reglab/statecodes huggingface dataset:
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.540 - Manner and period for enrollment of dependent of covered employee; period of special enrollment.

1. A carrier that offers group health insurance which makes coverage available to the dependent of an employee covered by the group health plan shall permit the employee to enroll a dependent after the close of a period of open enrollment if:
(a) The employee is a participant in the group health plan, or has met any waiting period applicable to becoming a participant and is eligible to be enrolled under the plan, except for a failure to enroll during a previous period of open enrollment; and
(b) The person to be enrolled became a dependent of the employee through marriage, birth, adoption or placement for adoption.
2. The group health plan or carrier shall provide a period of special enrollment for the enrollment of a dependent of an employee pursuant to this section. Such a period must be not less than 30 days and must begin on:
(a) The date specified by the group health plan or carrier for the period of special enrollment; or
(b) The date of the marriage, birth, adoption or placement for adoption, as appropriate.
3. If an employee seeks to enroll a dependent during the first 30 days of the period for special enrollment provided pursuant to subsection 2, the coverage of the dependent becomes effective:
(a) In the case of a marriage, not later than the first day of the first month beginning after the date on which the completed request for enrollment is received;
(b) In the case of a birth, on the date of the birth; and
(c) In the case of an adoption or placement for adoption, on the date of the adoption or the placement for adoption.
4. In the case of a birth, an adoption or a placement for adoption of a child of an employee, the spouse of the employee may be enrolled as a dependent pursuant to this section if the spouse is otherwise eligible for coverage under the group health plan.
(Added to NRS by 1997, 2908)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.550 - Carrier prohibited from imposing restriction on participation inconsistent with chapter; restrictions on rules of eligibility that may be established.

1. A carrier shall not place any restriction on a person or a dependent of the person as a condition of being a participant in or a beneficiary of a policy of blanket accident and health insurance or group health insurance that is inconsistent with the provisions of this chapter.
2. A carrier that offers coverage under a policy of blanket accident and health insurance or group health insurance pursuant to this chapter shall not establish rules of eligibility which conflict with the provisions of NRS 689B.500, including rules which define applicable waiting periods, for the initial or continued enrollment under a group health plan offered by the carrier that are based on the following factors relating to the employee or a dependent of the employee:
(a) Health status.
(b) Medical condition, including physical and mental illnesses, or both.
(c) Claims experience.
(d) Receipt of health care.
(e) Medical history.
(f) Genetic information.
(g) Evidence of insurability, including conditions which arise out of acts of domestic violence.
(h) Disability.
3. Except as otherwise provided in NRS 689B.500, the provisions of subsection 1 do not:
(a) Require a carrier to provide particular benefits other than those that would otherwise be provided under the terms of the blanket health and accident insurance or group health insurance or coverage; or
(b) Prevent a carrier from establishing limitations or restrictions on the amount, level, extent or nature of the benefits or coverage for similarly situated persons.
4. This section does not:
(a) Restrict the amount that an employer or employee may be charged for coverage by a carrier;
(b) Prevent a carrier from establishing premium discounts or rebates or from modifying otherwise applicable copayments or deductibles in return for adherence by the insured person to programs of health promotion and disease prevention; or
(c) Preclude a carrier from establishing rules relating to employer contribution or group participation when offering health insurance coverage to small employers in this state.
(Added to NRS by 1997, 2908; A 2001, 2227; 2019, 301)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.570 - Carrier that offers coverage through network plan not required to offer coverage to employer that does not employ enrollees who reside or work in geographic service area for which carrier is authorized to transact insurance.

1. A carrier that offers coverage through a network plan is not required to offer coverage to or accept an application from an employer that does not employ or no longer employs any enrollees who reside or work in the geographic service area of the carrier, provided that such coverage is refused or terminated uniformly without regard to any health status-related factor for any employee of the employer.
2. As used in this section, "network plan" means a health benefit plan offered by a health carrier under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the carrier. The term does not include an arrangement for the financing of premiums.
(Added to NRS by 1997, 2911; A 2013, 3624)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.580 - Plan sponsor of governmental plan authorized to elect to exclude governmental plan from compliance with certain statutes; duties of plan sponsor.

1. A plan sponsor of a governmental plan that is a group health plan to which the provisions of NRS 689B.340 to 689B.580, inclusive, otherwise apply may elect to exclude the governmental plan from compliance with those sections. Such an election:
(a) Must be made in such a form and in such a manner as the Commissioner prescribes by regulation.
(b) Is effective for a single specified year of the plan or, if the plan is provided pursuant to a collective bargaining agreement, for the term of that agreement.
(c) May be extended by subsequent elections.
(d) Excludes the governmental plan from those provisions in this chapter that apply only to group health plans.
2. If a plan sponsor of a governmental plan makes an election pursuant to this section, the plan sponsor shall:
(a) Annually and at the time of enrollment, notify the enrollees in the plan of the election and the consequences of the election; and
(b) Provide certification and disclosure of creditable coverage under the plan with respect to those enrollees pursuant to NRS 689B.490.
3. As used in this section, "governmental plan" has the meaning ascribed to in section 3(32) of the Employee Retirement Income Security Act of 1974, as that section existed on July 16, 1997.
(Added to NRS by 1997, 2911; A 2013, 3624)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.015 - Definitions.

Except as otherwise provided in this chapter, as used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 689C.017 to 689C.106, inclusive, have the meanings ascribed to them in those sections.
(Added to NRS by 1995, 978; A 1997, 1096, 2940; 2011, 3384; 2021, 1935)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.019 - "Affiliation period" defined.

"Affiliation period" means a period, not to exceed 60 days for new enrollees and 90 days for late enrollees, during which no premiums may be collected from, and coverage issued would not become effective for, a small employer or an eligible employee or a dependent of the eligible employee, if the affiliation period is applied uniformly and without regard to any health status-related factors.
(Added to NRS by 1997, 2916)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.025 - "Carrier" defined.

"Carrier" means any person who provides health insurance in this state, including a fraternal benefit society, a health maintenance organization, a nonprofit hospital and health service corporation, a health insurance company and any other person providing a plan of health insurance or health benefits subject to this title.
(Added to NRS by 1995, 978)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.053 - "Creditable coverage" defined.

"Creditable coverage" means health benefits or coverage provided to a person pursuant to:
1. A group health plan;
2. A health benefit plan;
3. Part A or Part B of Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395c et seq., also known as Medicare;
4. Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., also known as Medicaid, other than coverage consisting solely of benefits under section 1928 of that Title, 42 U.S.C. § 1396s;
5. The Civilian Health and Medical Program of Uniformed Services, CHAMPUS, 10 U.S.C. §§ 1071 et seq.;
6. A medical care program of the Indian Health Service or of a tribal organization;
7. A state health benefit risk pool;
8. A health plan offered pursuant to the Federal Employees Health Benefits Program, FEHBP, 5 U.S.C. §§ 8901 et seq.;
9. A public health plan as defined in federal regulations authorized by the Public Health Service Act, 42 U.S.C. § 300gg(c)(1)(I);
10. A health benefit plan under section 5(e) of the Peace Corps Act, 22 U.S.C. § 2504(e);
11. The Children’s Health Insurance Program established pursuant to 42 U.S.C. §§ 1397aa to 1397jj, inclusive;
12. A short-term health insurance policy; or
13. A blanket student accident and health insurance policy.
(Added to NRS by 1997, 2916; A 1999, 2240, 2811)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.055 - "Dependent" defined.

"Dependent" means a spouse, a domestic partner as defined in NRS 122A.030, or a child on or before the last day of the month in which the child attains 26 years of age.
(Added to NRS by 1995, 978; A 2013, 3625)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.065 - "Eligible employee" defined.

1. "Eligible employee" means a permanent employee who has a regular working week of 30 or more hours.
2. The term includes a sole proprietor, a partner of a partnership or an employee of a professional employer organization, if the sole proprietor, partner or employee of the professional employer organization is included as an employee under a health benefit plan of a small employer.
(Added to NRS by 1995, 978; A 2011, 3384; 2021, 1935)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.073 - "Group health plan" defined.

1. "Group health plan" means an employee welfare benefit plan, as defined in section 3(1) of the Employee Retirement Income Security Act of 1974, as that section existed on July 16, 1997, to the extent that the plan provides medical care to employees or their dependents as defined under the terms of the plan directly, or through insurance, reimbursement or otherwise.
2. The term does not include:
(a) Coverage that is only for accident or disability income insurance, or any combination thereof;
(b) Coverage issued as a supplement to liability insurance;
(c) Liability insurance, including general liability insurance and automobile liability insurance;
(d) Workers’ compensation or similar insurance;
(e) Coverage for medical payments under a policy of automobile insurance;
(f) Credit insurance;
(g) Coverage for on-site medical clinics; and
(h) Other similar insurance coverage specified in federal regulations adopted pursuant to Public Law 104-191 under which benefits for medical care are secondary or incidental to other insurance benefits.
3. The term does not include the following benefits if the benefits are provided under a separate policy, certificate or contract of insurance or are otherwise not an integral part of a health benefit plan:
(a) Limited-scope dental or vision benefits;
(b) Benefits for long-term care, nursing home care, home health care or community-based care, or any combination thereof; and
(c) Such other similar benefits as are specified in federal regulations adopted pursuant to Public Law 104-191.
4. The term does not include the following benefits if the benefits are provided under a separate policy, certificate or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and such benefits are paid for a claim without regard to whether benefits are provided for such a claim under any group health plan maintained by the same plan sponsor:
(a) Coverage that is only for a specified disease or illness; and
(b) Hospital indemnity or other fixed indemnity insurance.
5. The term does not include any of the following, if offered as a separate policy, certificate or contract of insurance:
(a) Medicare supplemental health insurance as defined in section 1882(g)(1) of the Social Security Act, as that section existed on July 16, 1997;
(b) Coverage supplemental to the coverage provided pursuant to chapter 55 of Title 10, United States Code (Civilian Health and Medical Program of Uniformed Services (CHAMPUS)); and
(c) Similar supplemental coverage provided under a group health plan.
(Added to NRS by 1997, 2917)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.075 - "Health benefit plan" defined.

"Health benefit plan" has the meaning ascribed to it in NRS 687B.470.
(Added to NRS by 1995, 978; A 1997, 2940; 1999, 2811; 2007, 3326; 2023, 2639)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.077 - "Network plan" defined.

"Network plan" means a health benefit plan offered by a health carrier under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the carrier. The term does not include an arrangement for the financing of premiums.
(Added to NRS by 1997, 2918)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.095 - "Small employer" defined.

"Small employer" has the meaning ascribed to it in 42 U.S.C. § 18024(b)(2).
(Added to NRS by 1995, 979; A 1997, 2941; 1999, 2812; 2013, 3625)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.104 - "Voluntary purchasing group" defined.

"Voluntary purchasing group" means the employers and their eligible employees and dependents who form a group pursuant to NRS 689C.360 to 689C.600, inclusive, and hold a certificate of registration issued by the Commissioner pursuant to NRS 689C.510.
(Added to NRS by 1995, 2677)—(Substituted in revision for NRS 689C.420)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.106 - "Waiting period" defined.

"Waiting period" means the period established by a plan of health insurance that must pass before a person who is an eligible participant or beneficiary in a plan is covered for benefits under the terms of the plan. The term includes the period from the date a person submits an application to an individual carrier for coverage under a health benefit plan until the first day of coverage under that health benefit plan.
(Added to NRS by 1997, 2919; A 1999, 2813)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.1065 - Applicability.

The provisions of this chapter apply to health benefit plans that provide coverage to the employees of small employers in this state and to carriers that offer those health benefit plans if:
1. A portion of the premium or benefits are paid by or on behalf of the small employer;
2. An eligible employee or a dependent of the eligible employee is reimbursed for a portion of the premium, whether by wage adjustments or otherwise, by or on behalf of the small employer; or
3. The health benefit plan is considered by the small employer or any of the small employer’s eligible employees or dependents as part of a plan or program for the purposes of section 106, 125 or 162 of the Internal Revenue Code, 26 U.S.C. § 106, 125 or 162.
(Added to NRS by 1999, 2810)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.109 - Certain plan, fund or program established or maintained by partnership required to be treated as employee welfare benefit plan which is group health plan; partnership deemed employer of each partner.

For the purposes of this chapter:
1. Any plan, fund or program which would not be, but for section 2721(e) of the Public Health Service Act, as amended by Public Law 104-191, as that section existed on July 16, 1997, an employee welfare benefit plan and which is established or maintained by a partnership to the extent that the plan, fund or program provides medical care to current or former partners in a partnership, or to their dependents, as defined under the terms of the plan, fund or program, directly, or through insurance, reimbursement or otherwise, must be treated, subject to the provisions of subsection 2, as an employee welfare benefit plan that is a group health plan.
2. In the case of a group health plan, a partnership shall be deemed to be the employer of each partner.
(Added to NRS by 1997, 2919)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.111 - Professional employer organization deemed large employer in certain circumstances.

A professional employer organization which has more than 50 employees, including leased employees at client locations, and which sponsors a fully insured health benefit plan for those employees shall be deemed to be a large employer for the purposes of this chapter.
(Added to NRS by 1997, 2919; A 2011, 3384; 2017, 2372; 2021, 1935)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.113 - Requirements for employee welfare benefit plan for providing benefits for employees of more than one employer.

1. An employee welfare benefit plan for providing benefits for employees of more than one employer under which health insurance coverage is provided to small employers must comply with the provisions of this chapter and with NRS 679B.139 and the regulations adopted by the Commissioner pursuant thereto.
2. As used in this section, the term "employee welfare benefit plan for providing benefits for employees of more than one employer" is intended to be equivalent to the term "employee welfare benefit plan which is a multiple employer welfare arrangement" as used in federal statutes and regulations.
(Added to NRS by 1997, 2928)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.115 - Mandatory and optional coverage.

1. A health benefit plan offered by a carrier pursuant to this chapter must include coverage of basic medical and hospital care.
2. In addition to the coverage required by subsection 1, a carrier may offer additional coverage for an additional cost upon the approval of the Commissioner.
(Added to NRS by 1995, 979)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.125 - Rating factors for determining premiums; rating periods.

1. A carrier serving small employers shall apply rating factors consistently with respect to all small employers. Rating factors must produce premiums for identical groups that differ only by the amounts attributable to the design of the plans and the terms of the coverage and do not reflect differences based on the nature of the groups that will select particular health benefit plans. As used in this subsection, "premium" means all money paid by a small employer and eligible employees to a carrier as a condition of receiving coverage from a carrier, including any fees or other contributions associated with the health benefit plan.
2. A carrier serving small employers shall treat all health benefit plans issued or renewed in the same calendar month as having the same rating period, if the terms of coverage provided in the plans are the same.
(Added to NRS by 1995, 979; A 2013, 3625)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.131 - Contracts between carrier and providers of health care: Prohibiting carrier from charging provider of health care fee for inclusion on list of providers given to insureds; carrier required to use form to obtain information on provider of health care; modification; submission by carrier of schedule of payments to providers.

1. A carrier serving small employers and a carrier that offers a contract to a voluntary purchasing group shall not charge a provider of health care a fee to include the name of the provider on a list of providers of health care given by the carrier to its insureds.
2. A carrier specified in subsection 1 shall not contract with a provider of health care to provide health care to an insured unless the carrier uses the form prescribed by the Commissioner pursuant to NRS 629.095 to obtain any information related to the credentials of the provider of health care.
3. A contract between a carrier specified in subsection 1 and a provider of health care may be modified:
(a) At any time pursuant to a written agreement executed by both parties.
(b) Except as otherwise provided in this paragraph, by the carrier upon giving to the provider 45 days’ written notice of the modification of the carrier’s schedule of payments, including any changes to the fee schedule applicable to the provider’s practice. If the provider fails to object in writing to the modification within the 45 day period, the modification becomes effective at the end of that period. If the provider objects in writing to the modification within the 45 day period, the modification must not become effective unless agreed to by both parties as described in paragraph (a).
4. If a carrier specified in subsection 1 contracts with a provider of health care to provide health care to an insured, the carrier shall:
(a) If requested by the provider of health care at the time the contract is made, submit to the provider of health care the schedule of payments applicable to the provider of health care; or
(b) If requested by the provider of health care at any other time, submit to the provider of health care the schedule of payments, including any changes to the fee schedule applicable to the provider’s practice, specified in paragraph (a) within 7 days after receiving the request.
5. As used in this section, "provider of health care" means a provider of health care who is licensed pursuant to chapter 630, 631, 632 or 633 of NRS.
(Added to NRS by 1999, 1648; A 2001, 2731; 2003, 3359; 2011, 2533)—(Substituted in revision for NRS 689C.435)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.135 - Effect of provision in health benefit plan for restricted network on determination of rates.

1. For the purposes of determining rates charged for health benefit plans, a health benefit plan that contains a provision for a restricted network is not similar coverage to a health benefit plan that does not contain such a provision if the restriction of benefits results in material differences in cost of claims.
2. As used in this section, "provision for a restricted network" means any provision of a group health benefit plan that conditions the payment of benefits, in whole or in part, on the use of providers of health care who have entered into a contractual arrangement with the carrier to provide health care to persons covered by the plan.
(Added to NRS by 1995, 980)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.143 - Offering of policy of health insurance for purposes of establishing health savings account.

A carrier 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, 2137)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.155 - Regulations.

The Commissioner may adopt regulations to carry out the provisions of NRS 689C.109 to 689C.143, inclusive, 689C.156 to 689C.159, inclusive, 689C.165, 689C.183, 689C.187, 689C.191 to 689C.198, inclusive, 689C.203, 689C.207, 689C.265, 689C.325, 689C.355 and 689C.610 to 689C.940, inclusive, and to ensure that rating practices used by carriers serving small employers are consistent with those sections, including regulations that:
1. Ensure that differences in rates charged for health benefit plans by such carriers are reasonable and reflect only differences in the designs of the plans, the terms of the coverage, the amount contributed by the employers to the cost of coverage and differences based on the rating factors established by the carrier.
2. Prescribe the manner in which rating factors may be used by such carriers.
(Added to NRS by 1995, 980; A 1997, 2942; 2013, 3626; 2015, 640)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.156 - Each health benefit plan marketed in this State required to be offered to small employers; issuance; carrier required to provide system for resolving complaints of employees if services provided or paid for through managed care.

1. As a condition of transacting business in this State with small employers, a carrier shall actively market to a small employer each health benefit plan which is actively marketed in this State by the carrier to any small employer in this State. A carrier shall be deemed to be actively marketing a health benefit plan when it makes available any of its plans to a small employer that is not currently receiving coverage under a health benefit plan issued by that carrier.
2. A carrier shall issue to a small employer any health benefit plan marketed in accordance with this section if the eligible small employer applies for the plan and agrees to make the required premium payments and satisfy the other reasonable provisions of the health benefit plan that are not inconsistent with NRS 689C.015 to 689C.355, inclusive, and 689C.610 to 689C.940, inclusive, except that a carrier is not required to issue a health benefit plan to a self-employed person who is covered by, or is eligible for coverage under, a health benefit plan offered by another employer.
3. If a health benefit plan marketed pursuant to this section provides, delivers, arranges for, pays for or reimburses any cost of health care services through managed care, the carrier shall provide a system for resolving any complaints of an employee concerning those health care services that complies with the provisions of NRS 695G.200 to 695G.310, inclusive.
(Added to NRS by 1997, 2920; A 2003, 775; 2011, 3384; 2013, 3626; 2015, 640)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.1565 - Coverage to small employers not required under certain circumstances; notice required to Commissioner of and prohibition on writing new business after election not to offer new coverage required.

1. A carrier is not required to provide coverage to small employers pursuant to NRS 689C.156:
(a) During any period in which the Commissioner determines that requiring the carrier to provide such coverage would place the carrier in a financially impaired condition.
(b) If the carrier elects not to offer any new coverage to any small employers in this State. A carrier that elects not to offer new coverage in accordance with this paragraph may maintain its existing policies issued to small employers in this State, subject to the requirements of NRS 689C.310 and 689C.320.
2. A carrier that elects not to offer new coverage pursuant to paragraph (b) of subsection 1 shall notify the Commissioner forthwith of that election and shall not thereafter write any new business to small employers in this State for 5 years after the date of the notification.
(Added to NRS by 1997, 2920)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.158 - Producer authorized only to market to or sign up small employers and eligible employees in bona fide associations if employers and employees are actively engaged in or directly related to bona fide association.

For the purposes of providing coverage under a health benefit plan pursuant to the provisions of this chapter, a producer may only market association memberships to small employers and eligible employees, accept applications for such membership or sign up such members in a bona fide association if the small employers and eligible employees being marketed are actively engaged in, or directly related to, the bona fide association.
(Added to NRS by 1997, 2919)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.159 - Certain provisions inapplicable to plan that carrier makes available only through bona fide association.

The provisions of NRS 689C.156 do not apply to health benefit plans offered by a carrier if the carrier makes the health benefit plan available in the small employer market only through a bona fide association.
(Added to NRS by 1997, 2921; A 2013, 3627; 2019, 302)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.160 - Carrier must uniformly apply requirements to determine whether to provide coverage.

The requirements used by a carrier serving small employers to determine whether to provide coverage to a small employer, including, without limitation, requirements for minimum participation of eligible employees and minimum employer’s contributions, must be applied uniformly among all small employers with the same number of eligible employees applying for coverage or receiving coverage from the carrier.
(Added to NRS by 1995, 980; A 2013, 3627)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.165 - Carrier prohibited from modifying plan to restrict or exclude coverage or benefits for specific diseases, medical conditions or services otherwise covered by plan; exceptions.

Except as otherwise provided in NRS 689C.170 and 689C.180, a carrier shall not modify a health benefit plan with respect to a small employer or any eligible employee or dependent of an eligible employee, through riders or endorsements, or otherwise, to restrict or exclude coverage or benefits for specific diseases, medical conditions or services otherwise covered by the plan.
(Added to NRS by 1997, 2921)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.1653 - Coverage for testing, treatment and prevention of sexually transmitted diseases required; coverage for condoms for certain insureds required.

1. A carrier that offers or issues a health benefit plan shall include in the plan:
(a) Coverage of testing for and the treatment and prevention of sexually transmitted diseases, including, without limitation,
Chlamydia trachomatis
, gonorrhea, syphilis, human immunodeficiency virus and hepatitis B and C, for all insureds, regardless of age. Such coverage must include, without limitation, the coverage required by NRS 689C.1671 and 689C.1675.
(b) Unrestricted coverage of condoms for insureds who are 13 years of age or older.
2. A health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2024, has the legal effect of including the coverage required by subsection 1, and any provision of the plan that conflicts with the provisions of this section is void.
(Added to NRS by 2023, 3516)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.166 - Coverage for alcohol or substance use disorder: Required in group health insurance policy.

Each group health insurance policy must contain in substance a provision for benefits payable for expenses incurred for the treatment of alcohol or substance use disorder, as provided in NRS 689C.1665 and 689C.167.
(Added to NRS by 2009, 1811; A 2023, 2374, 3516)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.167 - Coverage for alcohol or substance use disorders: Benefits provided by group health insurance policy.

1. In addition to the benefits required by NRS 689C.1665, the benefits provided by a group policy for health insurance, as required by NRS 689C.166, for the treatment of alcohol or substance use disorders must include, without limitation:
(a) Treatment for withdrawal from the physiological effects of alcohol or drugs, with a minimum benefit of $1,500 per calendar year.
(b) Treatment for a patient admitted to a facility, with a minimum benefit of $9,000 per calendar year.
(c) Counseling for a person, group or family who is not admitted to a facility, with a minimum benefit of $2,500 per calendar year.
2. Except as otherwise provided in NRS 687B.409, these benefits must be paid in the same manner as benefits for any other illness covered by a similar policy are paid.
3. The insured person is entitled to these benefits if treatment is received in any:
(a) Facility for the treatment of alcohol or substance use disorders which is certified by the Division of Public and Behavioral Health of the Department of Health and Human Services.
(b) Hospital or other medical facility or facility for the dependent which is licensed by the Division of Public and Behavioral Health of the Department of Health and Human Services, is accredited by The Joint Commission or CARF International and provides a program for the treatment of alcohol or substance use disorders as part of its accredited activities.
(Added to NRS by 2009, 1812; A 2017, 2210; 2023, 2374, 3516)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.1673 - Coverage for screening, genetic counseling and testing related to BRCA gene required in certain circumstances.

1. A carrier that issues a health benefit plan shall provide coverage for screening, genetic counseling and testing for harmful mutations in the BRCA gene for women under circumstances where such screening, genetic counseling or testing, as applicable, is required by NRS 457.301.
2. A carrier shall ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the carrier.
3. A health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2022, has the legal effect of including the coverage required by subsection 1, and any provision of the plan that conflicts with the provisions of this section is void.
4. As used in this section, "provider of health care" has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 2021, 781)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.1675 - Coverage for examination of person who is pregnant for certain diseases required.

1. A carrier that issues a health benefit plan shall provide coverage for the examination of a person who is pregnant for the discovery of:
(a)
Chlamydia trachomatis
, gonorrhea, hepatitis B and hepatitis C in accordance with NRS 442.013.
(b) Syphilis in accordance with NRS 442.010.
2. The coverage required by this section must be provided:
(a) Regardless of whether the benefits are provided to the insured by a provider of health care, facility or medical laboratory that participates in the network plan of the carrier; and
(b) Without prior authorization.
3. A health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2021, has the legal effect of including the coverage required by subsection 1, and any provision of the plan that conflicts with the provisions of this section is void.
4. As used in this section:
(a) "Medical laboratory" has the meaning ascribed to it in NRS 652.060.
(b) "Provider of health care" has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 2021, 2579)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.1679 - Plan covering prescription drugs: Required actions by carrier related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared.

1. If the Governor or the Legislature proclaims the existence of a state of emergency or issues a declaration of disaster pursuant to NRS 414.070, a carrier who has issued a health benefit plan which provides coverage for prescription drugs shall, notwithstanding any provision of the plan to the contrary:
(a) Waive any provision of the health benefit plan restricting the time within which an insured may refill a covered prescription if the insured:
(1) Has not exceeded the number of refills authorized by the prescribing practitioner;
(2) Resides in the area for which the emergency or disaster has been declared; and
(3) Requests the refill not later than the end of the state of emergency or disaster or 30 days after the issuance of the proclamation or declaration, whichever is later; and
(b) Authorize payment for, and may apply a copayment, coinsurance or deductible to, a supply of a covered prescription drug for up to 30 days for an insured who requests a refill pursuant to paragraph (a).
2. The Commissioner may extend the time periods prescribed by subsection 1 in increments of 15 or 30 days as he or she determines to be necessary.
3. As used in this section, "practitioner" has the meaning ascribed to it in NRS 639.0125.
(Added to NRS by 2021, 825)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.168 - Plan covering prescription drugs prohibited from limiting or excluding coverage for prescription drug previously approved for medical condition of insured; exception.

1. Except as otherwise provided in this section, a health benefit plan which provides coverage for prescription drugs must not limit or exclude coverage for a drug if the drug:
(a) Had previously been approved for coverage by the carrier for a medical condition of an insured and the insured’s provider of health care determines, after conducting a reasonable investigation, that none of the drugs which are otherwise currently approved for coverage are medically appropriate for the insured; and
(b) Is appropriately prescribed and considered safe and effective for treating the medical condition of the insured.
2. The provisions of subsection 1 do not:
(a) Apply to coverage for any drug that is prescribed for a use that is different from the use for which that drug has been approved for marketing by the Food and Drug Administration;
(b) Prohibit:
(1) The carrier from charging a deductible, copayment or coinsurance for the provision of benefits for prescription drugs to the insured or from establishing, by contract, limitations on the maximum coverage for prescription drugs;
(2) A provider of health care from prescribing another drug covered by the plan that is medically appropriate for the insured; or
(3) The substitution of another drug pursuant to NRS 639.23286 or 639.2583 to 639.2597, inclusive; or
(c) Require any coverage for a drug after the term of the plan.
3. Any provision of a health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2001, which is in conflict with this section is void.
(Added to NRS by 2001, 859; A 2003, 2299; 2017, 637)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.1682 - Plan covering prescription drugs: Submission to step therapy protocol for drug to treat psychiatric condition prohibited in certain circumstances.

1. A health benefit plan which provides coverage for prescription drugs must not require an insured to submit to a step therapy protocol before covering a drug approved by the Food and Drug Administration that is prescribed to treat a psychiatric condition of the insured, if:
(a) The drug has been approved by the Food and Drug Administration with indications for the psychiatric condition of the insured or the use of the drug to treat that psychiatric condition is otherwise supported by medical or scientific evidence;
(b) The drug is prescribed by:
(1) A psychiatrist;
(2) A physician assistant under the supervision of a psychiatrist;
(3) An advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120; or
(4) A primary care provider that is providing care to an insured in consultation with a practitioner listed in subparagraph (1), (2) or (3), if the closest practitioner listed in subparagraph (1), (2) or (3) who participates in the network plan of the health carrier is located 60 miles or more from the residence of the insured; and
(c) The practitioner listed in paragraph (b) who prescribed the drug knows, based on the medical history of the insured, or reasonably expects each alternative drug that is required to be used earlier in the step therapy protocol to be ineffective at treating the psychiatric condition.
2. Any provision of a health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2023, which is in conflict with this section is void.
3. As used in this section:
(a) "Medical or scientific evidence" has the meaning ascribed to it in NRS 695G.053.
(b) "Network plan" means a health benefit plan offered by a health carrier under which the financing and delivery of medical care is provided, in whole or in part, through a defined set of providers under contract with the health carrier. The term does not include an arrangement for the financing of premiums.
(c) "Step therapy protocol" means a procedure that requires an insured to use a prescription drug or sequence of prescription drugs other than a drug that a practitioner recommends for treatment of a psychiatric condition of the insured before his or her health benefit plan provides coverage for the recommended drug.
(Added to NRS by 2023, 1783)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.1683 - Coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications required in plan covering prescription drugs; prohibited acts; exception.

1. A carrier who offers or issues a health benefit plan which provides coverage for prescription drugs:
(a) Must authorize coverage for and may apply a copayment and deductible to a prescription that is dispensed by a pharmacy for less than a 30-day supply if, for the purpose of synchronizing the insured’s chronic medications:
(1) The prescriber or pharmacist determines that filling or refilling the prescription in that manner is in the best interest of the insured; and
(2) The insured requests less than a 30-day supply.
(b) May not deny coverage for a prescription described in paragraph (a) which is otherwise approved for coverage by the carrier.
(c) Unless otherwise provided by a contract or other agreement, may not prorate any pharmacy dispensing fees for a prescription described in paragraph (a).
2. A health benefit plan subject to the provisions of this chapter which provides coverage for prescription drugs and that is delivered, issued for delivery or renewed on or after January 1, 2017, has the legal effect of providing that coverage subject to the requirements of this section, and any provision of the health benefit plan or renewal which is in conflict with this section is void.
3. The provisions of this section do not apply to unit-of-use packaging for which synchronization is not practicable or to a controlled substance.
4. As used in this section:
(a) "Chronic medication" means any drug that is prescribed to treat any disease or other condition which is determined to be permanent, persistent or lasting indefinitely.
(b) "Synchronization" means the alignment of the dispensing of multiple medications by a single contracted pharmacy for the purpose of improving a patient’s adherence to a prescribed course of medication.
(c) "Unit-of-use packaging" means medication that is prepackaged by the manufacturer in blister packs, compliance packs, course-of-therapy packs or any other packaging which is designed and intended to be dispensed directly to the patient without modification by the dispensing pharmacy, except for the addition of a prescription label.
(Added to NRS by 2015, 2125)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.1685 - Plan covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products.

1. A carrier who offers or issues a health benefit plan which provides coverage for prescription drugs shall not deny coverage for a topical ophthalmic product which is otherwise approved for coverage by the carrier when the insured, pursuant to NRS 639.2395, receives a refill of the product:
(a) After 21 days or more but before 30 days after receiving any 30-day supply of the product;
(b) After 42 days or more but before 60 days after receiving any 60-day supply of the product; or
(c) After 63 days or more but before 90 days after receiving any 90-day supply of the product.
2. The provisions of this section do not affect any deductibles, copayments or coinsurance established by the health benefit plan.
3. A health benefit plan subject to the provisions of this chapter which provides coverage for prescription drugs and that is delivered, issued for delivery or renewed on or after January 1, 2016, has the legal effect of including the coverage required by this section, and any provision of the plan or renewal which is in conflict with this section is void.
4. As used in this section, "topical ophthalmic product" means a liquid prescription drug which is applied directly to the eye from a bottle or by means of a dropper.
(Added to NRS by 2015, 207)
2023 Nevada Revised Statutes › Chapter 689C - Health Insurance for Small Employers › NRS 689C.1687 - Coverage for management and treatment of sickle cell disease and its variants required; coverage for medically necessary prescription drugs to treat sickle cell disease and its variants required in plan covering prescription drugs.

1. A carrier that issues a health benefit plan shall include in the plan coverage for:
(a) Necessary case management services for an insured who has been diagnosed with sickle cell disease and its variants; and
(b) Medically necessary care for an insured who has been diagnosed with sickle cell disease and its variants.
2. A carrier that issues a health benefit plan which provides coverage for prescription drugs shall include in the plan coverage for medically necessary prescription drugs to treat sickle cell disease and its variants.
3. A carrier may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.
4. As used in this section:
(a) "Case management services" means medical or other health care management services to assist patients and providers of health care, including, without limitation, identifying and facilitating additional resources and treatments, providing information about treatment options and facilitating communication between providers of services to a patient.
(b) "Medical management technique" means a practice which is used to control the cost or utilization of health care services. The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.
(c) "Medically necessary" has the meaning ascribed to it in NRS 695G.055.
(d) "Sickle cell disease and its variants" has the meaning ascribed to it in NRS 439.4927.
(Added to NRS by 2019, 2170)