Nev. Rev. Stat. ch. 689A – Individual Health Insurance | Midpage

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Nevada Revised Statutes

Chapter 689A

Nev. Rev. Stat. ch. 689A

Individual Health Insurance

689A.010Short title 689A.020Scope 689A.030General requirements 689A.032Insurer required to offer and issue plan regardless of health status of persons; prohibited acts 689A.033Insurer prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression 689A.035Contracts 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; insurer required to use form to obtain information on provider of health care; modification; submission by insurer of schedule of payments to provider 689A.040Contents of policy; substitution of provisions; captions; omission or modification of provisions 689A.0403Procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations 689A.04032Construction of provisions requiring certain coverage by policy of health insurance 689A.04033Coverage for certain treatment received as part of clinical trial or study for treatment of cancer or chronic fatigue syndrome required; authority of insurer to require certain information; immunity from liability 689A.04036Coverage for continued medical treatment required in certain policies; exceptions; regulations 689A.0404Coverage for use of certain drugs and related services for treatment of cancer required in certain policies 689A.04041Policy covering prescription drug for treatment of cancer or cancer symptom that is part of step therapy protocol: Insurer required to allow insured or attending practitioner to apply for exemption from step therapy protocol in certain circumstances; procedure for applying for and granting exemption 689A.04042Coverage for colorectal cancer screening required in policy covering treatment of colorectal cancer 689A.040425Coverage for screening for lung cancer required in policy providing coverage for treatment of lung cancer 689A.04043Policy covering prescription drug for treatment of medical condition that is part of step therapy protocol: Use of certain guidelines required; establishment of process to request exemption from step therapy protocol; granting of request; applicability of provisions 689A.04044Policy covering prescription drugs: Required actions by insurer related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared 689A.04045Policy covering prescription drugs prohibited from limiting or excluding coverage for prescription drug previously approved for medical condition of insured; exception 689A.04046Coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications required in policy covering prescription drugs; prohibited acts; exception 689A.04047Policy covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products 689A.04048Policy covering prescription drugs: Submission to step therapy protocol for drug to treat psychiatric condition prohibited in certain circumstances 689A.040485Limitation on cost-sharing obligation for insulin covered by policy covering prescription insulin drugs 689A.04049Coverage for screening, genetic counseling and testing related to BRCA gene required in certain circumstances 689A.0405Coverage for certain screenings and tests for breast cancer required; prohibited acts 689A.041Coverage relating to mastectomy required in policy covering mastectomies; prohibited acts 689A.0412Coverage for examination of person who is pregnant for certain diseases required 689A.0413Coverage for certain gynecological or obstetrical services without authorization or referral from primary care physician required; designation of obstetrician or gynecologist as primary care physician 689A.0415Coverage for hormone replacement therapy in certain circumstances required in policy covering prescription drugs or devices; prohibited acts; exception 689A.0417Coverage for health care services related to hormone replacement therapy required in policy covering outpatient care; prohibited acts 689A.0418Coverage for drug or device for contraception and related health services required; prohibited acts; exceptions 689A.0419Coverage for certain services, screenings and tests relating to wellness required; prohibited acts 689A.042Policy containing exclusion, reduction or limitation of coverage relating to complications of pregnancy prohibited; exception 689A.0423Coverage for treatment of certain inherited metabolic diseases required 689A.0424Policy covering maternity care: Prohibited acts by insurer if insured is acting as gestational carrier; child deemed child of intended parent for purposes of policy 689A.0427Coverage for management and treatment of diabetes required in policy covering hospital, medical or surgical expenses 689A.0428Coverage for management and treatment of sickle cell disease and its variants required; coverage for medically necessary prescription drugs to treat sickle cell disease and its variants required by plan covering prescription drugs 689A.043Policy covering family on expense-incurred basis required to include certain coverage for insured’s newly born and adopted children and children placed with insured for adoption 689A.0432Coverage for medically necessary treatment of conditions relating to gender dysphoria and gender incongruence required; restriction on refusal to cover certain treatments; authority of insurer to prescribe requirements for covering surgical treatments for minors; determination of medical necessity 689A.0434Coverage for habilitative speech-language pathology and rehabilitative speech-language pathology as treatment for stuttering for certain persons required; prohibited acts 689A.0435Option of coverage for autism spectrum disorders for certain persons required; prohibited acts 689A.0437Coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus and hepatitis C required; reimbursement of certain providers of health care for certain services; prohibited acts 689A.0438Coverage for testing, treatment and prevention of sexually transmitted diseases required; coverage for condoms for certain insureds required 689A.044Coverage for certain tests and vaccines relating to human papillomavirus required; prohibited acts 689A.0445Coverage for prostate cancer screening 689A.0446Coverage for biomarker testing for diagnosis, treatment, management and monitoring of cancer required in certain circumstances; establishment of process to request exception or appeal denial of coverage; time for responding to request for prior authorization 689A.0447Policy covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy 689A.0455Coverage for treatment of conditions relating to severe mental illness required 689A.0459Coverage for certain drugs and services related to substance use disorder and opioid use disorder required; reimbursement of pharmacists and pharmacies for certain services; prohibited acts 689A.046Benefits for treatment of alcohol or substance use disorder required 689A.0463Coverage for services provided through telehealth required to same extent as though provided in person or by other means; reimbursement for certain services provided through telehealth required in same amount as though provided in person or by other means; prohibited acts 689A.0464Policy covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by insurer if insured is person with disability 689A.04645Coverage for dental service provided by qualified dental hygienist required in certain circumstances 689A.0465Policy prohibited from excluding coverage of treatment of temporomandibular joint; exception 689A.0475Acupuncture 689A.048Treatment by licensed psychologist 689A.0483Treatment by licensed marriage and family therapist or licensed clinical professional counselor 689A.0485Treatment by licensed associate in social work, social worker, master social worker, independent social worker or clinical social worker 689A.0487Treatment by licensed podiatrist 689A.049Treatment by licensed chiropractic physician; restriction on policy limitations 689A.0493Treatment by licensed clinical alcohol and drug counselor 689A.0495Services provided by certain registered nurses 689A.0497Provider of medical transportation 689A.050Entire contract; changes 689A.060Time limit on certain defenses 689A.070Grace period 689A.075Cancellation and rescission of short-term limited duration medical plan 689A.080Reinstatement 689A.090Notice of claim 689A.100Claim forms: Required provision 689A.105Claim forms: Uniform billing and claims forms 689A.110Claim forms: Proofs of loss 689A.120Time of payment of claims 689A.130Payment of claims 689A.135Assignment of benefits by insured to provider of health care 689A.140Physical examination and autopsy 689A.150Legal actions 689A.160Change of beneficiary 689A.170Right to examine and return policy 689A.180Optional provisions: Requirements; substitution of provisions; captions 689A.190Extended disability benefit 689A.200Change of occupation 689A.210Misstatement of age 689A.220Coordination of benefits: Same insurer 689A.230Coordination of benefits: All coverages 689A.240Relation of earnings to insurance 689A.250Unpaid premiums 689A.260Conformity with state statutes 689A.270Illegal occupation 689A.290Renewability 689A.300Order of certain provisions 689A.310Ownership of policy by person other than insured 689A.320Requirements of other jurisdictions 689A.330Policies issued for delivery in another state 689A.340Limitation on provisions not subject to chapter; effect of violation of chapter; conflict among provisions 689A.350Age limit 689A.380Definitions of terms used in policies 689A.405Policy covering prescription drugs: Provision of notice and information regarding use of formulary 689A.410Approval or denial of claims; payment of claims and interest; requests for additional information; award of costs and attorney’s fees; compliance with requirements; imposition of administrative fine or suspension or revocation of certificate of authority for failure to comply; report of compliance by insurer 689A.413Insurer prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence 689A.415Insurer prohibited from denying coverage solely because applicant or insured was intoxicated or under influence of controlled substance; exceptions 689A.417Insurer prohibited from requiring or using information concerning genetic testing; exceptions 689A.419Offering policy of health insurance for purposes of establishing health savings account 689A.420Definitions 689A.430Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency 689A.440Insurer prohibited from asserting certain grounds to deny enrollment of child of insured pursuant to order 689A.450Certain accommodations required to be made when child is covered under policy of noncustodial parent 689A.460Insurer required to authorize enrollment of child of parent who is required by order to provide medical coverage under certain circumstances; termination of coverage of child 689A.470Definitions 689A.485“Bona fide association” defined 689A.495“Control” defined 689A.505“Creditable coverage” defined 689A.510“Dependent” defined 689A.525“Geographic rating area” defined 689A.527“Geographic service area” defined 689A.535“Group health plan” defined 689A.540“Health benefit plan” defined 689A.550“Individual carrier” defined 689A.555“Individual health benefit plan” defined 689A.570“Plan for coverage of a bona fide association” defined 689A.580“Plan sponsor” defined 689A.590“Producer” defined 689A.600“Provision for a restricted network” defined 689A.615Certain plan, fund or program to be treated as employee welfare benefit plan which is group health plan; partnership deemed employer of each partner 689A.630Requirement to renew coverage at option of individual; exceptions; discontinuation of product; discontinuation of health benefit plan available through bona fide association 689A.635Coverage offered through network plan not required to be offered to person who does not reside or work in geographic service area or geographic rating area 689A.637Coverage offered through plan that provides for restricted network: Contracts with certain federally qualified health centers 689A.696Information and documents required to be made available to Commissioner; proprietary information 689A.700Regulations regarding rates 689A.705Regulations concerning reissuance of health benefit plan 689A.710Prohibited acts; denial of application for coverage; regulations; violation may constitute unfair trade practice; applicability of section 689A.715Requirements for employee welfare benefit plan for providing benefits for employees of more than one employer 689A.717Individual health benefit plan covering maternity care and pediatric care: Requirement to allow minimum stay in hospital in connection with childbirth; prohibited acts 689A.720Written certification of coverage required for determining period of creditable coverage accumulated by person; provision of certificate to insured 689A.725Requirements for plan for coverage 689A.740Regulations 689A.745Establishment; approval; requirements; examination; exception 689A.750Annual report; insurer required to maintain records of and report complaints concerning something other than health care services 689A.755Written notice required to be provided by insurer to insured explaining right to file complaint; written notice to insured and provider of health care required when insurer denies coverage of health care service