof.
(Added to NRS by 1973, 1247)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.070 - Certificate of authority: Application.

Each application for a certificate of authority must be verified by an officer or authorized representative of the applicant, must be in a form prescribed by the Commissioner, and must set forth or be accompanied by the following:
1. A copy of the basic organizational document, if any, of the applicant, and all amendments thereto;
2. A copy of the bylaws, rules or regulations, or a similar document, if any, regulating the conduct of the internal affairs of the applicant;
3. A list of the names, addresses and official positions of the persons who will be responsible for the conduct of the affairs of the applicant, including all members of the board of directors, board of trustees, executive committee, or other governing board or committee, the officers in the case of a corporation, and the partners or members in the case of a partnership or association;
4. A copy of any contract made or to be made between any providers or persons listed in subsection 3 and the applicant;
5. A statement generally describing the health maintenance organization, its health care plan or plans, the location of facilities at which health care services will be regularly available to enrollees and the type of health care personnel who will provide the health care services;
6. A copy of the form of evidence of coverage to be issued to the enrollees;
7. A copy of the form of the group contract, if any, which is to be issued to employers, unions, trustees or other organizations;
8. Certified financial statements showing the applicant’s assets, liabilities and sources of financial support;
9. The proposed method of marketing the plan, a financial plan which includes a 3-year projection of the initial operating results anticipated and the sources of working capital and any other sources of funding;
10. A power of attorney, executed by the applicant, appointing the Commissioner and the authorized deputies of the Commissioner as the true and lawful attorney of such applicant in and for this State upon whom all lawful process in any legal action or proceeding against the health maintenance organization on a cause of action arising in this State may be served;
11. A statement reasonably describing the geographic area to be served;
12. A description of the procedures for resolving complaints and procedures for external reviews to be used as required under NRS 695C.260;
13. A description of the procedures and programs to be implemented to meet the quality of health care requirements in NRS 695C.080;
14. A description of the mechanism by which enrollees will be afforded an opportunity to participate in matters of program content under subsection 2 of NRS 695C.110; and
15. Such other information as the Commissioner may require to make the determinations required in NRS 695C.080.
(Added to NRS by 1973, 1247; A 2003, 777)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.080 - Certificate of authority: Evaluation of application.

1. The Commissioner shall determine whether the applicant for a certificate of authority, with respect to health care services to be furnished:
(a) Has demonstrated the willingness and ability to ensure that such health care services will be provided in a manner to ensure both availability and accessibility of adequate personnel and facilities and in a manner enhancing availability, accessibility and continuity of service;
(b) Has organizational arrangements, established in accordance with regulations promulgated by the Commissioner; and
(c) Has a procedure established in accordance with regulations of the Commissioner to develop, compile, evaluate and report statistics relating to the cost of its operations, the pattern of utilization of its services, the availability and accessibility of its services and such other matters as may be reasonably required by the Commissioner.
2. Within 90 days of receipt of the application for issuance of a certificate of authority, the Commissioner shall certify whether the proposed health maintenance organization meets the requirements of subsection 1. If the Commissioner certifies that the health maintenance organization does not meet such requirements, it shall specify in what respects it is deficient.
(Added to NRS by 1973, 1249; A 2013, 3639; 2017, 2394)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.090 - Certificate of authority: Issuance.

The Commissioner shall issue or deny a certificate of authority to any person filing an application pursuant to NRS 695C.060 within 90 days after certification. Issuance of a certificate of authority must be granted upon payment of the fees prescribed in NRS 695C.230 if the Commissioner is satisfied that the following conditions are met:
1. The persons responsible for the conduct of the affairs of the applicant are competent, trustworthy and possess good reputations.
2. The Commissioner certifies, in accordance with NRS 695C.080, that the health maintenance organization’s proposed plan of operation meets the requirements of subsection 1 of NRS 695C.080.
3. The health care plan furnishes comprehensive health care services.
4. The health maintenance organization is financially responsible and may reasonably be expected to meet its obligations to enrollees and prospective enrollees. In making this determination, the Commissioner may consider:
(a) The financial soundness of the health care plan’s arrangements for health care services and the schedule of charges used in connection therewith;
(b) The adequacy of working capital;
(c) Any agreement with an insurer, a government, or any other organization for insuring the payment of the cost of health care services;
(d) Any agreement with providers for the provision of health care services; and
(e) Any surety bond or deposit of cash or securities submitted in accordance with NRS 695C.270 as a guarantee that the obligations will be duly performed.
5. The enrollees will be afforded an opportunity to participate in matters of program content pursuant to NRS 695C.110.
6. Nothing in the proposed method of operation, as shown by the information submitted pursuant to NRS 695C.060, 695C.070 and 695C.140, or by independent investigation is contrary to the public interest.
(Added to NRS by 1973, 1249; A 1987, 469; 1993, 2400; 2013, 3640)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.110 - Governing body: Composition; participation by enrollees.

1. The governing body of any health maintenance organization may include providers, other individuals or both.
2. Such governing body shall establish a mechanism to afford the enrollees an opportunity to participate in matters of program content through the establishment of advisory panels, by the use of advisory referenda on major policy decisions or through the use of other mechanisms. In addition there shall be a provider advisory board to advise the health plan in the matter of quality of care. There shall be a joint board of consumers and providers to advise on consumer satisfaction.
(Added to NRS by 1973, 1250)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.120 - Powers of health maintenance organization.

The powers of a health maintenance organization include, but are not limited to, the following:
1. The purchase, lease, construction, renovation, operation or maintenance of hospitals, medical facilities, or both, and their ancillary equipment, and such property as may reasonably be required for its principal office or for such other purposes as may be necessary in the transaction of the business of the organization;
2. The making of loans to a medical group under contract with it in furtherance of its program or the making of loans to a corporation under its control for the purpose of acquiring or constructing medical facilities and hospitals or in furtherance of a program providing health care services to enrollees;
3. The furnishing of health care service through providers which are under contract with or employed by the health maintenance organization;
4. The contracting with any person for the performance on its behalf of certain functions such as marketing, enrollment and administration; and
5. The contracting with an insurance company licensed in this state or authorized to do business in this state for the provision of such insurance, indemnity, or reimbursement against the cost of health care services provided by the health maintenance organization.
(Added to NRS by 1973, 1250; A 1995, 2166; 1999, 1834)
2023 Nevada Revised Statutes › Chapter 695C - Health Maintenance Organizations › NRS 695C.123 - Contracts with certain federally qualified health centers.

1. Except as otherwise provided in NRS 422.273, a health maintenance organization that furnishes health care services through providers which are under contract with the organization shall use its best efforts to contract with at least one health center in each geographic area served by the organization to provide such services to enrollees if the health center:
(a) Meets all conditions imposed by the organization on similarly situated providers of health care that are under contract with the organization, including, without limitation:
(1) Certification for participation in the Medicaid or Medicare program; and
(2) Requirements relating to the appropriate credentials for providers of health care; and
(b) Agrees to reasonable reimbursement rates that are generally consistent with those offered by the organization to similarly situated providers of health care that are under contract with the organization.
2. As used in this section, "health center" has the meaning ascribed to it in 42 U.S.C. § 254b.
(Added to NRS by 2001, 1924)