Title 57

NRS 689A.430 Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency. 1. An insurer shall not, when considering eligibility for coverage or making payments under a policy of health insurance, consider the availability of, or eligibility o…

NRS 689A.440 Insurer prohibited from asserting certain grounds to deny enrollment of child of insured pursuant to order. An insurer shall not deny the enrollment of a child pursuant to an order for medical coverage, under a policy of health insurance pursuant to which a parent of…

NRS 689A.450 Certain accommodations required to be made when child is covered under policy of noncustodial parent. If a child has coverage under a policy of health insurance pursuant to which a noncustodial parent of the child is insured, the insurer issuing that policy shall: 1.…

NRS 689A.460 Insurer 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. If a parent is required by an order for medical coverage to provide coverage under a policy…

NRS 689A.470 Definitions. As used in NRS 689A.470 to 689A.740, inclusive, unless the context otherwise requires, the words and terms defined in NRS 689A.485 to 689A.600, inclusive, have the meanings ascribed to them in those sections. (Added to NRS by 1997, 2883; A 2001, 1922; 20…

NRS 689A.485 “Bona fide association” defined. “Bona fide association” means, with respect to health insurance coverage offered in this state, an association that: 1. Has been actively in existence for at least 5 years; 2. Has been formed and maintained in good faith for purposes …

NRS 689A.495 “Control” defined. “Control” has the meaning ascribed to it in NRS 692C.050. (Added to NRS by 1997, 2884)

NRS 689A.505 “Creditable coverage” defined. “Creditable coverage” means, with respect to a person, health benefits or coverage provided pursuant to: 1. A group health plan; 2. A health benefit plan; 3. Part A or Part B of Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395c…

NRS 689A.510 “Dependent” defined. “Dependent” has the meaning ascribed to it in NRS 689C.055. (Added to NRS by 1997, 2884)

NRS 689A.525 “Geographic rating area” defined. “Geographic rating area” means an area established by the Commissioner for use in adjusting the rates for a health benefit plan. (Added to NRS by 1997, 2885; A 2013, 3613)

NRS 689A.527 “Geographic service area” defined. “Geographic service area” means a geographic area, as approved by the Commissioner, within which the carrier is authorized to provide coverage. (Added to NRS by 1997, 2885; A 2013, 3613)

NRS 689A.535 “Group health plan” defined. 1. “Group health plan” means an employee welfare benefit plan, as defined in section 3(1) of the Employee Retirement Income Security Act of 1974, as that section existed on July 16, 1997, to the extent that the plan provides medical care …

NRS 689A.540 “Health benefit plan” defined. “Health benefit plan” has the meaning ascribed to it in NRS 687B.470. (Added to NRS by 1997, 2886; A 1999, 2803; 2019, 1107, 1430)

NRS 689A.550 “Individual carrier” defined. “Individual carrier” means any entity subject to the provisions of this title and the regulations adopted pursuant thereto, that contracts or offers to contract to provide for, deliver payment for, arrange for payment of, pay for, or rei…

NRS 689A.555 “Individual health benefit plan” defined. “Individual health benefit plan” means: 1. A health benefit plan for individuals and their dependents, other than a converted policy or a plan for coverage of a bona fide association; and 2. A certificate issued to an individ…

NRS 689A.570 “Plan for coverage of a bona fide association” defined. “Plan for coverage of a bona fide association” means a health benefit plan for the members, and their dependents, of a bona fide association in this state regardless of the situs of delivery of the policy or con…

NRS 689A.580 “Plan sponsor” defined. “Plan sponsor” has the meaning ascribed to it in section 3(16)(B) of the Employee Retirement Security Act of 1974, as that section existed on July 16, 1997. (Added to NRS by 1997, 2888)

NRS 689A.590 “Producer” defined. “Producer” means an agent or broker licensed pursuant to this title. (Added to NRS by 1997, 2888)

NRS 689A.600 “Provision for a restricted network” defined. “Provision for a restricted network” means any provision of a health benefit plan that conditions the payment of benefits, in whole or in part, on the use of a provider of health care that has entered into a contractual a…

NRS 689A.615 Certain plan, fund or program to be treated as employee welfare benefit plan which is group health plan; partnership deemed employer of each partner. For the purposes of NRS 689A.470 to 689A.740, inclusive: 1. Any plan, fund or program which would not be, but for sec…

NRS 689A.630 Requirement to renew coverage at option of individual; exceptions; discontinuation of product; discontinuation of health benefit plan available through bona fide association. 1. Except as otherwise provided in this section, coverage under an individual health benefit…

NRS 689A.635 Coverage offered through network plan not required to be offered to person who does not reside or work in geographic service area or geographic rating area. 1. An individual carrier that offers coverage through a network plan is not required pursuant to NRS 689A.630 …

NRS 689A.637 Coverage offered through plan that provides for restricted network: Contracts with certain federally qualified health centers. 1. An individual carrier that offers a health benefit plan that includes a provision for a restricted network shall use its best efforts to …

NRS 689A.696 Information and documents required to be made available to Commissioner; proprietary information. 1. An individual carrier shall make the unified rate review template and rate filing documentation used by the individual carrier and any information and documents descr…

NRS 689A.700 Regulations regarding rates. The Commissioner may adopt regulations to carry out the provisions of this section and to ensure that the practices used by individual carriers relating to the establishment of rates are consistent with the purposes of NRS 689A.470 to 689…

NRS 689A.705 Regulations concerning reissuance of health benefit plan. The Commissioner may adopt regulations to require an individual carrier, as a condition of transacting business with individuals in this state after July 16, 1997, to reissue a health benefit plan to any indiv…

NRS 689A.710 Prohibited acts; denial of application for coverage; regulations; violation may constitute unfair trade practice; applicability of section. 1. Except as otherwise provided in this section, an individual carrier or a producer shall not, directly or indirectly: (a) Enc…

NRS 689A.715 Requirements for employee welfare benefit plan for providing benefits for employees of more than one employer. 1. An employee welfare benefit plan for providing benefits for employees of more than one employer under which individual health insurance coverage is provi…

NRS 689A.717 Individual health benefit plan covering maternity care and pediatric care: Requirement to allow minimum stay in hospital in connection with childbirth; prohibited acts. 1. Except as otherwise provided in this subsection, an individual health benefit plan issued pursu…

NRS 689A.720 Written certification of coverage required for determining period of creditable coverage accumulated by person; provision of certificate to insured. 1. To determine the period of creditable coverage of a person, a health insurance issuer offering individual health in…

NRS 689A.725 Requirements for plan for coverage. For the purposes of NRS 689A.470 to 689A.740, inclusive, a plan for coverage of a bona fide association must: 1. Conform with any regulations adopted pursuant to NRS 689A.700 concerning rates. 2. Provide for the renewability of cov…

NRS 689A.740 Regulations. The Commissioner shall adopt regulations as necessary to carry out the provisions of NRS 689A.470 to 689A.740, inclusive. (Added to NRS by 1997, 2896; A 2017, 2365) SYSTEM FOR RESOLVING COMPLAINTS OF INSUREDS

NRS 689A.745 Establishment; approval; requirements; examination; exception. 1. Except as otherwise provided in subsection 4, each insurer that issues a policy of health insurance in this State shall establish a system for resolving any complaints of an insured concerning health c…

NRS 689A.750 Annual report; insurer required to maintain records of and report complaints concerning something other than health care services. 1. Each insurer that issues a policy of health insurance in this State shall submit to the Commissioner an annual report regarding its s…

NRS 689A.755 Written notice required to be provided by insurer to insured explaining right to file complaint; written notice to insured and provider of health care required when insurer denies coverage of health care service. 1. Following approval by the Commissioner, each insure…