Nev. Rev. Stat. ch. 695A – Fraternal Benefit Societies | Midpage

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Nevada Revised Statutes

Chapter 695A

Nev. Rev. Stat. ch. 695A

Fraternal Benefit Societies

695A.001Definitions 695A.003“Benefit contract” defined 695A.004“Benefit member” defined 695A.006“Certificate” defined 695A.010“Fraternal benefit society” defined 695A.014“Insurer” defined 695A.016“Laws” defined 695A.018“Lodge” defined 695A.020“Lodge system” defined 695A.023“Medicaid” defined 695A.027“Order for medical coverage” defined 695A.030“Premiums” defined 695A.040“Representative form of government” defined 695A.042“Rules” defined 695A.044“Society” defined 695A.050Organization: Preparation and contents of articles of incorporation 695A.060Organization: Filing of documents and bond with Commissioner; preliminary certificate of authority 695A.070Organization: Solicitation of members; collection of advance premiums; reports to Commissioner 695A.080Certificate of authority: Issuance and renewal; effect; record; copies; fees 695A.090General powers and duties of society 695A.095Contracts between society and provider of health care: Prohibiting society from charging provider of health care fee for inclusion on list of providers given to insureds; society required to use form to obtain information on provider of health care; modification; submission by society of schedule of payments to provider 695A.110Unincorporated or voluntary association prohibited from transacting business as society 695A.120Location of principal office; meetings of supreme governing body; minutes of certain proceedings; official publications; grievances by benefit members 695A.130Consolidation; merger 695A.140Conversion of fraternal benefit society into mutual life insurer 695A.150Qualifications for and rights and privileges of membership 695A.151Effect of eligibility for medical assistance under Medicaid on eligibility for coverage; assignment of rights to state agency 695A.152Society required to comply with certain provisions concerning portability and availability of health insurance 695A.153Society prohibited from asserting certain grounds to deny enrollment of child of insured pursuant to order 695A.155Certain accommodations required to be made by society when child is covered under policy of noncustodial parent 695A.157Society 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 695A.160Amendment of laws of society: Manner; approval by Commissioner; provision to members 695A.180Scope of contractual benefits 695A.184Benefit contract covering prescription drugs prohibited from limiting or excluding coverage for prescription drug previously approved for medical condition of insured; exception 695A.1841Limitation on cost-sharing obligation for insulin covered under benefit contract covering prescription insulin drugs 695A.1843Coverage 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 695A.1844Coverage for testing, treatment and prevention of sexually transmitted diseases required; coverage for condoms for certain insureds required 695A.18445Coverage 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 695A.1845Coverage for certain tests and vaccines relating to human papillomavirus required; prohibited acts 695A.1853Coverage for screening, genetic counseling and testing related to BRCA gene required in certain circumstances 695A.1855Coverage for certain screenings and tests for breast cancer required; prohibited acts 695A.1856Coverage for examination of person who is pregnant for certain diseases required 695A.18565Coverage for noninvasive prenatal screening required 695A.1857Benefit contract covering maternity care: Prohibited acts by society if insured is acting as gestational carrier; child deemed child of intended parent for purposes of benefit contract 695A.18575Coverage for screening for lung cancer required in benefit contract providing coverage for treatment for lung cancer 695A.1859Coverage 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 695A.1865Coverage for drug or device for contraception and related health services required in benefit contract covering prescription drugs or devices; prohibited acts; exceptions 695A.1867Coverage for medically necessary treatment of conditions relating to gender dysphoria and gender incongruence required; restriction on refusal to cover certain treatments; authority of society to prescribe requirements for covering surgical treatment for minors; determination of medical necessity 695A.1873Coverage 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 benefit contract covering prescription drugs 695A.18735Coverage for habilitative speech-language pathology and rehabilitative speech-language pathology as treatment for stuttering required for certain persons; prohibited acts 695A.1874Coverage 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 695A.1875Coverage for certain services, screenings and tests relating to wellness required; prohibited acts 695A.188Approval or denial of claim; payment of claims and interest; request for additional information; payment of claim; 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 society 695A.195Society prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence 695A.197Society prohibited from denying coverage solely because applicant or insured was intoxicated or under the influence of controlled substance; exceptions 695A.198Society prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression 695A.200Nonforfeiture benefits, cash surrender values, certificate loans and other options 695A.210Beneficiaries; funeral benefits 695A.220Benefits not liable to attachment, garnishment or other process 695A.230Terms and conditions of benefit contracts 695A.232Society required to offer and issue plan regardless of health status of persons; prohibited acts 695A.235Offering policy of health insurance for purposes of establishing health savings account 695A.240Approval and contents of certificates 695A.255Benefit contract covering prescription drugs: Provision of notice and information regarding use of formulary 695A.256Benefit contract covering prescription drugs: Submission to step therapy protocol for drug to treat psychiatric condition prohibited in certain circumstances 695A.257Benefit contract covering prescription drugs: Required actions by society related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared 695A.258Benefit contract 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 695A.259Benefit contract covering prescription drug for treatment of cancer or cancer symptom that is part of step therapy protocol: Society 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 695A.261Benefit contract covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by society if insured is person with disability 695A.263Coverage for dental service provided by qualified dental hygienist required in certain circumstances 695A.265Coverage 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 695A.270Authority to prohibit in society’s laws waiver of provisions of society’s laws 695A.280Reinsurance 695A.300Foreign or alien society: License required to transact business; required information 695A.310Injunction against, liquidation of or appointment of receiver for domestic society 695A.320Suspension, revocation or refusal of license of foreign or alien society 695A.330Licensing of insurance agents of society; persons exempt from licensing 695A.400Service of process on society 695A.410Injunctions against societies 695A.420Judicial review of Commissioner’s findings and decisions 695A.430Assets, funds and accounts of society 695A.440Investments 695A.450Annual statement of financial condition, transactions and affairs: Filing; fee; contents; provision to members; valuation of certificates 695A.460Annual statement of financial condition, transactions and affairs: Penalties for failure to file properly 695A.475Liability of directors, officers, employees, members and volunteers; indemnification and reimbursement of directors, officers, employees and agents 695A.490Standards of valuation for certificates; excess reserves 695A.500Examination of societies transacting or applying to transact business in State 695A.530Applicability of provisions relating to trade practices and frauds 695A.550Exemption of societies from certain taxes 695A.555Nonexemption of societies from certain fees 695A.560Exemption of societies from other insurance laws; exceptions 695A.570Applicability of chapter; effect of exemption 695A.580Penalties