Nev. Rev. Stat. ch. 689C – Health Insurance for Small Employers | Midpage

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Nevada Revised Statutes

Chapter 689C

Nev. Rev. Stat. ch. 689C

Health Insurance for Small Employers

689C.015Definitions 689C.017“Affiliated” defined 689C.019“Affiliation period” defined 689C.023“Bona fide association” defined 689C.025“Carrier” defined 689C.045“Class of business” defined 689C.047“Control” defined 689C.053“Creditable coverage” defined 689C.055“Dependent” defined 689C.065“Eligible employee” defined 689C.071“Geographic rating area” defined 689C.072“Geographic service area” defined 689C.073“Group health plan” defined 689C.075“Health benefit plan” defined 689C.077“Network plan” defined 689C.078“Open enrollment” defined 689C.079“Plan for coverage of a bona fide association” defined 689C.081“Plan sponsor” defined 689C.083“Producer” defined 689C.0835“Professional employer organization” defined 689C.085“Rating period” defined 689C.095“Small employer” defined 689C.104“Voluntary purchasing group” defined 689C.106“Waiting period” defined 689C.1065Applicability 689C.109Certain plan, fund or program established or maintained by partnership required to be treated as employee welfare benefit plan which is group health plan; partnership deemed employer of each partner 689C.111Professional employer organization deemed large employer in certain circumstances 689C.113Requirements for employee welfare benefit plan for providing benefits for employees of more than one employer 689C.115Mandatory and optional coverage 689C.125Rating factors for determining premiums; rating periods 689C.131Contracts 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; carrier required to use form to obtain information on provider of health care; modification; submission by carrier of schedule of payments to providers 689C.135Effect of provision in health benefit plan for restricted network on determination of rates 689C.143Offering of policy of health insurance for purposes of establishing health savings account 689C.155Regulations 689C.156Each health benefit plan marketed in this State required to be offered to small employers; issuance; carrier required to provide system for resolving complaints of employees if services provided or paid for through managed care 689C.1565Coverage to small employers not required under certain circumstances; notice required to Commissioner of and prohibition on writing new business after election not to offer new coverage required 689C.158Producer authorized only to market to or sign up small employers and eligible employees in bona fide associations if employers and employees are actively engaged in or directly related to bona fide association 689C.159Certain provisions inapplicable to plan that carrier makes available only through bona fide association 689C.160Carrier must uniformly apply requirements to determine whether to provide coverage 689C.165Carrier prohibited from modifying plan to restrict or exclude coverage or benefits for specific diseases, medical conditions or services otherwise covered by plan; exceptions 689C.1652Coverage for medically necessary treatment of conditions relating to gender dysphoria and gender incongruence required; restriction on refusal to cover certain treatments; authority of carrier to prescribe requirements for covering surgical treatments for minors; determination of medical necessity 689C.1653Coverage for testing, treatment and prevention of sexually transmitted diseases required; coverage for condoms for certain insureds required 689C.1654Coverage for habilitative speech-language pathology and rehabilitative speech-language pathology as treatment for stuttering required for certain persons; prohibited acts 689C.1655Coverage for autism spectrum disorders for certain persons required; prohibited acts 689C.166Coverage for alcohol or substance use disorder: Required in group health insurance policy 689C.1665Coverage 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 689C.167Coverage for alcohol or substance use disorders: Benefits provided by group health insurance policy 689C.1671Coverage 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 689C.16715Coverage for certain gynecological or obstetrical services required without prior authorization or referral from primary care physician; designation of obstetrician or gynecologist as primary care physician 689C.1672Coverage for certain tests and vaccines relating to human papillomavirus required; prohibited acts 689C.1673Coverage for screening, genetic counseling and testing related to BRCA gene required in certain circumstances 689C.1674Coverage for certain screenings and tests for breast cancer required; prohibited acts 689C.16745Coverage for noninvasive prenatal screening required 689C.1675Coverage for examination of person who is pregnant for certain diseases required 689C.1676Coverage for drug or device for contraception and related health services required; prohibited acts; exceptions 689C.1678Coverage for certain services, screenings and tests relating to wellness required; prohibited acts 689C.1679Plan covering prescription drugs: Required actions by carrier related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared 689C.168Plan covering prescription drugs prohibited from limiting or excluding coverage for prescription drug previously approved for medical condition of insured; exception 689C.16805Limitation on cost-sharing obligation for insulin covered by plan covering prescription insulin drugs; prohibited acts 689C.1681Plan 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 689C.1682Plan covering prescription drugs: Submission to step therapy protocol for drug to treat psychiatric condition prohibited in certain circumstances 689C.1683Coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications required in plan covering prescription drugs; prohibited acts; exception 689C.1684Plan covering prescription drug for treatment of cancer or cancer symptom that is part of step therapy protocol: Carrier 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 689C.1685Plan covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products 689C.1687Coverage 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 in plan covering prescription drugs 689C.16875Coverage for screening for lung cancer required in plan providing coverage for treatment of lung cancer 689C.1688Coverage 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 689C.169Coverage for severe mental illness required under group health insurance policy 689C.170Authorized variation of minimum participation and contributions; denial of coverage based on industry prohibited 689C.180Carrier to offer same coverage to all eligible employees; denial of coverage to otherwise eligible employee 689C.183Plan and carrier required to permit employee or dependent of employee to enroll for coverage under certain circumstances 689C.187Manner and period for enrolling dependent of covered employee; period of special enrollment 689C.190Carrier required to offer and issue plan regardless of health status of employees; prohibited acts; authority to include wellness program in plan that offers discounts based on health status under certain circumstances 689C.191Determination of applicable creditable coverage of person; determining period of creditable coverage of person; required statement for certain election by carrier; applicability 689C.192Written certification of coverage required for purpose of determining period of creditable coverage accumulated by person 689C.193Carrier prohibited from imposing restriction on being participant of or beneficiary of plan inconsistent with certain provisions; restrictions on rules of eligibility that may be established 689C.194Plan covering maternity and pediatric care: Required to allow minimum stay in hospital in connection with childbirth; exceptions; prohibited acts 689C.1945Plan covering maternity care: Prohibited acts by carrier if insured is acting as gestational carrier; child deemed child of intended parent for purposes of plan 689C.1947Plan covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by carrier if insured is person with disability 689C.1948Coverage for dental service provided by qualified dental hygienist required in certain circumstances 689C.195Coverage 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 689C.196Insurer prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence 689C.197Carrier prohibited from denying coverage because applicant or insured was intoxicated or under influence of controlled substance; exceptions 689C.1975Carrier prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression 689C.198Insurer prohibited from requiring or using information concerning genetic testing; exceptions 689C.200Circumstances in which carrier is not required to offer coverage 689C.203Requirement for denial of application for coverage from small employer; regulations setting standards for fair marketing and broad availability of plans 689C.207Regulations concerning reissuance of health benefit plan 689C.220Adjustment in rates required to be applied uniformly 689C.265Carrier authorized to modify coverage for insurance product under certain circumstances 689C.281Plan covering prescription drugs: Provision of notice and information regarding use of formulary 689C.310Renewal of plan; discontinuance of issuance or renewal of coverage or of plan offered only through bona fide association; discontinuance of product; applicability 689C.320Required notification when carrier discontinues transacting insurance in this State or particular geographic service area of state; restrictions on carrier that discontinues transacting insurance 689C.325Coverage 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 689C.335Approval 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 carrier 689C.350Health benefit plan which offers difference of payment between preferred providers of health care and providers who are not preferred: Limitations on deductibles and copayments; circumstances in which service is deemed to be provided by preferred provider 689C.355Prohibited acts of carrier or producer related to encouraging or directing small employer to take certain actions; exceptions; prohibited acts by carrier related to contract or agreement with producer; violation may constitute unfair trade practice; applicability 689C.360Definitions 689C.380“Contract” defined 689C.390“Dependent” defined 689C.425Applicability of other provisions 689C.430Entities which are authorized to offer contracts to voluntary purchasing groups; compliance with provisions required 689C.455Coverage for prescription drugs: Provision of notice and information regarding use of formulary 689C.460Carrier to offer same coverage to all eligible employees; denial of coverage to otherwise eligible employee 689C.470Renewal of contract; discontinuance of product or issuance or renewal of plan offered only through bona fide association 689C.480Required notification when carrier ceases to renew all contracts; restrictions on carrier that ceases to renew all contracts 689C.490Formation of voluntary purchasing group by small employers; requirements when affiliate of group ceases to qualify as small employer 689C.500Registration: Requirements; application 689C.510Registration: Fee for application; response to application; regulations 689C.520Registration: Additional requirements 689C.530Filing reports; annual renewal fee; regulations 689C.540Duties 689C.550Collection of premiums; trust account for deposit of premiums 689C.560Regulations governing bond or other security to be maintained by voluntary purchasing group 689C.570Organizer prohibited from acquiring financial interest in group’s business for specified period 689C.580Prohibited acts 689C.590Disciplinary or other action for violation of provisions 689C.600Regulations 689C.940Regulations concerning determination of status of stop-loss policy