reglab/statecodes huggingface dataset:
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0315 - Required provision concerning coverage for examination of person who is pregnant for certain diseases.

1. An insurer that issues a policy of group health insurance shall provide coverage for the examination of a person who is pregnant for the discovery of:
(a)
Chlamydia trachomatis
, gonorrhea, hepatitis B and hepatitis C in accordance with NRS 442.013.
(b) Syphilis in accordance with NRS 442.010.
2. The coverage required by this section must be provided:
(a) Regardless of whether the benefits are provided to the insured by a provider of health care, facility or medical laboratory that participates in the network plan of the insurer; and
(b) Without prior authorization.
3. A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2021, has the legal effect of including the coverage required by subsection 1, and any provision of the policy that conflicts with the provisions of this section is void.
4. As used in this section:
(a) "Medical laboratory" has the meaning ascribed to it in NRS 652.060.
(b) "Network plan" means a policy of group health insurance offered by an insurer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the insurer. The term does not include an arrangement for the financing of premiums.
(c) "Provider of health care" has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 2021, 2578)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0316 - Required provision concerning coverage for testing, treatment and prevention of sexually transmitted diseases; required provision concerning coverage for condoms for certain insureds.

1. An insurer that offers or issues a policy of group health insurance shall include in the policy:
(a) Coverage of testing for and the treatment of 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 689B.0312 and 689B.0315.
(b) Unrestricted coverage of condoms for insureds who are 13 years of age or older.
2. A policy of group health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2024, has the legal effect of including the coverage required by subsection 1, and any provision of the policy that conflicts with the provisions of this section is void.
(Added to NRS by 2023, 3513)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0317 - Required provision in policy covering treatment of prostate cancer concerning coverage for prostate cancer screening; prohibited act.

1. A policy of group health insurance that provides coverage for the treatment of prostate cancer must provide coverage for prostate cancer screening in accordance with:
(a) The guidelines concerning prostate cancer screening which are published by the American Cancer Society; or
(b) Other guidelines or reports concerning prostate cancer screening which are published by nationally recognized professional organizations and which include current or prevailing supporting scientific data.
2. A policy of group health insurance that provides coverage for the treatment of prostate cancer must not require an insured to obtain prior authorization for any service provided pursuant to subsection 1.
3. A policy of group health insurance that provides coverage for the treatment of prostate cancer which is delivered, issued for delivery or renewed on or after July 1, 2007, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with subsection 1 is void.
(Added to NRS by 2007, 3238)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.033 - Certain policies covering family members required to include certain coverage for insured’s newly born and adopted children and children placed with insured for adoption.

1. All group health insurance policies providing coverage on an expense-incurred basis and all employee welfare plans providing medical, surgical or hospital care or benefits established or maintained for employees or their families or dependents, or for both, must as to the family members’ coverage provide that the health benefits applicable for children are payable with respect to:
(a) A newly born child of the insured from the moment of birth;
(b) An adopted child from the date the adoption becomes effective, if the child was not placed in the home before adoption; and
(c) A child placed with the insured for the purpose of adoption from the moment of placement as certified by the public or private agency making the placement. The coverage of such a child ceases if the adoption proceedings are terminated as certified by the public or private agency making the placement.
The policies must provide the coverage specified in subsection 3 and must not exclude premature births.
2. The policy or contract may require that notification of:
(a) The birth of a newly born child;
(b) The effective date of adoption of a child; or
(c) The date of placement of a child for adoption,
and payments of the required premium or fees, if any, must be furnished to the insurer or welfare plan within 31 days after the date of birth, adoption or placement for adoption in order to have the coverage continue beyond the 31-day period.
3. The coverage for newly born and adopted children and children placed for adoption consists of coverage of injury or sickness, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities and, within the limits of the policy, necessary transportation costs from place of birth to the nearest specialized treatment center under major medical policies, and with respect to basic policies to the extent such costs are charged by the treatment center.
(Added to NRS by 1975, 1109; A 1989, 740; 1995, 2430; 1997, 2914; 2013, 3618)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.034 - Required provision concerning effect of benefits under other valid group coverage; subrogation; prohibited act.

1. Every policy of group health insurance must contain a provision which reduces the insurer’s liability because of benefits under other valid group coverage. To the extent authorized by the Commissioner, such a provision may include subrogation.
2. A provision for subrogation may include a lien upon any recovery by an insured from a third person for the cost of medical benefits paid by the insurer for injuries incurred as a result of the actions of the third person. The lien may not exceed the amount paid by the insurer.
3. An insurer may not deny payment for services because of the inclusion of a provision required by this section.
(Added to NRS by 1985, 1060; A 1995, 1628)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0345 - Required provision concerning continuing coverage for employee or member on leave without pay as result of total disability.

1. As used in this section, "total disability" and "totally disabled" mean the continuing inability of the employee or member, because of an injury or illness, to perform substantially the duties related to his or her employment for which the employee or member is otherwise qualified.
2. No group policy of health insurance may be delivered or issued for delivery in this state unless it provides continuing coverage for an employee or member of the insured group, and the dependents of the employee or member who are otherwise covered by the policy, while the employee or member is on leave without pay as a result of a total disability. The coverage must be for any injury or illness suffered by the employee or member which is not related to the total disability or for any injury or illness suffered by the dependent of the employee or member. The coverage for such injury or illness must be equal to or greater than the coverage otherwise provided by the policy.
3. The coverage required pursuant to subsection 2 must continue until:
(a) The date on which the employment of the employee or member is terminated;
(b) The date on which the employee or member obtains another policy of health insurance;
(c) The date on which the group policy of health insurance is terminated; or
(d) After a period of 12 months in which benefits under such coverage are provided to the employee or member,
whichever occurs first.
(Added to NRS by 1989, 1249)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.035 - Required provision in certain policies concerning termination of coverage on dependent child.

1. A group health insurance policy delivered or issued for delivery after November 1, 1973, which provides for the termination of coverage on a dependent child of a member of the insured group, when such child attains a contractually specified limiting age, shall also provide that such coverage shall not terminate when the dependent child reaches such age if such child is and continues to be:
(a) Incapable of self-sustaining employment due to a physical handicap or an intellectual disability; and
(b) Dependent on the member of the insured group for support and maintenance.
2. Proof of such child’s incapacity and dependency shall be furnished to the insurer by the member of the insured group within 31 days after such child attains the specified limiting age and as often as the insurer may thereafter require, but no more than once a year beginning 2 years after such child attains the specified limiting age.
(Added to NRS by 1973, 548; A 2013, 699)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0353 - Required provision concerning coverage for treatment of certain inherited metabolic diseases.

1. A policy of group health insurance must provide coverage for:
(a) Enteral formulas for use at home that are prescribed or ordered by a physician as medically necessary for the treatment of inherited metabolic diseases characterized by deficient metabolism, or malabsorption originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate or fat; and
(b) At least $2,500 per year for special food products which are prescribed or ordered by a physician as medically necessary for the treatment of a person described in paragraph (a).
2. The coverage required by subsection 1 must be provided whether or not the condition existed when the policy was purchased.
3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2021, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void.
4. As used in this section:
(a) "Enteral formula" includes, without limitation, a formula that is ingested orally.
(b) "Inherited metabolic disease" means a disease caused by an inherited abnormality of the body chemistry of a person.
(c) "Special food product" means a food product that is specially formulated to have less than one gram of protein per serving and is intended to be consumed under the direction of a physician for the dietary treatment of an inherited metabolic disease. The term does not include a food that is naturally low in protein.
(Added to NRS by 1997, 1526; A 2021, 3623)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0357 - Required provision in policy covering hospital, medical or surgical expenses concerning coverage for management and treatment of diabetes.

1. No group policy of health insurance that provides coverage for hospital, medical or surgical expenses may be delivered or issued for delivery in this state unless the policy includes coverage for the management and treatment of diabetes, including, without limitation, coverage for the self-management of diabetes.
2. An insurer who delivers or issues for delivery a policy specified in subsection 1:
(a) Shall include in any disclosure of the coverage provided by the policy notice to each policyholder and subscriber under the policy of the availability of the benefits required by this section.
(b) Shall provide the coverage required by this section subject to the same deductible, copayment, coinsurance and other such conditions for coverage that are required under the policy.
3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 1998, has the legal effect of including the coverage required by this section, and any provision of the policy that conflicts with this section is void.
4. As used in this section:
(a) "Coverage for the management and treatment of diabetes" includes coverage for medication, equipment, supplies and appliances that are medically necessary for the treatment of diabetes.
(b) "Coverage for the self-management of diabetes" includes:
(1) The training and education provided to the employee or member of the insured group after the employee or member is initially diagnosed with diabetes which is medically necessary for the care and management of diabetes, including, without limitation, counseling in nutrition and the proper use of equipment and supplies for the treatment of diabetes;
(2) Training and education which is medically necessary as a result of a subsequent diagnosis that indicates a significant change in the symptoms or condition of the employee or member of the insured group and which requires modification of his or her program of self-management of diabetes; and
(3) Training and education which is medically necessary because of the development of new techniques and treatment for diabetes.
(c) "Diabetes" includes type I, type II and gestational diabetes.
(Added to NRS by 1997, 743; A 2017, 2369)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0358 - Required provision concerning coverage for management and treatment of sickle cell disease and its variants; required provision in policy covering prescription drugs concerning coverage for medically necessary prescription drugs to treat sickle cell disease and its variants.

1. An insurer that issues a policy of group health insurance shall include in the policy 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. An insurer that issues a policy of group health insurance which provides coverage for prescription drugs shall include in the policy coverage for medically necessary prescription drugs to treat sickle cell disease and its variants.
3. An insurer may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.
4. As used in this section:
(a) "Case management services" means medical or other health care management services to assist patients and providers of health care, including, without limitation, identifying and facilitating additional resources and treatments, providing information about treatment options and facilitating communication between providers of services to a patient.
(b) "Medical management technique" means a practice which is used to control the cost or utilization of health care services. The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.
(c) "Medically necessary" has the meaning ascribed to it in NRS 695G.055.
(d) "Sickle cell disease and its variants" has the meaning ascribed to it in NRS 439.4927.
(Added to NRS by 2019, 2170)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0362 - Policy covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy.

1. An insurer that offers or issues a policy of group health insurance which provides coverage for the treatment of cancer through the use of chemotherapy shall not:
(a) Require a copayment, deductible or coinsurance amount for chemotherapy administered orally by means of a prescription drug in a combined amount that is more than $100 per prescription. The limitation on the amount of the deductible that may be required pursuant to this paragraph does not apply to a health benefit plan, as defined in NRS 687B.470, if the health benefit plan is a high deductible health plan, as defined in 26 U.S.C. § 223, and the amount of the annual deductible has not been satisfied.
(b) Make the coverage subject to monetary limits that are less favorable for chemotherapy administered orally by means of a prescription drug than the monetary limits applicable to chemotherapy which is administered by injection or intravenously.
(c) Decrease the monetary limits applicable to chemotherapy administered orally by means of a prescription drug or to chemotherapy which is administered by injection or intravenously to meet the requirements of this section.
2. A policy subject to the provisions of this chapter which provides coverage for the treatment of cancer through the use of chemotherapy and that is delivered, issued for delivery or renewed on or after January 1, 2015, has the legal effect of providing that coverage subject to the requirements of this section, and any provision of the policy or renewal which is in conflict with this section is void.
3. Nothing in this section shall be construed as requiring an insurer to provide coverage for the treatment of cancer through the use of chemotherapy administered by injection or intravenously or administered orally by means of a prescription drug.
(Added to NRS by 2013, 1998; A 2013, 3658)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0365 - Required provision in certain policies concerning coverage for use of certain drugs and related services for treatment of cancer.

Except as otherwise provided in NRS 689B.0306:
1. No group policy of health insurance that provides coverage for a drug approved by the Food and Drug Administration for use in the treatment of an illness, disease or other medical condition may be delivered or issued for delivery in this state unless the policy includes coverage for any other use of the drug for the treatment of cancer, if that use is:
(a) Specified in the most recent edition of or supplement to:
(1) The
United States Pharmacopoeia Drug Information
; or
(2) The
American Hospital Formulary Service Drug Information
; or
(b) Supported by at least two articles reporting the results of scientific studies that are published in scientific or medical journals, as defined in 21 C.F.R. § 99.3.
2. The coverage required pursuant to this section:
(a) Includes coverage for any medical services necessary to administer the drug to the employee or member of the insured group.
(b) Does not include coverage for any:
(1) Experimental drug used for the treatment of cancer if that drug has not been approved by the Food and Drug Administration; or
(2) Use of a drug that is contraindicated by the Food and Drug Administration.
3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1999, has the legal effect of including the coverage required by this section, and any provision of the policy that conflicts with the provisions of this section is void.
(Added to NRS by 1999, 760; A 2003, 3525)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0367 - Required provision in policy covering treatment of colorectal cancer concerning coverage for colorectal cancer screening.

1. A policy of group health insurance that provides coverage for the treatment of colorectal cancer must provide coverage for colorectal cancer screening in accordance with:
(a) The guidelines concerning colorectal cancer screening which are published by the American Cancer Society; or
(b) Other guidelines or reports concerning colorectal cancer screening which are published by nationally recognized professional organizations and which include current or prevailing supporting scientific data.
2. A policy of group health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2003, has the legal effect of including the coverage required by this section, and any provision of the policy that conflicts with the provisions of this section is void.
(Added to NRS by 2003, 1335)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0368 - Policy covering prescription drugs prohibited from limiting or excluding coverage for certain prescription drugs previously approved for medical condition of insured; exceptions.

1. Except as otherwise provided in this section, a policy of group health insurance which provides coverage for prescription drugs must not limit or exclude coverage for a drug if the drug:
(a) Had previously been approved for coverage by the insurer for a medical condition of an insured and the insured’s provider of health care determines, after conducting a reasonable investigation, that none of the drugs which are otherwise currently approved for coverage are medically appropriate for the insured; and
(b) Is appropriately prescribed and considered safe and effective for treating the medical condition of the insured.
2. The provisions of subsection 1 do not:
(a) Apply to coverage for any drug that is prescribed for a use that is different from the use for which that drug has been approved for marketing by the Food and Drug Administration;
(b) Prohibit:
(1) The insurer from charging a deductible, copayment or coinsurance for the provision of benefits for prescription drugs to the insured or from establishing, by contract, limitations on the maximum coverage for prescription drugs;
(2) A provider of health care from prescribing another drug covered by the policy that is medically appropriate for the insured; or
(3) The substitution of another drug pursuant to NRS 639.23286 or 639.2583 to 639.2597, inclusive; or
(c) Require any coverage for a drug after the term of the policy.
3. Any provision of a policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2001, which is in conflict with this section is void.
(Added to NRS by 2001, 858; A 2003, 2298; 2017, 637)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0375 - Required provision in policy covering mastectomies concerning coverage relating to mastectomy; prohibited acts.

1. A policy of group health insurance which provides coverage for the surgical procedure known as a mastectomy must also provide commensurate coverage for:
(a) Reconstruction of the breast on which the mastectomy has been performed;
(b) Surgery and reconstruction of the other breast to produce a symmetrical structure; and
(c) Prostheses and physical complications for all stages of mastectomy, including lymphedemas.
2. The provision of services must be determined by the attending physician and the patient.
3. The plan or issuer may require deductibles and coinsurance payments if they are consistent with those established for other benefits.
4. Written notice of the availability of the coverage must be given upon enrollment and annually thereafter. The notice must be sent to all participants:
(a) In the next mailing made by the plan or issuer to the participant or beneficiary; or
(b) As part of any annual information packet sent to the participant or beneficiary,
whichever is earlier.
5. A plan or issuer may not:
(a) Deny eligibility, or continued eligibility, to enroll or renew coverage, in order to avoid the requirements of subsections 1 to 4, inclusive; or
(b) Penalize, or limit reimbursement to, a provider of care, or provide incentives to a provider of care, in order to induce the provider not to provide the care listed in subsections 1 to 4, inclusive.
6. A plan or issuer may negotiate rates of reimbursement with providers of care.
7. If reconstructive surgery is begun within 3 years after a mastectomy, the amount of the benefits for that surgery must equal those amounts provided for in the policy at the time of the mastectomy. If the surgery is begun more than 3 years after the mastectomy, the benefits provided are subject to all of the terms, conditions and exclusions contained in the policy at the time of the reconstructive surgery.
8. A policy subject to the provisions of this chapter which is delivered, issued for delivery or renewed on or after October 1, 2001, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void.
9. For the purposes of this section, "reconstructive surgery" means a surgical procedure performed following a mastectomy on one breast or both breasts to re-establish symmetry between the two breasts. The term includes augmentation mammoplasty, reduction mammoplasty and mastopexy.
(Added to NRS by 1983, 615; A 1989, 1889; 2001, 2220)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0376 - Required provision in policy covering prescription drugs or devices concerning coverage of hormone replacement therapy in certain circumstances; prohibited acts; exception.

1. An insurer that offers or issues a policy of group health insurance which provides coverage for prescription drugs or devices shall include in the policy coverage for any type of hormone replacement therapy which is lawfully prescribed or ordered and which has been approved by the Food and Drug Administration.
2. An insurer that offers or issues a policy of group health insurance that provides coverage for prescription drugs shall not:
(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition for coverage for a prescription for hormone replacement therapy;
(b) Refuse to issue a policy of group health insurance or cancel a policy of group health insurance solely because the person applying for or covered by the policy uses or may use in the future hormone replacement therapy;
(c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from accessing hormone replacement therapy;
(d) Penalize a provider of health care who provides hormone replacement therapy to an insured, including, without limitation, reducing the reimbursement of the provider of health care; or
(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay hormone replacement therapy to an insured.
3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1999, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with this section is void.
4. The provisions of this section do not require an insurer to provide coverage for fertility drugs.
5. As used in this section, "provider of health care" has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 1999, 1997; A 2017, 1819, 3939)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.03762 - Required provision in policy covering prescription drugs concerning coverage for drugs irregularly dispensed for purpose of synchronization of chronic medications; prohibited acts; exception.

1. An insurer who offers or issues a policy of group health insurance which provides coverage for prescription drugs:
(a) Must authorize coverage for and may apply a copayment and deductible to a prescription that is dispensed by a pharmacy for less than a 30-day supply if, for the purpose of synchronizing the insured’s chronic medications:
(1) The prescriber or pharmacist determines that filling or refilling the prescription in that manner is in the best interest of the insured; and
(2) The insured requests less than a 30-day supply.
(b) May not deny coverage for a prescription described in paragraph (a) which is otherwise approved for coverage by the insurer.
(c) Unless otherwise provided by a contract or other agreement, may not prorate any pharmacy dispensing fees for a prescription described in paragraph (a).
2. A policy subject to the provisions of this chapter which provides coverage for prescription drugs and that is delivered, issued for delivery or renewed on or after January 1, 2017, has the legal effect of providing that coverage subject to the requirements of this section, and any provision of the policy or renewal which is in conflict with this section is void.
3. The provisions of this section do not apply to unit-of-use packaging for which synchronization is not practicable or to a controlled substance.
4. As used in this section:
(a) "Chronic medication" means any drug that is prescribed to treat any disease or other condition which is determined to be permanent, persistent or lasting indefinitely.
(b) "Synchronization" means the alignment of the dispensing of multiple medications by a single contracted pharmacy for the purpose of improving a patient’s adherence to a prescribed course of medication.
(c) "Unit-of-use packaging" means medication that is prepackaged by the manufacturer in blister packs, compliance packs, course-of-therapy packs or any other packaging which is designed and intended to be dispensed directly to the patient without modification by the dispensing pharmacy, except for the addition of a prescription label.
(Added to NRS by 2015, 2124)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.03764 - Policy covering prescription drugs: Denial of coverage for early refills of otherwise covered topical ophthalmic products prohibited.

1. An insurer who offers or issues a policy of group health insurance which provides coverage for prescription drugs shall not deny coverage for a topical ophthalmic product which is otherwise approved for coverage by the insurer when the insured, pursuant to NRS 639.2395, receives a refill of the product:
(a) After 21 days or more but before 30 days after receiving any 30-day supply of the product;
(b) After 42 days or more but before 60 days after receiving any 60-day supply of the product; or
(c) After 63 days or more but before 90 days after receiving any 90-day supply of the product.
2. The provisions of this section do not affect any deductibles, copayments or coinsurance authorized or required pursuant to the policy of group health insurance.
3. A policy of group health insurance subject to the provisions of this chapter which provides coverage for prescription drugs and that is delivered, issued for delivery or renewed on or after January 1, 2016, has the legal effect of including the coverage required by this section, and any provision of the policy or renewal which is in conflict with this section is void.
4. As used in this section, "topical ophthalmic product" means a liquid prescription drug which is applied directly to the eye from a bottle or by means of a dropper.
(Added to NRS by 2015, 206)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.03765 - Policy covering prescription drugs: Submission to step therapy protocol for drug to treat psychiatric condition prohibited in certain circumstances.

1. A policy of group health insurance which provides coverage for prescription drugs must not require an insured to submit to a step therapy protocol before covering a drug approved by the Food and Drug Administration that is prescribed to treat a psychiatric condition of the insured, if:
(a) The drug has been approved by the Food and Drug Administration with indications for the psychiatric condition of the insured or the use of the drug to treat that psychiatric condition is otherwise supported by medical or scientific evidence;
(b) The drug is prescribed by:
(1) A psychiatrist;
(2) A physician assistant under the supervision of a psychiatrist;
(3) An advanced practice registered nurse who has the psychiatric training and experience prescribed by the State Board of Nursing pursuant to NRS 632.120; or
(4) A primary care provider that is providing care to an insured in consultation with a practitioner listed in subparagraph (1), (2) or (3), if the closest practitioner listed in subparagraph (1), (2) or (3) who participates in the network plan of the insurer is located 60 miles or more from the residence of the insured; and
(c) The practitioner listed in paragraph (b) who prescribed the drug knows, based on the medical history of the insured, or reasonably expects each alternative drug that is required to be used earlier in the step therapy protocol to be ineffective at treating the psychiatric condition.
2. Any provision of a policy of group health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2023, which is in conflict with this section is void.
3. As used in this section:
(a) "Medical or scientific evidence" has the meaning ascribed to it in NRS 695G.053.
(b) "Network plan" means a policy of group health insurance offered by an insurer under which the financing and delivery of medical care is provided, in whole or in part, through a defined set of providers under contract with the insurer. The term does not include an arrangement for the financing of premiums.
(c) "Step therapy protocol" means a procedure that requires an insured to use a prescription drug or sequence of prescription drugs other than a drug that a practitioner recommends for treatment of a psychiatric condition of the insured before his or her policy of group health insurance provides coverage for the recommended drug.
(Added to NRS by 2023, 1783)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.03766 - Policy covering maternity care: Prohibited acts by insurer if insured is acting as gestational carrier; child deemed child of intended parent for purposes of policy.

1. An insurer that offers or issues a policy of group health insurance that includes coverage for maternity care shall not deny, limit or seek reimbursement for maternity care because the insured is acting as a gestational carrier.
2. If an insured acts as a gestational carrier, the child shall be deemed to be a child of the intended parent, as defined in NRS 126.590, for purposes related to the policy of group health insurance.
3. As used in this section, "gestational carrier" has the meaning ascribed to it in NRS 126.580.
(Added to NRS by 2019, 1006)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0377 - Required provision in policy covering outpatient care concerning coverage for health care services related to hormone replacement therapy; prohibited acts.

1. An insurer that offers or issues a policy of group health insurance which provides coverage for outpatient care shall include in the policy coverage for any health care service related to hormone replacement therapy.
2. An insurer that offers or issues a policy of group health insurance that provides coverage for outpatient care shall not:
(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition for coverage for outpatient care related to hormone replacement therapy;
(b) Refuse to issue a policy of group health insurance or cancel a policy of group health insurance solely because the person applying for or covered by the policy uses or may use in the future hormone replacement therapy;
(c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from accessing hormone replacement therapy;
(d) Penalize a provider of health care who provides hormone replacement therapy to an insured, including, without limitation, reducing the reimbursement of the provider of health care; or
(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay hormone replacement therapy to an insured.
3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1999, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with this section is void.
4. As used in this section, "provider of health care" has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 1999, 1998; A 2017, 1821, 3940)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0379 - Policy prohibited from excluding coverage for treatment of temporomandibular joint; exception.

1. Except as otherwise provided in this section, no policy of group health insurance may be delivered or issued for delivery in this state if it contains an exclusion of coverage of the treatment of the temporomandibular joint whether by specific language in the policy or by a claims settlement practice. A policy may exclude coverage of those methods of treatment which are recognized as dental procedures, including, but not limited to, the extraction of teeth and the application of orthodontic devices and splints.
2. The insurer may limit its liability on the treatment of the temporomandibular joint to:
(a) No more than 50 percent of the usual and customary charges for such treatment actually received by an insured, but in no case more than 50 percent of the maximum benefits provided by the policy for such treatment; and
(b) Treatment which is medically necessary.
3. Any provision of a policy subject to the provisions of this chapter and issued or delivered on or after January 1, 1990, which is in conflict with this section is void.
(Added to NRS by 1989, 2138)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.038 - Reimbursement for treatments by licensed psychologist.

If any policy of group health insurance provides coverage for treatment of an illness which is within the authorized scope of the practice of a qualified psychologist, the insured is entitled to reimbursement for treatment by a licensed psychologist.
(Added to NRS by 1981, 575; A 1989, 1553; 2017, 935)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0383 - Reimbursement for treatments by licensed marriage and family therapist or licensed clinical professional counselor.

If any policy of group health insurance provides coverage for treatment of an illness which is within the authorized scope of practice of a licensed marriage and family therapist or licensed clinical professional counselor, the insured is entitled to reimbursement for treatment by a marriage and family therapist or clinical professional counselor who is licensed pursuant to chapter 641A of NRS.
(Added to NRS by 1987, 2133; A 2007, 3093)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0385 - Reimbursement for treatments by licensed associate in social work, social worker, master social worker, independent social worker or clinical social worker.

If any policy of group health insurance provides coverage for treatment of an illness which is within the authorized scope of the practice of a licensed associate in social work, a social worker, a master social worker, an independent social worker or a clinical social worker, the insured is entitled to reimbursement for treatment by an associate in social work, a social worker, a master social worker, an independent social worker or a clinical social worker who is licensed pursuant to chapter 641B of NRS.
(Added to NRS by 1987, 1123; A 2021, 3507)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.039 - Reimbursement for treatments by chiropractic physician.

1. If any group policy of health insurance provides coverage for treatment of an illness which is within the authorized scope of practice of a qualified chiropractic physician, the insured is entitled to reimbursement for treatments by a chiropractic physician who is licensed pursuant to chapter 634 of NRS.
2. The terms of the policy must not limit:
(a) Coverage for treatments by a chiropractic physician to a number less than for treatments by other physicians.
(b) Reimbursement for treatments by a chiropractic physician to an amount less than that charged for similar treatments by other physicians.
(Added to NRS by 1981, 930; A 1983, 327)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0393 - Reimbursement for treatments by podiatrist.

1. If any group policy of health insurance provides coverage for treatment of an illness which is within the authorized scope of practice of a qualified podiatrist, the insured is entitled to reimbursement for treatments by a podiatrist who is licensed pursuant to chapter 635 of NRS.
2. The terms of the policy must not limit:
(a) Coverage for treatments by a podiatrist to a number less than for treatments by other physicians.
(b) Reimbursement for treatments by a podiatrist to an amount less than that reimbursed for similar treatments by other physicians.
(Added to NRS by 2007, 1046)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0397 - Reimbursement for treatment by licensed clinical alcohol and drug counselor.

If any policy of group health insurance provides coverage for treatment of an illness which is within the authorized scope of practice of a licensed clinical alcohol and drug counselor, the insured is entitled to reimbursement for treatment by a clinical alcohol and drug counselor who is licensed pursuant to chapter 641C of NRS unless the clinical alcohol and drug counselor must be directly reimbursed pursuant to:
1. An assignment of benefits described in NRS 687B.409; or
2. Any other applicable assignment of benefits.
(Added to NRS by 2007, 3093; A 2017, 2210)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.040 - Direct payment for hospital and medical services and home health care; payment to assignee.

1. Any group health policy may provide that all or any portion of any indemnities provided by any such policy on account of hospital, nursing, medical or surgical services, home health care or supportive services:
(a) May, at the insurer’s option; or
(b) Must, upon the written request of the insured,
be paid directly to the hospital or person rendering the services. Payments made in this manner discharge the insurer’s obligation.
2. If the insured assigns his or her benefits pursuant to this section but the insurer after receiving a copy of the assignment pays the benefits to the insured, the insurer shall also pay the benefits to the assignee as soon as the insurer receives the notice of the incorrect payment.
(Added to NRS by 1971, 1767; A 1975, 448; 1983, 880)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.045 - Reimbursement for services provided by certain nurses.

1. If any group policy of health insurance provides coverage for services which are within the authorized scope of practice of a registered nurse who is authorized pursuant to chapter 632 of NRS to perform additional acts in an emergency or under other special conditions as prescribed by the State Board of Nursing, and which are reimbursed when provided by another provider of health care, the insured is entitled to reimbursement for services provided by such a registered nurse.
2. The terms of the policy must not limit:
(a) Coverage for services provided by such a registered nurse to a number of occasions less than for services provided by another provider of health care.
(b) Reimbursement for services provided by such a registered nurse to an amount less than that reimbursed for similar services provided by another provider of health care.
3. An insurer is not required to pay for services provided by such a registered nurse which duplicate services provided by another provider of health care.
(Added to NRS by 1985, 1447)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.047 - Reimbursement to provider of medical transportation.

1. Except as otherwise provided in subsection 3, every policy of group health insurance amended, delivered or issued for delivery in this State after October 1, 1989, that provides coverage for medical transportation, must contain a provision for the direct reimbursement of a provider of medical transportation for covered services if that provider does not receive reimbursement from any other source.
2. The insured or the provider may submit the claim for reimbursement. The provider shall not demand payment from the insured until after that reimbursement has been granted or denied.
3. Subsection 1 does not apply to any agreement between an insurer and a provider of medical transportation for the direct payment by the insurer for the provider’s services.
(Added to NRS by 1989, 1273)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.049 - Reimbursement for acupuncture.

If any policy of group health insurance provides coverage for acupuncture performed by a physician, the insured is entitled to reimbursement for acupuncture performed by a person who is licensed pursuant to chapter 634A of NRS.
(Added to NRS by 1991, 1134)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.050 - Extended disability benefit.

Any group health policy may provide for payment not exceeding three times the amount of the monthly benefit under the policy as an extended disability benefit upon the insured’s death from any cause. The extended disability benefit must not be construed as life insurance.
(Added to NRS by 1971, 1768; A 1993, 1982)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.060 - Readjustment of premiums; dividends.

1. Any contract of group health insurance may provide for the readjustment of the rate of premium based upon the experience thereunder. If a policy dividend is declared after January 1, 1972, or a reduction in rate is made after January 1, 1972, or continued for the first or any subsequent year of insurance under any policy of group health insurance issued before, on or after January 1, 1972, to any policyholder, the excess, if any, of the aggregate dividends or rate reductions under such a policy and all other group insurance policies of the policyholder over the aggregate expenditure for insurance under such policies made from money contributed by the policyholder, or by an employer of insured persons, or by a union or association to which the insured persons belong, including expenditures made in connection with administration of such policies, must be applied by the policyholder for the sole benefit of insured employees or members.
2. This section does not apply as to debtor groups.
(Added to NRS by 1971, 1768; A 1997, 1627)