Nev. Rev. Stat. ch. 689B – Group and Blanket Health Insurance | Midpage

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Nevada Revised Statutes

Chapter 689B

Nev. Rev. Stat. ch. 689B

Group and Blanket Health Insurance

689B.010Short title; scope 689B.015Contracts 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 providers 689B.020“Group health insurance” defined; authority to provide in certain policies for continuation of certain benefit provisions after death of person in insured group; authority of Commissioner to require filing of form of certificate proposed for delivery in this state of policy made under laws of another state 689B.026Delivery of policy to group formed to purchase health insurance prohibited; exception; applicable provisions for review of marketed insurance products by Commissioner; applicability to policy issued in another state 689B.0265Policy to guaranteed association 689B.0283Policy covering prescription drugs: Provision of notice and information regarding use of formulary 689B.0285System for resolving complaints of insureds: Establishment; approval; requirements; examination; exception 689B.029Annual report regarding system for resolving complaints of insureds; insurer required to maintain records of and report complaints concerning something other than health care services 689B.0295Written 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 689B.030Required provisions 689B.0301Construction of provisions requiring coverage by policy of group health insurance 689B.0303Required provision in certain policies concerning coverage for continued medical treatment; exceptions; regulations 689B.0304Policy 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 689B.0305Policy 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 689B.0306Required provision concerning coverage for certain treatment received as part of clinical trial or study for treatment of cancer or chronic fatigue syndrome; authority of insurer to require certain information; immunity from liability 689B.0307Policy 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 required; granting of request; applicability of provisions 689B.031Required provision concerning coverage of certain gynecological or obstetrical services without authorization or referral from primary care physician; designation of obstetrician or gynecologist as primary care physician 689B.0312Required provision concerning coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus and hepatitis C; reimbursement of certain providers of health care for certain services; prohibited acts 689B.0313Required coverage for certain tests and vaccines relating to human papillomavirus; prohibited acts 689B.0314Required provision concerning coverage for screening, genetic counseling and testing related to BRCA gene in certain circumstances 689B.0315Required provision concerning coverage for examination of person who is pregnant for certain diseases 689B.03155Required coverage for noninvasive prenatal screening 689B.0316Required provision concerning coverage for testing, treatment and prevention of sexually transmitted diseases; required provision concerning coverage for condoms for certain insureds 689B.0317Required provision in policy covering treatment of prostate cancer concerning coverage for prostate cancer screening; prohibited act 689B.0319Required provision concerning coverage for certain drugs and services related to substance use disorder and opioid use disorder; reimbursement of pharmacists and pharmacies for certain services; prohibited acts 689B.033Certain policies covering family members required to include certain coverage for insured’s newly born and adopted children and children placed with insured for adoption 689B.0334Required provision concerning coverage for medically necessary treatment of conditions relating to gender dysphoria and gender incongruence; restriction on refusal to cover certain treatments; authority of insurer to prescribe requirements for covering surgical treatments for minors; determination of medical necessity 689B.03345Required coverage for habilitative speech-language pathology and rehabilitative speech-language pathology for stuttering for certain persons; prohibited acts 689B.0335Required provision concerning coverage for autism spectrum disorders for certain persons; prohibited acts 689B.034Required provision concerning effect of benefits under other valid group coverage; subrogation; prohibited act 689B.0345Required provision concerning continuing coverage for employee or member on leave without pay as result of total disability 689B.035Required provision in certain policies concerning termination of coverage on dependent child 689B.0353Required provision concerning coverage for treatment of certain inherited metabolic diseases 689B.0357Required provision in policy covering hospital, medical or surgical expenses concerning coverage for management and treatment of diabetes 689B.0358Required provision concerning coverage for management and treatment of sickle cell disease and its variants; required provision in policy covering prescription drugs concerning coverage for medically necessary prescription drugs to treat sickle cell disease and its variants 689B.0361Required provision concerning coverage for biomarker testing for diagnosis, treatment, management and monitoring of cancer in certain circumstances; establishment of process to request exception or appeal denial of coverage; time for responding to request for prior authorization 689B.0362Policy covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy 689B.0365Required provision in certain policies concerning coverage for use of certain drugs and related services for treatment of cancer 689B.0367Required provision in policy covering treatment of colorectal cancer concerning coverage for colorectal cancer screening 689B.03675Required coverage for screening for lung cancer in policy providing coverage for treatment of lung cancer 689B.0368Policy covering prescription drugs prohibited from limiting or excluding coverage for certain prescription drugs previously approved for medical condition of insured; exceptions 689B.0369Required provision concerning coverage for services provided through telehealth to same extent as though provided in person or by other means; required provision concerning reimbursement for certain services provided through telehealth in same amount as though provided in person or by other means; prohibited acts 689B.0374Required provision concerning coverage for certain screenings and tests for breast cancer; prohibited acts 689B.0375Required provision in policy covering mastectomies concerning coverage relating to mastectomy; prohibited acts 689B.0376Required provision in policy covering prescription drugs or devices concerning coverage of hormone replacement therapy in certain circumstances; prohibited acts; exception 689B.03762Required provision in policy covering prescription drugs concerning coverage for drugs irregularly dispensed for purpose of synchronization of chronic medications; prohibited acts; exception 689B.03764Policy covering prescription drugs: Denial of coverage for early refills of otherwise covered topical ophthalmic products prohibited 689B.037645Limitation on cost-sharing obligation for insulin covered by policy covering prescription insulin drugs 689B.03765Policy covering prescription drugs: Submission to step therapy protocol for drug to treat psychiatric condition prohibited in certain circumstances 689B.03766Policy covering maternity care: Prohibited acts by insurer if insured is acting as gestational carrier; child deemed child of intended parent for purposes of policy 689B.0377Required provision in policy covering outpatient care concerning coverage for health care services related to hormone replacement therapy; prohibited acts 689B.0378Required provision concerning coverage for drug or device for contraception and related health services; prohibited acts; exceptions 689B.03785Required provisions concerning coverage for certain services, screenings and tests relating to wellness; prohibited acts 689B.03788Required coverage for dental service provided by qualified dental hygienist in certain circumstances 689B.0379Policy prohibited from excluding coverage for treatment of temporomandibular joint; exception 689B.038Reimbursement for treatments by licensed psychologist 689B.0383Reimbursement for treatments by licensed marriage and family therapist or licensed clinical professional counselor 689B.0385Reimbursement for treatments by licensed associate in social work, social worker, master social worker, independent social worker or clinical social worker 689B.039Reimbursement for treatments by chiropractic physician 689B.0393Reimbursement for treatments by podiatrist 689B.0397Reimbursement for treatment by licensed clinical alcohol and drug counselor 689B.040Direct payment for hospital and medical services and home health care; payment to assignee 689B.045Reimbursement for services provided by certain nurses 689B.047Reimbursement to provider of medical transportation 689B.049Reimbursement for acupuncture 689B.050Extended disability benefit 689B.060Readjustment of premiums; dividends 689B.061Limitations on deductibles and copayments charged under policy which offers difference of payment between preferred providers of health care and providers who are not preferred 689B.063Primary and secondary policies: Determination of benefits 689B.064Primary and secondary policies: Order of benefits 689B.065Policy issued to replace discontinued policy or coverage: Requirements; notice of reduction of benefits; statement of benefits; applicability of section 689B.067Provision in policy requiring binding arbitration for disputes with insurer authorized; procedure for arbitration; declaratory relief 689B.0675Insurer prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression 689B.068Insurer prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence 689B.069Insurer prohibited from requiring or using information concerning genetic testing; exceptions 689B.070“Blanket accident and health insurance” defined 689B.080Authority to issue; required provisions 689B.090Application and certificates 689B.100Payment of benefits 689B.110Legal liability of policyholders for death of or injury to insured member unaffected 689B.250Acceptance of uniform forms for billing and claims 689B.255Approval 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 689B.260Group health or blanket health policy containing exclusion, reduction or limitation of coverage relating to complications of pregnancy prohibited; exception 689B.265Policy covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by insurer if insured is person with disability 689B.270Required procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations 689B.275Contents, approval and provision of summary of coverage; provision of information about guaranteed availability of certain plans for benefits 689B.280Disclosure of information concerning medication of insured prohibited 689B.285Offering policy of health insurance for purposes of establishing health savings account 689B.287Insurer prohibited from denying coverage solely because applicant or insured was intoxicated or under influence of controlled substance; exceptions 689B.290Definitions 689B.300Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency 689B.310Insurer prohibited from asserting certain grounds to deny enrollment of child of insured pursuant to order 689B.320Certain accommodations required to be made when child is covered under policy of noncustodial parent 689B.330Insurer required to authorize enrollment of child of parent who is required by order to provide medical coverage for child in certain circumstances 689B.340Definitions 689B.350“Affiliation period” defined 689B.355“Blanket accident and health insurance” defined 689B.360“Carrier” defined 689B.370“Contribution” defined 689B.380“Creditable coverage” defined 689B.390“Group health plan” defined 689B.400“Group participation” defined 689B.430“Open enrollment” defined 689B.440“Plan sponsor” defined 689B.460“Waiting period” defined 689B.480Determination of applicable creditable coverage of person; determination of period of creditable coverage of person; required statement 689B.490Written certification of coverage required for purpose of determining period of creditable coverage accumulated by person 689B.500Carrier required to offer and issue plan regardless of health status of members; prohibited acts; authority to include wellness program in plan that offers discounts based on health status under certain circumstances 689B.510Carrier authorized to modify coverage for insurance product under certain circumstances 689B.520Group plan or coverage covering maternity care and pediatric care: Required to allow minimum stay in hospital in connection with childbirth; exception; prohibited acts 689B.530Carrier required to permit eligible employee or dependent of employee to enroll for coverage under certain circumstances 689B.540Manner and period for enrollment of dependent of covered employee; period of special enrollment 689B.550Carrier prohibited from imposing restriction on participation inconsistent with chapter; restrictions on rules of eligibility that may be established 689B.560Carrier required to renew coverage at option of plan sponsor; exceptions; discontinuation of product; discontinuation of group health insurance through bona fide association 689B.570Carrier 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 689B.580Plan sponsor of governmental plan authorized to elect to exclude governmental plan from compliance with certain statutes; duties of plan sponsor