reglab/statecodes huggingface dataset:
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › SYSTEM FOR RESOLVING COMPLAINTS OF MEMBERS › Section 695D.530 - Annual report: Submission; resolution of oral inquiry

Current through June 11, 2024
1.
					An organization shall submit its annual report regarding its system for
					resolving complaints as required pursuant to NAC 695D.540 on or before June 1
					of each year. The organization shall retain a copy of the annual report for at
					least 3 years or until the next examination conducted by the Division,
					whichever is longer.
2. The
					organization is not required to include in the annual report information
					concerning an oral inquiry by a member relating to a misunderstanding or
					miscommunication if the misunderstanding or miscommunication was resolved
					within 1 working day after the inquiry was made. If the misunderstanding or
					miscommunication was not resolved within 1 working day, the organization shall
					report it as a complaint in the annual report.
Added to NAC by Comm'r of
						Insurance by R132-98, eff. 3-30-99; A by R008-02,
						5-23-2002
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › SYSTEM FOR RESOLVING COMPLAINTS OF MEMBERS › Section 695D.540 - Annual report: Content; maintenance of records

Current through June 11, 2024
1.
					Each organization that issues a policy in this State shall submit to the
					Commissioner and the State Board of Health an annual report regarding its
					system for resolving complaints established pursuant to NAC 695D.500 on a form
					prescribed by the Commissioner in consultation with the State Board of Health
					which includes, without limitation:
(a) A
					description of the procedures used for resolving any complaints of a
					member;
(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.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › GENERAL PROVISIONS › Section 695F.010 - Definitions

Current through June 11, 2024
As used in this chapter, unless the context otherwise requires,
				the words and terms defined in
				NRS
				695F.020 to
				695F.070,
				inclusive, and NAC 695F.020 to 695F.050, inclusive, have the meanings ascribed
				to them in those sections.
Added to NAC by Comm'r of
				Insurance, eff. 2-3-97
NRS
				  679B.130,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › GENERAL PROVISIONS › Section 695F.030 - "Division" defined

Current through June 11, 2024
"Division" means the Division of Insurance of the Department of
				Business and Industry.
Added to NAC by Comm'r of
				Insurance, eff. 2-3-97
NRS
				  679B.130,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › GENERAL PROVISIONS › Section 695F.040 - "Limited health service plan" defined

Current through June 11, 2024
"Limited health service plan" means any arrangement whereby an
				organization agrees to provide or arrange for the provision of one or more
				limited health services to enrollees.
Added to NAC by Comm'r of
				Insurance, eff. 2-3-97
NRS
				  679B.130,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › CERTIFICATE OF AUTHORITY › Section 695F.100 - Application: Contents; certification of financial statements

Current through June 11, 2024
1. In addition to the documents required by
			 NRS
			 695F.110, an application for a certificate of
			 authority to operate an organization must include:
(a) All documents describing the financing
			 and ownership of the organization, including financial statements and copies of
			 any contracts made or to be made between the organization and any:
(1) Member of the governing board or
			 committee of the organization;
(2)
			 Corporate officers of the organization, if the organization is a
			 corporation;
(3) Partners of the
			 organization, if the organization is a partnership; and
(4) Providers associated or to be associated
			 with the organization, regarding the provision of a limited health service to
			 enrollees.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › CERTIFICATE OF AUTHORITY › Section 695F.110 - Application: Proposed plan of operation

Current through June 11, 2024
The proposed plan of operation required by NAC 695F.100 must
				include:
1. A projection of income and
			 expected costs allocated to:
(a) Services
			 rendered outside of the organization's specified geographic area of
			 service;
(b) Per capita payments to
			 providers pursuant to NAC 695F.310;
(c) Other fees to providers;
(d) A contract of stop loss insurance
			 pursuant to NAC 695F.210;
(e)
			 Expenses of administration; and
(f)
			 Amortization of necessary costs for the establishment of the
			 organization.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › CERTIFICATE OF AUTHORITY › Section 695F.120 - Application: Submission; incomplete application deemed withdrawn

Current through June 11, 2024
1. A person applying for a certificate of
			 authority to operate an organization must file an application as follows:
(a) An original and two copies of the
			 application must be submitted in binders having three rings.
(b) If a new page is submitted to supplement
			 or amend the application, the date of submission must be noted on the bottom of
			 the page, and the page must be prepared so it can be placed in the binder with
			 the other materials.
(c) Each
			 binder must contain a table of contents and include dividers which separate the
			 various sections of the application and indicate the subject in each
			 section.
(d) One binder must
			 contain the original application, the original of the completed forms supplied
			 by the Division and the original or a certified copy of any supporting
			 documents.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › CERTIFICATE OF AUTHORITY › Section 695F.130 - Application: Public inspection; notice of pending application or hearing

Current through June 11, 2024
1. Any person wishing to review an
			 application for issuance of a certificate of authority for an organization
			 shall submit a request to the Commissioner in writing. A copy of the
			 application may be reviewed at or, at the expense of the person making the
			 request, obtained from the offices of the Commissioner at 1818 East College
			 Parkway, Suite 103, Carson City, Nevada 89706.
2. If any person wishes to be notified of a
			 pending application or hearing concerning the denial of such a certificate of
			 authority, the person must request in writing that he or she be placed on a
			 list maintained by the Division for that purpose.
Added to NAC by Comm'r of
				Insurance, eff. 2-3-97; A by R250-03, 11-12-2004
NRS
				  679B.130,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › CERTIFICATE OF AUTHORITY › Section 695F.140 - Licensure in another state: Application for this State; copy of license; notice of disciplinary action

Current through June 11, 2024
1. Any applicant
			 for a certificate of authority to operate an organization in this State who is
			 licensed to operate an organization in another state or whose affiliate or
			 subsidiary is so licensed must include in its application a copy of that
			 license and, if available, a certificate of good standing from that state's
			 agency which regulates organizations.
2. An organization authorized to operate in
			 this State which obtains a license as an organization in another state or whose
			 affiliate or subsidiary obtains such a license shall furnish a copy of that
			 license to the Commissioner on the first day of each quarter of each calendar
			 year or at such other times as the Commissioner requests.
3. An organization also licensed in another
			 state shall notify the Commissioner of any disciplinary action taken by that
			 state against the organization and file copies of all documents relating to
			 that action with the Commissioner within 30 days after receipt of the documents
			 by the organization.
Added to NAC by Comm'r of
				Insurance, eff. 2-3-97
NRS
				  679B.130,
				  695F.110,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › CERTIFICATE OF AUTHORITY › Section 695F.150 - Licensure in another state: Contract with providers in contiguous state; approval of plan of operation

Current through June 11, 2024
1. An organization
			 holding a certificate of authority in this State which is licensed in a
			 contiguous state shall, before the organization contracts with providers in the
			 contiguous state for services for enrollees in this State, submit to the
			 Commissioner and obtain his or her approval of two copies of:
(a) The organization's plan for operation in
			 that state;
(b) A copy of the
			 evidence of coverage to be issued, if it has not been previously filed with the
			 Commissioner;
(c) Its lists of
			 providers and agreements with the providers; and
(d) Any other materials concerning the
			 administration of the plan necessary for the Commissioner's decision concerning
			 it.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › CERTIFICATE OF AUTHORITY › Section 695F.160 - Surety bond

Current through June 11, 2024
The surety bond required by
				NRS
				695F.200 must contain a provision which
				prohibits cancellation of the bond unless the Commissioner receives at least 90
				days' prior written notice of the cancellation.
Added to NAC by Comm'r of
				Insurance, eff. 2-3-97
NRS
				  679B.130,
				  695F.200,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › CERTIFICATE OF AUTHORITY › Section 695F.170 - Hearings and administrative proceedings

Current through June 11, 2024
1. Any person not
			 entitled to a hearing pursuant to
			 NRS
			 695F.140 or
			 695F.350
			 who is aggrieved by an action of the Commissioner in his or her approval,
			 denial or revocation of a certificate of authority for an organization may
			 request a hearing as provided in
			 NRS
			 679B.310.
2. Except as otherwise provided in subsection
			 3, any administrative proceeding held under this chapter or chapter 695F of NRS
			 must be held as provided in chapter 233B of NRS and NAC 679B.161 to 679B.480,
			 inclusive.
3. Any administrative
			 proceeding held under
			 NRS
			 695F.140 must be held as provided in chapter
			 233B of NRS and NAC 679B.161 to 679B.480, inclusive, to the extent that those
			 provisions are consistent with
			 NRS
			 679B.310 to
			 679B.370,
			 inclusive.
Added to NAC by Comm'r of
				Insurance, eff. 2-3-97
NRS
				  679B.130,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › FINANCIAL REQUIREMENTS; INSURANCE; ADVERTISING › Section 695F.200 - Reserves

Current through June 11, 2024
1. An organization shall:
(a) Maintain the reserve required to be set
			 aside pursuant to subsection 1 of
			 NRS
			 695F.190. The reserve must be:
(1) Based on the premiums collected for the
			 immediately preceding calendar year, as reported on the annual report of the
			 organization filed with the Commissioner; and
(2) Designated as a "write-in liability" on
			 each report of the organization filed with the Commissioner.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › FINANCIAL REQUIREMENTS; INSURANCE; ADVERTISING › Section 695F.205 - Capital account

Current through June 11, 2024
Each organization shall maintain a capital account with a net
				worth in an amount which is the greater of:
1. The amount required pursuant to
			 NRS
			 695F.200; or
2. The amount of risk-based capital
			 determined in the manner set forth in
			 NRS
			 681B.290 and the regulations adopted pursuant
			 thereto.
Added to NAC by Comm'r of
				Insurance by R005-03, eff. 2-12-2004
NRS
				  679B.130,
				  695F.200,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › FINANCIAL REQUIREMENTS; INSURANCE; ADVERTISING › Section 695F.210 - Requirements for insurance

Current through June 11, 2024
1. Except as
			 otherwise provided in subsections 2 and 5, each organization shall obtain a
			 contract of insurance for the cost of providing limited health services which
			 exceed in the aggregate, for an organization that has a free surplus of:
(a) Not more than $1,000,000, $30,000 per
			 enrollee per year.
(b) More than
			 $1,000,000 but not more than $2,000,000, $50,000 per enrollee per
			 year.
(c) More than $2,000,000,
			 $100,000 per enrollee per year.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › FINANCIAL REQUIREMENTS; INSURANCE; ADVERTISING › Section 695F.220 - Advertising and solicitation

Current through June 11, 2024
1. An organization
			 which advertises its benefits must, in that same advertisement, plainly state
			 the exclusions or limitations of its limited health service plan.
2. Any period of waiting required before an
			 enrollee is eligible to receive benefits under a limited health service plan
			 must be stated clearly in boldface type in any advertisement.
3. An organization shall not solicit persons
			 door to door.
4. Any printed
			 advertisement used by an organization must refer to the limited health service
			 plan being sold by the number used to file that plan with the
			 Commissioner.
5. Advertisements by
			 organizations must comply with the provisions of NAC 689A.010 to 689A.270,
			 inclusive.
Added to NAC by Comm'r of
				Insurance, eff. 2-3-97
NRS
				  679B.130,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › SERVICES AND BENEFITS › Section 695F.250 - Geographic area of service: Definition

Current through June 11, 2024
An organization shall clearly define the geographic area it
				intends to serve, which:
1. In a
			 county having a population of 30,000 or more, must have a radius of not more
			 than 25 miles between the subscriber or individual enrollee and the providers
			 used by the organization, unless the organization demonstrates to the
			 satisfaction of the Commissioner that the standards of that community differ
			 from the requirements of this subsection.
2. In any other county, must be defined by
			 the organization under a plan of operation for the provision of limited health
			 service which is approved in writing by the Commissioner. The plan of operation
			 must:
(a) Demonstrate the availability and
			 accessibility of services to the organization's enrollees, including reasonable
			 access to providers and to medically necessary services or services in an
			 emergency;
(b) Include a statement
			 concerning the standards within that community regarding the availability and
			 accessibility of other limited health services; and
(c) Demonstrate that the organization will
			 meet the standards of that community for limited health services.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › SERVICES AND BENEFITS › Section 695F.260 - Geographic area of service: Expansion

Current through June 11, 2024
1. An organization
			 that wishes to expand its geographic area of service from that stated in its
			 application for a certificate of authority must submit to the Commissioner:
(a) A copy of a written description of the
			 area it proposes to serve;
(b) A
			 list of the providers who will offer a limited health service to the
			 organization's enrollees in that area;
(c) A copy of the contract with those
			 providers;
(d) A statement
			 describing the effect of the expansion on the operation of the
			 organization;
(e) Certification
			 that the organization is financially able to expand;
(f) A statement describing the method of
			 marketing and the projected number of enrollees from the new area;
(g) Proof that the organization has notified
			 its insurers for its contracts of surety, fidelity and stop loss insurance of
			 the proposed changes;
(h) Any other
			 information requested by the Commissioner; and
(i) The fee for filing a material change or
			 addition of a limited health service.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › PROVIDERS OF LIMITED HEALTH SERVICE › Section 695F.300 - Requirements for agreement between provider and organization

Current through June 11, 2024
Each agreement between a provider and an organization
				must:
1. Adequately and completely
			 describe the responsibilities of the provider and organization under the
			 agreement.
2. Specify that the
			 provider releases the enrollee from liability for the cost of services rendered
			 pursuant to the organization's limited health service plan except for any
			 nominal payment made by the enrollee or for a service not covered under the
			 evidence of coverage.
3. Be
			 effective for not less than 1 year, subject to any right of termination stated
			 in the agreement.
4. Require the
			 provider to participate in a program to ensure the quality of health care
			 provided to enrollees by the organization through its providers.
5. Require the provider to provide all
			 medically necessary services within the scope of his or her license required by
			 the evidence of coverage and the agreement to each enrollee for the period for
			 which a premium has been paid to the organization.
6. Require the provider to give evidence of a
			 contract of insurance against loss resulting from injuries resulting to third
			 persons from the practice of his or her profession or a reasonable substitute
			 for it as determined by the organization. The organization may require the
			 provider to indemnify the organization for any liability resulting from the
			 limited health services rendered by the provider.
7. Require a provider to transfer or
			 otherwise arrange for the maintenance of the records of enrollees who are his
			 or her patients if the provider leaves the panel of providers associated with
			 the organization.
Added to NAC by Comm'r of
				Insurance, eff. 2-3-97
NRS
				  679B.130,
				  695F.220,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › PROVIDERS OF LIMITED HEALTH SERVICE › Section 695F.310 - Per capita payments

Current through June 11, 2024
1. An agreement
			 between a provider and an organization for the provision of a limited health
			 service to enrollees on a prepayment basis may provide for per capita payments
			 if the payments are:
(a) Paid in advance
			 without regard to the time services are rendered or the extent of those
			 services; and
(b) Based upon an
			 actuarial computation of the expected cost of those services.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › PROVIDERS OF LIMITED HEALTH SERVICE › Section 695F.320 - List of providers: Submission; changes; excessive reduction

Current through June 11, 2024
1. An applicant for a certificate of
			 authority to operate an organization shall:
(a) Submit a list of the providers in its
			 limited health service plan and a description of the type of providers based
			 upon a projected number of enrollees;
(b) Sufficiently describe its list of
			 providers to demonstrate the accessibility and availability of a limited health
			 service to its enrollees; and
(c)
			 Describe a plan for increasing the number of providers based upon increased
			 enrollment.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › PROVIDERS OF LIMITED HEALTH SERVICE › Section 695F.330 - Restriction of choice of provider

Current through June 11, 2024
An organization may restrict the enrollee's or subscriber's
				choice of a provider to those providers in a preselected group specified in its
				evidence of coverage or in a list or addendum to that evidence of
				coverage.
Added to NAC by Comm'r of
				Insurance, eff. 2-3-97
NRS
				  679B.130,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › PROVIDERS OF LIMITED HEALTH SERVICE › Section 695F.340 - Copayments

Current through June 11, 2024
1. An organization may establish schedules
			 for nominal copayments to be made by an enrollee to a provider. Each schedule
			 of copayments must be given to the enrollee and submitted to the Commissioner
			 for approval.
2. A copayment may be
			 not more than 20 percent of the total cost of providing the limited health
			 service described in the evidence of coverage, unless the Commissioner approves
			 a greater amount based upon the type of limited health service offered by the
			 organization and the dollar amount of the benefits provided. The amount of each
			 copayment must be stated in dollars and must not be expressed as a percentage
			 of the cost of the service or item supplied.
3. With each filing of a schedule of
			 copayments, the organization shall submit a:
(a) Certificate, signed by an officer of the
			 organization, stating that the schedule meets the requirements of this section;
			 and
(b) Copy of the calculations
			 demonstrating that the schedule meets those requirements.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › ADMINISTRATION OF ORGANIZATION › Section 695F.400 - Approval of contract for marketing, enrollment, administration or health care; effect of agreement; licensing of third party

Current through June 11, 2024
1. An
			 organization that enters into a contract with a third party to provide services
			 for marketing, enrollment, administration or health care shall submit a copy of
			 the contract to the Commissioner for his or her review and approval.
2. The Commissioner will consider such a
			 contract to be an agreement by the third party contracting with the
			 organization to:
(a) Submit to the
			 jurisdiction of the Commissioner for his or her review of the contract;
			 and
(b) Authorize the Commissioner
			 to examine that person concerning his or her duties under the contract to the
			 organization and the payment and handling of money pursuant to the
			 contract.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › ADMINISTRATION OF ORGANIZATION › Section 695F.430 - Segregation and separate treatment of records

Current through June 11, 2024
The records of an organization holding a certificate of
				authority in this State must be segregated from the records of any subsidiary
				or related corporation and treated as separate corporate documents.
Added to NAC by Comm'r of
				Insurance, eff. 2-3-97
NRS
				  679B.130,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › ADMINISTRATION OF ORGANIZATION › Section 695F.440 - Retention of minutes and of materials used for marketing or advertising

Current through June 11, 2024
An organization shall retain:
1. Indefinitely, by microfilm or any other
			 means, the minutes of the meetings of its governing body and any advisory panel
			 on enrollees' satisfaction.
2. For
			 3 years or until the next examination of the organization conducted by the
			 Commissioner, a copy of all:
(a) Published
			 material used to market the organization; and
(b) Scripts used for advertising on radio or
			 television.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › ADMINISTRATION OF ORGANIZATION › Section 695F.450 - Annual report (Repealed)

Current through June 11, 2024
Added to NAC by Comm'r of
				Insurance, eff. 2-3-97; R by
				R089-17AP,
				eff. 5/16/2018
NRS 679B.130
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › ADMINISTRATION OF ORGANIZATION › Section 695F.455 - Filing of reports and financial statements

Current through June 11, 2024
1. As a
			 condition of doing business in this State, each organization must file with the
			 Commissioner an annual report required by
			 NRS
			 695F.320 that:
(a) Conforms to the format prescribed by the
			 National Association of Insurance Commissioners in the Annual
and
			 Quarterly
Statement Instructions for Health and the Accounting
			 Practices and Procedures Manual, which have been adopted by reference in NAC
			 679B.033;
(b) Contains exhibits and schedules that
			 follow the specifications developed by the National Association of Insurance
			 Commissioners; and
(c) Contains any
			 other information relating to the organization required by the
			 Commissioner.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › ADMINISTRATION OF ORGANIZATION › Section 695F.460 - Filing of notice for modification of rates, charges, benefits, organization, operations, documents or services

Current through June 11, 2024
An organization shall file the notice required by
				NRS
				695F.170 at least 30 days before it desires a
				change in its charges to become effective. The notice must be accompanied
				by:
1. The loss experience or factor
			 for modification, which must be clearly defined and supported by documents
			 maintained as a part of the organization's records.
2. Certification by a qualified actuary, with
			 adequate supporting documentation, that the proposed charges are not excessive,
			 inadequate or unfairly discriminatory.
Added to NAC by Comm'r of
				Insurance, eff. 2-3-97
NRS
				  679B.130,
				  695F.170,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › ADMINISTRATION OF ORGANIZATION › Section 695F.470 - Summary of coverage: Filing, contents and delivery of disclosure

Current through June 11, 2024
1. An organization shall file with the
			 Commissioner, for his or her approval, a disclosure summarizing the coverage
			 provided by a limited health service plan offered by the
			 organization.
2. The disclosure
			 must:
(a) Be in at least 10-point
			 type;
(b) Include the name, address
			 and telephone number of the organization;
(c) Include the name, address and telephone
			 number of the agent, broker and administrator, if applicable;
(d) Include a statement describing the
			 principal benefits and the type of coverage being provided;
(e) Include a description of any provision of
			 the plan which significantly excludes, eliminates, reduces or in any other
			 manner operates to limit the payment of the benefits;
(f) Include a statement concerning the
			 renewal provisions of the plan; and
(g) Define the term "usual and customary" or
			 any similar term used in the plan.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › ADMINISTRATION OF ORGANIZATION › Section 695F.480 - Evidence of coverage: Requirements

Current through June 11, 2024
Any evidence of coverage issued by an organization:
1. Must, in addition to the requirements of
			 NRS
			 695F.150, contain a clear and complete
			 statement of any benefits other than a limited health service to which an
			 enrollee is entitled.
2. Must not
			 contain any provision authorizing:
(a)
			 Subrogation; or
(b) The
			 coordination of payment of any benefits with any other plan of health insurance
			 or plan for the provision of health care offered by an employer to the same
			 subscribers or enrollees as those covered by the organization.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › ADMINISTRATION OF ORGANIZATION › Section 695F.490 - Evidence of coverage: Submission of actuarial memorandum

Current through June 11, 2024
An organization shall, when it files with the Commissioner any
				evidence of coverage or notice of a material change in any evidence of
				coverage, submit to the Commissioner an actuarial memorandum which
				demonstrates:
1. The development of
			 rates; and
2. The reasonableness of
			 benefits in relation to the premiums charged.
Added to NAC by Comm'r of
				Insurance, eff. 2-3-97
NRS
				  679B.130,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › EMPLOYEE ASSISTANCE PROGRAM › Section 695F.500 - Exemption under certain circumstances of program for abuse of alcohol or other substances

Current through June 11, 2024
For the purposes of
				NRS
				695F.040, "limited health service" does not
				include a program which, pursuant to a contract with an employer or labor
				union, provides for consultations with employees or the members of employees'
				families to identify problems regarding their physical or mental health or the
				abuse of alcohol or other substances, and for the referral of those persons to
				providers of health care or other resources in the community for counseling,
				therapy or treatment, if:
1. The
			 purpose of the contract, as it relates to the provision of those services, is
			 to maintain or improve the efficiency of employees by assisting in the
			 alleviation of personal problems affecting their performance.
2. The contract does not authorize the
			 provision of counseling, therapy or treatment for problems regarding physical
			 or mental health or the abuse of alcohol or other substances.
3. The contract does not require any
			 employee, member of an employee's family or other person eligible for services
			 under the contract to pay, directly or indirectly, any prepaid or periodic
			 charge, copayment or other fee for any services under the contract for the
			 alleviation of problems regarding physical or mental health or the abuse of
			 alcohol or other substances, unless such a payment is:
(a) Part of the regular union dues of an
			 employee; or
(b) A benefit provided
			 by an employer on behalf of an employee and members of the employee's family,
			 which does not affect the amount of compensation or other benefits to which the
			 employee is entitled.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › EMPLOYEE ASSISTANCE PROGRAM › Section 695F.510 - Burden of proof to claim exemption

Current through June 11, 2024
The operator of a program described in NAC 695F.500 has the
				burden of proving that the program meets the requirements of that section for
				exemption from chapter 695F of NRS. This burden of proof may be met by
				providing the Commissioner with a claim of exemption in substantially the
				following form:
COMMISSIONER OF INSURANCE
DEPARTMENT OF BUSINESS AND INDUSTRY
STATE OF NEVADA
CLAIM OF EXEMPTION FOR EMPLOYEE ASSISTANCE PROGRAM
( ) Original claim ( ) Amendment to claim
				dated:.............................................
1. Legal name of the person filing this
			 claim:
			 .............................................................................
2. Address of the principal office of the
			 program and, if different, the mailing address of the program:
3. Fictitious names used in connection with
			 the operation of the program (if none, so state): ...
4. Name, title, address and telephone number
			 of a representative of the program who may be contacted regarding this claim:
			 ..........................................................................................................................................
The undersigned hereby declares that the employee assistance
				program specified in this claim meets the requirements of NAC 695F.500 and is
				exempt from chapter 695F of NRS. The undersigned agrees to amend this claim
				within 30 calendar days after the occurrence of any material change in the
				information specified in this claim.
Date of claim:
				...............................................................................................................................
Name of person filing claim:
				........................................................................................................
Signature of authorized officer of program:
				................................................................................
Printed name and title of authorized officer:
				...............................................................................
Verification:..................................................................................................................................
I hereby certify or declare under penalty of perjury under the
				laws of the State of Nevada that I have read this claim and any attachments
				thereto and know the contents thereof and that the statements therein are true
				and correct.
Executed at (city and state)
				........................................ on the ......... day of the month of
				....... of the year .
...................................................................................
(Signature)
Added to NAC by Comm'r of
				Insurance, eff. 2-3-97
NRS
				  679B.130,
				  695F.040,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › SYSTEM FOR RESOLVING COMPLAINTS OF ENROLLEES › Section 695F.600 - Establishment; scope; examination of system

Current through June 11, 2024
1. Each
			 organization that issues an evidence of coverage in this State shall establish
			 with the approval of the Commissioner a system for resolving any complaints of
			 an enrollee concerning limited health services covered under the evidence of
			 coverage. In determining whether to approve a system for resolving complaints,
			 the Commissioner will consult with the State Board of Health.
2. A system for resolving complaints 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
			 enrollees who receive limited health services pursuant to an evidence of
			 coverage issued by the organization.
3. Each organization shall allow the
			 Commissioner or the State Board of Health to examine the system for resolving
			 complaints established pursuant to this section at such times as either deems
			 necessary or appropriate.
Added to NAC by Comm'r of
				Insurance by R132-98, eff. 3-30-99
NRS
				  679B.130,
				  695F.230,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › SYSTEM FOR RESOLVING COMPLAINTS OF ENROLLEES › Section 695F.610 - Requirements for approval

Current through June 11, 2024
To obtain approval of a system for resolving complaints of
				enrollees concerning limited health services covered by an organization from
				the Commissioner as required pursuant to NAC 695F.600, an organization
				must:
1. Demonstrate that the system
			 will resolve oral and written complaints concerning:
(a) Payment or reimbursement for covered
			 limited health services;
(b) The
			 availability, delivery or quality of covered limited health services,
			 including, without limitation, adverse determinations made pursuant to
			 utilization review; and
(c) The
			 terms and conditions of the evidences of coverage of enrollees.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › SYSTEM FOR RESOLVING COMPLAINTS OF ENROLLEES › Section 695F.620 - Notices: Right of member to file complaint; denial of coverage; clear and comprehensive language

Current through June 11, 2024
1. After approval
			 by the Commissioner, each organization that issues an evidence of coverage in
			 this State shall provide a written notice to an enrollee, in clear and
			 comprehensible language that is understandable to an ordinary layperson,
			 explaining the right of the enrollee to file a written complaint. Such a notice
			 must be provided to an enrollee:
(a) At the
			 time he or she receives the evidence of coverage;
(b) Any time that the organization denies
			 coverage of a limited health service or limits coverage of a limited health
			 service to an enrollee; and
(c) Any
			 other time deemed necessary by the Commissioner.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › SYSTEM FOR RESOLVING COMPLAINTS OF ENROLLEES › Section 695F.630 - Annual report: Content; maintenance of records

Current through June 11, 2024
1.
			 Each organization that issues an evidence of coverage in this State shall
			 submit to the Commissioner and the State Board of Health an annual report
			 regarding its system for resolving complaints established pursuant to NAC
			 695F.600 on a form prescribed by the Commissioner in consultation with the
			 State Board of Health which includes, without limitation:
(a) A description of the procedures used for
			 resolving any complaints of an enrollee;
(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.
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › SYSTEM FOR RESOLVING COMPLAINTS OF ENROLLEES › Section 695F.640 - Annual report: Submission; resolution of oral inquiry

Current through June 11, 2024
1.
			 An organization shall submit its annual report regarding its system for
			 resolving complaints as required pursuant to NAC 695F.630 on or before June 1
			 of each year. The organization shall retain a copy of the annual report for at
			 least 3 years or until the next examination conducted by the Division,
			 whichever is longer.
2. The
			 organization is not required to include in the annual report information
			 concerning an oral inquiry by an enrollee relating to a misunderstanding or
			 miscommunication if the misunderstanding or miscommunication was resolved
			 within 1 working day after the inquiry was made. If the misunderstanding or
			 miscommunication was not resolved within 1 working day, the organization shall
			 report it as a complaint in the annual report.
Added to NAC by Comm'r of
				Insurance by R132-98, eff. 3-30-99; A by R008-02,
				5-23-2002
NRS
				  679B.130,
				  695F.230,
				  695F.300
Nevada Administrative Code › Chapter 695F - Prepaid Limited Health Services › SYSTEM FOR RESOLVING COMPLAINTS OF ENROLLEES › Section 695F.650 - Records of complaints: Maintenance; submission of summary; copies

Current through June 11, 2024
An organization shall:
1. Maintain records of complaints filed with
			 it regarding subjects other than the performance of a limited health
			 service;
2. Submit to the
			 Commissioner a summary of those records at such times and in such a format as
			 the Commissioner requests; and
3.
			 If such a complaint is against a person other than the organization, forward a
			 copy of the complaint to the Commissioner and that person.
Added to NAC by Comm'r of
				Insurance, eff. 2-3-97-Substituted in revision for NAC
				695F.420
NRS
				  679B.130,
				  695F.230,
				  695F.300
Nevada Administrative Code › Chapter 695G - Managed Care › GENERAL PROVISIONS › Section 695G.010 - Definitions

Current through June 11, 2024
As used in this chapter, unless the context otherwise requires, the words and terms defined in NAC 695G.020, 695G.030 and 695G.040 have the meanings ascribed to them in those sections.
Added to NAC by Comm'r of Insurance by R132-98, eff. 3-30-99
NRS 679B.130
Nevada Administrative Code › Chapter 695G - Managed Care › GENERAL PROVISIONS › Section 695G.040 - "Managed care organization" defined

Current through June 11, 2024
"Managed care organization" has the meaning ascribed to it in NRS 695G.050.
Added to NAC by Comm'r of Insurance by R132-98, eff. 3-30-99
NRS 679B.130
Nevada Administrative Code › Chapter 695G - Managed Care › GENERAL PROVISIONS › Section 695G.Sec. 7 - NEW

Current through June 11, 2024
1. A managed care organization that
			 issues a health care plan shall not require an insured to pay a
			 higher deductible or any copayment, coinsurance or other form of
			 cost-sharing for or use any medical management technique to restrict
			 access by an insured to:
(a) A visit
			 to the office of a provider of health care, an urgent care center, an
			 independent center for emergency medical care, the emergency room of
			 a hospital or a COVID-19 screening or testing site, if the purpose of
			 the visit is to determine whether the insured has COVID-19;
(b) A test to determine whether the
			 insured has COVID-19 if the attending provider of health care
			 determines, in accordance with generally accepted medical standards,
			 that the test is appropriate; or
(c) A vaccine to prevent the
			 insured from contracting COVID-19.
Nevada Administrative Code › Chapter 695G - Managed Care › SYSTEM FOR RESOLVING COMPLAINTS OF INSUREDS › Section 695G.100 - Requirements for approval

Current through June 11, 2024
To obtain approval of a system for resolving complaints of insureds from the Commissioner as required pursuant to NRS 695G.200, a managed care organization must:
1. Demonstrate that the system will include the external review of a final adverse determination.
2. Submit to the Division:
(a) The name and title of the employee responsible for the system;
(b) A description of the procedure used to notify an insured of the decision regarding his complaint; and
(c) A copy of the explanation of rights and procedures which is to be provided to insureds pursuant to NRS 695G.230.
Nevada Administrative Code › Chapter 695G - Managed Care › SYSTEM FOR RESOLVING COMPLAINTS OF INSUREDS › Section 695G.110 - Annual report

Current through June 11, 2024
1. A managed care organization shall submit its annual report regarding its system for resolving complaints as required pursuant to NRS 695G.220 on or before June 1 of each year. The managed care organization shall retain a copy of the annual report for at least 3 years or until the next examination conducted by the Division, whichever is longer.
2. The managed care organization is not required to include in the annual report information concerning an oral inquiry by an insured relating to a misunderstanding or miscommunication if the misunderstanding or miscommunication was resolved within 1 working day after the inquiry was made. If the misunderstanding or miscommunication was not resolved within 1 working day, the managed care organization shall report it as a complaint in the annual report.
Added to NAC by Comm'r of Insurance by R132-98, eff. 3-30-99; A by R008-02, 5-23-2002
NRS 679B.130, 695G.220
Nevada Administrative Code › Chapter 695H - Medical Discount Plans › GENERAL PROVISIONS › Section 695H.010 - Definitions

Current through June 11, 2024
As used in this chapter, unless the context otherwise requires, the words and terms defined in NAC 695H.020 to 695H.060, inclusive, have the meanings ascribed to them in those sections.
Added to NAC by Comm'r of Insurance by R133-05, eff. 10-31-2005
NRS 679B.130, 695H.160
Nevada Administrative Code › Chapter 695H - Medical Discount Plans › GENERAL PROVISIONS › Section 695H.030 - "Affiliate of an insurer" defined

Current through June 11, 2024
"Affiliate of an insurer" has the meaning ascribed to it in NRS.
Added to NAC by Comm'r of Insurance by R133-05, eff. 10-31-2005
NRS 679B.130, 695H.160
Nevada Administrative Code › Chapter 695H - Medical Discount Plans › GENERAL PROVISIONS › Section 695H.050 - "Insurer" defined

Current through June 11, 2024
"Insurer" has the meaning ascribed to it in NRS 695H.040.
Added to NAC by Comm'r of Insurance by R133-05, eff. 10-31-2005
NRS 679B.130, 695H.160
Nevada Administrative Code › Chapter 695H - Medical Discount Plans › GENERAL PROVISIONS › Section 695H.060 - "Medical discount plan" defined

Current through June 11, 2024
"Medical discount plan" has the meaning ascribed to it in NRS 695H.050.
Added to NAC by Comm'r of Insurance by R133-05, eff. 10-31-2005
NRS 679B.130, 695H.160
Nevada Administrative Code › Chapter 695H - Medical Discount Plans › APPLICATION FOR REGISTRATION › Section 695H.100 - Fee and documentation required

Current through June 11, 2024
Except as otherwise provided in NAC 695H.110 and 695H.120, an application for registration to engage in business as a medical discount plan must be accompanied by any fee and documentation required pursuant to subsection 1 of NRS 695H.090.
Added to NAC by Comm'r of Insurance by R133-05, eff. 10-31-2005
NRS 679B.130, 695H.090, 695H.160
Nevada Administrative Code › Chapter 695H - Medical Discount Plans › APPLICATION FOR REGISTRATION › Section 695H.110 - Administrator, insurer or affiliate of insurer: Satisfaction of requirements for organizational documents and financial statements

Current through June 11, 2024
An administrator, insurer or affiliate of an insurer shall be deemed to have satisfied the requirements of paragraph (b) or (f) of subsection 1 of NRS 695H.090 if the administrator, insurer or affiliate of an insurer:
1. Has a current license or certificate of authority issued by the Division; and
2. Has previously submitted, pursuant to any other provision of title 57 of NRS or any regulation adopted pursuant thereto, information that is substantially similar to the information required pursuant to paragraph (b) or (f) of subsection 1 of NRS 695H.090 and the previously submitted information:
(a) Is current and accurate;
(b) Involved the same person as is involved in the application for registration to engage in business as a medical discount plan; and
(c) Satisfies, at a minimum, the requirements set forth in paragraph (b) or (f) of subsection 1 of NRS 695H.090.
Nevada Administrative Code › Chapter 695H - Medical Discount Plans › APPLICATION FOR REGISTRATION › Section 695H.120 - Administrator, insurer or affiliate of insurer: Satisfaction of requirements for certain biographical information

Current through June 11, 2024
An administrator, insurer or affiliate of an insurer shall be deemed to have satisfied the requirements of paragraph (c) of subsection 1 of NRS 695H.090 if the administrator, insurer or affiliate of an insurer:
1. Has a current license or certificate of authority issued by the Division; and
2. Has previously submitted, pursuant to any other provision of title 57 of NRS or any regulation adopted pursuant thereto, biographical information that is substantially similar to the biographical information required pursuant to paragraph (c) of subsection 1 of NRS 695H.090 and the previously submitted biographical information:
(a) Is current and accurate;
(b) Involved the same person as is involved in the application for registration to engage in business as a medical discount plan; and
(c) Satisfies, at a minimum, the requirements set forth in paragraph (c) of subsection 1 of NRS 695H.090.
Nevada Administrative Code › Chapter 695J - Persons Who Facilitate Enrollment in Certain Qualified Health Plans › GENERAL PROVISIONS › Section 695J.010 - Definitions

Current through June 11, 2024
As used in this chapter, unless the context otherwise requires, the words and terms defined in NAC 695J.020 to 695J.080, inclusive, have the meanings ascribed to them in those sections.
Added to NAC by Comm'r of Insurance by R074-13, eff. 11/22/2013
NRS 679B.130, 695J.270
Nevada Administrative Code › Chapter 695J - Persons Who Facilitate Enrollment in Certain Qualified Health Plans › GENERAL PROVISIONS › Section 695J.020 - "Commissioner" defined

Current through June 11, 2024
"Commissioner" means the Commissioner of Insurance.
Added to NAC by Comm'r of Insurance by R074-13, eff. 11/22/2013
NRS 679B.130, 695J.270
Nevada Administrative Code › Chapter 695J - Persons Who Facilitate Enrollment in Certain Qualified Health Plans › GENERAL PROVISIONS › Section 695J.030 - "Course" defined

Current through June 11, 2024
"Course" includes, but is not limited to, a program of instruction, correspondence course, course of independent study, self-study course or seminar.
Added to NAC by Comm'r of Insurance by R074-13, eff. 11/22/2013
NRS 679B.130, 695J.270
Nevada Administrative Code › Chapter 695J - Persons Who Facilitate Enrollment in Certain Qualified Health Plans › GENERAL PROVISIONS › Section 695J.040 - "Designated representative" defined

Current through June 11, 2024
"Designated representative" means a person with whom the Commissioner contracts pursuant to NAC 695J.090.
Added to NAC by Comm'r of Insurance by R074-13, eff. 11/22/2013
NRS 679B.130, 695J.270