Title 57

NRS 695C.055 Applicability of certain other provisions. 1. The provisions of NRS 449.465, 679A.200, 679B.700, subsections 7 and 8 of NRS 680A.270, subsections 2, 4, 17, 18 and 30 of NRS 680B.010, NRS 680B.020 to 680B.060, inclusive, chapters 681B and 686A of NRS, NRS 686B.010 to …

NRS 695C.057 Applicability of certain provisions concerning portability and availability of health insurance. 1. A health maintenance organization is subject to the provisions of NRS 689A.470 to 689A.740, inclusive, 689B.340 to 689B.580, inclusive, and chapter 689C of NRS relatin…

NRS 695C.060 Establishment of health maintenance organization. 1. Any person may apply to the Commissioner for and obtain a certificate of authority to establish and operate a health maintenance organization in compliance with this chapter. No person shall operate a health mainte…

NRS 695C.070 Certificate of authority: Application. Each application for a certificate of authority must be verified by an officer or authorized representative of the applicant, must be in a form prescribed by the Commissioner, and must set forth or be accompanied by the followin…

NRS 695C.080 Certificate of authority: Evaluation of application. 1. The Commissioner shall determine whether the applicant for a certificate of authority, with respect to health care services to be furnished: (a) Has demonstrated the willingness and ability to ensure that such h…

NRS 695C.090 Certificate of authority: Issuance. The Commissioner shall issue or deny a certificate of authority to any person filing an application pursuant to NRS 695C.060 within 90 days after certification. Issuance of a certificate of authority must be granted upon payment of…

NRS 695C.100 Certificate of authority: Denial. A certificate of authority shall be denied only after compliance with the requirements of NRS 695C.340. (Added to NRS by 1973, 1250)

NRS 695C.110 Governing body: Composition; participation by enrollees. 1. The governing body of any health maintenance organization may include providers, other individuals or both. 2. Such governing body shall establish a mechanism to afford the enrollees an opportunity to partic…

NRS 695C.120 Powers of health maintenance organization. The powers of a health maintenance organization include, but are not limited to, the following: 1. The purchase, lease, construction, renovation, operation or maintenance of hospitals, medical facilities, or both, and their …

NRS 695C.123 Contracts with certain federally qualified health centers. 1. Except as otherwise provided in NRS 422.273, a health maintenance organization that furnishes health care services through providers which are under contract with the organization shall use its best effort…

NRS 695C.125 Contract between health maintenance organization and provider of health care: Organization required to use form to obtain information on provider of health care; modification; submission by organization of schedule of payments to provider. 1. A health maintenance org…

NRS 695C.128 Contracts to provide services pursuant to certain state programs: Payment of interest on claims. Repealed. (See chapter 366, Statutes of Nevada 2025, at page 2410.)

NRS 695C.130 Notice and approval required for exercise of powers; rules or regulations. 1. A health maintenance organization shall file notice, with adequate supporting information, with the Commissioner prior to the exercise of any power granted in subsections 1 and 2 of NRS 695…

NRS 695C.140 Notice and approval required for modification of operations; regulations. 1. A health maintenance organization shall, unless otherwise provided for in this chapter, file notice with the Commissioner before any material modification of the operations described in the …

NRS 695C.145 Accounting principles required for certain reports and transactions; health maintenance organization subject to requirements for certain insurers. 1. A health maintenance organization shall use accounting principles that are recognized by the laws of this state or ap…

NRS 695C.150 Fiduciary responsibilities. Any director, officer, partner, member or employee of a health maintenance organization who receives, collects, disburses or invests funds in connection with the activities of such organization shall be responsible for such funds in a fidu…

NRS 695C.160 Investments. With the exception of investments made in accordance with subsections 1 and 2 of NRS 695C.120 and NRS 695C.130, the investable funds of a health maintenance organization shall be invested only in securities or other investments permitted by the laws of t…

NRS 695C.161 Definitions. As used in NRS 695C.161 to 695C.169, inclusive, unless the context otherwise requires: 1. “Medicaid” means a program established in any state pursuant to Title XIX of the Social Security Act (42 U.S.C. §§ 1396 et seq.) to provide assistance for part or a…

NRS 695C.163 Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency. 1. A health maintenance organization shall not, when considering eligibility for coverage or making payments under a health care plan, consider the availability of, or …

NRS 695C.165 Health maintenance organization prohibited from asserting certain grounds to deny enrollment of child pursuant to order if parent is enrolled in health care plan. An organization shall not deny the enrollment of a child pursuant to an order for medical coverage under…

NRS 695C.167 Certain accommodations required to be made when child is covered under health care plan of noncustodial parent. If a child has coverage under a health care plan in which a noncustodial parent of the child is enrolled, the organization responsible for that plan shall:…

NRS 695C.169 Health maintenance organization 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…

NRS 695C.1691 Required provision in certain plans concerning coverage for continued medical treatment; exceptions; regulations. 1. The provisions of this section apply to a health care plan offered or issued by a health maintenance organization if an insured covered by the health…

NRS 695C.1693 Required provision concerning coverage for certain treatment received as part of clinical trial or study for treatment of cancer or chronic fatigue syndrome; authority of health maintenance organization to require certain information; immunity from liability. 1. Exc…

NRS 695C.16932 Required provision concerning coverage for biomarker testing for diagnosis, treatment, management and monitoring of cancer in certain circumstances; establishment of process to request exception or appeal denial of coverage; time for responding to request for prior…

NRS 695C.16934 Required provision concerning coverage for medically necessary treatment of conditions relating to gender dysphoria and gender incongruence; restriction on refusal to cover certain treatments; authority of health maintenance organization to prescribe requirements f…

NRS 695C.1694 Required provision in plan covering prescription drugs or devices concerning coverage of hormone replacement therapy in certain circumstances; prohibited acts; exception. 1. A health maintenance organization which offers or issues a health care plan that provides co…

NRS 695C.16945 Plan covering prescription drugs: Required actions by health maintenance organization related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared. 1. If the Governor or the Legislature proclai…

NRS 695C.16946 Required provision concerning coverage of recipients of Medicaid for antipsychotic or anticonvulsant medication that is not on list of preferred prescription drugs upon failure of drug on list to treat condition. A health maintenance organization that provides heal…

NRS 695C.16947 Plan covering prescription drugs: Submission to step therapy for drug to treat psychiatric condition prohibited in certain circumstances. 1. A health care plan which provides coverage for prescription drugs must not require an enrollee to submit to a step therapy p…

NRS 695C.1695 Required provision in plan covering outpatient care concerning coverage of health care services related to hormone replacement therapy; prohibited acts. 1. A health maintenance organization that offers or issues a health care plan which provides coverage for outpati…

NRS 695C.1696 Required provision concerning coverage for drug or device for contraception and related health services; prohibited acts; exceptions. 1. Except as otherwise provided in subsection 8, a health maintenance organization that offers or issues a health care plan shall in…

NRS 695C.1698 Required provision concerning coverage for certain services, screenings and tests relating to wellness; prohibited acts. 1. A health maintenance organization that offers or issues a health care plan shall include in the plan coverage for: (a) Counseling, support and…

NRS 695C.1699 Required provision concerning coverage for certain drugs and services related to substance use disorder and opioid use disorder; reimbursement of pharmacists and pharmacies for certain services; prohibited acts. 1. A health maintenance organization that offers or is…

NRS 695C.170 Evidence of coverage: Issuance; form and contents. 1. Every enrollee residing in this state is entitled to evidence of coverage under a health care plan. If the enrollee obtains coverage under a health care plan through an insurance policy, whether by option or other…

NRS 695C.1701 Health maintenance organization required to offer and issue plan regardless of health status of persons; prohibited acts; authority to include wellness program in plan that offers discounts based on health status under certain circumstances. 1. A health maintenance …

NRS 695C.1703 Evidence of coverage covering prescription drugs: Provision of notice and information regarding use of formulary. 1. A health maintenance organization or insurer that offers or issues evidence of coverage which provides coverage for prescription drugs shall include …

NRS 695C.1705 Group health care plan issued to replace discontinued policy or coverage: Requirements; notice of reduction of benefits; statement of benefits; applicability to self-insured employer. Except as otherwise provided in the provisions of NRS 689B.340 to 689B.580, inclus…

NRS 695C.1708 Required provision concerning coverage for services provided through telehealth to same extent as though provided in person or by other means; required provision concerning reimbursement for certain services provided through telehealth in same amount as though provi…

NRS 695C.1709 Required provision in group insurance policy concerning continuing coverage for enrollee on leave without pay as result of total disability. 1. As used in this section, “total disability” and “totally disabled” mean the continuing inability of the enrollee, because …

NRS 695C.17095 Plan covering prescription drug for treatment of medical condition that is part of step therapy protocol: Use of certain guidelines required; establishment of process to request exemption from step therapy protocol required; granting of request; applicability of pr…

NRS 695C.171 Required provision in plan covering mastectomies concerning coverage relating to mastectomy; prohibited acts. 1. A health maintenance plan which provides coverage for the surgical procedure known as a mastectomy must also provide commensurate coverage for: (a) Recons…

NRS 695C.1712 Health care plan covering maternity care: Prohibited acts by organization if enrollee is acting as gestational carrier; child deemed child of intended parent for purposes of plan. 1. A health maintenance organization that offers or issues a health care plan that inc…

NRS 695C.1713 Required provision concerning coverage of certain gynecological and obstetrical services without authorization or referral from primary care physician; designation of obstetrician or gynecologist as primary care physician. 1. A health care plan must include a provis…

NRS 695C.1715 Required provision concerning coverage for habilitative speech-language pathology and rehabilitative speech-language pathology as treatment for stuttering for certain persons; prohibited acts. 1. A health maintenance organization that offers or issues a health care …

NRS 695C.1717 Required provision concerning coverage for autism spectrum disorders for certain persons; prohibited acts. 1. A health care plan issued by a health maintenance organization must provide coverage for screening for and diagnosis of autism spectrum disorders and for tr…