reglab/statecodes huggingface dataset:
Nevada Administrative Code › Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations › QUALITY ASSURANCE PROGRAM › Section 695C.410 - Quality assurance committee: Appointment of members; staff; duties

Current through June 11, 2024
1. The program established pursuant to NAC
			 695C.400 must include a quality assurance committee which is directed by either
			 a licensed physician or dentist, as appropriate. The organization shall
			 establish written guidelines for the manner in which members are appointed. The
			 organization shall appoint members pursuant to those guidelines and provide
			 adequate staff to assist the committee.
2. The members of the committee must be
			 selected from the health care providers with whom the organization has
			 contracted to provide services to members. The members must include primary
			 care physicians, physicians who provide commonly used specialized care and may
			 include other persons who provide ancillary health care services.
3. The committee shall:
(a) Routinely select and review appropriate
			 medical records of members and other data related to the quality of health care
			 provided by health care providers.
(b) Review the clinical processes used by
			 providers of health care in providing services.
(c) Identify any problems related to the
			 quality of health care.
(d) Advise
			 health care providers regarding issues related to quality of care, performance
			 of services, outcomes of services and provide recommendations for improving the
			 quality of care when necessary.
(e)
			 Develop a methodology for monitoring and evaluating the quality of health care
			 provided to members. The methodology must include an analysis of the quality of
			 care provided for high volume common medical problems and less common higher
			 risk medical problems.
(f) Evaluate
			 the impact on the quality of care caused by incentives offered to providers of
			 health care by the organization to provide or not to provide certain
			 services.
(g) Interpret data
			 collected pursuant to NAC 695C.420 for use by the organization.
Nevada Administrative Code › Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations › QUALITY ASSURANCE PROGRAM › Section 695C.420 - System for collection and maintenance of information related to health care services

Current through June 11, 2024
1. The quality
			 assurance program must include a system to collect and maintain information
			 related to the health care services received by members.
2. The system must have the capacity to
			 aggregate data in a manner which will assist the committee in identifying
			 patterns of substandard care and any particular provider who is providing
			 substandard care. The information collected must include any complaints filed
			 by members or other providers, adverse outcomes to treatment or services,
			 inappropriate use of services and underutilization of services.
Added to NAC by Bd. of
				Health, eff. 11-1-95
NRS
				  439.200
Nevada Administrative Code › Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations › QUALITY ASSURANCE PROGRAM › Section 695C.430 - Written guidelines for remedial action; final determinations regarding quality of care

Current through June 11, 2024
1. The quality assurance program must include
			 written guidelines which set forth the procedures for remedial action when
			 problems related to quality of care are identified.
2. The guidelines must provide:
(a) A list of the types of problems which
			 require remedial action;
(b) The
			 specific remedial action that may be required;
(c) The time within which providers of health
			 care must comply with such remedial action;
(d) The action that the organization will
			 take if the remedial action is not implemented when required; and
(e) The procedures used to assess the
			 effectiveness of any remedial action.
Nevada Administrative Code › Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations › DELIVERY SYSTEM INTERMEDIARY › Section 695C.500 - Compliance with statutory provisions

Current through June 11, 2024
An organization shall ensure that a delivery system
				intermediary complies with the applicable provisions of title 57 of NRS
				relating to any services performed on behalf of the organization.
Added to NAC by Comm'r
				of Insurance by R129-96, eff. 10-29-97
NRS
				  679B.130,
				  695C.275
Nevada Administrative Code › Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations › DELIVERY SYSTEM INTERMEDIARY › Section 695C.505 - Required provisions of health service contracts

Current through June 11, 2024
Each health service contract submitted to the Commissioner
				pursuant to NAC 695C.510 must contain a provision which:
1. Requires the delivery system intermediary
			 to provide to the organization a written report, at least quarterly, which
			 identifies the total payments made or owed to its providers in sufficient
			 detail to enable the organization and the Commissioner to determine whether the
			 payments have been made in a timely manner and in compliance with the
			 applicable provisions of NRS.
2.
			 Requires the organization to review the reports of the delivery system
			 intermediary provided pursuant to subsection 1.
3. Authorizes the organization, upon
			 reasonable prior notice, to audit, inspect and copy the delivery system
			 intermediary's books, records and any other evidence of its operations which,
			 in the discretion of the organization, are relevant to the delivery system
			 intermediary's obligations pursuant to the health service contract.
4. Authorizes the Commissioner, upon
			 reasonable prior notice, to audit, inspect and copy the delivery system
			 intermediary's books, records and any other evidence of its operations to
			 determine whether the delivery system intermediary has complied with the
			 applicable provisions of NRS or any regulations adopted pursuant
			 thereto.
5. Requires the delivery
			 system intermediary to maintain working capital in the form of cash or
			 equivalent liquid assets in an amount equal to at least:
(a) Five hundred thousand dollars;
			 or
(b) The operating expenses paid
			 for 2 months calculated by using the monthly average of the operating expenses
			 for the prior 6 months, whichever is less. As used in this subsection,
			 "operating expenses" means the expenses of the delivery system intermediary,
			 except money paid or owed to providers for health services provided pursuant to
			 the health service contract.
Nevada Administrative Code › Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations › DELIVERY SYSTEM INTERMEDIARY › Section 695C.510 - Health service contract to be filed with Commissioner; certain documentation to be included in contract

Current through June 11, 2024
1. An organization
			 which enters into a health service contract with a delivery system intermediary
			 shall file a copy of the health service contract with the Commissioner as a
			 material modification of operations pursuant to
			 NRS
			 695C.140 or NAC 695C.350.
2. In addition to complying with the
			 provisions of NAC 695C.505, the contract must be signed by the organization and
			 the delivery system intermediary and include:
(a) All exhibits, attachments, addenda,
			 schedules or any other documents relating to the contract; and
(b) A statement of a qualified actuary that
			 the contract:
(1) Is a financially sound
			 transaction;
(2) Does not cause
			 excessive payments to the delivery system intermediary;
(3) Provides for reasonable incentives to the
			 delivery system intermediary for the containment of costs; and
(4) Does not substantially or unreasonably
			 contribute to the increase in the cost of providing health care services to
			 enrollees or subscribers.
Nevada Administrative Code › Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations › DELIVERY SYSTEM INTERMEDIARY › Section 695C.515 - Commissioner may order cancellation or renegotiation of health service contract under certain circumstances

Current through June 11, 2024
The Commissioner may order the immediate cancellation or
				renegotiation of any health service contract if he or she determines that the
				contract:
1. Provides for excessive
			 payments for health care services;
2. Fails to include incentives for the
			 containment of the costs of providing health care services to enrollees or
			 subscribers; or
3. Otherwise
			 substantially or unreasonably contributes to an increase in the cost of
			 providing health care services to enrollees or subscribers.
Added to NAC by Comm'r
				of Insurance by R129-96, eff. 10-29-97
NRS
				  679B.130,
				  695C.275
Nevada Administrative Code › Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations › DELIVERY SYSTEM INTERMEDIARY › Section 695C.520 - Conditions for paying claims or acting as agent for utilization review

Current through June 11, 2024
If a delivery system intermediary intends to pay claims or act
				as an agent for utilization review, the delivery system intermediary
				must:
1. Obtain the appropriate
			 licenses required pursuant to chapter 683A of NRS; and
2. Provide proof to the organization that the
			 delivery system intermediary has obtained those licenses.
Added to NAC by Comm'r
				of Insurance by R129-96, eff. 10-29-97
NRS
				  679B.130
Nevada Administrative Code › Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations › DELIVERY SYSTEM INTERMEDIARY › Section 695C.525 - Provision of health care services

Current through June 11, 2024
1. A delivery
			 system intermediary may employ or enter into a contract with a provider to
			 furnish or arrange for the furnishing of health care services to the members of
			 an organization covered under a health care plan.
2. Health care services provided by a
			 delivery system intermediary must be provided primarily by providers employed
			 by the delivery system intermediary or providers with whom the delivery system
			 intermediary has contracted for the provision of those services.
Added to NAC by Comm'r
				of Insurance by R129-96, eff. 10-29-97
NRS
				  679B.130
Nevada Administrative Code › Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations › DELIVERY SYSTEM INTERMEDIARY › Section 695C.530 - Contract for provision of health care services

Current through June 11, 2024
A contract entered into by a delivery system intermediary and a
				provider for the provision of health care services must:
1. Describe the responsibilities of the
			 provider and the delivery system intermediary under the contract.
2. Release enrollees and subscribers from
			 liability for the cost of the health care services provided pursuant to the
			 organization's health care plan, except for any nominal payment made by the
			 enrollee for a service not covered under the evidence of coverage.
3. Require the provider to participate in a
			 program to ensure the quality of health care provided to enrollees by the
			 organization.
4. Require the
			 provider to provide to each enrollee all medically necessary services required
			 by the evidence of coverage and the contract for the period for which a premium
			 has been paid to the organization.
5. Be effective for not less than 1 year,
			 subject to any right of termination provided in the contract.
6. Require the provider to furnish evidence
			 of a contract of insurance against loss arising from injuries to third parties
			 resulting from the practice of his or her profession or a reasonable substitute
			 as determined by the organization.
7. Require the provider to transfer or
			 arrange for the maintenance of the records of enrollees and subscribers who are
			 his or her patients if the provider terminates the contract with the delivery
			 system intermediary.
Added to NAC by Comm'r
				of Insurance by R129-96, eff. 10-29-97
NRS
				  679B.130
Nevada Administrative Code › Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations › DELIVERY SYSTEM INTERMEDIARY › Section 695C.535 - Organization prohibited from requiring provision of health care services for which delivery system intermediary has not contracted except under certain circumstances

Current through June 11, 2024
1. An organization
			 shall not require a delivery system intermediary to provide any health care
			 services which a provider of the delivery system is not required to
			 provide.
2. This section does not
			 prohibit the organization or the delivery system intermediary from entering
			 into an agreement for the provision of such health care services if the
			 agreement provides incentives to the delivery system intermediary for the
			 containment of the costs of providing those health care services.
Added to NAC by Comm'r
				of Insurance by R129-96, eff. 10-29-97
NRS
				  679B.130,
				  695C.275
Nevada Administrative Code › Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations › DELIVERY SYSTEM INTERMEDIARY › Section 695C.540 - Contract for evaluation of credentials of providers

Current through June 11, 2024
1. An
			 organization may enter into a contract with a delivery system intermediary for
			 evaluating the credentials of those providers who will provide health care
			 services to the members of the organization. The contract must include a
			 provision which requires the delivery system intermediary to comply with the
			 requirements established by the organization for evaluating the credentials of
			 providers.
2. The organization has
			 the exclusive authority to reject or terminate a contract with any provider who
			 fails to comply with requirements established by the organization pursuant to
			 subsection 1.
3. The organization
			 shall, at least annually, verify that the delivery system intermediary is in
			 compliance with the requirements established by the organization pursuant to
			 subsection 1.
Added to NAC by Comm'r
				of Insurance by R129-96, eff. 10-29-97
NRS
				  679B.130,
				  695C.275
Nevada Administrative Code › Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations › DELIVERY SYSTEM INTERMEDIARY › Section 695C.545 - Commissioner to have access to books and records

Current through June 11, 2024
An organization shall take all reasonable measures to provide
				the Commissioner with access to the books and records of any delivery system
				intermediary with which it contracts for the provision of health care services,
				to the same extent the Commissioner is given access to the books and records of
				the organization pursuant to title 57 of NRS. The organization shall pay the
				costs incurred by the Commissioner to examine the books and records of a
				delivery system intermediary.
Added to NAC by Comm'r
				of Insurance by R129-96, eff. 10-29-97
NRS
				  679B.130,
				  695C.275
Nevada Administrative Code › Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations › DELIVERY SYSTEM INTERMEDIARY › Section 695C.550 - Prohibited acts

Current through June 11, 2024
A delivery system intermediary shall not:
1. Solicit or sell to a person or group any
			 health care plan which provides for comprehensive health care services unless
			 it complies with the requirements set forth in NAC 695C.150; or
2. Contract directly with enrollees or
			 subscribers unless it has obtained a certificate of authority to operate
			 pursuant to chapter 695C or 695F of NRS.
Added to NAC by Comm'r
				of Insurance by R129-96, eff. 10-29-97
NRS
				  679B.130
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › GENERAL PROVISIONS › Section 695D.010 - Definitions

Current through June 11, 2024
As used in this chapter, unless the context otherwise requires,
						the words and terms defined in NAC 695D.015 to 695D.060, inclusive, have the
						meanings ascribed to them in those sections.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88; A by R132-98, 3-30-99
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › GENERAL PROVISIONS › Section 695D.020 - "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. 12-2-88; A 5-27-92
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › GENERAL PROVISIONS › Section 695D.025 - "Member" defined

Current through June 11, 2024
"Member" has the meaning ascribed to it in
						NRS
						695D.050.
Added to NAC by Comm'r of
						Insurance by R132-98, eff. 3-30-99
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › GENERAL PROVISIONS › Section 695D.030 - "Organization" defined

Current through June 11, 2024
"Organization" means an organization for dental care as defined
						by
						NRS
						695D.060.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › GENERAL PROVISIONS › Section 695D.040 - "Plan" defined

Current through June 11, 2024
"Plan" means a plan for dental care as defined by
						NRS
						695D.070.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › GENERAL PROVISIONS › Section 695D.045 - "Policy" defined

Current through June 11, 2024
"Policy" has the meaning ascribed to it in
						NRS
						695D.080.
Added to NAC by Comm'r of
						Insurance by R132-98, eff. 3-30-99
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › APPLICATION FOR CERTIFICATE OF AUTHORITY › Section 695D.070 - Submission; format

Current through June 11, 2024
1. An organization
					that applies for a certificate of authority must submit to the Commissioner an
					original and two copies of its application.
2. The original and each copy of the
					application must be submitted in a binder having three rings. The original
					application, the original of the completed forms supplied by the Division and
					the originals or certified copies of any supporting documents must all be
					contained in a single binder.
3.
					Each binder must contain a table of contents and dividers that separate the
					various sections of the application and indicate the subject of each
					section.
4. If an applicant submits
					any new pages to supplement or amend its application, the date of submission
					must be noted on the bottom of each page, and each page must be prepared so
					that it may be placed in the binder with the other materials.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88; A 5-27-92
NRS
							679B.130,
							695D.100,
							695D.120
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › APPLICATION FOR CERTIFICATE OF AUTHORITY › Section 695D.080 - Contents

Current through June 11, 2024
1. In addition to the information required to
					be submitted pursuant to
					NRS
					695D.120, an applicant for a certificate of
					authority shall include in its application:
(a) A list of its actual and prospective
					providers;
(b) A clear description
					of the geographic area it proposes to serve;
(c) A statement of facts demonstrating, with
					particular reference to the location of its providers and any provision made by
					them for emergencies, that the services of providers will be reasonably
					available to members;
(d) A
					description of the measures to be taken to increase the number of its providers
					as the number of members increases; and
(e) If the applicant is affiliated with an
					insurer:
(1) A description of its relationship
					with the insurer; and
(2) The
					information required by chapter 692C of NRS for filings by an insurance holding
					company system.
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › APPLICATION FOR CERTIFICATE OF AUTHORITY › Section 695D.090 - Applicant licensed in another state

Current through June 11, 2024
Any applicant licensed as an organization in another state, or
						having an affiliate or subsidiary that is so licensed, shall include in its
						application:
1. A copy of the license;
					and
2. If it is available, a
					certificate from the agency of the state responsible for regulating the
					organization, stating that the organization is licensed in good
					standing.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88
NRS
							679B.130,
							695D.100,
							695D.120
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › APPLICATION FOR CERTIFICATE OF AUTHORITY › Section 695D.100 - Incomplete application

Current through June 11, 2024
1. Any incomplete
					application, with respect to which there is no activity by the applicant for 60
					days or more, shall be deemed to have been withdrawn by the
					applicant.
2. If an application is
					deemed withdrawn, the Division will give written notice to the applicant of the
					status of the application. A new application, together with all applicable
					fees, including, without limitation, all applicable fees required by
					NRS
					695D.130, must be submitted before the
					Division takes any further action.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88; A 5-27-92; R103-09,
						1-28-2010
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › APPLICATION FOR CERTIFICATE OF AUTHORITY › Section 695D.110 - Request to review or obtain copy; notification of pending application

Current through June 11, 2024
1. Any person who wishes to review or obtain
					a copy of an application for a certificate of authority must submit a written
					request to the offices of the Division at 1818 East College Parkway, Suite 103,
					Carson City, Nevada 89706. If a copy is requested, a fee in an amount
					sufficient to cover the cost of the copy and any cost of postage must be
					submitted with the request.
2. Any
					person who wishes to be notified of a pending application must file with the
					Division a written request to be placed on a list maintained by the Division
					for that purpose.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88; A 5-27-92; R249-03,
						11-12-2004
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › ADMINISTRATION AND RECORDS › Section 695D.120 - Name of organization

Current through June 11, 2024
The name of an organization must not include the words "health"
						or "medical" or in any way imply coverage for other than dental care, unless
						the word "dental" is used in the name.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › ADMINISTRATION AND RECORDS › Section 695D.130 - Maintenance of principal office and place of business

Current through June 11, 2024
1.
					Except as otherwise provided in subsection 2, every domestic organization must
					maintain its principal office and place of business in this State.
2. The Commissioner, for good cause shown,
					may permit an organization to maintain its principal office or place of
					business in another state if it is:
(a) In the
					best interests of the organization and its members; and
(b) Reasonably convenient to the Commissioner
					in supervising the insurer.
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › ADMINISTRATION AND RECORDS › Section 695D.140 - Maintenance of records

Current through June 11, 2024
1. An organization
					shall retain permanently, on microfilm or by other suitable means, the minutes
					of each meeting of its governing body and any advisory panel on members'
					satisfaction.
2. An organization
					shall retain for 3 years, or until an examination of the organization has been
					completed by the Division, a copy of all published material used to market the
					organization and scripts used for advertising on radio or television.
3. The records of an organization must be
					segregated from the records of any subsidiary or related corporation and must
					be treated as separate corporate documents.
4. All records of the organization must be
					kept in this State and retained for examination by the Division for 3 years or
					until the next examination is completed by the Division. Each organization
					shall comply with the provisions of
					NRS
					693A.050,
					693A.060
					and
					693A.070.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88; A 5-27-92
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › ADMINISTRATION AND RECORDS › Section 695D.150 - Qualifications of person responsible for operating organization

Current through June 11, 2024
Each person responsible for operating an organization must
						possess adequate knowledge concerning the operation of such an organization and
						insurance laws and procedures that apply to the organization.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › ADMINISTRATION AND RECORDS › Section 695D.160 - Powers of organization; approval by Commissioner

Current through June 11, 2024
1. Subject
					to the approval of the Commissioner as provided in subsections 2 and 3, the
					powers of an organization include the power to:
(a) Purchase, lease, construct, renovate,
					operate or maintain any dental facility, ancillary equipment or other property
					reasonably required for its principal office or any other purpose related to
					the business of the organization.
(b) Make any loan in furtherance of its
					program to provide services to its members:
(1) To a dental group under contract with the
					organization; or
(2) To a
					corporation under its control.
(c) Furnish services through providers under
					contract with the organization or employed by it.
(d) Contract with any person for the
					performance of services related to marketing, enrollment and
					administration.
(e) Contract with
					any insurance company that is licensed in this State or is authorized to do
					business in this State for the provision of insurance for, indemnity against,
					or reimbursement of the cost of services provided by the
					organization.
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › ADMINISTRATION AND RECORDS › Section 695D.170 - Accessibility of services

Current through June 11, 2024
If the geographic area served or proposed to be served by an
						organization:
1. Includes a county
					having a population of 30,000 or more, the distance between the place of
					business of any provider and that of any subscriber must not exceed 25 miles.
					As used in this subsection, "subscriber" means a person who purchases a plan
					for himself or herself or another person pursuant to a written contract with
					the organization.
2. Does not
					include a county having a population of 30,000 or more, the organization must
					submit:
(a) With its application;
					and
(b) At any time thereafter,
					upon request of the Commissioner,
a statement demonstrating, with reference to the standards of
						the area for accessibility, that the services of providers are or will be
						reasonably available to members.
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › ADMINISTRATION AND RECORDS › Section 695D.180 - Organization desiring to enlarge its geographic area of service

Current through June 11, 2024
If an organization wishes to enlarge its geographic area of
						service beyond that stated in its application, it must submit to the
						Division:
1. A written description of
					the area it proposes to serve;
2. A
					list of the providers who will offer services to members in the new
					area;
3. A copy of the contract
					between the organization and each such provider;
4. A statement:
(a) Describing the effect of the expansion on
					the operation and financial position of the organization; and
(b) Certifying that the expansion is
					financially feasible for the organization;
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › ADMINISTRATION AND RECORDS › Section 695D.190 - Contract between organization and provider

Current through June 11, 2024
1. Each
					contract between an organization and a provider must:
(a) Contain a complete description of the
					duties of each party under the agreement.
(b) Require the provider to release each
					member of the organization from all liability for the cost of services rendered
					under the plan, except for uncovered expenditures and any copayments or
					deductibles made by a member.
(c)
					Be effective for not less than 1 year, subject to any mutual right of
					termination provided by the agreement.
(d) Require the provider to comply with the
					organization's program to assure the quality of dental care provided to
					members.
(e) If the organization
					becomes insolvent, require the provider to provide to each member all the
					services specified by the plan and the agreement during the period for which a
					premium has been paid by or on behalf of the member.
(f) Require the provider to furnish the
					organization with evidence of:
(1) A contract
					of insurance against liability to third persons for any injury caused by
					professional malpractice; or
(2) A
					reasonable substitute for such insurance, as determined by the
					organization.
(g)
					Require a provider, if he or she leaves the panel of dentists associated with
					the organization, to transfer or arrange for the maintenance of the records of
					members who are his or her patients.
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › ADMINISTRATION AND RECORDS › Section 695D.200 - Notification of changes in list of providers

Current through June 11, 2024
An organization shall notify a member in writing of the
						disassociation of his or her dentist from the organization within 30 working
						days after the disassociation occurs.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88; A 5-27-92; A by
						R081-16A,
						eff. 11/2/2016
NRS
						679B.130,
						695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › ADMINISTRATION AND RECORDS › Section 695D.220 - Coordination of benefits

Current through June 11, 2024
1. A plan that is
					offered to a group and that coordinates its benefits must determine its
					benefits and its order of benefits as provided in
					NRS
					689B.063 and
					689B.064.
2. An organization may include in its
					evidence of coverage provisions:
(a)
					Prohibiting the duplication of benefits; and
(b) Stating its intention to impose a lien,
					upon any money recovered by a member from a third person for injuries inflicted
					by that person, for the cost of any benefits provided to the member in
					connection with those injuries. The amount of the lien must not exceed the
					reasonable value of the services provided by the organization.
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › ADMINISTRATION AND RECORDS › Section 695D.225 - Summary of coverage: Filing, contents and delivery of disclosure

Current through June 11, 2024
1. Each organization for dental care shall
					file with the Commissioner, for his or her approval, a disclosure summarizing
					the coverage provided by a group plan for dental care offered by the
					organization for dental care.
2.
					The disclosure must:
(a) Be in at least
					10-point type;
(b) Include the
					name, address and telephone number of the organization for dental
					care;
(c) Include the name, address
					and telephone number of the agent and broker, 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 for dental care 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 695D - Organizations for Dental Care › ADMINISTRATION AND RECORDS › Section 695D.230 - Provision of copy of plan to members; advertising; solicitation

Current through June 11, 2024
1. Each organization shall, at the time a
					member enrolls, provide the member with a copy of its plan which:
(a) States clearly, in boldface type, any
					period of waiting required before a member is eligible to receive benefits
					under the plan; and
(b) Refers to
					the plan by the number used in filing it with the Division.
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › FINANCES › Section 695D.240 - Reserves maintained by organization

Current through June 11, 2024
All reserves maintained by an organization pursuant to
						NRS
						695D.250:
1. Must be deposited in a trust account in a
					federally insured financial institution located in this State. All income
					earned by the account belongs to the organization and may be credited and paid
					to the organization and used for its operations.
2. Are in addition to those reserves
					established by the organization according to good business and accounting
					practices to cover claims that have been incurred but not reported and other
					similar claims.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88
NRS
							679B.130,
							695D.100,
							695D.250
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › FINANCES › Section 695D.250 - Investment of money

Current through June 11, 2024
1. An organization
					may invest its money only in cash, cash equivalents or the securities described
					in NRS
					682A.033.
2. Any investment made by an organization:
(a) Must be authorized or ratified by its
					board of directors or by a committee charged with the supervision of such
					investments;
(b) Must be
					interest-bearing, interest-accruing, entitled to dividends or otherwise produce
					income;
(c) Must not be in default
					in any respect;
(d) Must not be
					purchased at a price above its fair or market value; and
(e) Must comply with the provisions of
					NRS
					682A.402, to the extent those provisions are
					applicable.
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › FINANCES › Section 695D.260 - Filing of periodic reports and financial statements

Current through June 11, 2024
1.
					As a condition of doing business in this State, each organization must submit
					to the Commissioner an annual report required by
					NRS
					695D.260 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 695D - Organizations for Dental Care › FINANCES › Section 695D.270 - Determination of financial condition: Assets considered

Current through June 11, 2024
The Division will consider the following assets owned by an
						organization in determining its financial condition:
1. Cash in the possession of the organization
					or in transit under its control, including the true balance of any deposit in a
					solvent bank, trust company or savings and loan association.
2. Any investment or security acquired or
					held as provided in NAC 695D.250.
3. Any asset acquired through the exercise of
					its powers contained in paragraphs (a) and (b) of subsection 1 of NAC 695D.160
					and approved pursuant to subsections 2 and 3 of that section.
4. Any interest due or accrued on:
(a) Any bond that is not in default and is
					not valued on a basis that includes accrued interest.
(b) Cash deposited in a solvent bank, trust
					company or savings and loan association.
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › FINANCES › Section 695D.280 - Determination of financial condition: Assets not considered

Current through June 11, 2024
The Division will not consider the following assets owned by an
						organization in determining its financial condition:
1. Any goodwill, trade name or similar
					intangible.
2. Any advance to an
					officer of the organization, whether secured or unsecured, and any advance made
					on personal security only.
3. Stock
					of the organization, owned by the organization, or any equity therein or loans
					secured thereby, or any proportionate interest in stock acquired or held
					through the ownership by the organization in another firm, corporation or
					business.
4. Except as otherwise
					provided in NAC 695D.270, any furniture, fixture, furnishing, safe, vehicle,
					library, stationery, literature or supplies.
5. The amount, if any, by which the aggregate
					book value of investments carried in the ledger assets of the organization
					exceeds the aggregate value thereof.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88; A 5-27-92
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › FINANCES › Section 695D.290 - Determination of financial condition: Charges against assets

Current through June 11, 2024
In determining the financial condition of an organization, the
						Division will charge against its assets:
1. The amount of its outstanding capital
					stock.
2. The amount necessary to
					pay any unpaid claims against the organization that are incurred on or before
					the date of its financial statement, whether the claims are reported or
					unreported, plus the expenses of adjusting those claims.
3. Unless a larger amount is required by
					NRS
					695D.250, the amount of the unearned premium
					reserves of the organization, computed as provided in
					NRS
					681B.080.
4. All taxes, expenses and other obligations
					of the organization that are due or accrued as of the date of its financial
					statement.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88; A 5-27-92
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › FINANCES › Section 695D.300 - Maintenance of financial security

Current through June 11, 2024
1. An organization
					shall maintain:
(a) A capital account with a
					net worth in an amount which is the greater of:
(1) The amount of risk-based capital
					determined in the manner set forth in
					NRS
					681B.290 and the regulations adopted pursuant
					thereto; or
(2) The amount,
					according to the number of members in the organization, that is not less than
					the following amounts:
Number of Members
Net Worth
Less than 2,500
$50,000
2,500 to 5,000
$75,000
5,000 or more
$125,000
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › ORGANIZATIONS LICENSED IN OTHER STATES › Section 695D.310 - Submission of copy of license to Commissioner

Current through June 11, 2024
An organization that:
1. Receives a license as an organization in
					another state; or
2. Whose
					affiliate or subsidiary receives such a license,
shall furnish a copy of the license to the Commissioner within
						30 days after it is received.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › ORGANIZATIONS LICENSED IN OTHER STATES › Section 695D.320 - Organization desiring to contract with providers out of State for services for members in State

Current through June 11, 2024
1. If an
					organization authorized to operate in this State is also licensed in a
					contiguous state and wishes to contract with providers in that state for
					services for members in this State, the organization shall submit to the
					Division, for its review and approval:
(a) Two
					copies of the plan of the organization for operation in the contiguous
					state;
(b) A copy of the evidence
					of coverage to be issued, if it has not previously been filed with the
					Division;
(c) Its list of providers
					in the contiguous state and a copy of its agreement with each provider;
					and
(d) Such other material
					concerning the administration of the plan as the Division deems necessary for
					its review.
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › ORGANIZATIONS LICENSED IN OTHER STATES › Section 695D.330 - Notification of disciplinary action taken in another state

Current through June 11, 2024
An organization authorized to operate in this State that is
						licensed in another state shall:
1.
					Notify the Division of any disciplinary action taken against it by the other
					state; and
2. File with the
					Division copies of all documents relating to that action within 10 days after
					it receives those documents.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88; A 5-27-92
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › MISCELLANEOUS PROVISIONS › Section 695D.340 - Certification of information concerning limitation on rates for coverage

Current through June 11, 2024
Any information provided by an organization to demonstrate its
						compliance with the provisions of
						NRS
						686B.125, limiting rates for coverage for
						dental care, must be certified by an actuary.
Added to NAC by Comm'r of
						Insurance, eff. 12-2-88
NRS
							679B.130,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › MISCELLANEOUS PROVISIONS › Section 695D.350 - Contract to perform marketing, enrollment or administrative services

Current through June 11, 2024
1. If an organization enters into a contract
					for the performance of marketing, enrollment or administrative services, it
					shall submit a copy of the contract to the Division for its review and
					approval.
2. A person who enters
					into such a contract with an organization shall be deemed to have:
(a) Submitted himself or herself to the
					jurisdiction of the Division for the purposes of the review; and
(b) Authorized the Division to examine him or
					her concerning:
(1) His or her duties under
					the contract; and
(2) The payment
					and handling of money pursuant to the contract.
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › MISCELLANEOUS PROVISIONS › Section 695D.360 - Administrative hearings and other proceedings

Current through June 11, 2024
1. Any person who
					is not otherwise entitled to a hearing pursuant to
					NRS
					695D.310 and who is aggrieved by an action of
					the Commissioner relating to the approval, denial, suspension or revocation of
					a certificate of authority may request a hearing on the matter as provided in
					NRS
					679B.310.
2. Any person who wishes to:
(a) Be notified of a pending hearing must
					file with the Division a written request to be placed on a list maintained by
					the Division for that purpose.
(b)
					Intervene in any proceeding held pursuant to
					NRS
					695D.310 may request leave to intervene as
					provided in NAC 679B.460, 679B.470 and 679B.480.
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › MISCELLANEOUS PROVISIONS › Section 695D.370 - Requirements for conducting examinations

Current through June 11, 2024
Each examination of an organization, including one made
						pursuant to
						NRS
						695D.270, must be conducted pursuant to the
						requirements found in the handbooks and manuals adopted by reference in NAC
						679B.033 and the provisions of
						NRS
						679B.250 to
						679B.300,
						inclusive.
Added to NAC by Comm'r of
						Insurance, eff. 12-9-91
NRS
							679B.130,
							695D.100,
							695D.270
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › SYSTEM FOR RESOLVING COMPLAINTS OF MEMBERS › Section 695D.500 - Establishment; scope; examination of system

Current through June 11, 2024
1. Each
					organization that issues a policy in this State shall establish with the
					approval of the Commissioner a system for resolving any complaints of a member
					concerning services covered under the policy. 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 persons
					on a review board must be members who receive services pursuant to a policy
					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,
							695D.100
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › SYSTEM FOR RESOLVING COMPLAINTS OF MEMBERS › Section 695D.510 - Requirements for approval

Current through June 11, 2024
To obtain approval of a system for resolving complaints of
						members concerning services covered by an organization from the Commissioner as
						required pursuant to NAC 695D.500, an organization must:
1. Demonstrate that the system will resolve
					oral and written complaints concerning:
(a)
					Payment or reimbursement for covered services;
(b) The availability, delivery or quality of
					covered services, including, without limitation, adverse determinations made
					pursuant to utilization review; and
(c) The terms and conditions of the policies
					of a member.
Nevada Administrative Code › Chapter 695D - Organizations for Dental Care › SYSTEM FOR RESOLVING COMPLAINTS OF MEMBERS › Section 695D.520 - Notices: Right of member to file complaint; denial of coverage; clear and comprehensible language

Current through June 11, 2024
1. Following
					approval by the Commissioner, each organization that issues a policy in this
					State shall provide written notice to a member, in clear and comprehensible
					language that is understandable to an ordinary layperson, explaining the right
					of the member to file a written complaint. Such notice must be provided to a
					member:
(a) At the time he or she receives the
					policy;
(b) Any time that the
					organization denies coverage of a service or limits coverage of a service to a
					member; and
(c) Any other time
					deemed necessary by the Commissioner.