reglab/statecodes huggingface dataset:
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › ADVERTISING › Section 689A.130 - Renewability, cancellation and termination

Current through June 11, 2024
An advertisement which:
1. Refers to renewability, cancellation or
			 termination of a policy;
2. Refers
			 to a policy benefit; or
3. States
			 or illustrates time or age in connection with eligibility of applicants or
			 continuation of the policy,
must disclose the provisions relating to renewability,
				cancellation and termination and any modification of benefits, losses covered
				or premiums because of age or for other reasons in a manner which does not
				minimize or render obscure the qualifying conditions.
Comm'r of Insurance,
				LH-1 § 4, eff. 5-13-72
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › ADVERTISING › Section 689A.140 - Manner of disclosure

Current through June 11, 2024
All information required to be disclosed by NAC 689A.010 to
				689A.270, inclusive, must be set out conspicuously and in close conjunction
				with the statements to which the information relates or under appropriate
				captions of such prominence that the information is not minimized, rendered
				obscure, presented in an ambiguous fashion or intermingled with the context of
				the advertisement so as to be confusing or misleading.
Comm'r of Insurance,
				LH-1 § 5, eff. 5-13-72
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › ADVERTISING › Section 689A.150 - Testimonials

Current through June 11, 2024
Testimonials used in advertisements must be genuine, represent
				the current opinion of the author, be applicable to the policy advertised and
				be accurately reproduced. The insurer, in using a testimonial, makes as its own
				all of the statements contained therein, and the advertisement including such
				statements is subject to all of the provisions of this chapter.
Comm'r of Insurance,
				LH-1 § 6, eff. 5-13-72
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › ADVERTISING › Section 689A.160 - Statistics

Current through June 11, 2024
An advertisement which includes the amounts of claims paid, the
				number of persons insured or similar statistical information relating to any
				insurer or policy must not be used unless it accurately reflects all relevant
				facts. The advertisement must not imply that statistics are derived from the
				policy advertised unless that is the fact.
Comm'r of Insurance,
				LH-1 § 7, eff. 5-13-72
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › ADVERTISING › Section 689A.170 - Effect of inspection or offer of refund

Current through June 11, 2024
An offer in an advertisement to permit a prospective buyer to
				inspect the policy or an offer of a refund of premiums paid is not a cure for
				misleading or deceptive statements contained in the advertisement.
Comm'r of Insurance,
				LH-1 § 8, eff. 5-13-72
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › ADVERTISING › Section 689A.180 - Disclosure of variance in premiums; combination of policies

Current through June 11, 2024
1. When a choice of the amount of benefits is
			 referred to, an advertisement must disclose that the amount of benefits
			 provided depends upon the plan selected and that the premium will vary with the
			 amount of benefits.
2. When an
			 advertisement refers to various benefits which may be contained in two or more
			 policies, other than group master policies, the advertisement must disclose
			 that the benefits are provided only through a combination of
			 policies.
Comm'r of Insurance,
				LH-1 § 9, eff. 5-13-72
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › ADVERTISING › Section 689A.190 - Comparisons and disparagement

Current through June 11, 2024
An advertisement must not directly or indirectly make unfair or
				incomplete comparisons of policies or benefits, or otherwise falsely disparage
				competitors or their policies, services or business methods.
Comm'r of Insurance,
				LH-1 § 10, eff. 5-13-72
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › ADVERTISING › Section 689A.200 - Advertising outside jurisdiction

Current through June 11, 2024
1. An advertisement
			 which is intended to be seen or heard beyond the limits of the jurisdiction in
			 which the insurer is licensed must not imply that the insurer is licensed
			 beyond those limits.
2. Such
			 advertisements by direct mail insurers must state that the insurer is not
			 licensed in a specified state or states, by use of some language such as "This
			 Company is not licensed in State B."
Comm'r of Insurance,
				LH-1 § 11, eff. 5-13-72
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › ADVERTISING › Section 689A.210 - Identity of insurer

Current through June 11, 2024
The identity of the insurer must be made clear in all of its
				advertisements. An advertisement must not include a trade name, service mark,
				slogan, symbol or other device which has the capacity and tendency to mislead
				or deceive as to the true identity of the insurer.
Comm'r of Insurance,
				LH-1 § 12, eff. 5-13-72
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › ADVERTISING › Section 689A.220 - Group insurance

Current through June 11, 2024
Unless a policyholder becomes a member of a group by purchasing
				insurance, an advertisement of a particular policy must not state or imply that
				prospective policyholders become members of a group and as such enjoy special
				rates or underwriting privileges.
Comm'r of Insurance,
				LH-1 § 13, eff. 5-13-72
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › ADVERTISING › Section 689A.230 - Introductory, initial or special offers

Current through June 11, 2024
An advertisement must not state or imply that a particular
				policy or combination of policies is an introductory, initial or special offer
				and that the applicant will receive advantages by accepting the offer unless
				the statement or implication is true.
Comm'r of Insurance,
				LH-1 § 14, eff. 5-13-72
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › ADVERTISING › Section 689A.240 - Examination by governmental agency; endorsements

Current through June 11, 2024
1. An
			 advertisement must not state or imply that an insurer or a policy has been
			 approved or an insurer's financial condition has been examined and found to be
			 satisfactory by a governmental agency unless the statement or implication is
			 true.
2. An advertisement must not
			 state or imply that an insurer or a policy has been approved or endorsed by any
			 person, group of persons, society, association or other organization unless the
			 statement or implication is true.
Comm'r of Insurance,
				LH-1 § 15, eff. 5-13-72
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › ADVERTISING › Section 689A.250 - Settlement of claims

Current through June 11, 2024
An advertisement must not contain any untrue statements with
				respect to the time within which claims are paid or any statements which imply
				that claim settlements will be liberal or generous beyond the terms of the
				policy.
Comm'r of Insurance,
				LH-1 § 16, eff. 5-13-72
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › ADVERTISING › Section 689A.260 - Statements regarding insurer

Current through June 11, 2024
An advertisement may not contain statements which are untrue in
				fact or misleading with respect to the insurer's assets, corporate structure,
				financial standing, age or relative position in the insurance business.
Comm'r of Insurance,
				LH-1 § 17, eff. 5-13-72
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › ADVERTISING › Section 689A.270 - File of advertisements; required certificate

Current through June 11, 2024
Each accident and health insurer shall maintain at its home or
				principal office a complete file containing every printed, published or
				prepared advertisement of individual policies and typical printed, published or
				prepared advertisements of blanket, franchise and group policies disseminated
				in this or any other state whether or not licensed in the other state, with a
				notation attached to each advertisement which indicates the manner and extent
				of distribution and the form number of any policy advertised. The file is
				subject to inspection by the Division. All advertisements must be retained for
				at least 3 years.
Comm'r of Insurance,
				LH-1, eff. 5-13-72-NAC A 5-27-92; R179-03, 12-16-2003; A by
				R039-14,
				eff. 4/4/2016
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › FORMS › Section 689A.310 - Acceptance of forms approved by Division

Current through June 11, 2024
All insurers which provide accident and health insurance,
				medical and dental service corporations, health maintenance organizations, and
				other organizations which accept prepayment for health services must accept
				forms approved by the Division for the administration of benefit
				payments.
Comm'r of Insurance,
				LH-5 § 2, eff. 7-1-76-NAC A 5-27-92
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › FORMS › Section 689A.320 - Unused portions

Current through June 11, 2024
When it prints a form approved by the Division, an insurer may
				screen out any portion of the form which it does not require to be
				completed.
Comm'r of Insurance,
				LH-5 § 3, eff. 7-1-76-NAC A 5-27-92
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › FORMS › Section 689A.330 - Permitted changes

Current through June 11, 2024
An insurer may add to a form approved by the Division its own
				identification and information to facilitate the use of that form. An insurer,
				service corporation or prepayment organization may request amplification of
				information from a provider of health care when the information is necessary
				for proper administration and determination of benefit payments. If an insurer
				or prepayment organization needs a form which differs from its approved form,
				the differing form must be submitted to the Division for approval. The insurer
				or organization must state the reasons for the deviation on its request.
Comm'r of Insurance,
				LH-5 § 4, eff. 7-1-76-NAC A 5-27-92
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › FORMS › Section 689A.340 - Statements completed by claimants or policyholders

Current through June 11, 2024
Statements, instructions or reports which are normally
				completed by claimants and policyholders, and which are required for
				administration of benefit payments, but which do not require information from
				providers of health care, may be included on the reverse side of any of the
				approved forms when printed by an insurer or prepayment organization for
				submission to their policyholders or contract holders.
Comm'r of Insurance,
				LH-5 § 5, eff. 7-1-76
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › FORMS › Section 689A.350 - Approved forms (Repealed)

Current through June 11, 2024
Comm'r of Insurance,
				LH-5 § 6, eff. 7-1-76-NAC A 5-27-92; R by
				R039-14,
				eff. 4/4/2016
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › FORMS › Section 689A.360 - Amendments

Current through June 11, 2024
New editions of reporting forms may be used only after they
				have been filed with and approved by the Commissioner. Minor changes negotiated
				with agencies of the Federal Government must be submitted to the Commissioner
				for approval.
Comm'r of Insurance,
				LH-5 § 7, eff. 7-1-76
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › MISCELLANEOUS PROVISIONS › Section 689A.411 - Summary of coverage: Filing, contents and delivery of disclosure

Current through June 11, 2024
1. Each insurer shall file with the
			 Commissioner, for his or her approval, a disclosure summarizing the coverage
			 provided by a policy of health insurance offered by the insurer.
2. The disclosure must:
(a) Be in at least 10-point type;
(b) Include the name, address and telephone
			 number of the insurance company;
(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 policy 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 policy; and
(g) Define the term "usual and customary" or
			 any similar term used in the policy.
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › MISCELLANEOUS PROVISIONS › Section 689A.421 - Programs of health insurance using preferred providers of health care

Current through June 11, 2024
An insurer may file with the Division a program of health
				insurance using preferred providers of health care for any individual policy
				offered pursuant to chapter 689A of NRS if it complies with the requirements
				set forth in NAC 689B.120 to 689B.160, inclusive.
Added to NAC by Comm'r
				of Insurance, 7-19-90, eff. 10-1-90; 5-27-92
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › MISCELLANEOUS PROVISIONS › Section 689A.425 - Coverage for prescription drugs: Removal from approved formulary prohibited; exception; movement to different tier in formulary; addition of drug to formulary

Current through June 11, 2024
1. Except as
			 otherwise provided in this section, an individual carrier that offers a health
			 benefit plan which provides coverage for prescription drugs and uses a
			 formulary that has been approved by the Commissioner pursuant to
			 NRS
			 687B.120 shall not:
(a) Remove a prescription drug from the
			 formulary; or
(b) If the formulary
			 includes two or more tiers of benefits providing for different deductibles,
			 copayments or coinsurance applicable to the prescription drugs in each tier,
			 move a drug to a tier with a larger deductible, copayment or coinsurance,
			 during the plan year for which the formulary was approved by the
			 Commissioner.
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › MISCELLANEOUS PROVISIONS › Section 689A.433 - Carrier prohibited from requiring purchase of other insurance as prerequisite to purchase or renewal of health benefit plan

Current through June 11, 2024
An individual carrier shall not require a person to purchase a
				life insurance policy or any other form of insurance as a prerequisite to the
				purchase or renewal of a basic health benefit plan or a standard health benefit
				plan.
Added to NAC by Comm'r
				of Insurance by R193-99, eff. 1-27-2000
NRS
				  679B.130,
				  689A.740
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › PORTABILITY AND ACCOUNTABILITY › Section 689A.434 - "Short-term health insurance policy" interpreted

Current through June 11, 2024
The Commissioner will interpret the term "short-term health
				insurance policy" as it is used in
				NRS
				689A.540 to exclude an individual health
				insurance policy that is:
1. Issued to
			 provide coverage for not more than 185 days or is extended to provide coverage
			 until the end of a period of hospitalization for a condition for which the
			 person covered by the policy is hospitalized on the day the coverage would have
			 otherwise ended; and
2.
			 Nonrenewable or is extended to provide coverage for the period of
			 hospitalization described in subsection 1,
if the total period of coverage is not more than 185
				consecutive days within a 365-day period plus any additional days for which
				coverage is provided because of that hospitalization.
Added to NAC by Comm'r
				of Insurance by R100-97, eff. 11-14-97-Substituted in revision for NAC
				689A.007
NRS
				  679B.130,
				  689A.540,
				  689A.740
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › PORTABILITY AND ACCOUNTABILITY › Section 689A.445 - Change of status: Application; approval; confidentiality; notice of approval or disapproval (Repealed)

Current through June 11, 2024
Added to NAC by Comm'r
				of Insurance by R224-97, eff. 11-16-98; R by
				R039-14,
				eff. 4/4/2016
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › PORTABILITY AND ACCOUNTABILITY › Section 689A.455 - Change of status: Notification of Commissioner (Repealed)

Current through June 11, 2024
Added to NAC by Comm'r
				of Insurance by R224-97, eff. 11-16-98; R by
				R039-14,
				eff. 4/4/2016
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › PORTABILITY AND ACCOUNTABILITY › Section 689A.465 - Actuarial certification (Repealed)

Current through June 11, 2024
Added to NAC by Comm'r
				of Insurance by R224-97, eff. 11-16-98; R by
				R039-14,
				eff. 4/4/2016
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › PORTABILITY AND ACCOUNTABILITY › Section 689A.475 - Evidence of creditable coverage

Current through June 11, 2024
If a person is unable to obtain a certificate of creditable
				coverage pursuant to
				NRS
				689A.720, an individual carrier shall accept
				from the person other evidence of creditable coverage if it determines that the
				evidence reasonably establishes prior continuous creditable coverage. Such
				evidence may include, without limitation, a copy of:
1. A policy of health insurance or evidence
			 of coverage;
2. A billing statement
			 for the payment of premiums;
3. A
			 cancelled check evidencing payment for health insurance coverage;
4. A proof of insurance card issued by an
			 insurer;
5. An explanation of
			 benefits relating to a specific claim for medical services that were provided
			 to the person by an insurer;
6. A
			 letter notifying the person that he or she is eligible for coverage pursuant to
			 the Consolidated Omnibus Budget Reconciliation Act of 1985, Public Law
			 99-272;
7. A letter written by the
			 liquidator of an insurer that verifies the dates that the person was covered by
			 the insurer under a policy of health insurance;
8. A statement written by the person that
			 includes the name and telephone number of any insurer under which he or she
			 previously received health insurance coverage;
9. Evidence of a payroll deduction from the
			 person's salary for health insurance coverage;
10. Any record from a provider of medical
			 care that indicates that the person had health insurance coverage; or
11. Any combination thereof.
Added to NAC by Comm'r
				of Insurance by R224-97, eff. 11-16-98
NRS
				  679B.130,
				  689A.710,
				  689A.740
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › PORTABILITY AND ACCOUNTABILITY › Section 689A.485 - Disclosure of variance in premium rate (Repealed)

Current through June 11, 2024
Added to NAC by Comm'r
				of Insurance by R224-97, eff. 11-16-98; R by
				R039-14,
				eff. 4/4/2016
NRS
				  679B.130
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › SYSTEM FOR RESOLVING COMPLAINTS OF INSUREDS › Section 689A.605 - Requirements for approval

Current through June 11, 2024
To obtain approval of a system for resolving complaints of
				insureds concerning health care services covered by an insurer from the
				Commissioner as required pursuant to
				NRS
				689A.745, an insurer must:
1. Demonstrate that the system will resolve
			 oral and written complaints concerning:
(a)
			 Payment or reimbursement for covered health care services;
(b) The availability, delivery or quality of
			 covered health care services, including, without limitation, adverse
			 determinations made pursuant to utilization review; and
(c) The terms and conditions of the health
			 care plans of insureds.
Nevada Administrative Code › Chapter 689A - Individual Health Insurance › SYSTEM FOR RESOLVING COMPLAINTS OF INSUREDS › Section 689A.615 - Annual report (Repealed)

Current through June 11, 2024
Added to NAC by Comm'r
				of Insurance by R132-98, eff. 3-30-99; A by R008-02, 5-23-2002; R by
				R039-14,
				eff. 4/4/2016
NRS
				  679B.130
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GENERAL PROVISIONS › Section 689B.010 - Definitions

Current through June 11, 2024
As used in this chapter, unless the context otherwise requires,
				the words and terms defined in NAC 689B.011 to 689B.019, inclusive, have the
				meanings ascribed to them in those sections.
Added to NAC by Comm'r of
				Insurance, eff. 10-12-88; A 5-27-92; R111-07,
				1-30-2008
NRS
				  679B.130
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GENERAL PROVISIONS › Section 689B.011 - "Actuarial memorandum" defined

Current through June 11, 2024
"Actuarial memorandum" means a memorandum created and signed by
				a qualified actuary that justifies the actuarial opinion rendered by the
				actuary.
Added to NAC by Comm'r of
				Insurance by R111-07, eff. 1-30-2008
NRS
				  679B.130
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GENERAL PROVISIONS › Section 689B.0115 - "Actuarial opinion" defined

Current through June 11, 2024
"Actuarial opinion" means the conclusion drawn by an actuary
				from actuarial knowledge or from the application of one or more actuarial
				methods to a body of data.
Added to NAC by Comm'r of
				Insurance by R111-07, eff. 1-30-2008
NRS
				  679B.130
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GENERAL PROVISIONS › Section 689B.012 - "Association" defined

Current through June 11, 2024
"Association" means any group formed for the purpose of
				purchasing insurance which has been approved and marketed pursuant to
				NRS
				688B.030 or
				689B.026.
Added to NAC by Comm'r of
				Insurance, eff. 10-12-88; A 5-27-92-Substituted in revision for part of NAC
				689B.010
NRS
				  679B.130
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GENERAL PROVISIONS › Section 689B.016 - "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. 10-12-88; A 5-27-92-Substituted in revision for part of NAC
				689B.010
NRS
				  679B.130
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GENERAL PROVISIONS › Section 689B.018 - "Employer's group" defined

Current through June 11, 2024
"Employer's group" means any subgroup within an association
				consisting of an employer, his employees and their dependents, who purchase
				group health insurance as members of the association.
Added to NAC by Comm'r of
				Insurance, eff. 10-12-88; A 5-27-92-Substituted in revision for part of NAC
				689B.010
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GENERAL PROVISIONS › Section 689B.019 - "Guaranteed association" defined

Current through June 11, 2024
"Guaranteed association" has the meaning ascribed to it in
				NRS
				689B.0265.
Added to NAC by Comm'r of
				Insurance by R111-07, eff. 1-30-2008
NRS
				  679B.130
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GENERAL PROVISIONS › Section 689B.Sec. 2 - NEW

Current through June 11, 2024
1. An insurer that issues a policy
			 of group health insurance 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 689B - Group and Blanket Health Insurance › GROUPS FORMED TO PURCHASE INSURANCE › Section 689B.020 - Request for approval of policy

Current through June 11, 2024
An insurer requesting approval of a policy for group insurance
				to be issued and delivered to an association shall submit to the
				Division:
1. A copy of each insurance
			 policy, certificate, rider, endorsement and application used for the
			 association.
2. A statement
			 illustrating that the benefits payable are reasonable in relation to the
			 premiums charged.
3. The name and
			 address of the administrator if an administrator is to pay the claims or
			 collect the premiums.
4. The name
			 and address of the trustee of the association and the name of the
			 trust.
5. Copies of all agreements
			 or contracts for the administration of claims and collection of premiums as
			 well as any information relating to utilization reviews, quality assurance
			 programs and the marketing of the insurance policy, including copies of any
			 advertising or brochures to be used.
6. For health insurance benefits:
(a) A description of the methodology used to
			 determine the usual and customary fees charged for services rendered by
			 providers; and
(b) A statement
			 verifying that the insurer has adopted at least three practices in
			 administering benefits that control or reduce the cost of health care, and a
			 brief description of those practices. The statement must list those sections of
			 the policy or certificate where the practices are described.
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GROUPS FORMED TO PURCHASE INSURANCE › Section 689B.030 - Certification, filing and approval of policy

Current through June 11, 2024
1. If an insurer
			 certifies its filing pursuant to this section and mails it to the Division by
			 certified mail, the approval of the filing of the policy shall be deemed to be
			 effective upon the date of the mailing subject to the notice of disapproval
			 provided in
			 NRS
			 687B.130.
2. An insurer's filing may be approved if it
			 certifies, on a form provided by the Division, that:
(a) The policy is issued to a group formed to
			 purchase insurance pursuant to
			 NRS
			 688B.030 or
			 689B.026;
(b) The policy contains the terms and
			 benefits required by title 57 of NRS;
(c) The benefits payable are reasonable in
			 relation to the premiums charged; and
(d) To the best of the insurer's knowledge,
			 the association to whom the policy is delivered is financially sound.
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GROUPS FORMED TO PURCHASE INSURANCE › Section 689B.040 - Standards for rates

Current through June 11, 2024
The rate charged by the insurer to a member or employer's group
				within the association must be based upon the experience of the entire
				association. Except as otherwise provided in NAC 689B.050, the insurer may not
				use rebates, surcharges, adjustments or similar rating standards for an
				employer's group based upon the claims experience of the employer's
				group.
Added to NAC by Comm'r of
				Insurance, eff. 10-12-88
NRS
				  679B.130
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GROUPS FORMED TO PURCHASE INSURANCE › Section 689B.050 - Establishment of program for rating experience

Current through June 11, 2024
1. An insurer
			 may establish an experience rating program which compares the loss experience
			 of an employer's group to the loss experience of the entire association and
			 which may result in different premiums. An insurer which establishes such a
			 program must establish its classes or class distinctions and schedules for
			 different premiums based upon commonly accepted actuarial principles. Such a
			 program may not result in rates that exceed the standards established in
			 NRS 686B.050 and
			 686B.060
			 or are unfairly discriminatory as described in
			 NRS
			 686A.100.
2. Upon receiving a request from a customer
			 or the Division, the insurer shall demonstrate, with appropriate statistical
			 evidence, the appropriateness of its classes and class distinctions and the
			 premiums charged.
3. The premium
			 for an employer's group may be adjusted, pursuant to an experience rating
			 program, at the time the policy is renewed if:
(a) The insurer has mailed a notice to the
			 employer's group at least 60 days before the renewal date, which clearly
			 explains the amount of the increase and the rationale for it; and
(b) The employer's group experienced a loss
			 ratio that was at least 150 percent greater than the loss ratio of the
			 association as a whole.
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GROUPS FORMED TO PURCHASE INSURANCE › Section 689B.060 - Standards for acceptance or rejection of employer's group

Current through June 11, 2024
At the time that an employer's group requests membership in an
				association, the insurer may accept or reject that group in accordance with the
				following standards:
1. For employer's
			 groups with more than 10 persons, if information on insurability is collected
			 by the insurer, the insurer may use this information only to determine whether
			 or not it will accept the employer's entire group. No member of the employer's
			 group may be excluded from the association by the insurer through the use of a
			 waiver or other device.
2. For
			 employer's groups of 10 persons or less:
(a)
			 The insurer may request information concerning evidence of insurability for the
			 individual members of the employer's group.
(b) After the review of this information, the
			 insurer may reject, because of insurability, any member of the employer's
			 group.
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GROUPS FORMED TO PURCHASE INSURANCE › Section 689B.070 - Coverage of employer's group; standards for exclusion or limitation

Current through June 11, 2024
1. Any insurer wishing to exclude or limit
			 the coverage in a policy issued to an association for any person based upon his
			 evidence of insurability, must submit the standards for exclusion or limitation
			 to the Division. These standards must comply with the provisions of this
			 section.
2. For all the employer's
			 groups within the association:
(a) The
			 coverage provided to members of that employer's group must be a guaranteed
			 renewable policy for as long as the association continues to renew that
			 employer's group.
(b) Once the
			 insurer accepts the employer's group, the insurer may not periodically
			 underwrite the employer's group or use that underwriting to cancel the
			 employer's group or any person within it or to transfer a member to another
			 policy.
(c) If a new employee
			 requests to be added to the employer's group, the insurer:
(1) Shall accept that employee and his
			 dependents based upon the underwriting standards used at the time the
			 employer's group was originally underwritten as required by NAC 689B.060 if the
			 request is made within the time established in the policy or by the employer
			 for the eligibility of new employees; and
(2) May request evidence of insurability from
			 the employee and his dependents if the request for coverage is not made within
			 the time established in the policy or by the employer for eligibility for new
			 employees.
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GROUPS FORMED TO PURCHASE INSURANCE › Section 689B.080 - Limiting benefits to certain employer's groups for preexisting conditions

Current through June 11, 2024
1. An insurer
			 offering an association to an employer's group with less than 25 members may
			 limit its benefits from those benefits offered pursuant to
			 NRS
			 689B.065, if the insurer has filed a plan
			 with the Commissioner which expressly provides for exclusions from coverage for
			 preexisting conditions and the exclusions:
(a)
			 Do not exceed a period of more than 12 months from the effective date of the
			 policy; and
(b) Limit payment for
			 medical treatment to less than $1,000 for each preexisting condition for the
			 12-month period.
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GROUPS FORMED TO PURCHASE INSURANCE › Section 689B.090 - Notice of cancellation, nonrenewal or renewal with altered terms

Current through June 11, 2024
Each notice of cancellation, nonrenewal or renewal with altered
				terms, issued by an insurer or an association to an employer's group must
				comply with the provisions of
				NRS
				687B.310 to
				687B.410,
				inclusive, and must be given to each employer's group in the
				association.
Added to NAC by Comm'r of
				Insurance, eff. 10-12-88
NRS
				  679B.130
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GUARANTEED ASSOCIATIONS › Section 689B.095 - Actuarial memorandum: Submission by insurer; contents

Current through June 11, 2024
An insurer that offers coverage under a policy of group health
				insurance to a guaranteed association must submit an actuarial memorandum to
				the Commissioner which must include, without limitation:
1. The purpose and scope of the actuarial
			 memorandum;
2. The numbers of the
			 forms to which the rates will apply;
3. A description of the benefits included in
			 the coverage;
4. An explanation of
			 how the base rate was developed;
5.
			 The methodology used to determine the underwriting rate;
6. The actuarial assumptions used in
			 establishing the rates;
7. Exhibits
			 addressing all loads and factors considered in establishing the
			 rates;
8. The basis used for the
			 rate structure;
9. An attestation
			 that the actuary has developed the rates in accordance with generally accepted
			 actuarial practices, including that the rates are reasonable in relation to the
			 benefits provided, are not inadequate and are not excessive or unfairly
			 discriminatory; and
10. An
			 actuarial certification that the actuary is qualified to render the actuarial
			 opinion.
Added to NAC by Comm'r of
				Insurance by R111-07, eff. 1-30-2008
NRS
				  679B.130,
				  689B.0265
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GUARANTEED ASSOCIATIONS › Section 689B.097 - Annual approval of actuarial memorandum and applicable rates; submission of additional information

Current through June 11, 2024
1. The actuarial
			 memorandum required by NAC 689B.095 and the applicable rates must be submitted
			 to and approved by the Commissioner annually.
2. After the submission of the initial
			 actuarial memorandum, each subsequent actuarial memorandum submitted to the
			 Commissioner by the insurer must, in addition to the items required by NAC
			 689B.095, include, without limitation:
(a) All
			 changes in rates from the inception of coverage;
(b) Any changes in actuarial
			 assumptions;
(c) All loss ratios
			 from the inception of coverage;
(d)
			 If a change in rates is being proposed, projections of the loss ratio both
			 before and after the rate change; and
(e) The number of members in the guaranteed
			 association.
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › GUARANTEED ASSOCIATIONS › Section 689B.099 - Notice of cancellation of policy when fewer than 200 persons covered

Current through June 11, 2024
If the number of members, employees of members or employees of
				a guaranteed association or their dependents covered under a policy of group
				health insurance falls below 200 in violation of a contract between the insurer
				and the guaranteed association, the insurer must comply with the notice
				requirement of subsection 2 of
				NRS
				687B.320 to cancel the
				policy.
Added to NAC by Comm'r of
				Insurance by R111-07, eff. 1-30-2008
NRS
				  679B.130
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › USE OF PREFERRED PROVIDERS OF HEALTH CARE › Section 689B.110 - Disclosure of points at which insured's payment for coinsurance is no longer required; sample calculation of claim; limitation on approval of policy

Current through June 11, 2024
1. The point at which an insured's payment
			 for coinsurance is no longer required to be paid for preferred providers of
			 health care and for providers who are not preferred in a policy of group health
			 insurance pursuant to subsection 6 of
			 NRS
			 689B.061 must be disclosed to the insured and
			 included in the disclosure filed pursuant to
			 NRS
			 689B.027.
2. Each form of policy filed with the
			 Commissioner must include a sample calculation of a claim using the method of
			 calculation selected by the insurer.
3. The Commissioner will not approve a policy
			 if the point at which an insured's payment for coinsurance is no longer
			 required to be paid for preferred providers of health care and for providers
			 who are not preferred is misleading or deceptively affects the risk purported
			 to be assumed.
Added to NAC by Comm'r of
				Insurance, eff. 6-1-88; A 6-20-90; 9-16-92
NRS
				  679B.130,
				  689B.027,
				  689B.061
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › USE OF PREFERRED PROVIDERS OF HEALTH CARE › Section 689B.120 - Contents of policy: General requirements

Current through June 11, 2024
A policy of group health insurance issued pursuant to
				NRS
				689B.061:
1. Must include a definition for preferred
			 providers of health care and providers of health care who are not
			 preferred.
2. Must include an
			 explanation of the amount of disincentives to be paid for using the services of
			 providers of health care who are not preferred.
3. Must include in the schedule of benefits
			 the amounts for deductibles and coinsurance payable for preferred providers of
			 health care and providers of health care who are not preferred.
4. Must include a description of the type of
			 plan used for preferred providers of health care and whether it is limited to
			 specific services only, such as services obtained from a physician or hospital
			 or for prescription drugs.
5. Must
			 provide that the services covered, if provided by preferred providers of health
			 care, are the same for providers of health care who are not
			 preferred.
6. Must include a
			 statement that the insured should verify whether a provider of health care is a
			 preferred provider of health care.
7. Must provide that, if the insured is
			 confined in a facility which is a preferred provider of health care at a time
			 when the facility terminates its agreement with the insurer, coverage will be
			 provided for the period of confinement at the rate negotiated for that facility
			 before it terminated its agreement and at no additional cost to the
			 insured.
8. Must provide that, if
			 the insured obtains prior authorization for health care services to be rendered
			 by a preferred provider of health care and the provider subsequently terminates
			 his agreement with the insurer, coverage will be provided for those services at
			 the rate negotiated for that provider before he terminated his agreement and at
			 no additional cost to the insured.
9. May not require that the payments to a
			 provider of health care who is not preferred be based upon the fee schedule or
			 arrangements for preferred providers of health care.
10. May not provide for more than a 50
			 percent difference or reduction in any payment of otherwise eligible expenses
			 for not complying with any procedures requiring the prior authorization of care
			 or notification that treatment was received for an emergency.
Added to NAC by Comm'r of
				Insurance, 7-19-90, eff. 10-1-90
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › USE OF PREFERRED PROVIDERS OF HEALTH CARE › Section 689B.130 - Contents of policy: Provisions concerning emergencies and medical necessity

Current through June 11, 2024
A policy of group health insurance issued pursuant to
				NRS
				689B.061 must:
1. Include the criteria used to determine
			 what is an emergency or treatment for an emergency.
2. Contain a description of any procedures
			 used to determine whether health care services rendered are medically
			 necessary.
3. If necessary, contain
			 a description of the benefits payable for emergency care.
Added to NAC by Comm'r of
				Insurance, 7-19-90, eff. 10-1-90
NRS
				  679B.130,
				  689B.061
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › USE OF PREFERRED PROVIDERS OF HEALTH CARE › Section 689B.140 - Filing of information with Division

Current through June 11, 2024
Each insurer offering a policy of group health insurance
				pursuant to
				NRS
				689B.061 shall file with the Division:
1. A copy of each standard agreement made
			 with each preferred provider of health care and a list of the preferred
			 providers of health care used by the insurer according to their
			 specialties.
2. A copy of any
			 agreement made with a third party to act as an administrator for the payment of
			 claims or the collection of premiums. A copy of the rates or payments to be
			 made to the administrator by the insurer may be omitted.
3. A copy of any contracts requiring a
			 preauthorization review or procedures for obtaining authorization for care
			 which may be separate from the policy.
4. A copy of any contracts entered into with
			 persons who conduct utilization reviews or a brief description of the standards
			 or guidelines used for a utilization review and the assurance of quality which
			 may be separate from the policy.
Added to NAC by Comm'r of
				Insurance, 7-19-90, eff. 10-1-90; A 5-27-92
NRS
				  679B.130,
				  689B.061
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › USE OF PREFERRED PROVIDERS OF HEALTH CARE › Section 689B.150 - Dissemination of list of preferred providers and any geographic limitations

Current through June 11, 2024
An insurer offering a policy of group health insurance pursuant
				to
				NRS
				689B.061 shall include with its health
				disclosure form a list of its preferred providers of health care and a
				description of any geographic limitation to the availability of
				services.
Added to NAC by Comm'r of
				Insurance, 7-19-90, eff. 10-1-90
NRS
				  679B.130,
				  689B.061
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › USE OF PREFERRED PROVIDERS OF HEALTH CARE › Section 689B.160 - Agreements with preferred providers: Notice of termination

Current through June 11, 2024
Each agreement entered into by an insurer and a preferred
				provider of health care must require a party who wishes to terminate the
				agreement to give notice to the other party at least 90 days before the date of
				termination.
Added to NAC by Comm'r of
				Insurance, 7-19-90, eff. 10-1-90
NRS
				  679B.130
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › PAYMENT OF BENEFITS › Section 689B.180 - Subrogation: Right of insurer and insured to recover from third party; lien against recovery; subrogation not basis for denial of payment of benefits

Current through June 11, 2024
1. Except as
			 otherwise provided by specific federal or state statute or regulation, an
			 insurer may include in a policy of group health insurance issued pursuant to
			 chapter 689B of NRS a provision for subrogation regarding the right of an
			 insured to recover, and the imposition of a lien upon any recovery by an
			 insured, from a third person for the cost of medical benefits reimbursed by the
			 insurer to the insured because of injuries incurred by the insured as a result
			 of the actions of the third person. The amount of the lien must not be more
			 than the amount of the reimbursements paid by the insurer.
2. An insurer shall not deny the payment of
			 any benefits based upon such a provision for subrogation.
Added to NAC by Comm'r of
				Insurance, eff. 12-15-94
NRS
				  679B.130
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › PAYMENT OF BENEFITS › Section 689B.190 - Group benefits payable by more than one insurer to provider; restrictions

Current through June 11, 2024
When the benefits of a policy of group health insurance issued
				pursuant to chapter 689B of NRS are payable by more than one insurer to a
				provider, the policy must not require the insured, or any secondary insurer who
				is a:
1. Group health
			 insurer;
2. Health maintenance
			 organization; or
3. Nonprofit
			 corporation for hospital, medical or dental service, to pay more than the
			 remaining deductible and coinsurance, if any, based upon the rates established
			 by the primary insurer for its payment of that provider.
Added to NAC by Comm'r of
				Insurance, eff. 12-15-94
NRS
				  679B.130
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › PAYMENT OF BENEFITS › Section 689B.195 - Determination of benefits; consideration of coverage under another policy not allowed

Current through June 11, 2024
A policy of group
			 health insurance issued pursuant to chapter 689B of NRS:
1. Must not, for the determination of
			 benefits payable for the coordination of benefits, provide for the
			 consideration of any benefits payable pursuant to any health insurance under a
			 franchise plan, no-fault automobile insurance or automobile medical
			 insurance.
2. Must provide for the
			 payment of benefits without regard to any benefits payable pursuant to any
			 health insurance under a franchise plan, no-fault automobile insurance or
			 automobile medical insurance.
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › SUMMARY OF COVERAGE › Section 689B.205 - Disclosures in advertising and sales materials; inclusion of certain information in health benefit plan

Current through June 11, 2024
1. As part of the
			 disclosure required by
			 NRS 689B.027, an
			 insurer shall disclose in the advertising and sales materials that the insurer
			 provides to employers:
(a) The term of the
			 contract applicable to the premium rates;
(b) A general description of the underwriting
			 factors that the insurer used to calculate premiums; and
(c) A description of the class of business in
			 which the employer is included.
Nevada Administrative Code › Chapter 689B - Group and Blanket Health Insurance › SUMMARY OF COVERAGE › Section 689B.210 - "Group policyholder" interpreted; filing, contents and delivery of disclosure

Current through June 11, 2024
1. For the purposes
			 of
			 NRS 689B.028, "group
			 policyholder" includes an employer's group in a marketing program of an
			 association.
2. Each insurer shall
			 file with the Commissioner, for his approval, a disclosure summarizing the
			 coverage provided by a policy of group health insurance offered by the
			 insurer.
3. The disclosure must:
(a) Be in at least 10-point type;
(b) Include the name, address and telephone
			 number of the insurance company;
(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 policy 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 policy; and
(g) Define the term "usual and customary" or
			 any similar term used in the policy.