Nevada Administrative Code

NAC 689A.411 Summary of coverage: Filing, contents and delivery of disclosure. (NRS 679B.130, 689A.390) 1. Each insurer shall file with the Commissioner, for his or her approval, a disclosure summarizing the coverage provided by a policy of health insurance offered by the insurer…

NAC 689A.421 Programs of health insurance using preferred providers of health care. (NRS 679B.130) An insurer may file with the Division a program of health insurance using preferred providers of health care for any individual policy offered pursuant to chapter 689A of NRS if it …

NAC 689A.425 Coverage for prescription drugs: Removal from approved formulary prohibited; exception; movement to different tier in formulary; addition of drug to formulary. (NRS 679B.130, 687B.120, 689A.710) 1. Except as otherwise provided in this section, an individual carrier t…

NAC 689A.433 Carrier prohibited from requiring purchase of other insurance as prerequisite to purchase or renewal of health benefit plan. (NRS 679B.130, 689A.740) An individual carrier shall not require a person to purchase a life insurance policy or any other form of insurance a…

NAC 689A.434 “Short-term health insurance policy” interpreted. (NRS 679B.130, 689A.540, 689A.740) The Commissioner will interpret the term “short-term health insurance policy” as it is used in NRS 689A.540 to exclude an individual health insurance policy that is: 1. Issued to pro…

NAC 689A.475 Evidence of creditable coverage. (NRS 679B.130, 689A.710, 689A.740) If a person is unable to obtain a certificate of creditable coverage pursuant to NRS 689A.720, an individual carrier shall accept from the person other evidence of creditable coverage if it determine…

NAC 689A.605 Requirements for approval. (NRS 679B.130, 689A.745) To obtain approval of a system for resolving complaints of insureds concerning health care services covered by an insurer from the Commissioner as required pursuant to NRS 689A.745, an insurer must: 1. Demonstrate t…

NAC 689B.010 Definitions. (NRS 679B.130) As used in this chapter, unless the context otherwise requires, the words and terms defined in NAC 689B.011 to 689B.019, inclusive, have the meanings ascribed to them in those sections. (Added to NAC by Comm’r of Insurance, eff. 10-12-88; …

NAC 689B.011 “Actuarial memorandum” defined. (NRS 679B.130) “Actuarial memorandum” means a memorandum created and signed by a qualified actuary that justifies the actuarial opinion rendered by the actuary. (Added to NAC by Comm’r of Insurance by R111-07, eff. 1-30-2008)

NAC 689B.0115 “Actuarial opinion” defined. (NRS 679B.130) “Actuarial opinion” means the conclusion drawn by an actuary from actuarial knowledge or from the application of one or more actuarial methods to a body of data. (Added to NAC by Comm’r of Insurance by R111-07, eff. 1-30-2…

NAC 689B.012 “Association” defined. (NRS 679B.130) “Association” means any group formed for the purpose of purchasing insurance which has been approved and marketed pursuant to NRS 688B.030 or 689B.026. (Added to NAC by Comm’r of Insurance, eff. 10-12-88; A 5-27-92)—(Substituted …

NAC 689B.014 “Commissioner” defined. “Commissioner” means the Commissioner of Insurance. (Supplied in codification)

NAC 689B.016 “Division” defined. (NRS 679B.130) “Division” means the Division of Insurance of the Department of Business and Industry. (Added to NAC by Comm’r of Insurance, eff. 10-12-88; A 5-27-92)—(Substituted in revision for part of NAC 689B.010)

NAC 689B.018 “Employer’s group” defined. “Employer’s group” means any subgroup within an association consisting of an employer, his or her employees and their dependents, who purchase group health insurance as members of the association. (Added to NAC by Comm’r of Insurance, eff.…

NAC 689B.019 “Guaranteed association” defined. (NRS 679B.130) “Guaranteed association” has the meaning ascribed to it in NRS 689B.0265. (Added to NAC by Comm’r of Insurance by R111-07, eff. 1-30-2008) GROUPS FORMED TO PURCHASE INSURANCE

NAC 689B.020 Request for approval of policy. (NRS 679B.130) An insurer requesting approval of a policy for group insurance to be issued and delivered to an association shall submit to the Division: 1. A copy of each insurance policy, certificate, rider, endorsement and applicatio…

NAC 689B.030 Certification, filing and approval of policy. (NRS 679B.130) 1. If an insurer certifies its filing pursuant to this section and mails it to the Division by certified mail, the approval of the filing of the policy shall be deemed to be effective upon the date of the m…

NAC 689B.040 Standards for rates. (NRS 679B.130) The rate charged by the insurer to a member or employer’s group within the association must be based upon the experience of the entire association. Except as otherwise provided in NAC 689B.050, the insurer may not use rebates, surc…

NAC 689B.050 Establishment of program for rating experience. (NRS 679B.130) 1. An insurer may establish an experience rating program which compares the loss experience of an employer’s group to the loss experience of the entire association and which may result in different premiu…

NAC 689B.060 Standards for acceptance or rejection of employer’s group. (NRS 679B.130) At the time that an employer’s group requests membership in an association, the insurer may accept or reject that group in accordance with the following standards: 1. For employer’s groups with…

NAC 689B.070 Coverage of employer’s group; standards for exclusion or limitation. 1. Any insurer wishing to exclude or limit the coverage in a policy issued to an association for any person based upon his or her evidence of insurability, must submit the standards for exclusion or…

NAC 689B.080 Limiting benefits to certain employer’s groups for preexisting conditions. 1. An insurer offering an association to an employer’s group with less than 25 members may limit its benefits from those benefits offered pursuant to NRS 689B.065, if the insurer has filed a p…

NAC 689B.090 Notice of cancellation, nonrenewal or renewal with altered terms. (NRS 679B.130) Each notice of cancellation, nonrenewal or renewal with altered terms, issued by an insurer or an association to an employer’s group must comply with the provisions of NRS 687B.310 to 68…

NAC 689B.095 Actuarial memorandum: Submission by insurer; contents. (NRS 679B.130, 689B.0265) An insurer that offers coverage under a policy of group health insurance to a guaranteed association must submit an actuarial memorandum to the Commissioner which must include, without l…

NAC 689B.097 Annual approval of actuarial memorandum and applicable rates; submission of additional information. (NRS 679B.130, 689B.0265) 1. The actuarial memorandum required by NAC 689B.095 and the applicable rates must be submitted to and approved by the Commissioner annually.…

NAC 689B.099 Notice of cancellation of policy when fewer than 200 persons covered. (NRS 679B.130) If the number of members, employees of members or employees of a guaranteed association or their dependents covered under a policy of group health insurance falls below 200 in violat…

NAC 689B.110 Disclosure of points at which insured’s payment for coinsurance is no longer required; sample calculation of claim; limitation on approval of policy. (NRS 679B.130, 689B.027, 689B.061) 1. The point at which an insured’s payment for coinsurance is no longer required t…

NAC 689B.120 Contents of policy: General requirements. A policy of group health insurance issued pursuant to NRS 689B.061: 1. Must include a definition for preferred providers of health care and providers of health care who are not preferred. 2. Must include an explanation of the…

NAC 689B.130 Contents of policy: Provisions concerning emergencies and medical necessity. (NRS 679B.130, 689B.061) A policy of group health insurance issued pursuant to NRS 689B.061 must: 1. Include the criteria used to determine what is an emergency or treatment for an emergency…

NAC 689B.140 Filing of information with Division. (NRS 679B.130, 689B.061) Each insurer offering a policy of group health insurance pursuant to NRS 689B.061 shall file with the Division: 1. A copy of each standard agreement made with each preferred provider of health care and a l…

NAC 689B.150 Dissemination of list of preferred providers and any geographic limitations. (NRS 679B.130, 689B.061) An insurer offering a policy of group health insurance pursuant to NRS 689B.061 shall include with its health disclosure form a list of its preferred providers of he…

NAC 689B.160 Agreements with preferred providers: Notice of termination. (NRS 679B.130) Each agreement entered into by an insurer and a preferred provider of health care must require a party who wishes to terminate the agreement to give notice to the other party at least 90 days …

NAC 689B.180 Subrogation: Right of insurer and insured to recover from third party; lien against recovery; subrogation not basis for denial of payment of benefits. (NRS 679B.130) 1. Except as otherwise provided by specific federal or state statute or regulation, an insurer may in…

NAC 689B.190 Restrictions on group benefits payable by more than one insurer to provider. (NRS 679B.130) When the benefits of a policy of group health insurance issued pursuant to chapter 689B of NRS are payable by more than one insurer to a provider, the policy must not require …

NAC 689B.195 Consideration of benefits payable under another policy prohibited to determine or pay benefits. (NRS 679B.130) A policy of group health insurance issued pursuant to chapter 689B of NRS: 1. Must not, for the determination of benefits payable for the coordination of be…

NAC 689B.205 Disclosures in advertising and sales materials; inclusion of certain information in health benefit plan. (NRS 679B.130, 689B.027) 1. As part of the disclosure required by NRS 689B.027, an insurer shall disclose in the advertising and sales materials that the insurer …

NAC 689B.210 “Group policyholder” interpreted; filing, contents and delivery of disclosure. 1. For the purposes of NRS 689B.028, “group policyholder” includes an employer’s group in a marketing program of an association. 2. Each insurer shall file with the Commissioner, for the C…

NAC 689B.230 Limitation on frequency of increases; exceptions. (NRS 679B.130) 1. Except as otherwise provided in this section, an insurer that issues group health insurance in this State shall not increase the premium rates for the insurance more frequently than every 6 months un…

NAC 689B.250 Requirements for approval. (NRS 679B.130, 689B.0285, 689B.029, 689B.0295) To obtain approval of a system for resolving complaints of insureds concerning health care services covered by an insurer from the Commissioner as required pursuant to NRS 689B.0285, an insurer…

NAC 689B.260 Annual report. (NRS 679B.130, 689B.029) 1. An insurer shall submit its annual report regarding its system for resolving complaints as required pursuant to NRS 689B.029 on or before June 1 of each year. The insurer shall retain a copy of the annual report for at least…

NAC 689B.280 Compliance with NAC 689B.205 and 689B.230. (NRS 679B.130, 689B.090) An insurer that offers blanket accident and health insurance in this State shall comply with the provisions of NAC 689B.205 and 689B.230. (Added to NAC by Comm’r of Insurance by R009-02, eff. 5-23-20…

NAC 689B.295 Definitions. (NRS 679B.130) As used in NAC 689B.295 to 689B.310, inclusive, unless the context otherwise requires, the words and terms defined in NRS 689B.350 to 689B.460, inclusive, have the meanings ascribed to them in those sections. (Added to NAC by Comm’r of Ins…

NAC 689B.300 Evidence of creditable coverage. (NRS 679B.130, 689B.480) If a person is unable to obtain a certificate of creditable coverage pursuant to NRS 689B.490, a carrier shall accept from the person other evidence of creditable coverage if it determines that the evidence re…

NAC 689B.305 Restrictions on rules of eligibility and on premium and contribution rates. (NRS 679B.130) 1. A group health plan and a carrier that issues group health insurance pursuant to chapter 689B of NRS shall not include or establish any rule of eligibility, including contin…

NAC 689B.310 Converted policies. (NRS 679B.130, 689B.590) 1. If a person is issued a converted policy before the date on which basic and standard health benefit plans were required to be offered pursuant to subsection 1 of NRS 689B.590, the carrier shall notify the person in writ…

NAC 689B.350 General requirements for policy; determination of persons in group health plan; effect of policy failing to meet general requirements; requirements specific to policy for group health plan with small employer; provision of disclosure to small employer; submission of …

NAC 689C.100 “Existing coverage” interpreted. (NRS 679B.130, 689C.190) For the purposes of subsection 2 of NRS 689C.190, the Commissioner will interpret “existing coverage” as not including coverage issued as a supplement to liability insurance, workers’ compensation or similar i…