Title 57

NRS 689C.025 “Carrier” defined. “Carrier” means any person who provides health insurance in this state, including a fraternal benefit society, a health maintenance organization, a nonprofit hospital and health service corporation, a health insurance company and any other person p…

NRS 689C.045 “Class of business” defined. “Class of business” means all or a distinct grouping of small employers as shown in the records of a carrier serving small employers. (Added to NRS by 1995, 978)

NRS 689C.047 “Control” defined. “Control” has the meaning ascribed to it in NRS 692C.050. (Added to NRS by 1997, 2916)

NRS 689C.053 “Creditable coverage” defined. “Creditable coverage” means health benefits or coverage provided to a person 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 et seq., also …

NRS 689C.055 “Dependent” defined. “Dependent” means a spouse, a domestic partner as defined in NRS 122A.030, or a child on or before the last day of the month in which the child attains 26 years of age. (Added to NRS by 1995, 978; A 2013, 3625)

NRS 689C.065 “Eligible employee” defined. 1. “Eligible employee” means a permanent employee who has a regular working week of 30 or more hours. 2. The term includes a sole proprietor, a partner of a partnership or an employee of a professional employer organization, if the sole p…

NRS 689C.071 “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, 2917; A 2013, 3625)

NRS 689C.072 “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, 2917; A 2013, 3625)

NRS 689C.073 “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 689C.075 “Health benefit plan” defined. “Health benefit plan” has the meaning ascribed to it in NRS 687B.470. (Added to NRS by 1995, 978; A 1997, 2940; 1999, 2811; 2007, 3326; 2023, 2639)

NRS 689C.077 “Network plan” defined. “Network plan” means a health benefit plan offered by a health carrier under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of p…

NRS 689C.078 “Open enrollment” defined. “Open enrollment” means the period designated for enrollment in a health benefit plan. (Added to NRS by 1997, 2918)

NRS 689C.079 “Plan for coverage of a bona fide association” defined. “Plan for coverage of a bona fide association” has the meaning ascribed to it in NRS 689A.570. (Added to NRS by 1997, 2918)

NRS 689C.081 “Plan sponsor” defined. “Plan sponsor” has the meaning ascribed to it in section 3(16)(B) of the Employee Retirement Income Security Act of 1974, as that section existed on July 16, 1997. (Added to NRS by 1997, 2918)

NRS 689C.083 “Producer” defined. “Producer” means an agent or broker licensed pursuant to this title. (Added to NRS by 1997, 2918)

NRS 689C.0835 “Professional employer organization” defined. “Professional employer organization” has the meaning ascribed to it in NRS 611.400. (Added to NRS by 2021, 1935)

NRS 689C.085 “Rating period” defined. “Rating period” means the period for which premium rates established by a carrier are assumed to be in effect. (Added to NRS by 1995, 979)

NRS 689C.095 “Small employer” defined. “Small employer” has the meaning ascribed to it in 42 U.S.C. § 18024(b)(2). (Added to NRS by 1995, 979; A 1997, 2941; 1999, 2812; 2013, 3625)

NRS 689C.104 “Voluntary purchasing group” defined. “Voluntary purchasing group” means the employers and their eligible employees and dependents who form a group pursuant to NRS 689C.360 to 689C.600, inclusive, and hold a certificate of registration issued by the Commissioner purs…

NRS 689C.106 “Waiting period” defined. “Waiting period” means the period established by a plan of health insurance that must pass before a person who is an eligible participant or beneficiary in a plan is covered for benefits under the terms of the plan. The term includes the per…

NRS 689C.1065 Applicability. The provisions of this chapter apply to health benefit plans that provide coverage to the employees of small employers in this state and to carriers that offer those health benefit plans if: 1. A portion of the premium or benefits are paid by or on be…

NRS 689C.109 Certain plan, fund or program established or maintained by partnership required to be treated as employee welfare benefit plan which is group health plan; partnership deemed employer of each partner. For the purposes of this chapter: 1. Any plan, fund or program whic…

NRS 689C.111 Professional employer organization deemed large employer in certain circumstances. A professional employer organization which has more than 50 employees, including leased employees at client locations, and which sponsors a fully insured health benefit plan for those …

NRS 689C.113 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 health insurance coverage is provided to smal…

NRS 689C.115 Mandatory and optional coverage. 1. A health benefit plan offered by a carrier pursuant to this chapter must include coverage of basic medical and hospital care. 2. In addition to the coverage required by subsection 1, a carrier may offer additional coverage for an a…

NRS 689C.125 Rating factors for determining premiums; rating periods. 1. A carrier serving small employers shall apply rating factors consistently with respect to all small employers. Rating factors must produce premiums for identical groups that differ only by the amounts attrib…

NRS 689C.131 Contracts between carrier and providers of health care: Prohibiting carrier from charging provider of health care fee for inclusion on list of providers given to insureds; carrier required to use form to obtain information on provider of health care; modification; su…

NRS 689C.135 Effect of provision in health benefit plan for restricted network on determination of rates. 1. For the purposes of determining rates charged for health benefit plans, a health benefit plan that contains a provision for a restricted network is not similar coverage to…

NRS 689C.143 Offering of policy of health insurance for purposes of establishing health savings account. A carrier may, subject to regulation by the Commissioner, offer a policy of health insurance that has a high deductible and is in compliance with 26 U.S.C. § 223 for the purpo…

NRS 689C.155 Regulations. The Commissioner may adopt regulations to carry out the provisions of NRS 689C.109 to 689C.143, inclusive, 689C.156 to 689C.159, inclusive, 689C.165, 689C.183, 689C.187, 689C.191 to 689C.198, inclusive, 689C.203, 689C.207, 689C.265, 689C.325, 689C.355 an…

NRS 689C.156 Each health benefit plan marketed in this State required to be offered to small employers; issuance; carrier required to provide system for resolving complaints of employees if services provided or paid for through managed care. 1. As a condition of transacting busin…

NRS 689C.1565 Coverage to small employers not required under certain circumstances; notice required to Commissioner of and prohibition on writing new business after election not to offer new coverage required. 1. A carrier is not required to provide coverage to small employers pu…

NRS 689C.158 Producer authorized only to market to or sign up small employers and eligible employees in bona fide associations if employers and employees are actively engaged in or directly related to bona fide association. For the purposes of providing coverage under a health be…

NRS 689C.159 Certain provisions inapplicable to plan that carrier makes available only through bona fide association. The provisions of NRS 689C.156 do not apply to health benefit plans offered by a carrier if the carrier makes the health benefit plan available in the small emplo…

NRS 689C.160 Carrier must uniformly apply requirements to determine whether to provide coverage. The requirements used by a carrier serving small employers to determine whether to provide coverage to a small employer, including, without limitation, requirements for minimum partic…

NRS 689C.165 Carrier prohibited from modifying plan to restrict or exclude coverage or benefits for specific diseases, medical conditions or services otherwise covered by plan; exceptions. Except as otherwise provided in NRS 689C.170 and 689C.180, a carrier shall not modify a hea…

NRS 689C.1652 Coverage for medically necessary treatment of conditions relating to gender dysphoria and gender incongruence required; restriction on refusal to cover certain treatments; authority of carrier to prescribe requirements for covering surgical treatments for minors; de…

NRS 689C.1653 Coverage for testing, treatment and prevention of sexually transmitted diseases required; coverage for condoms for certain insureds required. 1. A carrier that offers or issues a health benefit plan shall include in the plan: (a) Coverage of testing for and the trea…

NRS 689C.1654 Coverage for habilitative speech-language pathology and rehabilitative speech-language pathology as treatment for stuttering required for certain persons; prohibited acts. 1. A carrier that offers or issues a health benefit plan shall include in the plan coverage fo…

NRS 689C.1655 Coverage for autism spectrum disorders for certain persons required; prohibited acts. 1. A health benefit plan must provide coverage for screening for and diagnosis of autism spectrum disorders and for treatment of autism spectrum disorders to persons covered by the…

NRS 689C.166 Coverage for alcohol or substance use disorder: Required in group health insurance policy. Each group health insurance policy must contain in substance a provision for benefits payable for expenses incurred for the treatment of alcohol or substance use disorder, as p…

NRS 689C.1665 Coverage for certain drugs and services related to substance use disorder and opioid use disorder required; reimbursement of pharmacists and pharmacies for certain services; prohibited acts. 1. A carrier that offers or issues a health benefit plan shall include in t…

NRS 689C.167 Coverage for alcohol or substance use disorders: Benefits provided by group health insurance policy. 1. In addition to the benefits required by NRS 689C.1665, the benefits provided by a group policy for health insurance, as required by NRS 689C.166, for the treatment…

NRS 689C.1671 Coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus and hepatitis C required; reimbursement of certain providers of health care for certain services; prohibited acts. 1. A carrier that offers or issues a health benefit…

NRS 689C.16715 Coverage for certain gynecological or obstetrical services required without prior authorization or referral from primary care physician; designation of obstetrician or gynecologist as primary care physician. 1. A carrier that offers or issues a health benefit plan …

NRS 689C.1672 Coverage for certain tests and vaccines relating to human papillomavirus required; prohibited acts. 1. A health benefit plan must provide coverage for benefits payable for expenses incurred for: (a) Deoxyribonucleic acid testing for high-risk strains of human papill…