[Rev. 2/11/2015 11:53:09 AM--2014R2]

CHAPTER 689C - HEALTH INSURANCE FOR SMALL EMPLOYERS

HEALTH BENEFIT PLANS

NRS 689C.015        Definitions.

NRS 689C.017        “Affiliated” defined.

NRS 689C.019        “Affiliation period” defined.

NRS 689C.021        “Basic health benefit plan” defined. [Repealed.]

NRS 689C.023        “Bona fide association” defined.

NRS 689C.025        “Carrier” defined.

NRS 689C.035        “Characteristics” defined. [Repealed.]

NRS 689C.045        “Class of business” defined.

NRS 689C.047        “Control” defined.

NRS 689C.051        “Converted policy” defined. [Repealed.]

NRS 689C.053        “Creditable coverage” defined.

NRS 689C.055        “Dependent” defined.

NRS 689C.065        “Eligible employee” defined.

NRS 689C.066        “Employee leasing company” defined.

NRS 689C.067        “Established geographic service area” defined. [Replaced in revision by NRS 689C.072.]

NRS 689C.071        “Geographic rating area” defined.

NRS 689C.072        “Geographic service area” defined.

NRS 689C.073        “Group health plan” defined.

NRS 689C.075        “Health benefit plan” defined.

NRS 689C.076        “Health status-related factor” defined. [Repealed.]

NRS 689C.077        “Network plan” defined.

NRS 689C.078        “Open enrollment” defined.

NRS 689C.079        “Plan for coverage of a bona fide association” defined.

NRS 689C.081        “Plan sponsor” defined.

NRS 689C.082        “Preexisting condition” defined.

NRS 689C.083        “Producer” defined.

NRS 689C.084        “Program of Reinsurance” defined. [Repealed.]

NRS 689C.085        “Rating period” defined.

NRS 689C.089        “Risk-assuming carrier” defined. [Repealed.]

NRS 689C.095        “Small employer” defined. [Effective through December 31, 2015.]

NRS 689C.095        “Small employer” defined. [Effective January 1, 2016.]

NRS 689C.099        “Standard health benefit plan” defined. [Repealed.]

NRS 689C.106        “Waiting period” defined.

NRS 689C.1065      Applicability.

NRS 689C.107        Affiliated carriers deemed one carrier in certain circumstances; affiliated carrier that is health maintenance organization considered separate carrier; ceding arrangement prohibited in certain circumstances. [Repealed.]

NRS 689C.109        Certain plan, fund or program to be treated as employee welfare benefit plan which is group health plan; partnership deemed employer of each partner.

NRS 689C.111        Determination of whether employer is small or large; applicability of provisions after employer is deemed large.

NRS 689C.113        Requirements for employee welfare benefit plan for providing benefits for employees of more than one employer.

NRS 689C.115        Mandatory and optional coverage.

NRS 689C.125        Rating factors for determining premiums.

NRS 689C.135        Effect of provision in health benefit plan for restricted network on determination of rates.

NRS 689C.143        Offering of policy of health insurance for purposes of establishing health savings account.

NRS 689C.145        Characteristics that carrier may use to determine rating factors for establishing premiums. [Repealed.]

NRS 689C.155        Regulations.

NRS 689C.156        Each health benefit plan marketed in this State required to be offered to small employers.

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

NRS 689C.157        Requirement to file basic and standard health benefit plans with Commissioner; disapproval of plan. [Repealed.]

NRS 689C.158        Producer may only sign up small employers and eligible employees in bona fide associations if employers and employees are actively engaged in or related to bona fide association.

NRS 689C.159        Certain provisions inapplicable to plan that carrier makes available only through bona fide association.

NRS 689C.160        Carrier must uniformly apply requirements to determine whether to provide coverage.

NRS 689C.165        Carrier prohibited from modifying plan to restrict or exclude coverage for certain services.

NRS 689C.1655      Coverage for autism spectrum disorders.

NRS 689C.166        Coverage for abuse of alcohol or drugs: Required.

NRS 689C.167        Coverage for abuse of alcohol or drugs: Benefits.

NRS 689C.168        Coverage for prescription drug previously approved for medical condition of insured.

NRS 689C.169        Coverage for severe mental illness.

NRS 689C.170        Authorized variation of minimum participation and contributions; denial of coverage based on industry prohibited.

NRS 689C.180        Carrier to offer same coverage to all eligible employees; denial of coverage to otherwise eligible employee.

NRS 689C.183        Plan and carrier required to permit employee or dependent of employee to enroll for coverage under certain circumstances.

NRS 689C.187        Manner and period for enrolling dependent of covered employee; period of special enrollment.

NRS 689C.190        Coverage of preexisting conditions.

NRS 689C.191        Determination of applicable creditable coverage of person; determining period of creditable coverage of person; required statement; applicability.

NRS 689C.192        Written certification of coverage required for purpose of determining period of creditable coverage accumulated by person.

NRS 689C.193        Carrier prohibited from imposing restriction on participation inconsistent with certain sections; restrictions on rules of eligibility that may be established; premiums to be equitable.

NRS 689C.194        Plan that includes coverage for maternity and pediatric care: Required to allow minimum stay in hospital in connection with childbirth; prohibited acts.

NRS 689C.196        Insurer prohibited from denying coverage solely because person was victim of domestic violence.

NRS 689C.197        Carrier prohibited from denying coverage because insured was intoxicated or under influence of controlled substance; exceptions.

NRS 689C.198        Insurer prohibited from requiring or using information concerning genetic testing; exceptions.

NRS 689C.200        When carrier is not required to offer coverage.

NRS 689C.203        Denial of application for coverage from small employer; regulations.

NRS 689C.207        Regulations concerning reissuance of health benefit plan.

NRS 689C.210        Procedure for increasing premium rates. [Repealed.]

NRS 689C.220        Adjustment in rates to be applied uniformly.

NRS 689C.230        Determination and application of index rate. [Repealed.]

NRS 689C.240        Use of industry classifications as rating factor. [Repealed.]

NRS 689C.250        Information considered to be trade secret; exception.

NRS 689C.260        Manner in which carrier may establish separate class of business; transferring small employer into or out of class of business. [Repealed.]

NRS 689C.265        Carrier authorized to modify coverage for insurance product under certain circumstances.

NRS 689C.270        Regulations concerning disclosures by carrier to small employer; copy of disclosure to be made available to small employer.

NRS 689C.280        Carrier to provide required disclosures to small employer before issuing policy of insurance.

NRS 689C.281        Coverage for prescription drugs: Provision of notice and information regarding use of formulary.

NRS 689C.283        Election to operate as risk-assuming carrier or reinsuring carrier: Notice to Commissioner; effective date; change in status. [Repealed.]

NRS 689C.287        Election to act as risk-assuming carrier: Suspension by Commissioner; applicable statutes. [Repealed.]

NRS 689C.290        Commissioner authorized to suspend restriction on increase of premiums for new rating period based on new business for policy. [Repealed.]

NRS 689C.300        Carrier to file actuarial certification annually with Commissioner. [Repealed.]

NRS 689C.310        Renewal of health benefit plan; discontinuing issuance and renewal of coverage, plan or form of product of health benefit plan.

NRS 689C.320        Required notification when carrier discontinues transacting insurance in this State; restrictions on carrier that discontinues transacting insurance.

NRS 689C.325        Coverage offered through network plan not required to be offered to eligible employee who does not reside or work in geographic service area or if carrier lacks capacity to deliver adequate service to additional employers and employees.

NRS 689C.327        Carrier that offers network plan: Contracts with certain federally qualified health centers. [Repealed.]

NRS 689C.330        When insurer is required to allow employee to continue coverage after employee is no longer covered by health benefit plan.

NRS 689C.340        Required provisions in health benefit plan of employer who employs less than 20 employees related to continuation of coverage. [Repealed.]

NRS 689C.342        Notice of election and payment of premium. [Repealed.]

NRS 689C.344        Amount of premium for continuation of coverage; change in rates; payment to insurer; termination. [Repealed.]

NRS 689C.346        Effect of change in insurer during period of continued coverage. [Repealed.]

NRS 689C.348        Continued coverage ceases before end of established period under certain circumstances. [Repealed.]

NRS 689C.350        Health benefit plan with preferred providers of health care: Deductible; when service is deemed to be provided by preferred provider.

NRS 689C.355        Prohibited acts of carrier or producer; denial of application for coverage; violation may constitute unfair trade practice; applicability of section.

VOLUNTARY PURCHASING GROUPS

NRS 689C.360        Definitions.

NRS 689C.380        “Contract” defined.

NRS 689C.390        “Dependent” defined.

NRS 689C.420        “Voluntary purchasing group” defined.

NRS 689C.425        Applicability of other provisions.

NRS 689C.430        Entities which are authorized to offer contracts to voluntary purchasing groups.

NRS 689C.435        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; form to obtain information on provider of health care; modification; schedule of fees.

NRS 689C.440        Regulations regarding required disclosures by carrier.

NRS 689C.450        Carrier to provide disclosure before issuing contract.

NRS 689C.455        Coverage for prescription drugs: Provision of notice and information regarding use of formulary.

NRS 689C.460        Carrier to offer same coverage to all eligible employees; denial of coverage to otherwise eligible employee.

NRS 689C.470        Renewal of contract; discontinuing issuance and renewal of form of product of health benefit plan or health benefit plan.

NRS 689C.480        Required notification when carrier ceases to renew all contracts; restrictions on carrier that ceases to renew all contracts.

NRS 689C.485        Approval or denial of claims; payment of claims and interest; requests for additional information; award of costs and attorney’s fees; compliance with requirements.

NRS 689C.490        Formation of voluntary purchasing group by small employers; requirements when affiliate of group ceases to qualify as small employer.

NRS 689C.500        Requirements for registration as voluntary purchasing group; application.

NRS 689C.510        Fee for application; response to application.

NRS 689C.520        Additional requirements for registration.

NRS 689C.530        Filing reports; annual renewal fee.

NRS 689C.540        Duties.

NRS 689C.550        Collection of premiums; trust account for deposit of premiums.

NRS 689C.560        Regulations governing security to be maintained by voluntary purchasing group.

NRS 689C.570        Organizer prohibited from acquiring financial interest in group’s business.

NRS 689C.580        Prohibited acts.

NRS 689C.590        Disciplinary action for violation of provisions.

NRS 689C.600        Regulations.

REINSURANCE

General Provisions

NRS 689C.610        Definitions.

NRS 689C.620        “Board” defined. [Repealed.]

NRS 689C.630        “Church plan” defined.

NRS 689C.640        “Committee” defined. [Repealed.]

NRS 689C.650        “Eligible person” defined. [Repealed.]

NRS 689C.660        “Individual carrier” defined.

NRS 689C.670        “Individual health benefit plan” defined.

NRS 689C.680        “Individual reinsuring carrier” defined. [Repealed.]

NRS 689C.690        “Individual risk-assuming carrier” defined. [Repealed.]

NRS 689C.700        “Plan of operation” defined. [Repealed.]

NRS 689C.710        “Program of Reinsurance” defined. [Repealed.]

NRS 689C.720        “Reinsuring carrier” defined. [Repealed.]

NRS 689C.730        “Risk-assuming carrier” defined. [Repealed.]

 

Program of Reinsurance for Small Employers and Eligible Persons

NRS 689C.740        Creation. [Repealed.]

NRS 689C.750        Board of Directors: Creation; members; term; vacancy. [Repealed.]

NRS 689C.760        Meetings of Board; Chair of Board. [Repealed.]

NRS 689C.770        Plan of operation: Submission by Board; approval by Commissioner; temporary plan when plan not suitable or not submitted. [Repealed.]

NRS 689C.780        Requirements of plan of operation and temporary plan of operation. [Repealed.]

NRS 689C.790        Program deemed to have powers and authority of insurance companies and health maintenance organizations; exceptions; powers. [Repealed.]

NRS 689C.800        Amount of coverage to be reinsured; time within which reinsurance may begin; limitation on reimbursement to reinsuring carrier; termination of reinsurance; premium rate charged to federally qualified health maintenance organization; manner of handling managed care and claims by reinsuring carrier. [Repealed.]

NRS 689C.810        Premium rates: Methodology for determining; minimum rates; review of methodology. [Repealed.]

NRS 689C.820        Premiums for certain health benefit plans that are reinsured with program required to meet established requirements for premium rates. [Repealed.]

NRS 689C.830        Board required to determine, account for and report to Commissioner net loss. [Repealed.]

NRS 689C.840        Net loss from reinsuring small employers and eligible employees and dependents required to be recouped by assessments against reinsuring carriers. [Repealed.]

NRS 689C.850        Net loss from reinsuring individual eligible persons and dependents required to be recouped by assessments against individual reinsuring carriers. [Repealed.]

NRS 689C.860        Board required to determine, account for and report to Commissioner estimate of assessments needed to pay for losses; evaluation of operation of Program. [Repealed.]

NRS 689C.870        Additional funding: Eligibility based on amount of assessment needed; Board to establish formula for additional assessments on all carriers. [Repealed.]

NRS 689C.880        Use of excess assessments. [Repealed.]

NRS 689C.890        Assessment against reinsuring carrier to be determined annually; penalty for late payment of assessments; deferment of assessment. [Repealed.]

NRS 689C.900        Insurer to receive certificate of contribution for paying additional assessment; certain amount of contribution may be shown as asset and may offset liability for premium tax. [Repealed.]

NRS 689C.910        Adjustment of assessment on federally qualified health maintenance organizations. [Repealed.]

NRS 689C.920        Immunity from liability of Program and reinsuring carriers for certain acts. [Repealed.]

NRS 689C.930        Board to develop standards setting forth manner and levels of compensation paid to producers for sale of health benefit plans. [Repealed.]

NRS 689C.940        Regulations concerning determination of status of stop-loss policy.

NRS 689C.950        Certain provisions inapplicable to certain basic health benefit plan delivered to small employers or eligible persons. [Repealed.]

NRS 689C.955        Member, agent or employee of Board immune from liability in certain circumstances. [Repealed.]

 

Committee on Health Benefit Plans

NRS 689C.960        Creation; members; term; vacancy. [Repealed.]

NRS 689C.970        Meetings; Chair; duties. [Repealed.]

NRS 689C.980        Board and Committee to study and submit report concerning effectiveness of certain provisions. [Repealed.]

_________

 

HEALTH BENEFIT PLANS

      NRS 689C.015  Definitions.  Except as otherwise provided in this chapter, as used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 689C.017 to 689C.106, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 1995, 978; A 1997, 1096, 2940; 2011, 3384)

      NRS 689C.017  “Affiliated” defined.  “Affiliated” means any entity or person who directly, or indirectly through one or more intermediaries, controls or is controlled by or is under common control with a specified entity or person.

      (Added to NRS by 1997, 2916)

      NRS 689C.019  “Affiliation period” defined.  “Affiliation period” means a period, not to exceed 60 days for new enrollees and 90 days for late enrollees, during which no premiums may be collected from, and coverage issued would not become effective for, a small employer or an eligible employee or a dependent of the eligible employee, if the affiliation period is applied uniformly and without regard to any health status-related factors.

      (Added to NRS by 1997, 2916)

      NRS 689C.021  “Basic health benefit plan” defined.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.023  “Bona fide association” defined.  “Bona fide association” has the meaning ascribed to it in NRS 689A.485.

      (Added to NRS by 1997, 2916)

      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 providing a plan of health insurance or health benefits subject to this title.

      (Added to NRS by 1995, 978)

      NRS 689C.035  “Characteristics” defined.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      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.051  “Converted policy” defined.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      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 known as Medicare;

      4.  Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., also known as Medicaid, other than coverage consisting solely of benefits under section 1928 of that Title, 42 U.S.C. § 1396s;

      5.  The Civilian Health and Medical Program of Uniformed Services, CHAMPUS, 10 U.S.C. §§ 1071 et seq.;

      6.  A medical care program of the Indian Health Service or of a tribal organization;

      7.  A state health benefit risk pool;

      8.  A health plan offered pursuant to the Federal Employees Health Benefits Program, FEHBP, 5 U.S.C. §§ 8901 et seq.;

      9.  A public health plan as defined in federal regulations authorized by the Public Health Service Act, 42 U.S.C. § 300gg(c)(1)(I);

      10.  A health benefit plan under section 5(e) of the Peace Corps Act, 22 U.S.C. § 2504(e);

      11.  The Children’s Health Insurance Program established pursuant to 42 U.S.C. §§ 1397aa to 1397jj, inclusive;

      12.  A short-term health insurance policy; or

      13.  A blanket student accident and health insurance policy.

      (Added to NRS by 1997, 2916; A 1999, 2240, 2811)

      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 an employee leasing company, if the sole proprietor, partner or employee of the employee leasing company is included as an employee under a health benefit plan of a small employer.

      (Added to NRS by 1995, 978; A 2011, 3384)

      NRS 689C.066  “Employee leasing company” defined.  “Employee leasing company” has the meaning ascribed to it in NRS 616B.670.

      (Added to NRS by 2011, 3384)

      NRS 689C.067  “Established geographic service area” defined.  [Replaced in revision by NRS 689C.072.]

 

      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)—(Substituted in revision for NRS 689C.067)

      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 to employees or their dependents as defined under the terms of the plan directly, or through insurance, reimbursement or otherwise.

      2.  The term does not include:

      (a) Coverage that is only for accident or disability income insurance, or any combination thereof;

      (b) Coverage issued as a supplement to liability insurance;

      (c) Liability insurance, including general liability insurance and automobile liability insurance;

      (d) Workers’ compensation or similar insurance;

      (e) Coverage for medical payments under a policy of automobile insurance;

      (f) Credit insurance;

      (g) Coverage for on-site medical clinics; and

      (h) Other similar insurance coverage specified in federal regulations adopted pursuant to Public Law 104-191 under which benefits for medical care are secondary or incidental to other insurance benefits.

      3.  The term does not include the following benefits if the benefits are provided under a separate policy, certificate or contract of insurance or are otherwise not an integral part of a health benefit plan:

      (a) Limited-scope dental or vision benefits;

      (b) Benefits for long-term care, nursing home care, home health care or community-based care, or any combination thereof; and

      (c) Such other similar benefits as are specified in federal regulations adopted pursuant to Public Law 104-191.

      4.  The term does not include the following benefits if the benefits are provided under a separate policy, certificate or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and such benefits are paid for a claim without regard to whether benefits are provided for such a claim under any group health plan maintained by the same plan sponsor:

      (a) Coverage that is only for a specified disease or illness; and

      (b) Hospital indemnity or other fixed indemnity insurance.

      5.  The term does not include any of the following, if offered as a separate policy, certificate or contract of insurance:

      (a) Medicare supplemental health insurance as defined in section 1882(g)(1) of the Social Security Act, as that section existed on July 16, 1997;

      (b) Coverage supplemental to the coverage provided pursuant to chapter 55 of Title 10, United States Code (Civilian Health and Medical Program of Uniformed Services (CHAMPUS)); and

      (c) Similar supplemental coverage provided under a group health plan.

      (Added to NRS by 1997, 2917)

      NRS 689C.075  “Health benefit plan” defined.

      1.  “Health benefit plan” means a policy, contract, certificate or agreement to provide for, deliver payment for, arrange for the payment of, pay for or reimburse any of the costs of health care services. Except as otherwise provided in this section, the term includes short-term and catastrophic health insurance policies and a policy that pays on a cost-incurred basis.

      2.  The term does not include:

      (a) Coverage that is only for accident or disability income insurance, or any combination thereof;

      (b) Coverage issued as a supplement to liability insurance;

      (c) Liability insurance, including general liability insurance and automobile liability insurance;

      (d) Workers’ compensation or similar insurance;

      (e) Coverage for medical payments under a policy of automobile insurance;

      (f) Credit insurance;

      (g) Coverage for on-site medical clinics;

      (h) Coverage under a short-term health insurance policy;

      (i) Coverage under a blanket student accident and health insurance policy; and

      (j) Other similar insurance coverage specified in federal regulations issued pursuant to the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, under which benefits for medical care are secondary or incidental to other insurance benefits.

      3.  If the benefits are provided under a separate policy, certificate or contract of insurance or are otherwise not an integral part of a health benefit plan, the term does not include the following benefits:

      (a) Limited-scope dental or vision benefits;

      (b) Benefits for long-term care, nursing home care, home health care or community-based care, or any combination thereof; and

      (c) Such other similar benefits as are specified in any federal regulations adopted pursuant to the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191.

      4.  If the benefits are provided under a separate policy, certificate or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and the benefits are paid for a claim without regard to whether benefits are provided for such a claim under any group health plan maintained by the same plan sponsor, the term does not include:

      (a) Coverage that is only for a specified disease or illness; and

      (b) Hospital indemnity or other fixed indemnity insurance.

      5.  If offered as a separate policy, certificate or contract of insurance, the term does not include:

      (a) Medicare supplemental health insurance as defined in section 1882(g)(1) of the Social Security Act, 42 U.S.C. § 1395ss, as that section existed on July 16, 1997;

      (b) Coverage supplemental to the coverage provided pursuant to the Civilian Health and Medical Program of Uniformed Services, CHAMPUS, 10 U.S.C. §§ 1071 et seq.; and

      (c) Similar supplemental coverage provided under a group health plan.

      (Added to NRS by 1995, 978; A 1997, 2940; 1999, 2811; 2007, 3326)

      NRS 689C.076  “Health status-related factor” defined.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      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 providers under contract with the carrier. The term does not include an arrangement for the financing of premiums.

      (Added to NRS by 1997, 2918)

      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.082  “Preexisting condition” defined.  “Preexisting condition” means a condition, regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received during the 6 months immediately preceding the effective date of the new coverage. The term does not include genetic information in the absence of a diagnosis of the condition related to such information.

      (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.084  “Program of Reinsurance” defined.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      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.089  “Risk-assuming carrier” defined.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.095  “Small employer” defined. [Effective through December 31, 2015.]

      1.  “Small employer” means, with respect to a calendar year and a plan year, an employer who employed on business days during the preceding calendar year an average of at least 2 employees, but not more than 50 employees, who have a normal workweek of 30 hours or more, and who employs at least 2 employees on the first day of the plan year. For the purposes of determining the number of eligible employees, organizations which are affiliated or which are eligible to file a combined tax return for the purposes of taxation constitute one employer.

      2.  For the purposes of this section, organizations are “affiliated” if one directly, or indirectly, through one or more intermediaries, controls or is controlled by, or is under common control with, the other, as determined pursuant to the provisions of NRS 692C.050.

      (Added to NRS by 1995, 979; A 1997, 2941; 1999, 2812)

      NRS 689C.095  “Small employer” defined. [Effective January 1, 2016.]  “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, effective January 1, 2016)

      NRS 689C.099  “Standard health benefit plan” defined.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      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 period from the date a person submits an application to an individual carrier for coverage under a health benefit plan until the first day of coverage under that health benefit plan.

      (Added to NRS by 1997, 2919; A 1999, 2813)

      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 behalf of the small employer;

      2.  An eligible employee or a dependent of the eligible employee is reimbursed for a portion of the premium, whether by wage adjustments or otherwise, by or on behalf of the small employer; or

      3.  The health benefit plan is considered by the small employer or any of the small employer’s eligible employees or dependents as part of a plan or program for the purposes of section 106, 125 or 162 of the Internal Revenue Code, 26 U.S.C. § 106, 125 or 162.

      (Added to NRS by 1999, 2810)

      NRS 689C.107  Affiliated carriers deemed one carrier in certain circumstances; affiliated carrier that is health maintenance organization considered separate carrier; ceding arrangement prohibited in certain circumstances.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.109  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 this chapter:

      1.  Any plan, fund or program which would not be, but for section 2721(e) of the Public Health Service Act, as amended by Public Law 104-191, as that section existed on July 16, 1997, an employee welfare benefit plan and which is established or maintained by a partnership to the extent that the plan, fund or program provides medical care to current or former partners in a partnership, or to their dependents, as defined under the terms of the plan, fund or program, directly, or through insurance, reimbursement or otherwise, must be treated, subject to the provisions of subsection 2, as an employee welfare benefit plan that is a group health plan.

      2.  In the case of a group health plan, a partnership shall be deemed to be the employer of each partner.

      (Added to NRS by 1997, 2919)

      NRS 689C.111  Determination of whether employer is small or large; applicability of provisions after employer is deemed large.

      1.  If an employer was not in existence throughout the entire preceding calendar year, the determination of whether the employer is a small or large employer must be based on the average number of employees reasonably expected to be employed on business days in the current calendar year.

      2.  Except as otherwise provided by specific statute, the provisions of this chapter that apply to a small employer at the time that a carrier issues a health benefit plan to the small employer pursuant to the provisions of this chapter continue to apply at least until the plan anniversary following the date on which the small employer no longer meets the requirements of being a small employer.

      3.  An employee leasing company which has more than 50 employees, including leased employees at client locations, and which sponsors a fully insured health benefit plan for those employees shall be deemed to be a large employer for the purposes of this chapter.

      (Added to NRS by 1997, 2919; A 2011, 3384)

      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 small employers must comply with the provisions of this chapter and with NRS 679B.139 and the regulations adopted by the Commissioner pursuant thereto.

      2.  As used in this section, the term “employee welfare benefit plan for providing benefits for employees of more than one employer” is intended to be equivalent to the term “employee welfare benefit plan which is a multiple employer welfare arrangement” as used in federal statutes and regulations.

      (Added to NRS by 1997, 2928)

      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 additional cost upon the approval of the Commissioner.

      (Added to NRS by 1995, 979)

      NRS 689C.125  Rating factors for determining premiums.

      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 attributable to the design of the plans and the terms of the coverage and do not reflect differences based on the nature of the groups that will select particular health benefit plans. As used in this subsection, “premium” means all money paid by a small employer and eligible employees to a carrier as a condition of receiving coverage from a carrier, including any fees or other contributions associated with the health benefit plan.

      2.  A carrier serving small employers shall treat all health benefit plans issued or renewed in the same calendar month as having the same rating period, if the terms of coverage provided in the plans are the same.

      (Added to NRS by 1995, 979; A 2013, 3625)

      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 a health benefit plan that does not contain such a provision if the restriction of benefits results in material differences in cost of claims.

      2.  As used in this section, “provision for a restricted network” means any provision of a group health benefit plan that conditions the payment of benefits, in whole or in part, on the use of providers of health care who have entered into a contractual arrangement with the carrier to provide health care to persons covered by the plan.

      (Added to NRS by 1995, 980)

      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 purposes of establishing a health savings account.

      (Added to NRS by 2005, 2137)

      NRS 689C.145  Characteristics that carrier may use to determine rating factors for establishing premiums.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      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 and 689C.610 to 689C.940, inclusive, and to ensure that rating practices used by carriers serving small employers are consistent with those sections, including regulations that:

      1.  Ensure that differences in rates charged for health benefit plans by such carriers are reasonable and reflect only differences in the designs of the plans, the terms of the coverage, the amount contributed by the employers to the cost of coverage and differences based on the rating factors established by the carrier.

      2.  Prescribe the manner in which rating factors may be used by such carriers.

      (Added to NRS by 1995, 980; A 1997, 2942; 2013, 3626)

      NRS 689C.156  Each health benefit plan marketed in this State required to be offered to small employers.

      1.  As a condition of transacting business in this State with small employers, a carrier shall actively market to a small employer each health benefit plan which is actively marketed in this State by the carrier to any small employer in this State. A carrier shall be deemed to be actively marketing a health benefit plan when it makes available any of its plans to a small employer that is not currently receiving coverage under a health benefit plan issued by that carrier.

      2.  A carrier shall issue to a small employer any health benefit plan marketed in accordance with this section if the eligible small employer applies for the plan and agrees to make the required premium payments and satisfy the other reasonable provisions of the health benefit plan that are not inconsistent with NRS 689C.015 to 689C.355, inclusive, and 689C.610 to 689C.940, inclusive, except that a carrier is not required to issue a health benefit plan to a self-employed person who is covered by, or is eligible for coverage under, a health benefit plan offered by another employer.

      3.  If a health benefit plan marketed pursuant to this section provides, delivers, arranges for, pays for or reimburses any cost of health care services through managed care, the carrier shall provide a system for resolving any complaints of an employee concerning those health care services that complies with the provisions of NRS 695G.200 to 695G.310, inclusive.

      (Added to NRS by 1997, 2920; A 2003, 775; 2011, 3384; 2013, 3626)

      NRS 689C.1565  Coverage to small employers not required under certain circumstances; notice 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 pursuant to NRS 689C.156:

      (a) During any period in which the Commissioner determines that requiring the carrier to provide such coverage would place the carrier in a financially impaired condition.

      (b) If the carrier elects not to offer any new coverage to any small employers in this State. A carrier that elects not to offer new coverage in accordance with this paragraph may maintain its existing policies issued to small employers in this State, subject to the requirements of NRS 689C.310 and 689C.320.

      2.  A carrier that elects not to offer new coverage pursuant to paragraph (b) of subsection 1 shall notify the Commissioner forthwith of that election and shall not thereafter write any new business to small employers in this State for 5 years after the date of the notification.

      (Added to NRS by 1997, 2920)

      NRS 689C.157  Requirement to file basic and standard health benefit plans with Commissioner; disapproval of plan.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.158  Producer may only sign up small employers and eligible employees in bona fide associations if employers and employees are actively engaged in or related to bona fide association.  For the purposes of providing coverage under a health benefit plan pursuant to the provisions of this chapter, a producer may only market association memberships to small employers and eligible employees, accept applications for such membership or sign up such members in a bona fide association if the small employers and eligible employees being marketed are actively engaged in, or directly related to, the bona fide association.

      (Added to NRS by 1997, 2919)

      NRS 689C.159  Certain provisions inapplicable to plan that carrier makes available only through bona fide association.  The provisions of NRS 689C.156 and 689C.190 do not apply to health benefit plans offered by a carrier if the carrier makes the health benefit plan available in the small employer market only through a bona fide association.

      (Added to NRS by 1997, 2921; A 2013, 3627)

      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 participation of eligible employees and minimum employer’s contributions, must be applied uniformly among all small employers with the same number of eligible employees applying for coverage or receiving coverage from the carrier.

      (Added to NRS by 1995, 980; A 2013, 3627)

      NRS 689C.165  Carrier prohibited from modifying plan to restrict or exclude coverage for certain services.  Except as otherwise provided in NRS 689C.170 and 689C.180, a carrier shall not modify a health benefit plan with respect to a small employer or any eligible employee or dependent of an eligible employee, through riders or endorsements, or otherwise, to restrict or exclude coverage or benefits for specific diseases, medical conditions or services otherwise covered by the plan.

      (Added to NRS by 1997, 2921)

      NRS 689C.1655  Coverage for autism spectrum disorders.

      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 health benefit plan under the age of 18 or, if enrolled in high school, until the person reaches the age of 22.

      2.  Coverage provided under this section is subject to:

      (a) A maximum benefit of $36,000 per year for applied behavior analysis treatment; and

      (b) Copayment, deductible and coinsurance provisions and any other general exclusion or limitation of a health benefit plan to the same extent as other medical services or prescription drugs covered by the plan.

      3.  A health benefit plan that offers or issues a policy of group health insurance which provides coverage for outpatient care shall not:

      (a) Require an insured to pay a higher deductible, copayment or coinsurance or require a longer waiting period for coverage for outpatient care related to autism spectrum disorders than is required for other outpatient care covered by the plan; or

      (b) Refuse to issue a health benefit plan or cancel a health benefit plan solely because the person applying for or covered by the plan uses or may use in the future any of the services listed in subsection 1.

      4.  Except as provided in subsections 1 and 2, a carrier shall not limit the number of visits an insured may make to any person, entity or group for treatment of autism spectrum disorders.

      5.  Treatment of autism spectrum disorders must be identified in a treatment plan and may include medically necessary habilitative or rehabilitative care, prescription care, psychiatric care, psychological care, behavior therapy or therapeutic care that is:

      (a) Prescribed for a person diagnosed with an autism spectrum disorder by a licensed physician or licensed psychologist; and

      (b) Provided for a person diagnosed with an autism spectrum disorder by a licensed physician, licensed psychologist, licensed behavior analyst or other provider that is supervised by the licensed physician, psychologist or behavior analyst.

Ê A carrier may request a copy of and review a treatment plan created pursuant to this subsection.

      6.  A health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2011, has the legal effect of including the coverage required by subsection 1, and any provision of the plan or the renewal which is in conflict with subsection 1 or 2 is void.

      7.  Nothing in this section shall be construed as requiring a carrier to provide reimbursement to an early intervention agency or school for services delivered through early intervention or school services.

      8.  As used in this section:

      (a) “Applied behavior analysis” means the design, implementation and evaluation of environmental modifications using behavioral stimuli and consequences to produce socially significant improvement in human behavior, including, without limitation, the use of direct observation, measurement and functional analysis of the relations between environment and behavior.

      (b) “Autism spectrum disorders” means a neurobiological medical condition including, without limitation, autistic disorder, Asperger’s Disorder and Pervasive Developmental Disorder Not Otherwise Specified.

      (c) “Behavioral therapy” means any interactive therapy derived from evidence-based research, including, without limitation, discrete trial training, early intensive behavioral intervention, intensive intervention programs, pivotal response training and verbal behavior provided by a licensed psychologist, licensed behavior analyst, licensed assistant behavior analyst or certified autism behavior interventionist.

      (d) “Certified autism behavior interventionist” means a person who is certified as an autism behavior interventionist by the Board of Psychological Examiners and who provides behavior therapy under the supervision of:

             (1) A licensed psychologist;

             (2) A licensed behavior analyst; or

             (3) A licensed assistant behavior analyst.

      (e) “Evidence-based research” means research that applies rigorous, systematic and objective procedures to obtain valid knowledge relevant to autism spectrum disorders.

      (f) “Habilitative or rehabilitative care” means counseling, guidance and professional services and treatment programs, including, without limitation, applied behavior analysis, that are necessary to develop, maintain and restore, to the maximum extent practicable, the functioning of a person.

      (g) “Licensed assistant behavior analyst” means a person who holds current certification or meets the standards to be certified as a board certified assistant behavior analyst issued by the Behavior Analyst Certification Board, Inc., or any successor in interest to that organization, who is licensed as an assistant behavior analyst by the Board of Psychological Examiners and who provides behavioral therapy under the supervision of a licensed behavior analyst or psychologist.

      (h) “Licensed behavior analyst” means a person who holds current certification or meets the standards to be certified as a board certified behavior analyst or a board certified assistant behavior analyst issued by the Behavior Analyst Certification Board, Inc., or any successor in interest to that organization and who is licensed as a behavior analyst by the Board of Psychological Examiners.

      (i) “Prescription care” means medications prescribed by a licensed physician and any health-related services deemed medically necessary to determine the need or effectiveness of the medications.

      (j) “Psychiatric care” means direct or consultative services provided by a psychiatrist licensed in the state in which the psychiatrist practices.

      (k) “Psychological care” means direct or consultative services provided by a psychologist licensed in the state in which the psychologist practices.

      (l) “Screening for autism spectrum disorders” means medically necessary assessments, evaluations or tests to screen and diagnose whether a person has an autism spectrum disorder.

      (m) “Therapeutic care” means services provided by licensed or certified speech pathologists, occupational therapists and physical therapists.

      (n) “Treatment plan” means a plan to treat an autism spectrum disorder that is prescribed by a licensed physician or licensed psychologist and may be developed pursuant to a comprehensive evaluation in coordination with a licensed behavior analyst.

      (Added to NRS by 2009, 1469)

      NRS 689C.166  Coverage for abuse of alcohol or drugs: Required.  Each group health insurance policy must contain in substance a provision for benefits payable for expenses incurred for the treatment of abuse of alcohol or drugs, as provided in NRS 689C.167.

      (Added to NRS by 2009, 1811)

      NRS 689C.167  Coverage for abuse of alcohol or drugs: Benefits.

      1.  The benefits provided by a group policy for health insurance, as required by NRS 689C.166, for the treatment of abuse of alcohol or drugs must consist of:

      (a) Treatment for withdrawal from the physiological effects of alcohol or drugs, with a minimum benefit of $1,500 per calendar year.

      (b) Treatment for a patient admitted to a facility, with a minimum benefit of $9,000 per calendar year.

      (c) Counseling for a person, group or family who is not admitted to a facility, with a minimum benefit of $2,500 per calendar year.

      2.  These benefits must be paid in the same manner as benefits for any other illness covered by a similar policy are paid.

      3.  The insured person is entitled to these benefits if treatment is received in any:

      (a) Facility for the treatment of abuse of alcohol or drugs which is certified by the Division of Public and Behavioral Health of the Department of Health and Human Services.

      (b) Hospital or other medical facility or facility for the dependent which is licensed by the Division of Public and Behavioral Health of the Department of Health and Human Services, is accredited by the Joint Commission on Accreditation of Healthcare Organizations and provides a program for the treatment of abuse of alcohol or drugs as part of its accredited activities.

      (Added to NRS by 2009, 1812)

      NRS 689C.168  Coverage for prescription drug previously approved for medical condition of insured.

      1.  Except as otherwise provided in this section, a health benefit plan which provides coverage for prescription drugs must not limit or exclude coverage for a drug if the drug:

      (a) Had previously been approved for coverage by the carrier for a medical condition of an insured and the insured’s provider of health care determines, after conducting a reasonable investigation, that none of the drugs which are otherwise currently approved for coverage are medically appropriate for the insured; and

      (b) Is appropriately prescribed and considered safe and effective for treating the medical condition of the insured.

      2.  The provisions of subsection 1 do not:

      (a) Apply to coverage for any drug that is prescribed for a use that is different from the use for which that drug has been approved for marketing by the Food and Drug Administration;

      (b) Prohibit:

             (1) The carrier from charging a deductible, copayment or coinsurance for the provision of benefits for prescription drugs to the insured or from establishing, by contract, limitations on the maximum coverage for prescription drugs;

             (2) A provider of health care from prescribing another drug covered by the plan that is medically appropriate for the insured; or

             (3) The substitution of another drug pursuant to NRS 639.23286 or 639.2583 to 639.2597, inclusive; or

      (c) Require any coverage for a drug after the term of the plan.

      3.  Any provision of a health benefit plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2001, which is in conflict with this section is void.

      (Added to NRS by 2001, 859; A 2003, 2299)

      NRS 689C.169  Coverage for severe mental illness.

      1.  A policy of group health insurance delivered or issued for delivery in this State pursuant to this chapter must provide coverage for the treatment of conditions relating to severe mental illness.

      2.  As used in this section, “severe mental illness” means any of the following mental illnesses that are biologically based and for which diagnostic criteria are prescribed in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association:

      (a) Schizophrenia.

      (b) Schizoaffective disorder.

      (c) Bipolar disorder.

      (d) Major depressive disorders.

      (e) Panic disorder.

      (f) Obsessive-compulsive disorder.

      (Added to NRS by 2009, 1811; A 2013, 3627)

      NRS 689C.170  Authorized variation of minimum participation and contributions; denial of coverage based on industry prohibited.

      1.  A carrier serving small employers may vary the application of requirements for minimum participation of eligible employees and minimum employer’s contributions only by the size of the small employer’s group or the product offered.

      2.  In applying requirements for minimum participation with respect to a small employer, a carrier shall not consider employees or dependents who have creditable coverage when determining whether the applicable percentage of participation is met, but may consider employees or dependents who have coverage under another health benefit plan that is sponsored by the employer.

      3.  A carrier shall not deny an application for coverage solely because the applicant works in a certain industry.

      4.  After a small employer has been accepted for coverage, a carrier shall not increase any requirement for minimum employee participation or modify any requirement for minimum employer contribution applicable to the small employer.

      (Added to NRS by 1995, 980; A 1997, 2942; 2007, 3327)

      NRS 689C.180  Carrier to offer same coverage to all eligible employees; denial of coverage to otherwise eligible employee.

      1.  If a carrier serving small employers offers coverage to a small employer, the carrier shall offer the same coverage to all of the eligible employees of the small employer and their dependents. A carrier shall not offer coverage to only certain members of a small employer’s group or to only part of the group, but may exclude an otherwise eligible employee, or a dependent of the eligible employee, who requests enrollment in a health benefit plan after the end of the initial period during which the employee or dependent is entitled to enroll under the terms of the plan, if the initial period is at least 30 days.

      2.  A carrier shall not exclude an eligible employee or dependent if:

      (a) The employee or dependent:

             (1) Was covered under other creditable coverage at the time of the initial period for enrollment;

             (2) Lost coverage under the other creditable coverage as a result of termination of employment or eligibility, the involuntary termination of the creditable coverage, the death of a spouse or divorce; and

             (3) Requests enrollment within 30 days after termination of the other creditable coverage;

      (b) The employee is employed by an employer that offers multiple health benefit plans and elects a different plan during an open period for enrollment; or

      (c) A court has ordered that coverage be provided for a dependent under a covered employee’s health benefit plan and the request for enrollment is made within 30 days after issuance of the court order.

      (Added to NRS by 1995, 981; A 1997, 2942)

      NRS 689C.183  Plan and carrier required to permit employee or dependent of employee to enroll for coverage under certain circumstances.  A health benefit plan and a carrier offering such a plan shall permit an employee or a dependent of an employee covered by the health benefit plan who is eligible, but not enrolled, for coverage in connection with the health benefit plan to enroll for coverage under the terms of the health benefit plan if:

      1.  The employee or dependent was covered under a different health benefit plan or had other health insurance coverage at the time coverage was previously offered to the employee or dependent;

      2.  The employee stated in writing at that time that the other coverage was the reason for declining enrollment, but only if the plan sponsor or carrier required such a written statement and informed the employee of that requirement and the consequences of the requirement; and

      3.  The employee or dependent:

      (a) Was covered under any provision of the Consolidated Omnibus Budget Reconciliation Act of 1985 relating to the continuation of coverage and such continuation of coverage was exhausted; or

      (b) Was not covered under such a provision and his or her insurance coverage was lost as a result of cessation of contributions by his or her employer, termination of employment or eligibility, reduction in the number of hours of employment, or the death of, or divorce or legal separation from, a covered spouse.

      (Added to NRS by 1997, 2921)

      NRS 689C.187  Manner and period for enrolling dependent of covered employee; period of special enrollment.

      1.  A health benefit plan and a carrier of such a plan that makes coverage available to the dependent of a covered employee shall permit the employee to enroll a dependent after the close of a period of open enrollment if:

      (a) The employee is a participant in the health benefit plan, or has met any waiting period applicable to becoming a participant and is eligible to be enrolled under the plan, except for a failure to enroll during a previous period of open enrollment; and

      (b) The person to be enrolled became a dependent of the employee through marriage, birth, adoption or placement for adoption.

      2.  The health benefit plan or carrier shall provide a period of special enrollment for the enrollment of a dependent of an employee pursuant to this section. Such a period must be not less than 30 days and must begin on:

      (a) The date specified by the health benefit plan or carrier for the period of special enrollment; or

      (b) The date of the marriage, birth, adoption or placement for adoption, as appropriate.

      3.  If an employee seeks to enroll a dependent during the first 30 days of the period for special enrollment provided pursuant to subsection 2, the coverage of the dependent becomes effective:

      (a) In the case of a marriage, not later than the first day of the first month beginning after the date on which the completed request for enrollment is received;

      (b) In the case of a birth, on the date of the birth; and

      (c) In the case of an adoption or placement for adoption, on the date of the adoption or the placement for adoption.

      4.  In the case of a birth, an adoption or a placement for adoption of a child of an employee, the spouse of the employee may be enrolled as a dependent pursuant to this section if the spouse is otherwise eligible for coverage under the health benefit plan.

      (Added to NRS by 1997, 2922)

      NRS 689C.190  Coverage of preexisting conditions.  A carrier serving small employers that issues a health benefit plan shall not deny, exclude or limit a benefit for a preexisting condition.

      (Added to NRS by 1995, 981; A 1997, 2943; 2013, 3628)

      NRS 689C.191  Determination of applicable creditable coverage of person; determining period of creditable coverage of person; required statement; applicability.

      1.  In determining the applicable creditable coverage of a person, a period of creditable coverage must not be included if, after the expiration of that period but before the enrollment date, there was a 63-day period during all of which the person was not covered under any creditable coverage. To establish a period of creditable coverage, an eligible employee must present any certificates of coverage provided to the eligible employee in accordance with NRS 689C.192 and such other evidence of coverage as required by regulations adopted by the Commissioner. For the purposes of this subsection, any waiting period for coverage or an affiliation period must not be considered in determining the applicable period of creditable coverage.

      2.  In determining the period of creditable coverage of a person, a carrier shall include each applicable period of creditable coverage without regard to the specific benefits covered during that period, except that the carrier may elect to include applicable periods of creditable coverage based on coverage of specific benefits as specified by the United States Department of Health and Human Services by regulation, if such an election is made on a uniform basis for all participants and beneficiaries of the health benefit plan or coverage. Pursuant to such an election, the carrier shall include each applicable period of creditable coverage with respect to any class or category of benefits if any level of benefits is covered within that class or category, as specified by those regulations.

      3.  Regardless of whether coverage is actually provided, if a carrier elects in accordance with subsection 2 to determine creditable coverage based on specified benefits, a statement that such an election has been made and a description of the effect of the election must be:

      (a) Included prominently in any disclosure statement concerning the health benefit plan; and

      (b) Provided to each eligible employee at the time of enrollment in the health benefit plan.

      4.  The provisions of this section apply only to grandfathered plans.

      (Added to NRS by 1997, 2926; A 2013, 3630)

      NRS 689C.192  Written certification of coverage required for purpose of determining period of creditable coverage accumulated by person.

      1.  For the purposes of determining the period of creditable coverage of a person accumulated under a health benefit plan or group health insurance, the insurer shall provide written certification of coverage on a form prescribed by the Commissioner to the person which certifies the length of:

      (a) The period of creditable coverage that the person accumulated under the plan and any coverage under any provision of the Consolidated Omnibus Budget Reconciliation Act of 1985, as that act existed on July 16, 1997, relating to the continuation of coverage; and

      (b) Any waiting and affiliation period imposed on the person pursuant to that coverage.

      2.  The certification of coverage must be provided to the person who was insured:

      (a) At the time that the person ceases to be covered under the plan, if the person does not otherwise become covered under any provision of the Consolidated Omnibus Budget Reconciliation Act of 1985, as that act existed on July 16, 1997, relating to the continuation of coverage;

      (b) If the person becomes covered under such a provision, at the time that the person ceases to be covered by that provision; and

      (c) Upon request, if the request is made not later than 24 months after the date on which the person ceased to be covered as described in paragraphs (a) and (b).

      (Added to NRS by 1997, 2927)

      NRS 689C.193  Carrier prohibited from imposing restriction on participation inconsistent with certain sections; restrictions on rules of eligibility that may be established; premiums to be equitable.

      1.  A carrier shall not place any restriction on a small employer or an eligible employee or a dependent of the eligible employee as a condition of being a participant in or a beneficiary of a health benefit plan that is inconsistent with NRS 689C.015 to 689C.355, inclusive.

      2.  A carrier that offers health insurance coverage to small employers pursuant to this chapter shall not establish rules of eligibility, including, but not limited to, rules which define applicable waiting periods, for the initial or continued enrollment under a health benefit plan offered by the carrier that are based on the following factors relating to the eligible employee or a dependent of the eligible employee:

      (a) Health status.

      (b) Medical condition, including physical and mental illnesses, or both.

      (c) Claims experience.

      (d) Receipt of health care.

      (e) Medical history.

      (f) Genetic information.

      (g) Evidence of insurability, including conditions which arise out of acts of domestic violence.

      (h) Disability.

      3.  Except as otherwise provided in NRS 689C.190, the provisions of subsection 1 do not require a carrier to provide particular benefits other than those that would otherwise be provided under the terms of the health benefit plan or coverage.

      4.  As a condition of enrollment or continued enrollment under a health benefit plan, a carrier shall not require any person to pay a premium or contribution that is greater than the premium or contribution for a similarly situated person covered by similar coverage on the basis of any factor described in subsection 2 in relation to the person or a dependent of the person.

      5.  Nothing in this section:

      (a) Restricts the amount that a small employer may be charged for coverage by a carrier;

      (b) Prevents a carrier from establishing premium discounts or rebates or from modifying otherwise applicable copayments or deductibles in return for adherence by the insured person to programs of health promotion and disease prevention; or

      (c) Precludes a carrier from establishing rules relating to employer contribution or group participation when offering health insurance coverage to small employers in this State.

      6.  As used in this section:

      (a) “Contribution” means the minimum employer contribution toward the premium for enrollment of participants and beneficiaries in a health benefit plan.

      (b) “Group participation” means the minimum number of participants or beneficiaries that must be enrolled in a health benefit plan in relation to a specified percentage or number of eligible persons or employees of the employer.

      (Added to NRS by 1997, 2925; A 2013, 3630)

      NRS 689C.194  Plan that includes coverage for maternity and pediatric care: Required to allow minimum stay in hospital in connection with childbirth; prohibited acts.

      1.  Except as otherwise provided in this subsection, a health benefit plan issued pursuant to this chapter that includes coverage for maternity care and pediatric care for newborn infants may not restrict benefits for any length of stay in a hospital in connection with childbirth for a mother or newborn infant covered by the plan to:

      (a) Less than 48 hours after a normal vaginal delivery; and

      (b) Less than 96 hours after a cesarean section.

Ê If a different length of stay is provided in the guidelines established by the American College of Obstetricians and Gynecologists, or its successor organization, and the American Academy of Pediatrics, or its successor organization, the health benefit plan may follow such guidelines in lieu of following the length of stay set forth above. The provisions of this subsection do not apply to any health benefit plan in any case in which the decision to discharge the mother or newborn infant before the expiration of the minimum length of stay set forth in this subsection is made by the attending physician of the mother or newborn infant.

      2.  Nothing in this section requires a mother to:

      (a) Deliver her baby in a hospital; or

      (b) Stay in a hospital for a fixed period following the birth of her child.

      3.  A health benefit plan that offers coverage for maternity care and pediatric care of newborn infants may not:

      (a) Deny a mother or her newborn infant coverage or continued coverage under the terms of the plan if the sole purpose of the denial of coverage or continued coverage is to avoid the requirements of this section;

      (b) Provide monetary payments or rebates to a mother to encourage her to accept less than the minimum protection available pursuant to this section;

      (c) Penalize, or otherwise reduce or limit, the reimbursement of an attending provider of health care because the attending provider of health care provided care to a mother or newborn infant in accordance with the provisions of this section;

      (d) Provide incentives of any kind to an attending physician to induce the attending physician to provide care to a mother or newborn infant in a manner that is inconsistent with the provisions of this section; or

      (e) Except as otherwise provided in subsection 4, restrict benefits for any portion of a hospital stay required pursuant to the provisions of this section in a manner that is less favorable than the benefits provided for any preceding portion of that stay.

      4.  Nothing in this section:

      (a) Prohibits a health benefit plan or carrier from imposing a deductible, coinsurance or other mechanism for sharing costs relating to benefits for hospital stays in connection with childbirth for a mother or newborn child covered by the plan, except that such coinsurance or other mechanism for sharing costs for any portion of a hospital stay required by this section may not be greater than the coinsurance or other mechanism for any preceding portion of that stay.

      (b) Prohibits an arrangement for payment between a health benefit plan or carrier and a provider of health care that uses capitation or other financial incentives, if the arrangement is designed to provide services efficiently and consistently in the best interest of the mother and her newborn infant.

      (c) Prevents a health benefit plan or carrier from negotiating with a provider of health care concerning the level and type of reimbursement to be provided in accordance with this section.

      (Added to NRS by 1997, 2924)

      NRS 689C.196  Insurer prohibited from denying coverage solely because person was victim of domestic violence.  An insurer shall not deny a claim, refuse to issue a health benefit plan or cancel a health benefit plan solely because the claim involves an act that constitutes domestic violence pursuant to NRS 33.018, or because the person applying for or covered by the health benefit plan was the victim of such an act of domestic violence, regardless of whether the insured or applicant contributed to any loss or injury.

      (Added to NRS by 1997, 1096)

      NRS 689C.197  Carrier prohibited from denying coverage because insured was intoxicated or under influence of controlled substance; exceptions.

      1.  Except as otherwise provided in subsection 2, a carrier shall not:

      (a) Deny a claim under a health benefit plan solely because the claim involves an injury sustained by an insured as a consequence of being intoxicated or under the influence of a controlled substance.

      (b) Cancel participation under a health benefit plan solely because an insured has made a claim involving an injury sustained by the insured as a consequence of being intoxicated or under the influence of a controlled substance.

      (c) Refuse participation under a health benefit plan to an eligible applicant solely because the applicant has made a claim involving an injury sustained by the applicant as a consequence of being intoxicated or under the influence of a controlled substance.

      2.  The provisions of subsection 1 do not prohibit a carrier from enforcing a provision included in a health benefit plan to:

      (a) Deny a claim which involves an injury to which a contributing cause was the insured’s commission of or attempt to commit a felony;

      (b) Cancel participation in a health benefit plan solely because of such a claim; or

      (c) Refuse participation in a health benefit plan to an eligible applicant solely because of such a claim.

      3.  The provisions of this section do not apply to a carrier under a health benefit plan that provides coverage for long-term care or disability income.

      (Added to NRS by 2005, 2344; A 2007, 85)

      NRS 689C.198  Insurer prohibited from requiring or using information concerning genetic testing; exceptions.

      1.  Except as otherwise provided in subsection 2, a carrier serving small employers shall not:

      (a) Require an insured person or any member of the family of the insured person to take a genetic test;

      (b) Require an insured person to disclose whether the insured person or any member of the family of the insured person has taken a genetic test or any genetic information of the insured person or a member of the family of the insured person; or

      (c) Determine the rates or any other aspect of the coverage or benefits for health care provided to an insured person based on:

             (1) Whether the insured person or any member of the family of the insured person has taken a genetic test; or

             (2) Any genetic information of the insured person or any member of the family of the insured person.

      2.  The provisions of this section do not apply to a carrier serving small employers who issues a policy of health insurance that provides coverage for long-term care or disability income.

      3.  As used in this section:

      (a) “Genetic information” means any information that is obtained from a genetic test.

      (b) “Genetic test” means a test, including a laboratory test that uses deoxyribonucleic acid extracted from the cells of a person or a diagnostic test, to determine the presence of abnormalities or deficiencies, including carrier status, that:

             (1) Are linked to physical or mental disorders or impairments; or

             (2) Indicate a susceptibility to illness, disease, impairment or any other disorder, whether physical or mental.

      (Added to NRS by 1997, 1460)

      NRS 689C.200  When carrier is not required to offer coverage.  A carrier serving small employers is not required to accept applications from or offer coverage to:

      1.  A small employer if the employer is not physically located in the carrier’s geographic service area; or

      2.  An employee if the employee does not work or reside within the carrier’s geographic service area.

      (Added to NRS by 1995, 982; A 1997, 2946; 2013, 3631)

      NRS 689C.203  Denial of application for coverage from small employer; regulations.

      1.  A denial by a carrier of an application for coverage from a small employer must be in writing and must state the reason for the denial.

      2.  The Commissioner may adopt regulations that set forth standards to provide for the fair marketing and broad availability of health benefit plans to small employers in this state.

      (Added to NRS by 1997, 2924)

      NRS 689C.207  Regulations concerning reissuance of health benefit plan.  The Commissioner may adopt regulations to require a carrier, as a condition of transacting insurance with small employers in this state after July 16, 1997, to reissue a health benefit plan to any small employer whose health benefit plan has been terminated or not renewed by the carrier after July 1, 1997. The Commissioner may prescribe such terms for the reissue of coverage as the Commissioner finds are reasonable and necessary to provide continuity of coverage to small employers.

      (Added to NRS by 1997, 2924)

      NRS 689C.210  Procedure for increasing premium rates.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.220  Adjustment in rates to be applied uniformly.  A carrier serving small employers shall not charge adjustments in rates for claim experience, health status and duration of coverage to individual employees or dependents. Any such adjustment must be applied uniformly to the rates charged for all employees and dependents of a small employer.

      (Added to NRS by 1995, 984)

      NRS 689C.230  Determination and application of index rate.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.240  Use of industry classifications as rating factor.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.250  Information considered to be trade secret; exception.

      1.  Except in cases of violations of NRS 689C.015 to 689C.355, inclusive, the unified rate review template and rate filing documentation used by carriers servicing small employers are considered proprietary, constitute a trade secret, and are not subject to disclosure by the Commissioner to persons outside of the Division except as agreed to by the carrier or as ordered by a court of competent jurisdiction.

      2.  As used in this section, “rate filing documentation” and “unified rate review template” have the meanings ascribed to them in 45 C.F.R. § 154.215.

      (Added to NRS by 1995, 984; A 2013, 3631)

      NRS 689C.260  Manner in which carrier may establish separate class of business; transferring small employer into or out of class of business.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.265  Carrier authorized to modify coverage for insurance product under certain circumstances.  A carrier may modify the health insurance coverage for a product offered to small employers pursuant to a group health plan if, for coverage that is available in that market other than through one or more bona fide associations, the modification is consistent with the provisions of this title and is effective on a uniform basis among such group health plans.

      (Added to NRS by 1997, 2927)

      NRS 689C.270  Regulations concerning disclosures by carrier to small employer; copy of disclosure to be made available to small employer.

      1.  The Commissioner shall adopt regulations which require a carrier to file with the Commissioner, for approval by the Commissioner, a disclosure offered by the carrier to a small employer. The disclosure must include:

      (a) Any significant exception, reduction or limitation that applies to the policy;

      (b) Any restrictions on payments for emergency care, including, without limitation, related definitions of an emergency and medical necessity;

      (c) The provision of the health benefit plan concerning the carrier’s right to change premium rates and the characteristics, other than claim experience, that affect changes in premium rates;

      (d) The provisions relating to renewability of policies and contracts;

      (e) The provisions relating to any preexisting condition; and

      (f) Any other information that the Commissioner finds necessary to provide for full and fair disclosure of the provisions of a policy or contract of insurance issued pursuant to this chapter.

      2.  The disclosure must be written in language which is easily understood and must include a statement that the disclosure is a summary of the policy only, and that the policy itself should be read to determine the governing contractual provisions.

      3.  The Commissioner shall not approve any proposed disclosure submitted to the Commissioner pursuant to this section which does not comply with the requirements of this section and the applicable regulations.

      4.  The carrier shall make available to a small employer or a producer acting on behalf of a small employer, upon request, a copy of the disclosure approved by the Commissioner pursuant to this section for policies of health insurance for which that employer may be eligible.

      (Added to NRS by 1995, 985; A 1997, 2947; 1999, 2814)

      NRS 689C.280  Carrier to provide required disclosures to small employer before issuing policy of insurance.  A carrier shall provide to a small employer to whom it has offered a health benefit plan a copy of the disclosure approved for that plan pursuant to NRS 689C.270 before any policy or contract of insurance under a health benefit plan is issued. A carrier shall not offer a health benefit plan to a small employer unless the disclosure for the plan has been approved by the Commissioner.

      (Added to NRS by 1995, 985)

      NRS 689C.281  Coverage for prescription drugs: Provision of notice and information regarding use of formulary.

      1.  A carrier that offers or issues a health benefit plan which provides coverage for prescription drugs shall include with any summary, certificate or evidence of that coverage provided to an insured, notice of whether a formulary is used and, if so, of the opportunity to secure information regarding the formulary from the carrier pursuant to subsection 2. The notice required by this subsection must:

      (a) Be in a language that is easily understood and in a format that is easy to understand;

      (b) Include an explanation of what a formulary is; and

      (c) If a formulary is used, include:

             (1) An explanation of:

                   (I) How often the contents of the formulary are reviewed; and

                   (II) The procedure and criteria for determining which prescription drugs are included in and excluded from the formulary; and

             (2) The telephone number of the carrier for making a request for information regarding the formulary pursuant to subsection 2.

      2.  If a carrier offers or issues a health benefit plan which provides coverage for prescription drugs and a formulary is used, the carrier shall:

      (a) Provide to any insured or participating provider of health care, upon request:

             (1) Information regarding whether a specific drug is included in the formulary.

             (2) Access to the most current list of prescription drugs in the formulary, organized by major therapeutic category, with an indication of whether any listed drugs are preferred over other listed drugs. If more than one formulary is maintained, the carrier shall notify the requester that a choice of formulary lists is available.

      (b) Notify each person who requests information regarding the formulary, that the inclusion of a drug in the formulary does not guarantee that a provider of health care will prescribe that drug for a particular medical condition.

      (Added to NRS by 2001, 858)

      NRS 689C.283  Election to operate as risk-assuming carrier or reinsuring carrier: Notice to Commissioner; effective date; change in status.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.287  Election to act as risk-assuming carrier: Suspension by Commissioner; applicable statutes.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.290  Commissioner authorized to suspend restriction on increase of premiums for new rating period based on new business for policy.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.300  Carrier to file actuarial certification annually with Commissioner.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.310  Renewal of health benefit plan; discontinuing issuance and renewal of coverage, plan or form of product of health benefit plan.

      1.  Except as otherwise provided in subsections 2 and 3, a carrier shall renew a health benefit plan at the option of the small employer who purchased the plan.

      2.  A carrier may refuse to issue or to renew a health benefit plan if:

      (a) The carrier discontinues transacting insurance in this state or in the geographic service area of this state where the employer is located;

      (b) The employer fails to pay the premiums or contributions required by the terms of the plan;

      (c) The employer misrepresents any information regarding the employees covered under the plan or other information regarding eligibility for coverage under the plan;

      (d) The plan sponsor has engaged in an act or practice that constitutes fraud to obtain or maintain coverage under the plan;

      (e) The employer is not in compliance with the minimum requirements for participation or employer contribution as set forth in the plan; or

      (f) The employer fails to comply with any of the provisions of this chapter.

      3.  A carrier may require a small employer to exclude a particular employee or a dependent of the particular employee from coverage under a health benefit plan as a condition to renewal of the plan if the employee or dependent of the employee commits fraud upon the carrier or misrepresents a material fact which affects his or her coverage under the plan.

      4.  A carrier shall discontinue the issuance and renewal of coverage to a small employer if the Commissioner finds that the continuation of the coverage would not be in the best interests of the policyholders or certificate holders of the carrier in this state or would impair the ability of the carrier to meet its contractual obligations. If the Commissioner makes such a finding, the Commissioner shall assist the affected small employers in finding replacement coverage.

      5.  A carrier may discontinue the issuance and renewal of a form of a product of a health benefit plan offered to small employers pursuant to this chapter if the Commissioner finds that the form of the product offered by the carrier is obsolete and is being replaced with comparable coverage. A form of a product of a health benefit plan may be discontinued by a carrier pursuant to this subsection only if:

      (a) The carrier notifies the Commissioner and the chief regulatory officer for insurance in each state in which it is licensed of its decision pursuant to this subsection to discontinue the issuance and renewal of the form of the product at least 60 days before the carrier notifies the affected small employers pursuant to paragraph (b).

      (b) The carrier notifies each affected small employer and the Commissioner and the chief regulatory officer for insurance in each state in which any affected small employer is located or eligible employee resides of the decision of the carrier to discontinue offering the form of the product. The notice must be made at least 180 days before the date on which the carrier will discontinue offering the form of the product.

      (c) The carrier offers to each affected small employer the option to purchase any other health benefit plan currently offered by the carrier to small employers in this state.

      (d) In exercising the option to discontinue the particular form of the product and in offering the option to purchase other coverage pursuant to paragraph (c), the carrier acts uniformly without regard to the claims experience of the affected small employers or any health status-related factor relating to any participant or beneficiary covered by the discontinued product or any new participant or beneficiary who may become eligible for such coverage.

      6.  A carrier may discontinue the issuance and renewal of a health benefit plan offered to a small employer or an eligible employee pursuant to this chapter only through a bona fide association if:

      (a) The membership of the small employer or eligible employee in the association was the basis for the provision of coverage;

      (b) The membership of the small employer or eligible employee in the association ceases; and

      (c) The coverage is terminated pursuant to this subsection uniformly without regard to any health status-related factor relating to the small employer or eligible employee or dependent of the eligible employee.

      7.  If a carrier does business in only one geographic service area of this state, the provisions of this section apply only to the operations of the carrier in that service area.

      (Added to NRS by 1995, 986; A 1997, 2948; 2013, 3632)

      NRS 689C.320  Required notification when carrier discontinues transacting insurance in this State; restrictions on carrier that discontinues transacting insurance.

      1.  A carrier that discontinues transacting insurance in this State or in a particular geographic service area of this State shall:

      (a) Notify the Commissioner and the chief regulatory officer for insurance in each state in which the carrier is licensed to transact insurance at least 60 days before a notice of cancellation or nonrenewal is delivered or mailed to the affected small employers pursuant to paragraph (b).

      (b) Notify the Commissioner and each small employer affected not less than 180 days before the expiration of any policy or contract of insurance under any health benefit plan issued to a small employer pursuant to this chapter.

      2.  A carrier that cancels any health benefit plan because it has discontinued transacting insurance in this State or in a particular geographic service area of this State:

      (a) Shall discontinue the issuance and delivery for issuance of all health benefit plans pursuant to this chapter in this State and not renew coverage under any health benefit plan issued to a small employer; and

      (b) May not issue any health benefit plans pursuant to this chapter in this State or in the particular geographic service area for 5 years after it gives notice to the Commissioner pursuant to paragraph (b) of subsection 1.

      (Added to NRS by 1995, 986; A 1997, 2949; 2013, 3633)

      NRS 689C.325  Coverage offered through network plan not required to be offered to eligible employee who does not reside or work in geographic service area or if carrier lacks capacity to deliver adequate service to additional employers and employees.  A carrier that offers coverage through a network plan is not required to offer coverage to or accept any applications for coverage from the eligible employees of a small employer pursuant to NRS 689C.310 and 689C.320 if:

      1.  The eligible employees do not reside or work in the geographic service area of the network plan.

      2.  For a small employer whose eligible employees reside or work in the geographic service area of the network plan, the carrier demonstrates to the satisfaction of the Commissioner that the carrier does not have the capacity to deliver adequate service to additional small employers and eligible employees because of the existing obligations of the carrier. If a carrier is authorized by the Commissioner not to offer coverage pursuant to this subsection, the carrier shall not thereafter offer coverage to additional small employers and eligible employees within that geographic service area until the carrier demonstrates to the satisfaction of the Commissioner that it has regained the capacity to deliver adequate service to additional small employers and eligible employees within that service area.

      (Added to NRS by 1997, 2921; A 2013, 3633)

      NRS 689C.327  Carrier that offers network plan: Contracts with certain federally qualified health centers.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.330  When insurer is required to allow employee to continue coverage after employee is no longer covered by health benefit plan.

      1.  Any policy or contract of insurance delivered or issued for delivery in this state under a health benefit plan which provides for coverage of benefits under the plan on an expense-incurred basis must contain a provision that the employee is entitled to have issued to him or her by the insurer a policy of health insurance when the employee is no longer covered by the health benefit plan.

      2.  The requirement in subsection 1 only applies to a policy or contract of insurance issued under a health benefit plan if:

      (a) The termination of coverage is not because of termination of the health benefit plan, unless the termination of the health benefit plan resulted from the failure of the employer to remit the required premiums;

      (b) The termination is not because of failure of the employee to remit any required contributions;

      (c) The employee has been continuously insured under any health benefit plan of the employer for at least 3 consecutive months immediately preceding the termination; and

      (d) The employee applies in writing for the converted policy and pays the first premium to the insurer not later than 31 days after the termination.

      (Added to NRS by 1995, 986)

      NRS 689C.340  Required provisions in health benefit plan of employer who employs less than 20 employees related to continuation of coverage.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.342  Notice of election and payment of premium.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.344  Amount of premium for continuation of coverage; change in rates; payment to insurer; termination.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.346  Effect of change in insurer during period of continued coverage.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.348  Continued coverage ceases before end of established period under certain circumstances.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.350  Health benefit plan with preferred providers of health care: Deductible; when service is deemed to be provided by preferred provider.  A health benefit plan which offers a difference of payment between preferred providers of health care and providers of health care who are not preferred:

      1.  Must require that the deductible and payment for coinsurance paid by the insured to a preferred provider of health care be applied to the negotiated reduced rates of that provider.

      2.  Must include for providers of health care who are not preferred a provision establishing the point at which an insured’s payment for coinsurance is no longer required to be paid if such a provision is included for preferred providers of health care. Such provisions must be based on a plan year. The point at which an insured’s payment for coinsurance is no longer required to be paid for providers of health care who are not preferred must not be greater than twice the amount for preferred providers of health care, regardless of the method of payment.

      3.  Must provide that if there is a particular service which a preferred provider of health care does not provide and the provider of health care who is treating the insured requests the service and the insurer determines that the use of the service is necessary for the health of the insured, the service shall be deemed to be provided by the preferred provider of health care.

      (Added to NRS by 1995, 987; A 2013, 3634)

      NRS 689C.355  Prohibited acts of carrier or producer; denial of application for coverage; violation may constitute unfair trade practice; applicability of section.

      1.  Except as otherwise provided in this section, a carrier or a producer shall not, directly or indirectly:

      (a) Encourage or direct a small employer to refrain from filing an application for coverage with the carrier because of the health status, claims experience, industry, occupation or geographic location of the small employer.

      (b) Encourage or direct a small employer to seek coverage from another carrier because of the health status, claims experience, industry, occupation or geographic location of the small employer.

      2.  The provisions of subsection 1 do not apply to information provided to a small employer by a carrier or a producer relating to the geographic service area or a provision for a restricted network of the carrier.

      3.  A carrier shall not, directly or indirectly, enter into any contract, agreement or arrangement with a producer if the contract, agreement or arrangement provides for or results in a variation to the compensation that is paid to a producer for the sale of a health benefit plan because of the health status, claims experience, industry, occupation or geographic location of the small employer at the time that the health benefit plan is issued to or renewed by the small employer.

      4.  A carrier shall not terminate, fail to renew, or limit its contract or agreement of representation with a producer for any reason related to the health status, claims experience, occupation or geographic location of a small employer at the time that the health benefit plan is issued to or renewed by the small employer placed by the producer with the carrier.

      5.  A carrier or producer shall not induce or otherwise encourage a small employer to separate or otherwise exclude an employee or a dependent of the employee from health coverage or benefits provided in connection with the employment of the employee.

      6.  A violation of any provision of this section by a carrier may constitute an unfair trade practice for the purposes of chapter 686A of NRS.

      7.  The provisions of this section apply to a third-party administrator if the third-party administrator enters into a contract, agreement or other arrangement with a carrier to provide administrative, marketing or other services related to the offering of a health benefit plan to small employers in this state.

      8.  Nothing in this section interferes with the right and responsibility of a producer to advise and represent the best interests of a small employer who is seeking health insurance coverage from a small employer carrier.

      (Added to NRS by 1997, 2923; A 2013, 3634)

VOLUNTARY PURCHASING GROUPS

      NRS 689C.360  Definitions.  As used in NRS 689C.360 to 689C.600, inclusive, unless the context otherwise requires, the words and terms defined in NRS 689C.380 to 689C.420, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 1995, 2677; A 1997, 2951)

      NRS 689C.380  “Contract” defined.  “Contract” means a policy or certificate for hospital or medical expenses, a contract for dental, hospital or medical services, or a health care plan of a health maintenance organization available for use by or offered or sold to a small employer. The term does not include coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, automobile medical payment insurance, coverage for a specified disease, hospital confinement indemnity or limited-benefit health insurance.

      (Added to NRS by 1995, 2677)

      NRS 689C.390  “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, 2677; A 2013, 3635)

      NRS 689C.420  “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 Commission pursuant to NRS 689C.510.

      (Added to NRS by 1995, 2677)

      NRS 689C.425  Applicability of other provisions.  A voluntary purchasing group and any contract issued to such a group pursuant to NRS 689C.360 to 689C.600, inclusive, are subject to the provisions of NRS 689C.015 to 689C.355, inclusive, to the extent applicable and not in conflict with the express provisions of NRS 687B.408 and 689C.360 to 689C.600, inclusive.

      (Added to NRS by 1997, 2929; A 2001, 860; 2009, 1812)

      NRS 689C.430  Entities which are authorized to offer contracts to voluntary purchasing groups.  Every insurer, fraternal benefit society, corporation providing hospital or medical services or health maintenance organization, whose policies or activities relating to health insurance are governed by the provisions of chapter 689B, 695A, 695B or 695C of NRS, may offer contracts to voluntary purchasing groups and, if it does so, shall comply with the provisions of NRS 689C.360 to 689C.600, inclusive.

      (Added to NRS by 1995, 2677)

      NRS 689C.435  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; form to obtain information on provider of health care; modification; schedule of fees.

      1.  A carrier serving small employers and a carrier that offers a contract to a voluntary purchasing group shall not charge a provider of health care a fee to include the name of the provider on a list of providers of health care given by the carrier to its insureds.

      2.  A carrier specified in subsection 1 shall not contract with a provider of health care to provide health care to an insured unless the carrier uses the form prescribed by the Commissioner pursuant to NRS 629.095 to obtain any information related to the credentials of the provider of health care.

      3.  A contract between a carrier specified in subsection 1 and a provider of health care may be modified:

      (a) At any time pursuant to a written agreement executed by both parties.

      (b) Except as otherwise provided in this paragraph, by the carrier upon giving to the provider 45 days’ written notice of the modification of the carrier’s schedule of payments, including any changes to the fee schedule applicable to the provider’s practice. If the provider fails to object in writing to the modification within the 45 day period, the modification becomes effective at the end of that period. If the provider objects in writing to the modification within the 45 day period, the modification must not become effective unless agreed to by both parties as described in paragraph (a).

      4.  If a carrier specified in subsection 1 contracts with a provider of health care to provide health care to an insured, the carrier shall:

      (a) If requested by the provider of health care at the time the contract is made, submit to the provider of health care the schedule of payments applicable to the provider of health care; or

      (b) If requested by the provider of health care at any other time, submit to the provider of health care the schedule of payments, including any changes to the fee schedule applicable to the provider’s practice, specified in paragraph (a) within 7 days after receiving the request.

      5.  As used in this section, “provider of health care” means a provider of health care who is licensed pursuant to chapter 630, 631, 632 or 633 of NRS.

      (Added to NRS by 1999, 1648; A 2001, 2731; 2003, 3359; 2011, 2533)

      NRS 689C.440  Regulations regarding required disclosures by carrier.

      1.  The Commissioner shall adopt regulations which require a carrier to file with the Commissioner, for approval by the Commissioner, a disclosure offered by the carrier to a voluntary purchasing group. The disclosure must include:

      (a) Any significant exception, prior authorization, reduction or limitation that applies to a contract;

      (b) Any restrictions on payments for emergency care, including, without limitation, related definitions of an emergency and medical necessity;

      (c) Any provision of a contract concerning the carrier’s right to change premium rates and the characteristics, other than claim experience, that affect changes in premium rates;

      (d) The provisions relating to renewability of contracts;

      (e) The provisions relating to any preexisting condition; and

      (f) Any other information that the Commissioner finds necessary to provide for full and fair disclosure of the provisions of a contract.

      2.  The disclosure must be written in a language which is easily understood and must include a statement that the disclosure is a summary of the contract only, and that the contract itself should be read to determine the governing contractual provisions.

      3.  The Commissioner shall not approve any proposed disclosure submitted to the Commissioner pursuant to this section which does not comply with the requirements of this section and the applicable regulations.

      (Added to NRS by 1995, 2678)

      NRS 689C.450  Carrier to provide disclosure before issuing contract.  A carrier shall provide to a voluntary purchasing group to which it has offered a contract a copy of the disclosure approved for that contract pursuant to NRS 689C.440 before the contract is issued. A carrier shall not offer a contract to a voluntary purchasing group unless the disclosure for the contract has been approved by the Commissioner.

      (Added to NRS by 1995, 2678)

      NRS 689C.455  Coverage for prescription drugs: Provision of notice and information regarding use of formulary.

      1.  A carrier that offers or issues a contract which provides coverage for prescription drugs shall include with any summary, certificate or evidence of that coverage provided to an insured, notice of whether a formulary is used and, if so, of the opportunity to secure information regarding the formulary from the carrier pursuant to subsection 2. The notice required by this subsection must:

      (a) Be in a language that is easily understood and in a format that is easy to understand;

      (b) Include an explanation of what a formulary is; and

      (c) If a formulary is used, include:

             (1) An explanation of:

                   (I) How often the contents of the formulary are reviewed; and

                   (II) The procedure and criteria for determining which prescription drugs are included in and excluded from the formulary; and

             (2) The telephone number of the carrier for making a request for information regarding the formulary pursuant to subsection 2.

      2.  If a carrier offers or issues a contract which provides coverage for prescription drugs and a formulary is used, the carrier shall:

      (a) Provide to any insured or participating provider of health care, upon request:

             (1) Information regarding whether a specific drug is included in the formulary.

             (2) Access to the most current list of prescription drugs in the formulary, organized by major therapeutic category, with an indication of whether any listed drugs are preferred over other listed drugs. If more than one formulary is maintained, the carrier shall notify the requester that a choice of formulary lists is available.

      (b) Notify each person who requests information regarding the formulary, that the inclusion of a drug in the formulary does not guarantee that a provider of health care will prescribe that drug for a particular medical condition.

      (Added to NRS by 2001, 859)

      NRS 689C.460  Carrier to offer same coverage to all eligible employees; denial of coverage to otherwise eligible employee.

      1.  If a carrier offers a contract to a voluntary purchasing group, the carrier shall offer the same coverage to all of the eligible employees of the small employers that are members of the voluntary purchasing group and their dependents. A carrier shall not offer coverage to only certain members of that group or to only part of that group, but may exclude an otherwise eligible employee, or a dependent of the otherwise eligible employee, who requests enrollment in the contract after the end of the initial period during which the employee or dependent is entitled to enroll under the terms of the contract, if the initial period is at least 30 days.

      2.  A carrier shall not exclude an eligible employee or dependent if:

      (a) The employee or dependent:

             (1) Was covered under other creditable coverage at the time of the initial period for enrollment;

             (2) Lost coverage under the other creditable coverage as a result of termination of employment or eligibility, the involuntary termination of the creditable coverage, the death of a spouse or divorce; and

             (3) Requests enrollment within 30 days after termination of the other creditable coverage;

      (b) The employee is employed by an employer that offers multiple contracts and elects a different contract during an open period for enrollment; or

      (c) A court has ordered that coverage be provided for a dependent under a covered employee’s contract and the request for enrollment is made within 30 days after issuance of the court order.

      (Added to NRS by 1995, 2678; A 1997, 2951)

      NRS 689C.470  Renewal of contract; discontinuing issuance and renewal of form of product of health benefit plan or health benefit plan.

      1.  Except as otherwise provided in NRS 689C.360 to 689C.600, inclusive, a carrier shall renew a contract as to all insured small employers that are members of a voluntary purchasing group and their employees and dependents at the request of the purchaser unless:

      (a) Required premiums are not paid;

      (b) The insured employer or other purchaser is guilty of fraud or misrepresentation;

      (c) Provisions of the contract are breached;

      (d) The number or percentage of employees covered under the contract is less than the number or percentage of eligible employees required by the contract;

      (e) The employer or purchaser is no longer engaged in the business in which it was engaged on the effective date of the contract; or

      (f) The Commissioner finds that the continuation of the coverage is not in the best interests of the persons insured under the contract or would impair the carrier’s ability to meet its contractual obligations. If nonrenewal occurs as a result of findings pursuant to this subsection, the Commissioner shall assist affected persons in replacing coverage.

      2.  A carrier may discontinue issuance and renewal of a form of a product of a health benefit plan offered to a small employer or purchasers pursuant to NRS 689C.360 to 689C.600, inclusive, if the Commissioner finds that the form of the product offered by the carrier is obsolete and is being replaced with comparable coverage. A form of a product of a health benefit plan may be discontinued by a carrier pursuant to this subsection only if:

      (a) The carrier notifies the Commissioner and the chief regulatory officer for insurance in each state in which it is licensed of its decision pursuant to this subsection to discontinue offering and renewing the form of the product at least 60 days before the carrier notifies the affected small employers and purchasers pursuant to paragraph (b).

      (b) The carrier notifies each affected small employer and purchaser, and the Commissioner and the chief regulatory officer for insurance in each state in which any affected small employer is located or employee resides, of the decision of the carrier to discontinue offering the form of the product. The notice must be made at least 180 days before the date on which the carrier will discontinue offering the form of the product.

      (c) The carrier offers to each affected small employer and purchaser the option to purchase any other health benefit plan currently offered by the carrier to small employers in this state.

      (d) In exercising the option to discontinue the particular form of the product and in offering the option to purchase other coverage pursuant to paragraph (c), the carrier acts uniformly without regard to the claim experience of the affected small employers and any health status-related factor relating to any participant or beneficiary covered by the discontinued product or any new participant or beneficiary who may become eligible for such coverage.

      3.  A carrier may discontinue the issuance and renewal of a health benefit plan offered to a voluntary purchasing group pursuant to this chapter only through a bona fide association if:

      (a) The membership of the small employer who employs the members of the voluntary purchasing group or the purchaser in the association was the basis for the provision of coverage;

      (b) The membership of that small employer or the purchaser in the association ceases; and

      (c) The coverage is terminated pursuant to this subsection uniformly without regard to any health status-related factor relating to the small employer or the purchaser or his or her dependent.

      (Added to NRS by 1995, 2679; A 1997, 2951)

      NRS 689C.480  Required notification when carrier ceases to renew all contracts; restrictions on carrier that ceases to renew all contracts.

      1.  A carrier may cease to renew all contracts covering voluntary purchasing groups and discontinue issuing and delivering for issuance any such contracts. The carrier shall provide notice:

      (a) At least 60 days before the notice of termination is provided pursuant to paragraph (b), to the Commissioner and the chief regulatory officer for insurance of each state in which the carrier is licensed to transact insurance; and

      (b) At least 180 days before termination of coverage to holders of all affected contracts and to the Commissioner and the chief regulatory officer for insurance in each state in which an affected insured person is known to reside.

      2.  A carrier that exercises its right to cease to renew all contracts covering voluntary purchasing groups shall not transfer or otherwise provide coverage to any of the insureds from a nonrenewed voluntary purchasing group unless the carrier offers to transfer or provide coverage to all affected employers and eligible employees and dependents without regard to characteristics of the insured, experience as to claims, health or duration of coverage.

      3.  A carrier that decides to terminate its contracts and to discontinue issuing and delivering for issuance any contracts pursuant to this section:

      (a) Shall discontinue issuance and delivery for issuance all health benefit plans pursuant to this chapter in this state and, except as otherwise provided in this section, not renew any such contracts; and

      (b) Shall not enter into any new contract with a voluntary purchasing group for 5 years after the date on which the carrier terminated its contracts with voluntary purchasing groups.

      (Added to NRS by 1995, 2679; A 1997, 2953)

      NRS 689C.485  Approval or denial of claims; payment of claims and interest; requests for additional information; award of costs and attorney’s fees; compliance with requirements.

      1.  Except as otherwise provided in subsection 2, a carrier serving small employers and a carrier that offers a contract to a voluntary purchasing group shall approve or deny a claim relating to a policy of health insurance within 30 days after the carrier receives the claim. If the claim is approved, the carrier shall pay the claim within 30 days after it is approved. Except as otherwise provided in this section, if the approved claim is not paid within that period, the carrier shall pay interest on the claim at a rate of interest equal to the prime rate at the largest bank in Nevada, as ascertained by the Commissioner of Financial Institutions, on January 1 or July 1, as the case may be, immediately preceding the date on which the payment was due, plus 6 percent. The interest must be calculated from 30 days after the date on which the claim is approved until the date on which the claim is paid.

      2.  If the carrier requires additional information to determine whether to approve or deny the claim, it shall notify the claimant of its request for the additional information within 20 days after it receives the claim. The carrier shall notify the provider of health care of all the specific reasons for the delay in approving or denying the claim. The carrier shall approve or deny the claim within 30 days after receiving the additional information. If the claim is approved, the carrier shall pay the claim within 30 days after it receives the additional information. If the approved claim is not paid within that period, the carrier shall pay interest on the claim in the manner prescribed in subsection 1.

      3.  A carrier shall not request a claimant to resubmit information that the claimant has already provided to the carrier, unless the carrier provides a legitimate reason for the request and the purpose of the request is not to delay the payment of the claim, harass the claimant or discourage the filing of claims.

      4.  A carrier shall not pay only part of a claim that has been approved and is fully payable.

      5.  A court shall award costs and reasonable attorney’s fees to the prevailing party in an action brought pursuant to this section.

      6.  The payment of interest provided for in this section for the late payment of an approved claim may be waived only if the payment was delayed because of an act of God or another cause beyond the control of the carrier.

      7.  The Commissioner may require a carrier to provide evidence which demonstrates that the carrier has substantially complied with the requirements set forth in this section, including, without limitation, payment within 30 days of at least 95 percent of approved claims or at least 90 percent of the total dollar amount for approved claims.

      8.  If the Commissioner determines that a carrier is not in substantial compliance with the requirements set forth in this section, the Commissioner may require the carrier to pay an administrative fine in an amount to be determined by the Commissioner. Upon a second or subsequent determination that a carrier is not in substantial compliance with the requirements set forth in this section, the Commissioner may suspend or revoke the certificate of authority of the carrier.

      (Added to NRS by 1999, 1648; A 2001, 2731; 2003, 3359)

      NRS 689C.490  Formation of voluntary purchasing group by small employers; requirements when affiliate of group ceases to qualify as small employer.

      1.  A small employer may, in accordance with the provisions of NRS 689C.490 to 689C.600, inclusive, choose to affiliate voluntarily with other small employers as a voluntary purchasing group to purchase health benefits for eligible employees and their dependents.

      2.  An employer who affiliates with a voluntary purchasing group shall notify the carrier for that group when the employer has less than 2 or more than 50 employees. The carrier shall:

      (a) Upon receiving such a notification, inform the employer of the provisions of paragraph (b).

      (b) If the employer ceases to be a small employer, refuse to renew the coverage of that employer and employees of that employer and their dependents under any contract provided through the voluntary purchasing group.

      (Added to NRS by 1995, 2679; A 1997, 2953)

      NRS 689C.500  Requirements for registration as voluntary purchasing group; application.

      1.  An organization seeking to be registered as a voluntary purchasing group:

      (a) Must be incorporated as a Nevada corporation not for profit for the purpose of securing health benefits for its members and their eligible employees and dependents;

      (b) Shall file articles of incorporation with the Secretary of State and provide a copy of the articles to the Commissioner in such a form as the Commissioner may require; and

      (c) Must apply to the Commissioner for and obtain a certificate of registration to operate as a voluntary purchasing group.

      2.  The contents of the application must be established by the Commissioner and include at least:

      (a) The name of the voluntary purchasing group and any agent for service of process;

      (b) Provisions to govern the business and affairs of the group, including the management and organizational structure;

      (c) An affidavit by an officer of the organization that the group is in compliance with the requirements of NRS 689C.490 to 689C.600, inclusive; and

      (d) The names of managing personnel of the voluntary purchasing group.

      (Added to NRS by 1995, 2680)

      NRS 689C.510  Fee for application; response to application.

      1.  The application must be accompanied by a fee in an amount to be established by the Commissioner by regulation to cover the direct costs of examining the qualifications of an applicant.

      2.  The Commissioner shall respond to each application for a certificate of registration within 30 days after receipt. The Commissioner shall either approve the application or shall inform the organization of specific changes to the application necessary to permit approval.

      (Added to NRS by 1995, 2680)

      NRS 689C.520  Additional requirements for registration.

      1.  Before the issuance of a certificate of registration, each voluntary purchasing group shall, to the satisfaction of the Commissioner:

      (a) Establish the conditions of membership in the group and require as a condition of membership that all employers include all their eligible employees. The group may not differentiate among classes of membership on the basis of the kind of employment, race, religion, sex, education, health or income. The group shall set reasonable fees for membership which will finance all reasonable and necessary costs incurred in administering the group.

      (b) Provide to members of the group and their eligible employees information meeting the requirements of NRS 689C.440 regarding any proposed contracts.

      2.  In addition to the information required pursuant to subsection 1, a voluntary purchasing group shall provide annually to members of the group information regarding available benefits and carriers.

      (Added to NRS by 1995, 2680)

      NRS 689C.530  Filing reports; annual renewal fee.  A voluntary purchasing group shall:

      1.  File any reports required by the Commissioner; and

      2.  Pay a renewal fee established by the Commissioner by regulation to recover the direct costs to the Division to determine annually that a voluntary purchasing group is in compliance with NRS 689C.490 to 689C.600, inclusive.

      (Added to NRS by 1995, 2680)

      NRS 689C.540  Duties.  A voluntary purchasing group shall:

      1.  Establish administrative and accounting procedures for the operation of the group and the provision of services to members, prepare an annual budget and annual operational fiscal reports;

      2.  Provide for internal and independent audits; and

      3.  Maintain all records, reports and other information of the group and may contract with qualified third-party administrators, licensed insurance agents or brokers as needed.

      (Added to NRS by 1995, 2681)

      NRS 689C.550  Collection of premiums; trust account for deposit of premiums.  A voluntary purchasing group shall offer to collect premiums for contracts offered through the purchasing group and maintain a trust account for the deposit of premiums collected to be paid to carriers for coverage offered through the purchasing group. A voluntary purchasing group is a fiduciary with respect to any premiums so collected.

      (Added to NRS by 1995, 2681)

      NRS 689C.560  Regulations governing security to be maintained by voluntary purchasing group.  A voluntary purchasing group shall post a bond for the benefit of members of the group and their eligible employees and dependents, or deposit a certificate of deposit or securities, in such a manner and amount as the Commissioner establishes by regulation.

      (Added to NRS by 1995, 2681)

      NRS 689C.570  Organizer prohibited from acquiring financial interest in group’s business.  No person who organizes a voluntary purchasing group may acquire or attempt to acquire a financial interest in the group’s business for a period of 3 years after organization of the group.

      (Added to NRS by 1995, 2681)

      NRS 689C.580  Prohibited acts.  A voluntary purchasing group shall not perform any activity included in the definition of transacting insurance in this state as defined in NRS 679A.130, perform any activity for which it is subject to regulation pursuant to NRS 685B.120 or establish or otherwise engage in the activities of a health maintenance organization as provided in chapter 695C of NRS.

      (Added to NRS by 1995, 2681)

      NRS 689C.590  Disciplinary action for violation of provisions.  The Commissioner may deny, revoke or suspend a certificate of registration of any voluntary purchasing group found to be in violation of NRS 689C.490 to 689C.600, inclusive.

      (Added to NRS by 1995, 2681)

      NRS 689C.600  Regulations.  The Commissioner shall adopt such regulations as are needed to carry out the requirements of NRS 689C.490 to 689C.600, inclusive.

      (Added to NRS by 1995, 2681)

REINSURANCE

General Provisions

      NRS 689C.610  Definitions.  As used in NRS 689C.610 to 689C.940, inclusive, unless the context otherwise requires, the words and terms defined in NRS 689C.630, 689C.660 and 689C.670 have the meanings ascribed to them in those sections.

      (Added to NRS by 1997, 2929; A 1999, 2814; 2013, 3635)

      NRS 689C.620  “Board” defined.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.630  “Church plan” defined.  “Church plan” has the meaning ascribed to it in section 3(33) of the Employee Retirement Income Security Act of 1974, as that section existed on July 16, 1997.

      (Added to NRS by 1997, 2929)

      NRS 689C.640  “Committee” defined.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.650  “Eligible person” defined.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.660  “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 reimburse any cost of health care services, including a sickness and accident health service corporation, and any other entity providing a plan of health insurance, health benefits or health services to individuals and their dependents in this state.

      (Added to NRS by 1997, 2929)

      NRS 689C.670  “Individual health benefit plan” defined.  “Individual health benefit plan” means:

      1.  A health benefit plan, other than a converted policy or a plan for coverage of a bona fide association, for individuals and their dependents; and

      2.  A certificate issued to an individual that evidences coverage under a policy or contract issued to a trust, an association or other similar group of persons, other than a plan for coverage of a bona fide association, regardless of the situs of delivery of the policy or contract, if the eligible person pays the premium and is not being covered under the policy or contract pursuant to any provision for the continuation of benefits applicable under federal or state law.

      (Added to NRS by 1997, 2929)

      NRS 689C.680  “Individual reinsuring carrier” defined.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.690  “Individual risk-assuming carrier” defined.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.700  “Plan of operation” defined.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.710  “Program of Reinsurance” defined.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.720  “Reinsuring carrier” defined.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.730  “Risk-assuming carrier” defined.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

Program of Reinsurance for Small Employers and Eligible Persons

      NRS 689C.740  Creation.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.750  Board of Directors: Creation; members; term; vacancy.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.760  Meetings of Board; Chair of Board.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.770  Plan of operation: Submission by Board; approval by Commissioner; temporary plan when plan not suitable or not submitted.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.780  Requirements of plan of operation and temporary plan of operation.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.790  Program deemed to have powers and authority of insurance companies and health maintenance organizations; exceptions; powers.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.800  Amount of coverage to be reinsured; time within which reinsurance may begin; limitation on reimbursement to reinsuring carrier; termination of reinsurance; premium rate charged to federally qualified health maintenance organization; manner of handling managed care and claims by reinsuring carrier.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.810  Premium rates: Methodology for determining; minimum rates; review of methodology.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.820  Premiums for certain health benefit plans that are reinsured with program required to meet established requirements for premium rates.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.830  Board required to determine, account for and report to Commissioner net loss.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.840  Net loss from reinsuring small employers and eligible employees and dependents required to be recouped by assessments against reinsuring carriers.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

 

      NRS 689C.850  Net loss from reinsuring individual eligible persons and dependents required to be recouped by assessments against individual reinsuring carriers.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.860  Board required to determine, account for and report to Commissioner estimate of assessments needed to pay for losses; evaluation of operation of Program.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.870  Additional funding: Eligibility based on amount of assessment needed; Board to establish formula for additional assessments on all carriers.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

 

      NRS 689C.880  Use of excess assessments.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.890  Assessment against reinsuring carrier to be determined annually; penalty for late payment of assessments; deferment of assessment.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.900  Insurer to receive certificate of contribution for paying additional assessment; certain amount of contribution may be shown as asset and may offset liability for premium tax.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.910  Adjustment of assessment on federally qualified health maintenance organizations.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.920  Immunity from liability of Program and reinsuring carriers for certain acts.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.930  Board to develop standards setting forth manner and levels of compensation paid to producers for sale of health benefit plans.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.940  Regulations concerning determination of status of stop-loss policy.  The Commissioner may, by regulation, prescribe standards for determining whether a policy issued as a stop-loss policy is a health benefit plan for the purposes of this chapter.

      (Added to NRS by 1997, 2938)

      NRS 689C.950  Certain provisions inapplicable to certain basic health benefit plan delivered to small employers or eligible persons.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.955  Member, agent or employee of Board immune from liability in certain circumstances.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

Committee on Health Benefit Plans

      NRS 689C.960  Creation; members; term; vacancy.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.970  Meetings; Chair; duties.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)

 

      NRS 689C.980  Board and Committee to study and submit report concerning effectiveness of certain provisions.  Repealed. (See chapter 541, Statutes of Nevada 2013, at page 3661.)