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Nevada Revised Statutes

Chapter 695B

Nev. Rev. Stat. ch. 695B

Nonprofit Corporations for Hospital, Medical and Dental Service

695B.010Short title 695B.020Scope 695B.030Definitions 695B.035Contract between corporation and provider of health care: Prohibiting corporation from charging provider of health care fee for inclusion on list of providers given to insureds; corporation required to use form to obtain information on provider of health care; modification; submission by corporation of schedule of payments to provider 695B.040Corporations authorized to undertake and operate plans 695B.050Manner of incorporation 695B.060Directors: Qualifications 695B.070Merger and consolidation: Procedure 695B.080Merger and consolidation: Continuance of contracts and contribution certificates 695B.090Merger and consolidation: Withdrawal of prior deposit of securities 695B.110Certificate of authority: Required; fees 695B.120Certificate of authority: Qualifications 695B.130Certificate of authority: Application; issuance 695B.135Certificate of authority: Expiration; renewal 695B.140Reserve fund: Minimum amounts; computation; contracts with hospitals; participation of physicians or dentists 695B.150Insolvency; determination of financial condition; actions by Commissioner; review; regulations 695B.160Annual statement of condition and affairs; annual financial statement; quarterly statement; fees; examination by Commissioner 695B.165Annual statement required to include report of net worth 695B.170Acquisition costs and administrative expenses; effect of finding of excess costs 695B.176Contract covering prescription drugs: Provision of notice and information regarding use of formulary 695B.180Required provisions 695B.181Provision in contract requiring binding arbitration authorized; procedures for arbitration; declaratory relief 695B.182Required procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations 695B.183Insurer required to offer and issue plan regardless of health status of persons; prohibited acts; authority to include wellness program in plan that offers discounts based on health status under certain circumstances 695B.185Group contract 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; processing of claims of providers who are not preferred 695B.187Group contract issued to replace discontinued policy or coverage: Requirements; notice of reduction of benefits; statement of benefits; applicability to self-insured employer 695B.189Group contract: Required provision permitting continuation of coverage 695B.190Family contracts 695B.1901Required provision in certain policies concerning coverage for continued medical treatment; exceptions; regulations 695B.1903Required provision concerning coverage for certain treatment as part of clinical trial or study for treatment of cancer or chronic fatigue syndrome; authority of corporation to require certain information; immunity from liability 695B.1904Required 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 695B.19045Policy covering prescription drugs: Required actions by corporation related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared 695B.19046Policy covering prescription drugs: Submission to step therapy protocol for drug to treat psychiatric condition prohibited in certain circumstances 695B.19047Policy covering prescription drug for 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 695B.1905Contract covering prescription drugs prohibited from limiting or excluding coverage for certain prescription drugs previously approved for medical condition of insured; exceptions 695B.19055Limitation on cost-sharing obligation for insulin covered under policy covering prescription insulin drugs prohibited from imposing certain cost-sharing obligations 695B.1906Required provision in policy covering prescription drugs concerning coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications; prohibited acts; exception 695B.19065Required provision concerning coverage for screening for lung cancer in policy that provides coverage for treatment of lung cancer 695B.1907Required provision in policy covering treatment of colorectal cancer concerning coverage for colorectal cancer screening 695B.1908Required provision in certain contracts concerning coverage for certain drugs and related services for treatment of cancer 695B.19085Policy covering prescription drug for treatment of cancer or cancer symptom that is part of step therapy protocol: Corporation required to allow insured or attending practitioner to apply exemption from step therapy protocol in certain circumstances; procedure for applying for and granting exemption 695B.19087Required 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 695B.1909Contract covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy 695B.191Required provision in policy covering mastectomies concerning coverage relating to mastectomy; prohibited acts 695B.1911Required provision concerning coverage for screening, genetic counseling and testing related to BRCA gene in certain circumstances 695B.1912Required provision concerning coverage for certain screenings and tests for breast cancer; prohibited acts 695B.1913Required provision concerning coverage for examination of person who is pregnant for certain diseases 695B.1914Required provision concerning coverage of certain gynecological and obstetrical services without authorization or referral from primary care physician; designation of obstetrician or gynecologist as primary care provider 695B.1915Required 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 corporation to prescribe requirements for covering surgical treatments for minors; determination of medical necessity 695B.19155Required provision concerning coverage for habilitative speech-language pathology and rehabilitative speech-language pathology as treatment for stuttering for certain persons; prohibited acts 695B.1916Required provision in contract covering prescription drugs or devices concerning coverage of hormone replacement therapy in certain circumstances; prohibited acts; exception 695B.1918Required provision in contract covering outpatient care concerning coverage of health care services related to hormone replacement therapy; prohibited acts 695B.1919Required provision concerning coverage for drug or device for contraception and related health services; prohibited acts; exceptions 695B.19192Required provision concerning coverage for procedure or service for preservation of fertility in certain circumstances; exemption 695B.19195Required provision concerning coverage for certain services, screenings and tests relating to wellness; prohibited acts 695B.19197Required 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 695B.19199Required provision concerning coverage for noninvasive prenatal screening 695B.192Contract containing exclusion, reduction or limitation of coverage relating to complications of pregnancy prohibited; exception 695B.1923Required provision concerning coverage for treatment of certain inherited metabolic diseases 695B.1924Required 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 695B.1925Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus; prohibited acts 695B.1926Required provision concerning coverage for testing, treatment and prevention of sexually transmitted diseases; required provision concerning coverage for condoms for certain insureds 695B.1927Required provision in contract covering hospital, medical or surgical expenses concerning coverage for management and treatment of diabetes 695B.1929Required provision of coverage for management and treatment of sickle cell disease and its variants; policy covering prescription drugs required to provide coverage for medically necessary prescription drugs to treat sickle cell disease and its variants 695B.193Contract covering family member of subscriber required to include certain coverage for subscriber’s newly born and adopted children and children placed with subscriber for adoption 695B.19305Required provision concerning coverage for dental service provided by qualified dental hygienist in certain circumstances 695B.1931Contract prohibited from excluding coverage relating to treatment of temporomandibular joint; exception 695B.1932Policy covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products 695B.1942Required provision in contract covering treatment of prostate cancer concerning coverage for prostate cancer screening; prohibited act 695B.1944Required provision in certain group contracts concerning continuing coverage for employee or member on leave without pay as result of total disability 695B.1948Contract covering maternity care: Prohibited acts by insurer if insured is acting as gestational carrier; child deemed child of intended parent for purposes of contract 695B.1949Contract covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by insurer if insured is person with disability 695B.1951Reimbursement for treatment by podiatrist 695B.1955Reimbursement for treatment by licensed clinical alcohol and drug counselor 695B.196Reimbursement for acupuncture 695B.197Reimbursement for treatment by licensed psychologist 695B.1973Reimbursement for treatment by licensed marriage and family therapist or licensed clinical professional counselor 695B.1975Reimbursement for treatment by licensed associate in social work, social worker, master social worker, independent social worker or clinical social worker 695B.198Reimbursement for treatment by chiropractic physician 695B.199Reimbursement for services provided by certain nurses 695B.1995Reimbursement to provider of medical transportation 695B.1997Assignment of benefits by insured to provider of health care 695B.200Group contracts written under master contract: Conditions required for issuance 695B.210Group master service contract: Required provisions 695B.220Blanket service contracts: Issuance to college, school or school personnel; pupils not to be compelled to accept service 695B.225Policies of group insurance: Order of benefits 695B.230Filing and approval of forms and schedules of premium rates 695B.240Provision of group service coverage before approval of forms 695B.250Extensions of time; automatic approval 695B.2505Approval 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 corporation 695B.251Group subscriber contracts required to contain provision for conversion to individual contracts; exceptions 695B.252Conversion privilege available to spouse and children; conditions 695B.253Denial of converted contract because of overinsurance; notice concerning cancellation of other coverage 695B.254Choice of types of contracts required to be offered 695B.255Benefits exceeding those provided under group contract not required; exclusions and limitations 695B.2555Benefits payable under converted contract authorized to be reduced by amount payable under group contract; limitation 695B.256Issuance and effective date of converted contract; premiums; persons covered 695B.2565Renewal of converted contract: Request for information on sources of other benefits; grounds for refusal to renew; notice concerning cancellation of other coverage 695B.257Notice of conversion privilege 695B.2575Converted contract delivered outside Nevada: Form 695B.258Extension of coverage under existing group contract 695B.2585Provision of group coverage in lieu of converted individual contract 695B.259Continuation of identical coverage in lieu of converted contract 695B.260Suspension or revocation of permission to provide coverage before approval of forms 695B.270Disapproval of forms; issuance unlawful 695B.280Regulations; limitations 695B.285Use of Uniform Billing and Claims Forms authorized 695B.290Agent’s license required 695B.300Contracts with agencies or political subdivisions of United States or State of Nevada; acceptance of money; subcontracts 695B.310Corporation subject to same taxes, licenses, fees and supervision as domestic mutual insurer 695B.315Provision of information regarding claims by policyholder for renewal of insurance policy required upon request; fee; regulations 695B.316Corporation prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence 695B.3165Corporation prohibited from denying coverage solely because applicant or insured was intoxicated or under the influence of controlled substance; exceptions 695B.3167Corporation prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression 695B.317Corporation that provides health insurance prohibited from requiring or using information concerning genetic testing; exceptions 695B.318Applicability of certain provisions concerning portability and availability of health insurance 695B.319Offering policy of health insurance for purposes of establishing health savings account 695B.320Applicability of other provisions 695B.330Definitions 695B.340Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency 695B.350Corporation prohibited from asserting certain grounds to deny enrollment of child of insured pursuant to order 695B.360Certain accommodations required to be made when child is covered under policy of noncustodial parent 695B.370Corporation 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 695B.380Establishment; approval; requirements; examination 695B.390Annual report; insurer required to maintain records of complaints concerning something other than health care services 695B.400Written notice to insured required to be provided by insurer explaining right to file complaint; written notice to insured required when insurer denies coverage of health care service