Nevada Administrative Code

NAC 695D.150 Qualifications of person responsible for operating organization. (NRS 679B.130, 695D.100) Each person responsible for operating an organization must possess adequate knowledge concerning the operation of such an organization and insurance laws and procedures that app…

NAC 695D.160 Powers of organization; approval by Commissioner. (NRS 679B.130, 695D.100) 1. Subject to the approval of the Commissioner as provided in subsections 2 and 3, the powers of an organization include the power to: (a) Purchase, lease, construct, renovate, operate or main…

NAC 695D.170 Accessibility of services. (NRS 679B.130, 695D.100) If the geographic area served or proposed to be served by an organization: 1. Includes a county having a population of 30,000 or more, the distance between the place of business of any provider and that of any subsc…

NAC 695D.180 Organization desiring to enlarge its geographic area of service. (NRS 679B.130, 695D.100, 695D.140) If an organization wishes to enlarge its geographic area of service beyond that stated in its application, it must submit to the Division: 1. A written description of …

NAC 695D.190 Contract between organization and provider. (NRS 679B.130, 695D.100) 1. Each contract between an organization and a provider must: (a) Contain a complete description of the duties of each party under the agreement. (b) Require the provider to release each member of t…

NAC 695D.200 Notification of disassociation of dentist from organization. (NRS 679B.130, 695D.100) An organization shall notify a member in writing of the disassociation of his or her dentist from the organization within 30 working days after the disassociation occurs. (Added to …

NAC 695D.220 Coordination of benefits. (NRS 679B.130, 695D.100) 1. A plan that is offered to a group and that coordinates its benefits must determine its benefits and its order of benefits as provided in NRS 689B.063 and 689B.064. 2. An organization may include in its evidence of…

NAC 695D.225 Summary of coverage: Filing, contents and delivery of disclosure. (NRS 679B.130, 695D.100, 695D.102) 1. Each organization for dental care shall file with the Commissioner, for his or her approval, a disclosure summarizing the coverage provided by a group plan for den…

NAC 695D.230 Provision of copy of plan to members; advertising; solicitation. (NRS 679B.130, 695D.100) 1. Each organization shall, at the time a member enrolls, provide the member with a copy of its plan which: (a) States clearly, in boldface type, any period of waiting required …

NAC 695D.240 Reserves maintained by organization. (NRS 679B.130, 695D.100, 695D.250) All reserves maintained by an organization pursuant to NRS 695D.250: 1. Must be deposited in a trust account in a federally insured financial institution located in this State. All income earned …

NAC 695D.250 Investment of money. (NRS 679B.130, 695D.100) 1. An organization may invest its money only in cash, cash equivalents or the securities described in NRS 682A.033. 2. Any investment made by an organization: (a) Must be authorized or ratified by its board of directors o…

NAC 695D.260 Filing of periodic reports and financial statements; quarterly report of domestic organization; extension of time for filing report or statement; disciplinary action for failure to file report or statement. (NRS 679B.130, 695D.100, 695D.260) 1. As a condition of doin…

NAC 695D.270 Determination of financial condition: Assets considered. (NRS 679B.130, 695D.100) The Division will consider the following assets owned by an organization in determining its financial condition: 1. Cash in the possession of the organization or in transit under its co…

NAC 695D.280 Determination of financial condition: Assets not considered. (NRS 679B.130, 695D.100) The Division will not consider the following assets owned by an organization in determining its financial condition: 1. Any goodwill, trade name or similar intangible. 2. Any advanc…

NAC 695D.290 Determination of financial condition: Charges against assets. (NRS 679B.130, 695D.100) In determining the financial condition of an organization, the Division will charge against its assets: 1. The amount of its outstanding capital stock. 2. The amount necessary to p…

NAC 695D.300 Maintenance of financial security. (NRS 679B.130, 695D.100, 695D.250) 1. An organization shall maintain: (a) A capital account with a net worth in an amount which is the greater of: (1) The amount of risk-based capital determined in the manner set forth in NRS 681B.5…

NAC 695D.310 Submission of copy of license to Commissioner. (NRS 679B.130, 695D.100) An organization that: 1. Receives a license as an organization in another state; or 2. Whose affiliate or subsidiary receives such a license, Ê shall furnish a copy of the license to the Commissi…

NAC 695D.320 Organization desiring to contract with providers out of State for services for members in State. (NRS 679B.130, 695D.100) 1. If an organization authorized to operate in this State is also licensed in a contiguous state and wishes to contract with providers in that st…

NAC 695D.330 Notification of disciplinary action taken in another state. (NRS 679B.130, 695D.100) An organization authorized to operate in this State that is licensed in another state shall: 1. Notify the Division of any disciplinary action taken against it by the other state; an…

NAC 695D.340 Certification of information concerning limitation on rates for coverage. (NRS 679B.130, 695D.100) Any information provided by an organization to demonstrate its compliance with the provisions of NRS 686B.125, limiting rates for coverage for dental care, must be cert…

NAC 695D.350 Contract to perform marketing, enrollment or administrative services. (NRS 679B.130, 695D.100) 1. If an organization enters into a contract for the performance of marketing, enrollment or administrative services, it shall submit a copy of the contract to the Division…

NAC 695D.360 Administrative hearings and other proceedings. (NRS 679B.130, 695D.100) 1. Any person who is not otherwise entitled to a hearing pursuant to NRS 695D.310 and who is aggrieved by an action of the Commissioner relating to the approval, denial, suspension or revocation …

NAC 695D.370 Requirements for conducting examinations. (NRS 679B.130, 695D.100, 695D.270) Each examination of an organization, including one made pursuant to NRS 695D.270, must be conducted pursuant to the requirements found in the handbooks and manuals adopted by reference in NA…

NAC 695D.500 Establishment; scope; examination of system. (NRS 679B.130, 695D.100) 1. Each organization that issues a policy in this State shall establish with the approval of the Commissioner a system for resolving any complaints of a member concerning services covered under the…

NAC 695D.510 Requirements for approval. (NRS 679B.130, 695D.100) To obtain approval of a system for resolving complaints of members concerning services covered by an organization from the Commissioner as required pursuant to NAC 695D.500, an organization must: 1. Demonstrate that…

NAC 695D.520 Notices: Right of member to file complaint; denial of coverage; clear and comprehensible language. (NRS 679B.130, 695D.100) 1. Following approval by the Commissioner, each organization that issues a policy in this State shall provide written notice to a member, in cl…

NAC 695D.530 Annual report: Submission; resolution of oral inquiry. (NRS 679B.130, 695D.100) 1. An organization shall submit its annual report regarding its system for resolving complaints as required pursuant to NAC 695D.540 on or before June 1 of each year. The organization sha…

NAC 695D.540 Annual report: Content; maintenance of records. (NRS 679B.130, 695D.100) 1. Each organization that issues a policy in this State shall submit to the Commissioner and the State Board of Health an annual report regarding its system for resolving complaints established …

NAC 695F.010 Definitions. (NRS 679B.130, 695F.300) As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 695F.020 to 695F.070, inclusive, and NAC 695F.020 to 695F.050, inclusive, have the meanings ascribed to them in those sections. (A…

NAC 695F.020 “Commissioner” defined. (NRS 679B.130, 695F.300) “Commissioner” means the Commissioner of Insurance. (Added to NAC by Comm’r of Insurance, eff. 2-3-97)

NAC 695F.030 “Division” defined. (NRS 679B.130, 695F.300) “Division” means the Division of Insurance of the Department of Business and Industry. (Added to NAC by Comm’r of Insurance, eff. 2-3-97)

NAC 695F.040 “Limited health service plan” defined. (NRS 679B.130, 695F.300) “Limited health service plan” means any arrangement whereby an organization agrees to provide or arrange for the provision of one or more limited health services to enrollees. (Added to NAC by Comm’r of …

NAC 695F.050 “Organization” defined. (NRS 679B.130, 695F.300) “Organization” means a prepaid limited health service organization. (Added to NAC by Comm’r of Insurance, eff. 2-3-97) CERTIFICATE OF AUTHORITY

NAC 695F.100 Application: Contents; certification of financial statements. (NRS 679B.130, 695F.110, 695F.300) 1. In addition to the documents required by NRS 695F.110, an application for a certificate of authority to operate an organization must include: (a) All documents describ…

NAC 695F.110 Application: Proposed plan of operation. (NRS 679B.130, 695F.110, 695F.300) The proposed plan of operation required by NAC 695F.100 must include: 1. A projection of income and expected costs allocated to: (a) Services rendered outside of the organization’s specified …

NAC 695F.120 Application: Submission; incomplete application deemed withdrawn. (NRS 679B.130, 695F.110, 695F.300) 1. A person applying for a certificate of authority to operate an organization must file an application as follows: (a) An original and two copies of the application …

NAC 695F.130 Application: Public inspection; notice of pending application or hearing. (NRS 679B.130, 695F.300) 1. Any person wishing to review an application for issuance of a certificate of authority for an organization shall submit a request to the Commissioner in writing. A c…

NAC 695F.140 Licensure in another state: Application for this State; copy of license; notice of disciplinary action. (NRS 679B.130, 695F.110, 695F.300) 1. Any applicant for a certificate of authority to operate an organization in this State who is licensed to operate an organizat…

NAC 695F.150 Licensure in another state: Contract with providers in contiguous state; approval of plan of operation. (NRS 679B.130, 695F.300) 1. An organization holding a certificate of authority in this State which is licensed in a contiguous state shall, before the organization…

NAC 695F.160 Surety bond. (NRS 679B.130, 695F.200, 695F.300) The surety bond required by NRS 695F.200 must contain a provision which prohibits cancellation of the bond unless the Commissioner receives at least 90 days’ prior written notice of the cancellation. (Added to NAC by Co…

NAC 695F.170 Hearings and administrative proceedings. (NRS 679B.130, 695F.300) 1. Any person not entitled to a hearing pursuant to NRS 695F.140 or 695F.350 who is aggrieved by an action of the Commissioner in his or her approval, denial or revocation of a certificate of authority…

NAC 695F.200 Reserves. (NRS 679B.130, 695F.190, 695F.300) 1. An organization shall: (a) Maintain the reserve required to be set aside pursuant to subsection 1 of NRS 695F.190. The reserve must be: (1) Based on the premiums collected for the immediately preceding calendar year, as…

NAC 695F.205 Capital account. (NRS 679B.130, 695F.200, 695F.300) Each organization shall maintain a capital account with a net worth in an amount which is the greater of: 1. The amount required pursuant to NRS 695F.200; or 2. The amount of risk-based capital determined in the man…

NAC 695F.210 Requirements for insurance. (NRS 679B.130, 695F.215, 695F.300) 1. Except as otherwise provided in subsections 2 and 5, each organization shall obtain a contract of insurance for the cost of providing limited health services which exceed in the aggregate, for an organ…

NAC 695F.220 Advertising and solicitation. (NRS 679B.130, 695F.300) 1. An organization which advertises its benefits must, in that same advertisement, plainly state the exclusions or limitations of its limited health service plan. 2. Any period of waiting required before an enrol…

NAC 695F.250 Geographic area of service: Definition. (NRS 679B.130, 695F.300) An organization shall clearly define the geographic area it intends to serve, which: 1. In a county having a population of 30,000 or more, must have a radius of not more than 25 miles between the subscr…

NAC 695F.260 Geographic area of service: Expansion. (NRS 679B.130, 695F.300) 1. An organization that wishes to expand its geographic area of service from that stated in its application for a certificate of authority must submit to the Commissioner: (a) A copy of a written descrip…