Nevada Administrative Code

NAC 695F.330 Restriction of choice of provider. (NRS 679B.130, 695F.300) An organization may restrict the enrollee’s or subscriber’s choice of a provider to those providers in a preselected group specified in its evidence of coverage or in a list or addendum to that evidence of c…

NAC 695F.340 Copayments. (NRS 679B.130, 695F.300) 1. An organization may establish schedules for nominal copayments to be made by an enrollee to a provider. Each schedule of copayments must be given to the enrollee and submitted to the Commissioner for approval. 2. A copayment ma…

NAC 695F.400 Approval of contract for marketing, enrollment, administration or health care; effect of agreement; licensing of third party. (NRS 679B.130, 695F.300) 1. An organization that enters into a contract with a third party to provide services for marketing, enrollment, adm…

NAC 695F.430 Segregation and separate treatment of records. (NRS 679B.130, 695F.300) The records of an organization holding a certificate of authority in this State must be segregated from the records of any subsidiary or related corporation and treated as separate corporate docu…

NAC 695F.440 Retention of minutes and of materials used for marketing or advertising. (NRS 679B.130, 695F.300) An organization shall retain: 1. Indefinitely, by microfilm or any other means, the minutes of the meetings of its governing body and any advisory panel on enrollees’ sa…

NAC 695F.455 Filing of reports and financial statements; quarterly report of domestic organization; extension of time for filing report or statement. (NRS 679B.130, 695F.300, 695F.320) 1. As a condition of doing business in this State, each organization must file with the Commiss…

NAC 695F.460 Filing of notice for modification of rates, charges, benefits, organization, operations, documents or services. (NRS 679B.130, 695F.170, 695F.300) An organization shall file the notice required by NRS 695F.170 at least 30 days before it desires a change in its charge…

NAC 695F.470 Summary of coverage: Filing, contents and delivery of disclosure. (NRS 679B.130, 695F.300) 1. An organization shall file with the Commissioner, for his or her approval, a disclosure summarizing the coverage provided by a limited health service plan offered by the org…

NAC 695F.480 Evidence of coverage: Requirements. (NRS 679B.130, 695F.150, 695F.300) Any evidence of coverage issued by an organization: 1. Must, in addition to the requirements of NRS 695F.150, contain a clear and complete statement of any benefits other than a limited health ser…

NAC 695F.490 Evidence of coverage: Submission of actuarial memorandum. (NRS 679B.130, 695F.300) An organization shall, when it files with the Commissioner any evidence of coverage or notice of a material change in any evidence of coverage, submit to the Commissioner an actuarial …

NAC 695F.500 Exemption under certain circumstances of program for abuse of alcohol or other substances. (NRS 679B.130, 695F.040, 695F.300) For the purposes of NRS 695F.040, “limited health service” does not include a program which, pursuant to a contract with an employer or labor…

NAC 695F.510 Burden of proof to claim exemption. (NRS 679B.130, 695F.040, 695F.300) The operator of a program described in NAC 695F.500 has the burden of proving that the program meets the requirements of that section for exemption from chapter 695F of NRS. This burden of proof m…

NAC 695F.600 Establishment; scope; examination of system. (NRS 679B.130, 695F.230, 695F.300) 1. Each organization that issues an evidence of coverage in this State shall establish with the approval of the Commissioner a system for resolving any complaints of an enrollee concernin…

NAC 695F.610 Requirements for approval. (NRS 679B.130, 695F.230, 695F.300) To obtain approval of a system for resolving complaints of enrollees concerning limited health services covered by an organization from the Commissioner as required pursuant to NAC 695F.600, an organizatio…

NAC 695F.620 Notices: Right of member to file complaint; denial of coverage; clear and comprehensive language. (NRS 679B.130, 695F.230, 695F.300) 1. After approval by the Commissioner, each organization that issues an evidence of coverage in this State shall provide a written not…

NAC 695F.630 Annual report: Content; maintenance of records. (NRS 679B.130, 695F.230, 695F.300) 1. Each organization that issues an evidence of coverage in this State shall submit to the Commissioner and the State Board of Health an annual report regarding its system for resolvin…

NAC 695F.640 Annual report: Submission; resolution of oral inquiry. (NRS 679B.130, 695F.230, 695F.300) 1. An organization shall submit its annual report regarding its system for resolving complaints as required pursuant to NAC 695F.630 on or before June 1 of each year. The organi…

NAC 695F.650 Records of complaints: Maintenance; submission of summary; copies. (NRS 679B.130, 695F.230, 695F.300) An organization shall: 1. Maintain records of complaints filed with it regarding subjects other than the performance of a limited health service; 2. Submit to the Co…

NAC 695G.010 Definitions. (NRS 679B.130) As used in this chapter, unless the context otherwise requires, the words and terms defined in NAC 695G.020, 695G.030 and 695G.040 have the meanings ascribed to them in those sections. (Added to NAC by Comm’r of Insurance by R132-98, eff. …

NAC 695G.020 “Commissioner” defined. (NRS 679B.130) “Commissioner” means the Commissioner of Insurance. (Added to NAC by Comm’r of Insurance by R132-98, eff. 3-30-99)

NAC 695G.030 “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 by R132-98, eff. 3-30-99)

NAC 695G.040 “Managed care organization” defined. (NRS 679B.130) “Managed care organization” has the meaning ascribed to it in NRS 695G.050. (Added to NAC by Comm’r of Insurance by R132-98, eff. 3-30-99) SYSTEM FOR RESOLVING COMPLAINTS OF INSUREDS

NAC 695G.100 Requirements for approval. (NRS 679B.130, 695G.200) To obtain approval of a system for resolving complaints of insureds from the Commissioner as required pursuant to NRS 695G.200, a managed care organization must: 1. Demonstrate that the system will include the exter…

NAC 695G.110 Annual report. (NRS 679B.130, 695G.220) 1. A managed care organization shall submit its annual report regarding its system for resolving complaints as required pursuant to NRS 695G.220 on or before June 1 of each year. The managed care organization shall retain a cop…

NAC 695H.010 Definitions. (NRS 679B.130, 695H.160) As used in this chapter, unless the context otherwise requires, the words and terms defined in NAC 695H.020 to 695H.060, inclusive, have the meanings ascribed to them in those sections. (Added to NAC by Comm’r of Insurance by R13…

NAC 695H.020 “Administrator” defined. (NRS 679B.130, 695H.160) “Administrator” has the meaning ascribed to it in NRS 695H.020. (Added to NAC by Comm’r of Insurance by R133-05, eff. 10-31-2005)

NAC 695H.030 “Affiliate of an insurer” defined. (NRS 679B.130, 695H.160) “Affiliate of an insurer” has the meaning ascribed to it in NRS 695H.030. (Added to NAC by Comm’r of Insurance by R133-05, eff. 10-31-2005)

NAC 695H.040 “Division” defined. (NRS 679B.130, 695H.160) “Division” means the Division of Insurance of the Department of Business and Industry. (Added to NAC by Comm’r of Insurance by R133-05, eff. 10-31-2005)

NAC 695H.050 “Insurer” defined. (NRS 679B.130, 695H.160) “Insurer” has the meaning ascribed to it in NRS 695H.040. (Added to NAC by Comm’r of Insurance by R133-05, eff. 10-31-2005)

NAC 695H.060 “Medical discount plan” defined. (NRS 679B.130, 695H.160) “Medical discount plan” has the meaning ascribed to it in NRS 695H.050. (Added to NAC by Comm’r of Insurance by R133-05, eff. 10-31-2005) APPLICATION FOR REGISTRATION

NAC 695H.100 Fee and documentation required. (NRS 679B.130, 695H.090, 695H.160) Except as otherwise provided in NAC 695H.110 and 695H.120, an application for registration to engage in business as a medical discount plan must be accompanied by any fee and documentation required pu…

NAC 695H.110 Administrator, insurer or affiliate of insurer: Satisfaction of requirements for organizational documents and financial statements. (NRS 679B.130, 695H.090, 695H.160) An administrator, insurer or affiliate of an insurer shall be deemed to have satisfied the requireme…

NAC 695H.120 Administrator, insurer or affiliate of insurer: Satisfaction of requirements for certain biographical information. (NRS 679B.130, 695H.090, 695H.160) An administrator, insurer or affiliate of an insurer shall be deemed to have satisfied the requirements of paragraph …

NAC 695J.010 Definitions. (NRS 679B.130, 695J.270) As used in this chapter, unless the context otherwise requires, the words and terms defined in NAC 695J.030 to 695J.080, inclusive, have the meanings ascribed to them in those sections. (Added to NAC by Comm’r of Insurance by R07…

NAC 695J.020 “Commissioner” defined. (NRS 679B.130, 695J.270) “Commissioner” means the Commissioner of Insurance. (Added to NAC by Comm’r of Insurance by R074-13, eff. 11-22-2013)

NAC 695J.030 “Course” defined. (NRS 679B.130, 695J.270) “Course” includes, but is not limited to, a program of instruction, correspondence course, course of independent study, self-study course or seminar. (Added to NAC by Comm’r of Insurance by R074-13, eff. 11-22-2013)

NAC 695J.040 “Designated representative” defined. (NRS 679B.130, 695J.270) “Designated representative” means a person with whom the Commissioner contracts pursuant to NAC 695J.090. (Added to NAC by Comm’r of Insurance by R074-13, eff. 11-22-2013)

NAC 695J.050 “Division” defined. (NRS 679B.130, 695J.270) “Division” means the Division of Insurance of the Department of Business and Industry. (Added to NAC by Comm’r of Insurance by R074-13, eff. 11-22-2013)

NAC 695J.060 “Instructor” defined. (NRS 679B.130, 695J.270) “Instructor” means the person who will be responsible for teaching the material of the course to the participants of the course. The instructor may be, but is not required to be, the same person as the sponsor. (Added to…

NAC 695J.070 “Sponsor” defined. (NRS 679B.130, 695J.270) “Sponsor” means the person seeking approval for a course of instruction pursuant to NAC 695J.110. (Added to NAC by Comm’r of Insurance by R074-13, eff. 11-22-2013)

NAC 695J.080 “Unsuitable person” defined. (NRS 679B.130, 695J.270) “Unsuitable person” has the meaning ascribed to it in NAC 679B.039. (Added to NAC by Comm’r of Insurance by R074-13, eff. 11-22-2013)

NAC 695J.090 Authorization to contract with person outside Division for certain administrative duties. (NRS 679B.130, 695J.270) The Commissioner may contract with a person outside the Division to perform all or part of the administrative duties associated with precertification, c…

NAC 695J.100 Attestation of completion of precertification course of instruction. (NRS 679B.130, 695J.110, 695J.270) In addition to the requirements of chapter 695J of NRS, an applicant for a certificate as an exchange enrollment facilitator must attest that he or she has success…

NAC 695J.110 Approval of precertification course of instruction and instructor: Required documents; grounds for denial; limitation on hours of instruction. (NRS 679B.130, 695J.270) 1. A precertification course of instruction and the instructor for the precertification course must…

NAC 695J.120 Qualifications of instructor; limitations on instruction. (NRS 679B.130, 695J.270) 1. An instructor must: (a) Have at least 5 years of relevant experience in the topic to be taught; or (b) Be approved by the Nevada System of Higher Education to teach insurance within…

NAC 695J.130 Approval of correspondence, extension or self-study precertification course of instruction. (NRS 679B.130, 695J.270) 1. A correspondence, extension or self-study precertification course may be approved by the Division if: (a) The precertification course satisfies all…

NAC 695J.140 Subject matter of precertification course of instruction; hours of instruction. (NRS 679B.130, 695J.270) 1. A precertification course must consist of: (a) At least 5 hours of instruction in the classroom in the provisions of title 57 of NRS and the regulations adopte…