GENERAL PROVISIONS

NRS 689B.010. Short title; scope.

NRS 689B.015. Contracts between insurer and provider of health care: Prohibiting insurer from charging provider of health care fee for inclusion on list of providers given to insureds; form to obtain information on provider of health care; modification; schedule of fees.

GROUP POLICIES

General Provisions

NRS 689B.020. “Group health insurance” defined; eligible groups and benefits.

NRS 689B.026. Delivery of policy to group formed to purchase health insurance prohibited; exception.

NRS 689B.0265. Policy to guaranteed association.

NRS 689B.027. Summary of coverage: Contents of disclosure; approval by Commissioner; copy to be made available to employer or producer acting on behalf of employer.

NRS 689B.028. Summary of coverage: Copy to be provided before policy issued; policy may not be offered unless summary approved by Commissioner.

NRS 689B.0283. Coverage for prescription drugs: Provision of notice and information regarding use of formulary.

NRS 689B.0285. System for resolving complaints: Approval; requirements; examination.

NRS 689B.029. Annual report regarding system for resolving complaints; insurer to maintain records of complaints concerning something other than health care services.

NRS 689B.0295. Written notice to insured explaining right to file complaint; notice to insured required when insurer denies coverage of health care service.

Coverage

NRS 689B.030. Required provisions.

NRS 689B.0303. Required provision concerning coverage for continued medical treatment.

NRS 689B.0306. Required provision concerning coverage for treatment received as part of clinical trial or study.

NRS 689B.031. Required provision concerning coverage of certain gynecological or obstetrical services without authorization or referral from primary care physician.

NRS 689B.0313. Required provision concerning coverage for human papillomavirus vaccine. [Effective through December 31, 2013.]

NRS 689B.0313. Required provision concerning coverage for human papillomavirus vaccine. [Effective January 1, 2014.]

NRS 689B.0317. Required provision concerning coverage for prostate cancer screening.

NRS 689B.033. Required provision concerning coverage for newly born and adopted children and children placed for adoption. [Effective through December 31, 2013.]

NRS 689B.033. Required provision concerning coverage for newly born and adopted children and children placed for adoption. [Effective January 1, 2014.]

NRS 689B.0335. Required provision concerning coverage for autism spectrum disorders.

NRS 689B.034. Required provision concerning effect of benefits under other valid group coverage; subrogation.

NRS 689B.0345. Required provision concerning coverage for employee or member on leave without pay as result of total disability.

NRS 689B.035. Required provision concerning termination of coverage on dependent child.

NRS 689B.0353. Required provision concerning coverage for treatment of certain inherited metabolic diseases.

NRS 689B.0357. Required provision concerning coverage for management and treatment of diabetes.

NRS 689B.0362. Required provision concerning coverage for orally administered chemotherapy.

NRS 689B.0365. Required provision concerning coverage for use of certain drugs for treatment of cancer.

NRS 689B.0367. Required provision concerning coverage for screening for colorectal cancer.

NRS 689B.0368. Required provision concerning coverage for prescription drug previously approved for medical condition of insured.

NRS 689B.0374. Required provision concerning coverage for cytologic screening tests and mammograms for certain women.

NRS 689B.0375. Required provision concerning coverage relating to mastectomy.

NRS 689B.0376. Policy covering prescription drugs or devices to provide coverage for drug or device for contraception and of hormone replacement therapy in certain circumstances; prohibited actions by insurer; exceptions.

NRS 689B.0377. Policy covering outpatient care to provide coverage for health care services related to contraceptives and hormone replacement therapy; prohibited actions by insurer; exceptions.

NRS 689B.0379. Required provision concerning coverage for treatment of temporomandibular joint.

Reimbursement and Payment

NRS 689B.038. Reimbursement for treatments by licensed psychologist.

NRS 689B.0383. Reimbursement for treatments by licensed marriage and family therapist or licensed clinical professional counselor.

NRS 689B.0385. Reimbursement for treatments by licensed associate in social work, social worker, independent social worker or clinical social worker.

NRS 689B.039. Reimbursement for treatments by chiropractor.

NRS 689B.0393. Reimbursement for treatments by podiatrist.

NRS 689B.0397. Reimbursement for treatment by licensed clinical alcohol and drug abuse counselor.

NRS 689B.040. Direct payment for hospital and medical services and home health care; payment to assignee.

NRS 689B.045. Reimbursement for services provided by certain nurses; prohibited limitations; exception.

NRS 689B.047. Reimbursement to provider of medical transportation.

NRS 689B.049. Reimbursement for acupuncture.

Miscellaneous Provisions

NRS 689B.050. Extended disability benefit.

NRS 689B.060. Readjustment of premiums; dividends.

NRS 689B.061. Limitations on deductibles and copayments charged under policy which offers difference of payment between preferred providers of health care and providers who are not preferred. [Effective through December 31, 2013.]

NRS 689B.061. Limitations on deductibles and copayments charged under policy which offers difference of payment between preferred providers of health care and providers who are not preferred. [Effective January 1, 2014.]

NRS 689B.063. Primary and secondary policies: Determination of benefits. [Effective through December 31, 2013.]

NRS 689B.063. Primary and secondary policies: Determination of benefits. [Effective January 1, 2014.]

NRS 689B.064. Primary and secondary policies: Order of benefits.

NRS 689B.065. Policy issued to replace discontinued policy or coverage: Requirements; notice of reduction of benefits; statement of benefits; applicability of section.

NRS 689B.067. Provision in policy requiring binding arbitration for disputes with insurer authorized; procedure for arbitration; declaratory relief.

NRS 689B.068. Insurer prohibited from denying coverage solely because person was victim of domestic violence.

NRS 689B.069. Insurer prohibited from requiring or using information concerning genetic testing; exceptions.

BLANKET POLICIES

NRS 689B.070. “Blanket accident and health insurance” defined.

NRS 689B.080. Authority to issue; required provisions.

NRS 689B.090. Application and certificates.

NRS 689B.100. Payment of benefits.

NRS 689B.110. Legal liability of policyholders for death of or injury to insured member unaffected.

NRS 689B.115. Access by Commissioner to information concerning rates; confidentiality of information.

CONVERSION OF GROUP POLICIES TO INDIVIDUAL POLICIES

NRS 689B.120. Policies of group health insurance to contain provision for conversion; exceptions; conditions. [Effective through December 31, 2013.]

NRS 689B.130. Conversion privilege available to spouse and children; conditions. [Effective through December 31, 2013.]

NRS 689B.140. Denial of converted policy because of overinsurance; notice concerning cancellation of other coverage. [Effective through December 31, 2013.]

NRS 689B.150. Choice of plans for converted policy. [Effective through December 31, 2013.]

NRS 689B.170. Benefits payable under converted policy may be reduced by amount payable under group policy. [Effective through December 31, 2013.]

NRS 689B.180. Issuance and effective date of converted policy; premiums; persons covered. [Effective through December 31, 2013.]

NRS 689B.200. Notice of conversion privilege. [Effective through December 31, 2013.]

NRS 689B.210. Converted policy delivered outside Nevada: Form. [Effective through December 31, 2013.]

CONTINUATION OF COVERAGE UNDER CERTAIN GROUP POLICIES

NRS 689B.245. Required provision concerning continuation of coverage. [Effective through December 31, 2013.]

NRS 689B.246. Notice of eligibility or election to continue coverage. [Effective through December 31, 2013.]

NRS 689B.247. Payment of premium for continued coverage. [Effective through December 31, 2013.]

NRS 689B.248. New insurer to provide continued coverage. [Effective through December 31, 2013.]

NRS 689B.249. Termination of continued coverage before end of period. [Effective through December 31, 2013.]

MISCELLANEOUS PROVISIONS

NRS 689B.250. Acceptance of uniform forms for billing and claims.

NRS 689B.255. Approval or denial of claims; payment of claims and interest; requests for additional information; award of costs and attorney’s fees; compliance with requirements.

NRS 689B.260. Required provision concerning coverage relating to complications of pregnancy.

NRS 689B.270. Required procedure for arbitration of disputes concerning independent medical evaluations.

NRS 689B.275. Contents, approval and provision of summary of coverage; provision of information about guaranteed availability of certain plans for benefits.

NRS 689B.280. Disclosure of information concerning medication of insured prohibited.

NRS 689B.283. Mandatory renewal of coverage under conversion health benefit plan. [Effective through December 31, 2013.]

NRS 689B.285. Offering policy of health insurance for purposes of establishing health savings account.

NRS 689B.287. Insurer prohibited from denying coverage solely because insured was intoxicated or under influence of controlled substance; exceptions.

ELIGIBILITY FOR COVERAGE UNDER GROUP POLICY

NRS 689B.290. Definitions.

NRS 689B.300. Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency.

NRS 689B.310. Insurer prohibited from asserting certain grounds to deny enrollment of child of insured pursuant to order.

NRS 689B.320. Certain accommodations to be made when child is covered under policy of noncustodial parent.

NRS 689B.330. Insurer to authorize enrollment of child of parent who is required by order to provide medical coverage for child.

PORTABILITY AND ACCOUNTABILITY

NRS 689B.340. Definitions. [Effective through December 31, 2013.]

NRS 689B.340. Definitions. [Effective January 1, 2014.]

NRS 689B.350. “Affiliation period” defined.

NRS 689B.355. “Blanket accident and health insurance” defined.

NRS 689B.360. “Carrier” defined.

NRS 689B.370. “Contribution” defined.

NRS 689B.380. “Creditable coverage” defined.

NRS 689B.390. “Group health plan” defined.

NRS 689B.400. “Group participation” defined.

NRS 689B.410. “Health benefit plan” defined. [Effective through December 31, 2013.]

NRS 689B.420. “Health status-related factor” defined. [Effective through December 31, 2013.]

NRS 689B.430. “Open enrollment” defined.

NRS 689B.440. “Plan sponsor” defined.

NRS 689B.450. “Preexisting condition” defined.

NRS 689B.460. “Waiting period” defined.

NRS 689B.470. Certain plan, fund or program to be treated as employee welfare benefit plan which is group health plan; partnership deemed employer of each partner. [Effective through December 31, 2013.]

NRS 689B.480. Determination of applicable creditable coverage of person; determination of period of creditable coverage of person; required statement. [Effective through December 31, 2013.]

NRS 689B.480. Determination of applicable creditable coverage of person; determination of period of creditable coverage of person; required statement. [Effective January 1, 2014.]

NRS 689B.490. Written certification of coverage required for purpose of determining period of creditable coverage accumulated by person.

NRS 689B.500. Coverage of preexisting conditions; when health maintenance organization may require affiliation period. [Effective through December 31, 2013.]

NRS 689B.500. Coverage of preexisting conditions. [Effective January 1, 2014.]

NRS 689B.510. Carrier authorized to modify coverage for insurance product under certain circumstances.

NRS 689B.520. Group plan or coverage that includes coverage for maternity care and pediatric care: Required to allow minimum stay in hospital in connection with childbirth; prohibited acts.

NRS 689B.530. Carrier required to permit eligible employee or dependent of employee to enroll for coverage under certain circumstances.

NRS 689B.540. Manner and period for enrollment of dependent of covered employee; period of special enrollment.

NRS 689B.550. Carrier prohibited from imposing restriction on participation inconsistent with chapter; restrictions on rules of eligibility that may be established; premiums to be equitable.

NRS 689B.560. Carrier required to renew coverage at option of plan sponsor; exceptions; discontinuation of form of product of group health insurance; discontinuation of group health insurance through bona fide association. [Effective through December 31, 2013.]

NRS 689B.560. Carrier required to renew coverage at option of plan sponsor; exceptions; discontinuation of form of product of group health insurance; discontinuation of group health insurance through bona fide association. [Effective January 1, 2014.]

NRS 689B.570. Carrier that offers coverage through network plan not required to offer coverage to employer that does not employ enrollees who reside or work in geographic area for which carrier is authorized to transact insurance. [Effective through December 31, 2013.]

NRS 689B.570. Carrier that offers coverage through network plan not required to offer coverage to employer that does not employ enrollees who reside or work in geographic service area for which carrier is authorized to transact insurance. [Effective January 1, 2014.]

NRS 689B.575. Carrier that offers coverage through network plan: Contracts with certain federally qualified health centers. [Effective through December 31, 2013.]

NRS 689B.580. Plan sponsor of governmental plan authorized to elect to exclude governmental plan from compliance with certain statutes; duties of plan sponsor. [Effective through December 31, 2013.]

NRS 689B.580. Plan sponsor of governmental plan authorized to elect to exclude governmental plan from compliance with certain statutes; duties of plan sponsor. [Effective January 1, 2014.]

NRS 689B.590. Converted policies: Carrier may only offer choice of basic and standard plans; election of basic or standard plan; premium; rates must be same for persons with similar case characteristics; losses must be spread across book. [Effective through December 31, 2013.]