1. 1. Following approval by the Commissioner, each insurer that issues a policy of group health insurance in this State shall provide written notice to an insured, in clear and comprehensible language that is understandable to an ordinary layperson, explaining the right of the insured to file a written complaint. Such notice must be provided to an insured:

   1. (a) At the time the insured receives his or her certificate of coverage or evidence of coverage;
   2. (b) Any time that the insurer denies coverage of a health care service or limits coverage of a health care service to an insured; and
   3. (c) Any other time deemed necessary by the Commissioner.

2. 2. Any time that an insurer denies coverage of a health care service, including, without limitation, denying a claim relating to a policy of group health insurance or blanket insurance pursuant to NRS 689B.255, to an insured it shall notify the insured in writing within:

   1. (a) Twenty-one days after the insurer receives all information necessary to make a determination concerning the claim, if the information is submitted electronically;
   2. (b) Thirty days after the insurer receives all information necessary to make a determination concerning the claim, if the information is not submitted electronically; or
   3. (c) If no claim is received, within 10 working days after the insurer denies coverage of the health care service.

3. 3. The notice required pursuant to subsection 2 must include, without limitation:

   1. (a) All reasons for denying coverage of the service, including, without limitation, the specific facts and provisions of the policy relied upon by the insurer as a basis to deny coverage of the service;
   2. (b) The criteria by which the insurer determines whether to authorize or deny coverage of the health care service and a description of the manner in which the insurer applied those criteria to the health care service;
   3. (c) A summary of any applicable process established pursuant to NRS 687B.820 for challenging the denial of the claim; and
   4. (d) The right of the insured to file a written complaint and the procedure for filing such a complaint.
4. 4. A written notice which is approved by the Commissioner shall be deemed to be in clear and comprehensible language that is understandable to an ordinary layperson.

5. 5. If an insurer denies a claim submitted by a provider of health care, the insurer shall notify the provider of health care in writing of the denial within:

   1. (a) Twenty-one days after the insurer receives all information necessary to make a determination concerning the claim, if the information is submitted electronically; or
   2. (b) Thirty days after the insurer receives all information necessary to make a determination concerning the claim, if the information is not submitted electronically.

6. 6. The notice required pursuant to subsection 5 must include, without limitation:

   1. (a) All reasons for denying the claim;
   2. (b) The criteria by which the insurer determines whether to approve or deny the claim and a description of the manner in which the insurer applied those criteria to the claim;
   3. (c) Any other legal or factual basis for denying the claim; and
   4. (d) A summary of any applicable process established pursuant to NRS 687B.820 for challenging the denial of the claim.

(Added to NRS by 1997, 309; A 1999, 3084; 2025, 2395)