Nevada Administrative Code

NAC 686A.130 Availability of insurance; restrictions; marital status. (NRS 679B.130, 686A.015) 1. Availability of insurance may not be denied to an insured on the basis of sex or marital status. The amount of benefits payable, conditions or types of coverage may not be restricted…

NAC 686A.140 Prohibited practices. (NRS 679B.130, 686A.015) Practices prohibited by NAC 686A.110 to 686A.150, inclusive, include, but are not limited to: 1. Denying coverage to women who are gainfully employed at home, part-time or by relatives when coverage is offered to men who…

NAC 686A.150 Rates. (NRS 679B.130, 686A.015) No rate differential may be applied on the basis of the sex or marital status of an insured unless the rate differential is based on sound actuarial data. Any justification for a rate differential based on sex or marital status must be…

NAC 686A.160 Blindness or partial blindness. (NRS 679B.130, 686A.015, 686A.100) 1. With regard to any policy or contract of life insurance, health insurance or annuity: (a) The following acts or practices constitute unfair discrimination between persons of the same class: (1) Ref…

NAC 686A.210 Transfer of property with existing coverage. (NRS 679B.130, 686A.015) 1. No agent, broker or insurer may participate in any transaction in which an insured is forced to cancel existing coverage on property which the insured is transferring to another and purchase oth…

NAC 686A.220 Insurer prohibited from taking certain actions with respect to property or casualty insurance on basis of status of person as victim or potential victim of domestic violence; permissible bases for action; exceptions. (NRS 679B.130, 686A.015) 1. Except as otherwise pr…

NAC 686A.240 Disclosure when estimate of cost of repair based on use of body part not manufactured for or by original manufacturer of vehicle. (NRS 679B.130, 686A.015) 1. If an insurer or a representative of the insurer bases an estimate of the cost of repairing the body of a mot…

NAC 686A.270 Payment for services rendered. (NRS 679B.130, 686A.015) 1. If a benefit or medical service is otherwise covered by a policy, the insurer shall pay for the service without regard to the type of health care practitioner providing the service, if the practitioner is: (a…

NAC 686A.280 Definitions. (NRS 679B.130, 686A.015) As used in NAC 686A.280 to 686A.306, inclusive, unless the context otherwise requires, the words and terms defined in NAC 686A.282, 686A.284 and 686A.286 have the meanings ascribed to them in those sections. (Added to NAC by Comm…

NAC 686A.282 “Clean claim” defined. (NRS 679B.130, 686A.015) A “clean claim” means a claim: 1. That contains the information required to be included for the applicable use of a form prescribed in NAC 686A.288; and 2. For which any additional information that has been requested pu…

NAC 686A.284 “Health care practitioner” defined. (NRS 679B.130, 686A.015) “Health care practitioner” means a person licensed to practice one of the health professions regulated by title 54 of NRS. (Added to NAC by Comm’r of Insurance by R175-01, eff. 5-23-2002)

NAC 686A.286 “Payer” defined. (NRS 679B.130, 686A.015) “Payer” includes administrators, individual health insurers, group health insurers, nonprofit hospitals, medical and dental service corporations and health maintenance organizations who pay claims under any contract for healt…

NAC 686A.288 Forms for submission of claims. (NRS 679B.130, 679B.138, 686A.015) 1. The payer of a claim under a contract for health insurance: (a) Shall accept a claim submitted on a form that: (1) Has been approved by the Commissioner for the filing of a claim under a contract f…

NAC 686A.290 Commencement of time for adjudication and payment of claims. (NRS 679B.130, 686A.015) The time for a payer to adjudicate and pay claims pursuant to NRS 683A.0879, 689A.410, 689B.255, 689C.335, 695B.2505, 695C.185 and 695D.215 begins when the payer receives a clean cl…

NAC 686A.302 Claim by hospital or other institutional provider: Prohibited use of field; optional inclusion of additional data. (NRS 679B.130, 679B.138, 686A.015) 1. A payer shall not use or require a hospital or other institutional provider to use any field for purposes that are…

NAC 686A.303 Coverage for dental procedures for children. (NRS 679B.130, 686A.015) 1. A policy or contract of health insurance issued pursuant to chapter 689A, 689B, 689C, 695B or 695C of NRS which is delivered or issued for delivery in this State and which provides coverage for …

NAC 686A.304 Processing of claims: Duties of payer; date of receipt of claim. (NRS 679B.130, 679B.136, 679B.138, 686A.015) 1. Each payer shall establish a tracking system to monitor the timeliness of the payer’s processing of a claim. 2. Each payer shall: (a) Maintain a written o…

NAC 686A.306 Proof of compliance by payer. (NRS 679B.130, 679B.136, 679B.138, 686A.015) The Commissioner, when deemed appropriate, will require a payer to report substantial compliance with the provisions of NAC 686A.280 to 686A.306, inclusive. Proof that claims are being paid by…

NAC 686A.320 Definitions. (NRS 679B.130, 686A.015) As used in NAC 686A.320 to 686A.340, inclusive, unless the context otherwise requires: 1. “Agent” has the meaning ascribed to it in NRS 683A.321. 2. “Financial planner” means a producer of insurance who has successfully completed…

NAC 686A.330 Agreement for consultation or related advice: Contents; copies; fee. (NRS 679B.130, 686A.015, 686A.230) 1. Any agreement for consultation or related advice which is entered into by a financial planner, producer of insurance or insurance consultant must be in writing …

NAC 686A.333 Agreement for consultation or related advice concerning certain individual health benefit plans: Additional contents. (NRS 679B.130, 686A.015, 686A.230) If a financial planner, producer of insurance or insurance consultant charges a fee pursuant to paragraph (c) of s…

NAC 686A.335 Agreement for consultation or related advice concerning sale of certain insurance: Additional contents related to commissions and fees; form. (NRS 679B.130, 686A.015, 686A.230) 1. Except as otherwise provided in subsection 2, an agreement for consultation or related …

NAC 686A.340 Commission for services to be taxed as premium. (NRS 679B.130, 686A.015) Any commission received by a financial planner, agent or broker or producer of insurance pursuant to NAC 686A.320 to 686A.340, inclusive, for services related to the sale of insurance shall be d…

NAC 686A.410 Scope. (NRS 679B.130, 686A.015) 1. This regulation requires insurers to deliver to purchasers of life insurance, information which will: (a) Improve the buyer’s ability to select the most appropriate plan of life insurance for his or her needs; (b) Improve the buyer’…

NAC 686A.415 Applicability. (NRS 679B.130, 686A.015) 1. This regulation applies to: (a) Any solicitation, negotiation, or procurement of life insurance occurring within this State; and (b) Any issuer of life insurance contracts, including fraternal benefit societies. 2. Unless th…

NAC 686A.420 Definitions. (NRS 679B.130, 686A.015) As used in NAC 686A.410 to 686A.455, inclusive, unless the context otherwise requires, the following words and terms have the meanings ascribed to them: 1. “Agent” has the meaning ascribed to it in NRS 683A.321. 2. “Buyer’s guide…

NAC 686A.425 General requirements. (NRS 679B.130, 679B.137, 686A.015) 1. Each insurer shall maintain at its home office or principal office, a complete file containing one copy of each document which it has authorized for use pursuant to this regulation. The file must contain one…

NAC 686A.430 Insurer to provide buyer’s guide and policy summary to applicant; exception. (NRS 679B.130, 686A.015) 1. Except as otherwise provided in subsection 4, an insurer shall provide a buyer’s guide and a policy summary to each applicant before accepting the applicant’s ini…

NAC 686A.435 Policy summaries. (NRS 679B.130, 686A.015) 1. Policy summaries required by NAC 686A.430 must contain: (a) A prominently placed title as follows: Statement of Policy Cost and Benefit Information. (b) The name and address of the insurance agent, or, if no agent is invo…

NAC 686A.440 Equivalent level death benefit. (NRS 679B.130, 686A.015) The equivalent level death benefit of a policy or term life insurance rider is an amount calculated as follows: 1. Accumulate the guaranteed amount payable upon death, regardless of the cause of death, at the b…

NAC 686A.445 Cost indexes. (NRS 679B.130, 686A.015) 1. The life insurance surrender cost index is calculated by: (a) Determining the guaranteed cash surrender value, if any, available at the end of the 10th and 20th policy years. (b) For participating policies, adding the termina…

NAC 686A.450 Equivalent level annual dividend. (NRS 679B.130, 686A.015) The equivalent level annual dividend is calculated by: 1. Accumulating the annual cash dividend at 5 percent interest compounded annually to the end of the 10th and 20th policy years. 2. Dividing each accumul…

NAC 686A.455 Failure to comply. (NRS 679B.130, 686A.015, 686A.030) Failure of an insurer to provide or deliver a buyer’s guide or a policy summary as required by NAC 686A.430 constitutes an omission which misrepresents the benefits, advantages, conditions or terms of an insurance…

NAC 686A.460 Definitions. (NRS 679B.130, 686A.015) As used in NAC 686A.460 to 686A.479, inclusive, unless the context otherwise requires, the words and terms defined in NAC 686A.4605 to 686A.469, inclusive, have the meanings ascribed to them in those sections. (Added to NAC by Co…

NAC 686A.4605 “Actuarial Standards Board” defined. (NRS 679B.130, 686A.015) “Actuarial Standards Board” means the Board established by the American Academy of Actuaries to develop and adopt standards of actuarial practice. (Added to NAC by Comm’r of Insurance by R089-97, eff. 1-1…

NAC 686A.461 “Basic illustration” defined. (NRS 679B.130, 686A.015) “Basic illustration” means a ledger or proposal used in connection with the sale of a policy of life insurance that sets forth the guaranteed and nonguaranteed elements of the policy. (Added to NAC by Comm’r of I…

NAC 686A.4615 “Contract premium” defined. (NRS 679B.130, 686A.015) “Contract premium” means the premium that is required to be paid pursuant to a policy of life insurance that requires the payment of fixed premiums, including, without limitation, a premium for a rider for which b…

NAC 686A.462 “Currently payable scale” defined. (NRS 679B.130, 686A.015) “Currently payable scale” means a scale of nonguaranteed elements that: 1. Are in effect for a policy form on the date of the preparation of the illustration; or 2. Will be effective within 95 days after tha…

NAC 686A.4625 “Disciplined current scale” defined. (NRS 679B.130, 686A.015) “Disciplined current scale” means a scale of nonguaranteed elements constituting a limit on illustrations currently being used by an insurer that is reasonably based on actual recent historical experience…

NAC 686A.463 “Generic name” defined. (NRS 679B.130, 686A.015) “Generic name” means a term that is descriptive of a policy of life insurance being illustrated, including, without limitation, the terms “whole life,” “term life” or “flexible premium adjustable life.” (Added to NAC b…

NAC 686A.4635 “Guaranteed elements” defined. (NRS 679B.130, 686A.015) “Guaranteed elements” means the premiums, benefits, values, credits or charges under a policy of life insurance that are guaranteed and determined at the time the policy is issued. (Added to NAC by Comm’r of In…

NAC 686A.464 “Illustrated scale” defined. (NRS 679B.130, 686A.015) “Illustrated scale” means a scale of nonguaranteed elements that is not more favorable to the policy owner than the lesser of the disciplined current scale or the currently payable scale. (Added to NAC by Comm’r o…

NAC 686A.4645 “Illustration” defined. (NRS 679B.130, 686A.015) “Illustration” means a presentation or depiction of the nonguaranteed elements of a policy of life insurance over a period of years. The term includes, without limitation, a basic illustration, an in-force illustratio…

NAC 686A.465 “In-force illustration” defined. (NRS 679B.130, 686A.015) “In-force illustration” means an illustration furnished at any time after the policy being illustrated has been in force for 1 year or more. (Added to NAC by Comm’r of Insurance by R089-97, eff. 1-14-98)

NAC 686A.4655 “Lapse-supported illustration” defined. (NRS 679B.130, 686A.015) “Lapse-supported illustration” means an illustration that: 1. Is not a self-supporting illustration; and 2. Uses persistency rates underlying the disciplined current scale for the first 5 years of the …

NAC 686A.466 “Minimum assumed expenses” defined. (NRS 679B.130, 686A.015) “Minimum assumed expenses” means the minimum expenses that may be used in the calculation of the disciplined current scale for a policy form. (Added to NAC by Comm’r of Insurance by R089-97, eff. 1-14-98)

NAC 686A.4665 “Nonguaranteed elements” defined. (NRS 679B.130, 686A.015) “Nonguaranteed elements” means the premiums, benefits, values, credits or charges under a policy of life insurance that are not guaranteed or not determined at the time the policy is issued. (Added to NAC by…