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2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.460 - Insurer required to authorize enrollment of child of parent who is required by order to provide medical coverage under certain circumstances; termination of coverage of child.

If a parent is required by an order for medical coverage to provide coverage under a policy of health insurance for a child and the parent is eligible for coverage of members of the family of the parent under a policy of health insurance, the insurer that issued the policy:
1. Shall, if the child is otherwise eligible for that coverage, allow the parent to enroll the child in that coverage without regard to any restrictions upon periods for enrollment.
2. Shall, if:
(a) The child is otherwise eligible for that coverage; and
(b) The parent is enrolled in that coverage but fails to apply for enrollment of the child,
enroll the child in that coverage upon application by the other parent of the child, or by an agency of this or another state responsible for the administration of Medicaid or a state program for the enforcement of child support established pursuant to 42 U.S.C. §§ 651 et seq., without regard to any restrictions upon periods for enrollment.
3. Shall not terminate the enrollment of the child in that coverage or otherwise eliminate that coverage of the child unless the insurer has written proof that:
(a) The order for medical coverage is no longer in effect; or
(b) The child is or will be enrolled in comparable coverage through another insurer on or before the effective date of the termination of enrollment or elimination of coverage.
(Added to NRS by 1995, 2428)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.470 - Definitions.

As used in NRS 689A.470 to 689A.740, inclusive, unless the context otherwise requires, the words and terms defined in NRS 689A.475 to 689A.600, inclusive, have the meanings ascribed to them in those sections.
(Added to NRS by 1997, 2883; A 2001, 1922; 2005, 2136; 2013, 3613; 2017, 2362)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.485 - "Bona fide association" defined.

"Bona fide association" means, with respect to health insurance coverage offered in this state, an association that:
1. Has been actively in existence for at least 5 years;
2. Has been formed and maintained in good faith for purposes other than obtaining insurance;
3. Does not condition membership in the association on any health status-related factor relating to an individual, including an employee of an employer or a dependent of an employee;
4. Makes health insurance coverage offered through the association available to all of its members regardless of any health status-related factors of the members or other individuals who are eligible for such health insurance coverage through a member of the association;
5. Does not make health insurance coverage offered through the association available other than in connection with a member of the association; and
6. Meets such additional requirements as may be imposed by specific statute.
(Added to NRS by 1997, 2883)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.505 - "Creditable coverage" defined.

"Creditable coverage" means, with respect to a person, health benefits or coverage provided 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 45 C.F.R. § 146.113, 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, 2884; A 1999, 2239, 2802)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.530 - "Governmental plan" defined.

"Governmental plan" has the meaning ascribed to it in section 3(32) of the Employee Retirement Income Security Act of 1974, as that section existed on July 16, 1997, and any health plan of the Federal Government.
(Added to NRS by 1997, 2885)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.535 - "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, 2885)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.550 - "Individual carrier" defined.

"Individual carrier" means any entity subject to the provisions of this title and the regulations adopted pursuant thereto, that contracts or offers to contract to provide for, deliver payment for, arrange for payment of, pay for, or reimburse any cost of health care services, including a sickness and accident health service corporation, and any other entity providing a plan of health insurance, health benefits or health services to individuals and their dependents in this state.
(Added to NRS by 1997, 2887)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.555 - "Individual health benefit plan" defined.

"Individual health benefit plan" means:
1. A health benefit plan for individuals and their dependents, other than a converted policy or a plan for coverage of a bona fide association; and
2. A certificate issued to an individual that evidences coverage under a policy or contract issued to a trust or an association or to any other similar group of persons, other than a plan for coverage of a bona fide association, regardless of the situs of delivery of the policy or contract, if the individual pays the premium and is not being covered under the policy or contract pursuant to any provision for the continuation of benefits applicable under federal or state law.
(Added to NRS by 1997, 2887)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.570 - "Plan for coverage of a bona fide association" defined.

"Plan for coverage of a bona fide association" means a health benefit plan for the members, and their dependents, of a bona fide association in this state regardless of the situs of delivery of the policy or contract, if the health benefit plan conforms with NRS 689A.725.
(Added to NRS by 1997, 2888)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.600 - "Provision for a restricted network" defined.

"Provision for a restricted network" means any provision of a health benefit plan that conditions the payment of benefits, in whole or in part, on the use of a provider of health care that has entered into a contractual arrangement with an individual carrier to provide health care services to individuals covered by the plan.
(Added to NRS by 1997, 2888)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.615 - Certain plan, fund or program to be treated as employee welfare benefit plan which is group health plan; partnership deemed employer of each partner.

For the purposes of NRS 689A.470 to 689A.740, inclusive:
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 the 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 subsection 2, as an employee welfare benefit plan which 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, 2889; A 2017, 2362)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.635 - Coverage offered through network plan not required to be offered to person who does not reside or work in geographic service area or geographic rating area.

1. An individual carrier that offers coverage through a network plan is not required pursuant to NRS 689A.630 to offer coverage to or accept an application from a person if the person does not reside or work in the geographic service area or in a geographic rating area, provided that the coverage is refused or terminated uniformly without regard to any health status-related factor of any eligible person.
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 is 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, 2892; A 2013, 3615)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.637 - Coverage offered through plan that provides for restricted network: Contracts with certain federally qualified health centers.

1. An individual carrier that offers a health benefit plan that includes a provision for a restricted network shall use its best efforts to contract with at least one health center in each geographic service area to provide health care services to persons covered by the plan if the health center:
(a) Meets all conditions imposed by the carrier on similarly situated providers of health care with which the carrier contracts, including, without limitation:
(1) Certification for participation in the Medicaid or Medicare program; and
(2) Requirements relating to the appropriate credentials for providers of health care; and
(b) Agrees to reasonable reimbursement rates that are generally consistent with those offered by the carrier to similarly situated providers of health care with which the carrier contracts.
2. As used in this section, "health center" has the meaning ascribed to it in 42 U.S.C. § 254b.
(Added to NRS by 2001, 1922; A 2013, 3615)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.696 - Information and documents required to be made available to Commissioner; proprietary information.

1. An individual carrier shall make the unified rate review template and rate filing documentation used by the individual carrier and any information and documents described in any regulations adopted pursuant to NRS 689A.700 available to the Commissioner upon request. Except in cases of violations of the provisions of this chapter, the unified rate review template and rate filing documentation used by an individual carrier are considered proprietary, constitute a trade secret and are not subject to disclosure by the Commissioner to persons outside of the Division except as agreed to by the individual carrier or as ordered by a court of competent jurisdiction.
2. As used in this section, "rate filing documentation" and "unified rate review template" have the meanings ascribed to them in 45 C.F.R. § 154.215.
(Added to NRS by 2017, 2358)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.700 - Regulations regarding rates.

The Commissioner may adopt regulations to carry out the provisions of this section and to ensure that the practices used by individual carriers relating to the establishment of rates are consistent with the purposes of NRS 689A.470 to 689A.740, inclusive.
(Added to NRS by 1997, 2895; A 2013, 3617; 2015, 3485; 2017, 2364)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.705 - Regulations concerning reissuance of health benefit plan.

The Commissioner may adopt regulations to require an individual carrier, as a condition of transacting business with individuals in this state after July 16, 1997, to reissue a health benefit plan to any individual whose health benefit plan has been terminated or not renewed by the individual carrier after July 1, 1997. The Commissioner may prescribe such terms for the reissue of coverage as the Commissioner finds are reasonable and necessary to provide continuity of coverage to individuals.
(Added to NRS by 1997, 2897)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.710 - Prohibited acts; denial of application for coverage; regulations; violation may constitute unfair trade practice; applicability of section.

1. Except as otherwise provided in this section, an individual carrier or a producer shall not, directly or indirectly:
(a) Encourage or direct an individual or family to refrain from filing an application for coverage with an individual carrier because of the health status, claims experience, industry, occupation or geographic location of the individual or family.
(b) Encourage or direct an individual or family to seek coverage from another carrier because of the health status, claims experience, industry, occupation or geographic location of the individual or family.
2. The provisions of subsection 1 do not apply to information provided to an individual or family by an individual carrier or a producer relating to the geographic service area or a provision for a restricted network of the individual carrier.
3. An individual carrier shall not, directly or indirectly, enter into any contract, agreement or arrangement with a producer if the contract, agreement or arrangement provides for or results in a variation to the compensation paid to a producer for the sale of a health benefit plan because of the health status, claims experience, industry, occupation or geographic location of the individual at the time that the health benefit plan is issued to or renewed by the individual.
4. An individual carrier shall not terminate, fail to renew, or limit its contract or agreement of representation with a producer for any reason related to the health status, claims experience, industry, occupation or geographic location of an individual at the time that the health benefit plan is issued to or renewed by the individual placed by the producer with the individual carrier.
5. A denial by an individual carrier of an application for coverage from an individual or family must be in writing and must state the reason for the denial.
6. The Commissioner may adopt regulations that set forth additional standards to provide for the fair marketing and broad availability of health benefit plans to individuals or families in this state.
7. A violation of any provision of this section by an individual carrier may constitute an unfair trade practice for the purposes of chapter 686A of NRS.
8. The provisions of this section apply to a third-party administrator if the third-party administrator enters into a contract, agreement or other arrangement with an individual carrier to provide administrative, marketing or other services related to the offering of a health benefit plan to individuals or families in this state.
9. Nothing in this section interferes with the right and responsibility of a producer to advise and represent the best interests of an individual or family who is seeking health insurance coverage from an individual carrier.
(Added to NRS by 1997, 2896; A 2013, 3617)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.715 - 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 individual health insurance coverage is provided must comply with the provisions of NRS 679B.139 and 689A.470 to 689A.740, inclusive, 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, 2890; A 2017, 2364)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.720 - Written certification of coverage required for determining period of creditable coverage accumulated by person; provision of certificate to insured.

1. To determine the period of creditable coverage of a person, a health insurance issuer offering individual health insurance coverage shall provide written certification of coverage on a form prescribed by the Commissioner to the person that certifies:
(a) The period of creditable coverage of the person under the individual health insurance coverage; and
(b) The date that a substantially completed application was received by the health insurance issuer from the person for individual health insurance coverage.
2. The certification of coverage must be provided to the insured:
(a) At the time that the insured ceases to be covered under the individual health insurance coverage or otherwise becomes covered under any provision of the Consolidated Omnibus Budget Reconciliation Act of 1985, as that act existed on July 16, 1997, relating to the continuation of coverage;
(b) If the insured becomes covered under such a provision, at the time that the insured ceases to be covered by that provision; and
(c) Upon the request of the insured, if the request is made not later than 24 months after the date on which the insured ceased to be covered as described in paragraphs (a) and (b).
(Added to NRS by 1997, 2897)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.725 - Requirements for plan for coverage.

For the purposes of NRS 689A.470 to 689A.740, inclusive, a plan for coverage of a bona fide association must:
1. Conform with any regulations adopted pursuant to NRS 689A.700 concerning rates.
2. Provide for the renewability of coverage for members of the bona fide association, and their dependents, if such coverage meets the criteria set forth in NRS 689A.630.
(Added to NRS by 1997, 2889; A 2013, 3618; 2015, 3485; 2017, 2364)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.745 - Establishment; approval; requirements; examination; exception.

1. Except as otherwise provided in subsection 4, each insurer that issues a policy of health insurance in this State shall establish a system for resolving any complaints of an insured concerning health care services covered under the policy. The system must be approved by the Commissioner.
2. A system for resolving complaints established pursuant to subsection 1 must include an initial investigation, a review of the complaint by a review board and a procedure for appealing a determination regarding the complaint. The majority of the members on a review board must be insureds who receive health care services pursuant to a policy of health insurance issued by the insurer.
3. The Commissioner may examine the system for resolving complaints established pursuant to subsection 1 at such times as the Commissioner deems necessary or appropriate.
4. Each insurer that issues a policy of health insurance in this State that provides, delivers, arranges for, pays for or reimburses any cost of health care services through managed care shall provide a system for resolving any complaints of an insured concerning those health care services that complies with the provisions of NRS 695G.200 to 695G.310, inclusive.
(Added to NRS by 1997, 307; A 2003, 774; 2011, 3381; 2017, 2365)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.750 - Annual report; insurer required to maintain records of and report complaints concerning something other than health care services.

1. Each insurer that issues a policy of health insurance in this State shall submit to the Commissioner an annual report regarding its system for resolving complaints established pursuant to subsection 1 of NRS 689A.745 on a form prescribed by the Commissioner which includes, without limitation:
(a) A description of the procedures used for resolving any complaints of an insured;
(b) The total number of complaints and appeals handled through the system for resolving complaints since the last report and a compilation of the causes underlying the complaints filed;
(c) The current status of each complaint and appeal filed; and
(d) The average amount of time that was needed to resolve a complaint and an appeal, if any.
2. Each insurer shall maintain records of complaints filed with it which concern something other than health care services and shall submit to the Commissioner a report summarizing such complaints at such times and in such format as the Commissioner may require.
(Added to NRS by 1997, 308; A 2003, 774; 2017, 2365)
2023 Nevada Revised Statutes › Chapter 689A - Individual Health Insurance › NRS 689A.755 - Written notice required to be provided by insurer to insured explaining right to file complaint; written notice to insured required when insurer denies coverage of health care service.

1. Following approval by the Commissioner, each insurer that issues a policy of health insurance in this State shall provide written notice to an insured, in clear and comprehensible language that is understandable to an ordinary layperson, explaining the right of the insured to file a written complaint. Such notice must be provided to an insured:
(a) At the time the insured receives his or her evidence of coverage;
(b) Any time that the insurer denies coverage of a health care service or limits coverage of a health care service to an insured; and
(c) Any other time deemed necessary by the Commissioner.
2. Any time that an insurer denies coverage of a health care service to an insured, including, without limitation, denying a claim relating to a policy of health insurance pursuant to NRS 689A.410, it shall notify the insured in writing within 10 working days after it denies coverage of the health care service of:
(a) The reason for denying coverage of the service;
(b) The criteria by which the insurer determines whether to authorize or deny coverage of the health care service; and
(c) The right of the insured to file a written complaint and the procedure for filing such a complaint.
3. A written notice which is approved by the Commissioner shall be deemed to be in clear and comprehensible language that is understandable to an ordinary layperson.
(Added to NRS by 1997, 308; A 1999, 3082)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.010 - Short title; scope.

1. This chapter may be cited as the Group or Blanket Health Insurance Law.
2. This chapter applies only to group health insurance contracts and to blanket accident and health insurance contracts as provided in this chapter.
(Added to NRS by 1971, 1767; A 2001, 2220)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.015 - Contracts between insurer and provider of health care: Prohibiting insurer from charging provider of health care fee for inclusion on list of providers given to insureds; insurer required to use form to obtain information on provider of health care; modification; submission by insurer of schedule of payments to providers.

1. An insurer that issues a policy of group health insurance 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 insurer to its insureds.
2. An insurer specified in subsection 1 shall not contract with a provider of health care to provide health care to an insured unless the insurer 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 an insurer 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 insurer upon giving to the provider 45 days’ written notice of the modification of the insurer’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 an insurer specified in subsection 1 contracts with a provider of health care to provide health care to an insured, the insurer 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, 2730; 2003, 3357; 2011, 2533)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.020 - "Group health insurance" defined; authority to provide in certain policies for continuation of certain benefit provisions after death of person in insured group; authority of Commissioner to require filing of form of certificate proposed for delivery in this state of policy made under laws of another state.

1. "Group health insurance" is hereby declared to be that form of health insurance covering groups of two or more persons, formed for a purpose other than obtaining insurance.
2. Any group health policy which contains provisions for the payment by the insurer of benefits for expenses incurred on account of hospital, nursing, medical, dental or surgical services, home health care or health supportive services for members of the family or dependents of a person in the insured group may provide for the continuation of such benefit provisions, or any part or parts thereof, after the death of the person in the insured group.
3. The Commissioner may, in the discretion of the Commissioner, require the form of each certificate proposed to be delivered in this state under a group health policy not made under the laws of this state to be filed with the Commissioner by the insurer for informational purposes only.
(Added to NRS by 1971, 1767; A 1971, 1954; 1975, 447)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.026 - Delivery of policy to group formed to purchase health insurance prohibited; exception; applicable provisions for review of marketed insurance products by Commissioner; applicability to policy issued in another state.

1. Except as otherwise provided in this section, no policy of group health insurance may be delivered or issued for delivery in this state to a group which was formed for the purpose of purchasing one or more policies of group health insurance.
2. A policy of group health insurance may be delivered to a group described in subsection 1 if the Commissioner approves the issuance. The Commissioner shall not grant approval unless the Commissioner finds that:
(a) The benefits of the policy are reasonable in relation to the premiums charged;
(b) The group to which the policy is issued is organized and operated in a fiscally sound manner; and
(c) All policy rates and forms are filed with and approved by the Division before marketing to a resident or employer in this State.
3. The Commissioner shall use the provisions of this chapter and chapter 689C of NRS to review insurance products marketed to employers in this State. The Commissioner shall use the provisions of chapter 689A of NRS to review insurance products marketed to natural persons in this State.
4. The provisions of this section apply to the offering in this state of a policy issued in another state.
(Added to NRS by 1985, 1060; A 1995, 1628; 2011, 3381)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0283 - Policy covering prescription drugs: Provision of notice and information regarding use of formulary.

1. An insurer that offers or issues a policy of group health insurance which provides coverage for prescription drugs shall include with any summary, certificate or evidence of that coverage provided to an insured, notice of whether a formulary is used and, if so, of the opportunity to secure information regarding the formulary from the insurer pursuant to subsection 2. The notice required by this subsection must:
(a) Be in a language that is easily understood and in a format that is easy to understand;
(b) Include an explanation of what a formulary is; and
(c) If a formulary is used, include:
(1) An explanation of:
(I) How often the contents of the formulary are reviewed; and
(II) The procedure and criteria for determining which prescription drugs are included in and excluded from the formulary; and
(2) The telephone number of the insurer for making a request for information regarding the formulary pursuant to subsection 2.
2. If an insurer offers or issues a policy of group health insurance which provides coverage for prescription drugs and a formulary is used, the insurer shall:
(a) Provide to any insured or participating provider of health care, upon request:
(1) Information regarding whether a specific drug is included in the formulary.
(2) Access to the most current list of prescription drugs in the formulary, organized by major therapeutic category, with an indication of whether any listed drugs are preferred over other listed drugs. If more than one formulary is maintained, the insurer shall notify the requester that a choice of formulary lists is available.
(b) Notify each person who requests information regarding the formulary, that the inclusion of a drug in the formulary does not guarantee that a provider of health care will prescribe that drug for a particular medical condition.
(Added to NRS by 2001, 857)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0285 - System for resolving complaints of insureds: Establishment; approval; requirements; examination; exception.

1. Except as otherwise provided in subsection 4, each insurer that issues a policy of group health insurance in this State shall establish a system for resolving any complaints of an insured concerning health care services covered under the policy. The system must be approved by the Commissioner.
2. A system for resolving complaints established pursuant to subsection 1 must include an initial investigation, a review of the complaint by a review board and a procedure for appealing a determination regarding the complaint. The majority of the members on a review board must be insureds who receive health care services pursuant to a policy of group health insurance issued by the insurer.
3. The Commissioner may examine the system for resolving complaints established pursuant to subsection 1 at such times as the Commissioner deems necessary or appropriate.
4. Each insurer that issues a policy of group health insurance in this State that provides, delivers, arranges for, pays for or reimburses any cost of health care services through managed care shall provide a system for resolving any complaints of an insured concerning the health care services that complies with the provisions of NRS 695G.200 to 695G.310, inclusive.
(Added to NRS by 1997, 309; A 2003, 775; 2011, 3382; 2017, 2365)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.029 - Annual report regarding system for resolving complaints of insureds; insurer required to maintain records of and report complaints concerning something other than health care services.

1. Each insurer that issues a policy of group health insurance in this State shall submit to the Commissioner an annual report regarding its system for resolving complaints established pursuant to subsection 1 of NRS 689B.0285 on a form prescribed by the Commissioner which includes, without limitation:
(a) A description of the procedures used for resolving any complaints of an insured;
(b) The total number of complaints and appeals handled through the system for resolving complaints since the last report and a compilation of the causes underlying the complaints filed;
(c) The current status of each complaint and appeal filed; and
(d) The average amount of time that was needed to resolve a complaint and an appeal, if any.
2. Each insurer shall maintain records of complaints filed with it which concern something other than health care services and shall submit to the Commissioner a report summarizing such complaints at such times and in such format as the Commissioner may require.
(Added to NRS by 1997, 309; A 2003, 775; 2017, 2366)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0295 - Written notice required to be provided by insurer to insured explaining right to file complaint; written notice to insured required when insurer denies coverage of health care service.

1. Following approval by the Commissioner, each insurer that issues a policy of group health insurance in this State shall provide written notice to an insured, in clear and comprehensible language that is understandable to an ordinary layperson, explaining the right of the insured to file a written complaint. Such notice must be provided to an insured:
(a) At the time the insured receives his or her certificate of coverage or evidence of coverage;
(b) Any time that the insurer denies coverage of a health care service or limits coverage of a health care service to an insured; and
(c) Any other time deemed necessary by the Commissioner.
2. Any time that an insurer denies coverage of a health care service, including, without limitation, denying a claim relating to a policy of group health insurance or blanket insurance pursuant to NRS 689B.255, to an insured it shall notify the insured in writing within 10 working days after it denies coverage of the health care service of:
(a) The reason for denying coverage of the service;
(b) The criteria by which the insurer determines whether to authorize or deny coverage of the health care service; and
(c) The right of the insured to file a written complaint and the procedure for filing such a complaint.
3. A written notice which is approved by the Commissioner shall be deemed to be in clear and comprehensible language that is understandable to an ordinary layperson.
(Added to NRS by 1997, 309; A 1999, 3084)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.030 - Required provisions.

Each group health insurance policy must contain in substance the following provisions:
1. A provision that, in the absence of fraud, all statements made by applicants or the policyholders or by an insured person are representations and not warranties, and that no statement made for the purpose of effecting insurance voids the insurance or reduces its benefits unless the statement is contained in a written instrument signed by the policyholder or the insured person, a copy of which has been furnished to the policyholder or insured person or a beneficiary of the policyholder or insured person.
2. A provision that the insurer will furnish to the policyholder for delivery to each employee or member of the insured group a statement in summary form of the essential features of the insurance coverage of that employee or member and to whom benefits thereunder are payable. If dependents are included in the coverage, only one statement need be issued for each family.
3. A provision that to the group originally insured may be added from time to time eligible new employees or members or dependents, as the case may be, in accordance with the terms of the policy.
4. A provision for benefits for expense arising from care at home or health supportive services if the care or service was prescribed by a physician and would have been covered by the policy if performed in a medical facility or facility for the dependent as defined in chapter 449 of NRS.
5. A provision for benefits for expenses arising from hospice care.
(Added to NRS by 1971, 1767; A 1975, 448, 1850; 1979, 1178; 1983, 1934, 2037; 1985, 1774; 1989, 1032; 2009, 1810)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0303 - Required provision in certain policies concerning coverage for continued medical treatment; exceptions; regulations.

1. The provisions of this section apply to a policy of group health insurance offered or issued by an insurer if an insured covered by the policy receives health care through a defined set of providers of health care who are under contract with the insurer.
2. Except as otherwise provided in this section, if an insured who is covered by a policy described in subsection 1 is receiving medical treatment for a medical condition from a provider of health care whose contract with the insurer is terminated during the course of the medical treatment, the policy must provide that:
(a) The insured may continue to obtain medical treatment for the medical condition from the provider of health care pursuant to this section, if:
(1) The insured is actively undergoing a medically necessary course of treatment; and
(2) The provider of health care and the insured agree that the continuity of care is desirable.
(b) The provider of health care is entitled to receive reimbursement from the insurer for the medical treatment the provider of health care provides to the insured pursuant to this section, if the provider of health care agrees:
(1) To provide medical treatment under the terms of the contract between the provider of health care and the insurer with regard to the insured, including, without limitation, the rates of payment for providing medical service, as those terms existed before the termination of the contract between the provider of health care and the insurer; and
(2) Not to seek payment from the insured for any medical service provided by the provider of health care that the provider of health care could not have received from the insured were the provider of health care still under contract with the insurer.
3. The coverage required by subsection 2 must be provided until the later of:
(a) The 120th day after the date the contract is terminated; or
(b) If the medical condition is pregnancy, the 45th day after:
(1) The date of delivery; or
(2) If the pregnancy does not end in delivery, the date of the end of the pregnancy.
4. The requirements of this section do not apply to a provider of health care if:
(a) The provider of health care was under contract with the insurer and the insurer terminated that contract because of the medical incompetence or professional misconduct of the provider of health care; and
(b) The insurer did not enter into another contract with the provider of health care after the contract was terminated pursuant to paragraph (a).
5. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2003, has the legal effect of including the coverage required by this section, and any provision of the policy or renewal thereof that is in conflict with this section is void.
6. The Commissioner shall adopt regulations to carry out the provisions of this section.
(Added to NRS by 2003, 3356)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0304 - Policy covering prescription drugs: Required actions by insurer related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared.

1. If the Governor or the Legislature proclaims the existence of a state of emergency or issues a declaration of disaster pursuant to NRS 414.070, an insurer who has issued a policy of group health insurance which provides coverage for prescription drugs shall, notwithstanding any provision of the policy to the contrary:
(a) Waive any provision of the policy restricting the time within which an insured may refill a covered prescription if the insured:
(1) Has not exceeded the number of refills authorized by the prescribing practitioner;
(2) Resides in the area for which the emergency or disaster has been declared; and
(3) Requests the refill not later than the end of the state of emergency or disaster or 30 days after the issuance of the proclamation or declaration, whichever is later; and
(b) Authorize payment for, and may apply a copayment, coinsurance or deductible to, a supply of a covered prescription drug for up to 30 days for an insured who 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, 824)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.031 - Required provision concerning coverage of certain gynecological or obstetrical services without authorization or referral from primary care physician.

1. A policy of group health insurance must include a provision authorizing a woman covered by the policy to obtain covered gynecological or obstetrical services without first receiving authorization or a referral from her primary care physician.
2. The provisions of this section do not authorize a woman covered by a policy of group health insurance to designate an obstetrician or gynecologist as her primary care physician.
3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1999, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void.
4. As used in this section, "primary care physician" has the meaning ascribed to it in NRS 695G.060.
(Added to NRS by 1999, 1944)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0314 - Required provision concerning coverage for screening, genetic counseling and testing related to BRCA gene in certain circumstances.

1. An insurer that issues a policy of group health insurance shall provide coverage for screening, genetic counseling and testing for harmful mutations in the BRCA gene for women under circumstances where such screening, genetic counseling or testing, as applicable, is required by NRS 457.301.
2. An insurer shall ensure that the benefits required by subsection 1 are made available to an insured through a provider of health care who participates in the network plan of the insurer.
3. A policy of group health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2022, has the legal effect of including the coverage required by subsection 1, and any provision of the policy that conflicts with the provisions of this section is void.
4. As used in this section:
(a) "Network plan" means a policy of 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.
(b) "Provider of health care" has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 2021, 781)