HEALTH BENEFIT PLANS

NRS 689C.015. Definitions.

NRS 689C.017. “Affiliated” defined.

NRS 689C.019. “Affiliation period” defined.

NRS 689C.021. “Basic health benefit plan” defined. [Effective through December 31, 2013.]

NRS 689C.023. “Bona fide association” defined.

NRS 689C.025. “Carrier” defined.

NRS 689C.035. “Characteristics” defined. [Effective through December 31, 2013.]

NRS 689C.045. “Class of business” defined.

NRS 689C.047. “Control” defined.

NRS 689C.051. “Converted policy” defined. [Effective through December 31, 2013.]

NRS 689C.053. “Creditable coverage” defined.

NRS 689C.055. “Dependent” defined. [Effective through December 31, 2013.]

NRS 689C.055. “Dependent” defined. [Effective January 1, 2014.]

NRS 689C.065. “Eligible employee” defined.

NRS 689C.066. “Employee leasing company” defined.

NRS 689C.067. “Established geographic service area” defined. [Effective through December 31, 2013.]

NRS 689C.071. “Geographic area” defined. [Effective through December 31, 2013.]

NRS 689C.071. “Geographic rating area” defined. [Effective January 1, 2014.]

NRS 689C.072. “Geographic service area” defined. [Effective January 1, 2014.]

NRS 689C.073. “Group health plan” defined.

NRS 689C.075. “Health benefit plan” defined.

NRS 689C.076. “Health status-related factor” defined. [Effective through December 31, 2013.]

NRS 689C.077. “Network plan” defined.

NRS 689C.078. “Open enrollment” defined.

NRS 689C.079. “Plan for coverage of a bona fide association” defined.

NRS 689C.081. “Plan sponsor” defined.

NRS 689C.082. “Preexisting condition” defined.

NRS 689C.083. “Producer” defined.

NRS 689C.084. “Program of Reinsurance” defined. [Effective through December 31, 2013.]

NRS 689C.085. “Rating period” defined.

NRS 689C.089. “Risk-assuming carrier” defined. [Effective through December 31, 2013.]

NRS 689C.095. “Small employer” defined. [Effective through December 31, 2015.]

NRS 689C.095. “Small employer” defined. [Effective January 1, 2016.]

NRS 689C.099. “Standard health benefit plan” defined. [Effective through December 31, 2013.]

NRS 689C.106. “Waiting period” defined.

NRS 689C.1065. Applicability.

NRS 689C.107. Affiliated carriers deemed one carrier in certain circumstances; affiliated carrier that is health maintenance organization considered separate carrier; ceding arrangement prohibited in certain circumstances. [Effective through December 31, 2013.]

NRS 689C.109. Certain plan, fund or program to be treated as employee welfare benefit plan which is group health plan; partnership deemed employer of each partner.

NRS 689C.111. Determination of whether employer is small or large; applicability of provisions after employer is deemed large.

NRS 689C.113. Requirements for employee welfare benefit plan for providing benefits for employees of more than one employer.

NRS 689C.115. Mandatory and optional coverage.

NRS 689C.125. Rating factors for determining premiums. [Effective through December 31, 2013.]

NRS 689C.125. Rating factors for determining premiums. [Effective January 1, 2014.]

NRS 689C.135. Effect of provision in health benefit plan for restricted network on determination of rates.

NRS 689C.143. Offering of policy of health insurance for purposes of establishing health savings account.

NRS 689C.145. Characteristics that carrier may use to determine rating factors for establishing premiums. [Effective through December 31, 2013.]

NRS 689C.155. Regulations. [Effective through December 31, 2013.]

NRS 689C.155. Regulations. [Effective January 1, 2014.]

NRS 689C.156. Each health benefit plan marketed in this State required to be offered to small employers. [Effective through December 31, 2013.]

NRS 689C.156. Each health benefit plan marketed in this State required to be offered to small employers. [Effective January 1, 2014.]

NRS 689C.1565. Coverage to small employers not required under certain circumstances; notice to Commissioner of and prohibition on writing new business after election not to offer new coverage required.

NRS 689C.157. Requirement to file basic and standard health benefit plans with Commissioner; disapproval of plan. [Effective through December 31, 2013.]

NRS 689C.158. Producer may only sign up small employers and eligible employees in bona fide associations if employers and employees are actively engaged in or related to bona fide association.

NRS 689C.159. Certain provisions inapplicable to plan that carrier makes available only through bona fide association. [Effective through December 31, 2013.]

NRS 689C.159. Certain provisions inapplicable to plan that carrier makes available only through bona fide association. [Effective January 1, 2014.]

NRS 689C.160. Carrier must uniformly apply requirements to determine whether to provide coverage. [Effective through December 31, 2013.]

NRS 689C.160. Carrier must uniformly apply requirements to determine whether to provide coverage. [Effective January 1, 2014.]

NRS 689C.165. Carrier prohibited from modifying plan to restrict or exclude coverage for certain services.

NRS 689C.1655. Coverage for autism spectrum disorders.

NRS 689C.166. Coverage for abuse of alcohol or drugs: Required.

NRS 689C.167. Coverage for abuse of alcohol or drugs: Benefits.

NRS 689C.168. Coverage for prescription drug previously approved for medical condition of insured.

NRS 689C.169. Coverage for severe mental illness. [Effective through December 31, 2013.]

NRS 689C.169. Coverage for severe mental illness. [Effective January 1, 2014.]

NRS 689C.170. Authorized variation of minimum participation and contributions; denial of coverage based on industry prohibited.

NRS 689C.180. Carrier to offer same coverage to all eligible employees; denial of coverage to otherwise eligible employee.

NRS 689C.183. Plan and carrier required to permit employee or dependent of employee to enroll for coverage under certain circumstances.

NRS 689C.187. Manner and period for enrolling dependent of covered employee; period of special enrollment.

NRS 689C.190. Coverage of preexisting conditions; period of exclusion for preexisting condition; when health maintenance organization may require affiliation period. [Effective through December 31, 2013.]

NRS 689C.190. Coverage of preexisting conditions. [Effective January 1, 2014.]

NRS 689C.191. Determination of applicable creditable coverage of person; determining period of creditable coverage of person; required statement. [Effective through December 31, 2013.]

NRS 689C.191. Determination of applicable creditable coverage of person; determining period of creditable coverage of person; required statement; applicability. [Effective January 1, 2014.]

NRS 689C.192. Written certification of coverage required for purpose of determining period of creditable coverage accumulated by person.

NRS 689C.193. Carrier prohibited from imposing restriction on participation inconsistent with certain sections; restrictions on rules of eligibility that may be established; premiums to be equitable. [Effective through December 31, 2013.]

NRS 689C.193. Carrier prohibited from imposing restriction on participation inconsistent with certain sections; restrictions on rules of eligibility that may be established; premiums to be equitable. [Effective January 1, 2014.]

NRS 689C.194. Plan that includes coverage for maternity and pediatric care: Required to allow minimum stay in hospital in connection with childbirth; prohibited acts.

NRS 689C.196. Insurer prohibited from denying coverage solely because person was victim of domestic violence.

NRS 689C.197. Carrier prohibited from denying coverage because insured was intoxicated or under influence of controlled substance; exceptions.

NRS 689C.198. Insurer prohibited from requiring or using information concerning genetic testing; exceptions.

NRS 689C.200. When carrier is not required to offer coverage. [Effective through December 31, 2013.]

NRS 689C.200. When carrier is not required to offer coverage. [Effective January 1, 2014.]

NRS 689C.203. Denial of application for coverage from small employer; regulations.

NRS 689C.207. Regulations concerning reissuance of health benefit plan.

NRS 689C.210. Procedure for increasing premium rates. [Effective through December 31, 2013.]

NRS 689C.220. Adjustment in rates to be applied uniformly.

NRS 689C.230. Determination and application of index rate. [Effective through December 31, 2013.]

NRS 689C.240. Use of industry classifications as rating factor. [Effective through December 31, 2013.]

NRS 689C.250. Required disclosures to Commissioner; when disclosures constitute trade secret. [Effective through December 31, 2013.]

NRS 689C.250. Information considered to be trade secret; exception. [Effective January 1, 2014.]

NRS 689C.260. Manner in which carrier may establish separate class of business; transferring small employer into or out of class of business. [Effective through December 31, 2013.]

NRS 689C.265. Carrier authorized to modify coverage for insurance product under certain circumstances.

NRS 689C.270. Regulations concerning disclosures by carrier to small employer; copy of disclosure to be made available to small employer.

NRS 689C.280. Carrier to provide required disclosures to small employer before issuing policy of insurance.

NRS 689C.281. Coverage for prescription drugs: Provision of notice and information regarding use of formulary.

NRS 689C.283. Election to operate as risk-assuming carrier or reinsuring carrier: Notice to Commissioner; effective date; change in status. [Effective through December 31, 2013.]

NRS 689C.287. Election to act as risk-assuming carrier: Suspension by Commissioner; applicable statutes. [Effective through December 31, 2013.]

NRS 689C.290. Commissioner authorized to suspend restriction on increase of premiums for new rating period based on new business for policy. [Effective through December 31, 2013.]

NRS 689C.300. Carrier to file actuarial certification annually with Commissioner. [Effective through December 31, 2013.]

NRS 689C.310. Renewal of health benefit plan; discontinuing issuance and renewal of coverage, plan or form of product of health benefit plan. [Effective through December 31, 2013.]

NRS 689C.310. Renewal of health benefit plan; discontinuing issuance and renewal of coverage, plan or form of product of health benefit plan. [Effective January 1, 2014.]

NRS 689C.320. Required notification when carrier discontinues transacting insurance in this State; restrictions on carrier that discontinues transacting insurance. [Effective through December 31, 2013.]

NRS 689C.320. Required notification when carrier discontinues transacting insurance in this State; restrictions on carrier that discontinues transacting insurance. [Effective January 1, 2014.]

NRS 689C.325. Coverage offered through network plan not required to be offered to eligible employee who does not reside or work in established geographic service area or if carrier lacks capacity to deliver adequate service to additional employers and employees. [Effective through December 31, 2013.]

NRS 689C.325. Coverage offered through network plan not required to be offered to eligible employee who does not reside or work in geographic service area or if carrier lacks capacity to deliver adequate service to additional employers and employees. [Effective January 1, 2014.]

NRS 689C.327. Carrier that offers network plan: Contracts with certain federally qualified health centers. [Effective through December 31, 2013.]

NRS 689C.330. When insurer is required to allow employee to continue coverage after employee is no longer covered by health benefit plan.

NRS 689C.340. Required provisions in health benefit plan of employer who employs less than 20 employees related to continuation of coverage. [Effective through December 31, 2013.]

NRS 689C.342. Notice of election and payment of premium. [Effective through December 31, 2013.]

NRS 689C.344. Amount of premium for continuation of coverage; change in rates; payment to insurer; termination. [Effective through December 31, 2013.]

NRS 689C.346. Effect of change in insurer during period of continued coverage. [Effective through December 31, 2013.]

NRS 689C.348. Continued coverage ceases before end of established period under certain circumstances. [Effective through December 31, 2013.]

NRS 689C.350. Health benefit plan with preferred providers of health care: Deductible; percentage rate of payment; when coinsurance is no longer required; when service is deemed to be provided by preferred provider; processing claims of provider who is not preferred. [Effective through December 31, 2013.]

NRS 689C.350. Health benefit plan with preferred providers of health care: Deductible; when service is deemed to be provided by preferred provider. [Effective January 1, 2014.]

NRS 689C.355. Prohibited acts of carrier or producer; denial of application for coverage; violation may constitute unfair trade practice; applicability of section. [Effective through December 31, 2013.]

NRS 689C.355. Prohibited acts of carrier or producer; denial of application for coverage; violation may constitute unfair trade practice; applicability of section. [Effective January 1, 2014.]

VOLUNTARY PURCHASING GROUPS

NRS 689C.360. Definitions.

NRS 689C.380. “Contract” defined.

NRS 689C.390. “Dependent” defined. [Effective through December 31, 2013.]

NRS 689C.390. “Dependent” defined. [Effective January 1, 2014.]

NRS 689C.420. “Voluntary purchasing group” defined.

NRS 689C.425. Applicability of other provisions.

NRS 689C.430. Entities which are authorized to offer contracts to voluntary purchasing groups.

NRS 689C.435. Contracts between carrier and providers of health care: Prohibiting carrier 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.

NRS 689C.440. Regulations regarding required disclosures by carrier.

NRS 689C.450. Carrier to provide disclosure before issuing contract.

NRS 689C.455. Coverage for prescription drugs: Provision of notice and information regarding use of formulary.

NRS 689C.460. Carrier to offer same coverage to all eligible employees; denial of coverage to otherwise eligible employee.

NRS 689C.470. Renewal of contract; discontinuing issuance and renewal of form of product of health benefit plan or health benefit plan.

NRS 689C.480. Required notification when carrier ceases to renew all contracts; restrictions on carrier that ceases to renew all contracts.

NRS 689C.485. 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 689C.490. Formation of voluntary purchasing group by small employers; requirements when affiliate of group ceases to qualify as small employer.

NRS 689C.500. Requirements for registration as voluntary purchasing group; application.

NRS 689C.510. Fee for application; response to application.

NRS 689C.520. Additional requirements for registration.

NRS 689C.530. Filing reports; annual renewal fee.

NRS 689C.540. Duties.

NRS 689C.550. Collection of premiums; trust account for deposit of premiums.

NRS 689C.560. Regulations governing security to be maintained by voluntary purchasing group.

NRS 689C.570. Organizer prohibited from acquiring financial interest in group’s business.

NRS 689C.580. Prohibited acts.

NRS 689C.590. Disciplinary action for violation of provisions.

NRS 689C.600. Regulations.

REINSURANCE

General Provisions

NRS 689C.610. Definitions. [Effective through December 31, 2013.]

NRS 689C.610. Definitions. [Effective January 1, 2014.]

NRS 689C.620. “Board” defined. [Effective through December 31, 2013.]

NRS 689C.630. “Church plan” defined.

NRS 689C.640. “Committee” defined. [Effective through December 31, 2013.]

NRS 689C.650. “Eligible person” defined. [Effective through December 31, 2013.]

NRS 689C.660. “Individual carrier” defined.

NRS 689C.670. “Individual health benefit plan” defined.

NRS 689C.680. “Individual reinsuring carrier” defined. [Effective through December 31, 2013.]

NRS 689C.690. “Individual risk-assuming carrier” defined. [Effective through December 31, 2013.]

NRS 689C.700. “Plan of operation” defined. [Effective through December 31, 2013.]

NRS 689C.710. “Program of Reinsurance” defined. [Effective through December 31, 2013.]

NRS 689C.720. “Reinsuring carrier” defined. [Effective through December 31, 2013.]

NRS 689C.730. “Risk-assuming carrier” defined. [Effective through December 31, 2013.]

Program of Reinsurance for Small Employers and Eligible Persons

NRS 689C.740. Creation. [Effective through December 31, 2013.]

NRS 689C.750. Board of Directors: Creation; members; term; vacancy. [Effective through December 31, 2013.]

NRS 689C.760. Meetings of Board; Chair of Board. [Effective through December 31, 2013.]

NRS 689C.770. Plan of operation: Submission by Board; approval by Commissioner; temporary plan when plan not suitable or not submitted. [Effective through December 31, 2013.]

NRS 689C.780. Requirements of plan of operation and temporary plan of operation. [Effective through December 31, 2013.]

NRS 689C.790. Program deemed to have powers and authority of insurance companies and health maintenance organizations; exceptions; powers. [Effective through December 31, 2013.]

NRS 689C.800. Amount of coverage to be reinsured; time within which reinsurance may begin; limitation on reimbursement to reinsuring carrier; termination of reinsurance; premium rate charged to federally qualified health maintenance organization; manner of handling managed care and claims by reinsuring carrier. [Effective through December 31, 2013.]

NRS 689C.810. Premium rates: Methodology for determining; minimum rates; review of methodology. [Effective through December 31, 2013.]

NRS 689C.820. Premiums for certain health benefit plans that are reinsured with program required to meet established requirements for premium rates. [Effective through December 31, 2013.]

NRS 689C.830. Board required to determine, account for and report to Commissioner net loss. [Effective through December 31, 2013.]

NRS 689C.840. Net loss from reinsuring small employers and eligible employees and dependents required to be recouped by assessments against reinsuring carriers. [Effective through December 31, 2013.]

NRS 689C.850. Net loss from reinsuring individual eligible persons and dependents required to be recouped by assessments against individual reinsuring carriers. [Effective through December 31, 2013.]

NRS 689C.860. Board required to determine, account for and report to Commissioner estimate of assessments needed to pay for losses; evaluation of operation of Program. [Effective through December 31, 2013.]

NRS 689C.870. Additional funding: Eligibility based on amount of assessment needed; Board to establish formula for additional assessments on all carriers. [Effective through December 31, 2013.]

NRS 689C.880. Use of excess assessments. [Effective through December 31, 2013.]

NRS 689C.890. Assessment against reinsuring carrier to be determined annually; penalty for late payment of assessments; deferment of assessment. [Effective through December 31, 2013.]

NRS 689C.900. Insurer to receive certificate of contribution for paying additional assessment; certain amount of contribution may be shown as asset and may offset liability for premium tax. [Effective through December 31, 2013.]

NRS 689C.910. Adjustment of assessment on federally qualified health maintenance organizations. [Effective through December 31, 2013.]

NRS 689C.920. Immunity from liability of Program and reinsuring carriers for certain acts. [Effective through December 31, 2013.]

NRS 689C.930. Board to develop standards setting forth manner and levels of compensation paid to producers for sale of health benefit plans. [Effective through December 31, 2013.]

NRS 689C.940. Regulations concerning determination of status of stop-loss policy.

NRS 689C.950. Certain provisions inapplicable to certain basic health benefit plan delivered to small employers or eligible persons. [Effective through December 31, 2013.]

NRS 689C.955. Member, agent or employee of Board immune from liability in certain circumstances. [Effective through December 31, 2013.]

Committee on Health Benefit Plans

NRS 689C.960. Creation; members; term; vacancy. [Effective through December 31, 2013.]

NRS 689C.970. Meetings; Chair; duties. [Effective through December 31, 2013.]

NRS 689C.980. Board and Committee to study and submit report concerning effectiveness of certain provisions. [Effective through December 31, 2013.]