[Rev. 11/21/2013 1:20:00 PM--2013]

CHAPTER 695H - MEDICAL DISCOUNT PLANS

NRS 695H.010        Definitions.

NRS 695H.020        “Administrator” defined.

NRS 695H.030        “Affiliate of an insurer” defined.

NRS 695H.040        “Insurer” defined.

NRS 695H.050        “Medical discount plan” defined.

NRS 695H.060        “Provider of health care” defined.

NRS 695H.070        Medical discount plans under exclusive jurisdiction of Commissioner.

NRS 695H.080        Registration of medical discount plan required; exceptions.

NRS 695H.090        Application for registration; forms; fees; contents; renewal of registration; regulations.

NRS 695H.100        Person responsible for conducting business activities of medical discount plan prohibited from engaging in certain acts.

NRS 695H.110        Required disclosures.

NRS 695H.120        Type size for disclosures.

NRS 695H.130        Net worth.

NRS 695H.140        Examinations; inspection of accounts, books and records by Commissioner.

NRS 695H.150        Records.

NRS 695H.160        Regulations.

NRS 695H.170        Administrative penalty for commission of certain acts.

NRS 695H.180        Penalties.

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      NRS 695H.010  Definitions.  As used in this chapter, unless the context otherwise requires, the words and terms defined in NRS 695H.020 to 695H.060, inclusive, have the meanings ascribed to them in those sections.

      (Added to NRS by 2005, 2101)

      NRS 695H.020  “Administrator” defined.  “Administrator” means a person authorized pursuant to NRS 683A.0805 to 683A.0893, inclusive, to conduct business in this State as an administrator.

      (Added to NRS by 2005, 2101)

      NRS 695H.030  “Affiliate of an insurer” defined.  “Affiliate of an insurer” means a person who directly, or indirectly through one or more intermediaries, controls, is controlled by or is under common control with an insurer.

      (Added to NRS by 2005, 2101)

      NRS 695H.040  “Insurer” defined.  “Insurer” means any insurer, fraternal benefit society, nonprofit corporation for hospital, medical and dental services, organization for dental care, health maintenance organization or prepaid limited health service organization authorized pursuant to this title to conduct business in this State.

      (Added to NRS by 2005, 2101)

      NRS 695H.050  “Medical discount plan” defined.  “Medical discount plan” means a business arrangement or program evidenced by a membership agreement, contract, card, certificate, device or mechanism in which a person, in exchange for fees, dues, charges or any other form of consideration, offers to provide or provides health care or medical services at a discount from providers of health care who are participating in the business arrangement or program or whom the person advertises as or claims to be participating in the business arrangement or program.

      (Added to NRS by 2005, 2101)

      NRS 695H.060  “Provider of health care” defined.  “Provider of health care” has the meaning ascribed to it in NRS 629.031.

      (Added to NRS by 2005, 2101)

      NRS 695H.070  Medical discount plans under exclusive jurisdiction of Commissioner.  Notwithstanding any other provision of law, the Commissioner has exclusive jurisdiction to regulate medical discount plans in this State.

      (Added to NRS by 2005, 2101)

      NRS 695H.080  Registration of medical discount plan required; exceptions.

      1.  Except as otherwise provided in this section, it is unlawful for any person to offer, market, sell or engage in business as a medical discount plan in this State without first registering the medical discount plan pursuant to the provisions of this chapter.

      2.  An insurer is not required to register any medical discount plan pursuant to the provisions of this chapter unless the insurer offers, markets or sells the medical discount plan in this State for separate consideration.

      3.  If an affiliate of an insurer offers, markets, sells or engages in business as a medical discount plan in this State, the affiliate is required to register the medical discount plan pursuant to the provisions of this chapter.

      4.  The provisions of this chapter do not apply to any medical discount plan that offers or provides discounts only on prescriptions.

      (Added to NRS by 2005, 2101)

      NRS 695H.090  Application for registration; forms; fees; contents; renewal of registration; regulations.

      1.  An application for registration to engage in business as a medical discount plan must be submitted on a form prescribed by the Commissioner. The form must be signed by an officer or an authorized representative of the applicant. Except as otherwise provided in this section, the application must be accompanied by:

      (a) A registration fee of $500 and, in addition to any other fee or charge, all applicable fees required pursuant to NRS 680C.110.

      (b) A copy of the organizational documents of the applicant, if any.

      (c) A list of names, addresses, positions of employment and biographical information of each person who is responsible for conducting the business activities of the medical discount plan of the applicant, including, but not limited to, all members of the board of directors, board of trustees, officers and managers. The list must set forth the extent and nature of any contracts or other agreements between any person who is responsible for conducting the business activities of the applicant and the medical discount plan, including disclosure of any possible conflicts of interest.

      (d) A complete biographical statement, on a form prescribed by the Commissioner, describing the facilities, employees and services that will be offered by the applicant.

      (e) A copy of all forms used for contracts between the applicant and networks of providers of health care regarding the provision of health care or medical services to members.

      (f) A copy of the most recent financial statements of the applicant, audited by an independent certified public accountant.

      (g) A description of the method of marketing proposed by the applicant.

      (h) A description of the procedures for making a complaint to be established and maintained by the applicant.

      (i) Any other information required by the Commissioner.

      2.  Each person who registers a medical discount plan must renew the registration on or before March 1 of each year. Except as otherwise provided in this section, an application to renew the registration must include:

      (a) An annual renewal fee of $500 and, in addition to any other fee or charge, all applicable fees required pursuant to NRS 680C.110; and

      (b) Any information set forth in subsection 1 that the Commissioner requires to be included in the application.

      3.  An administrator or insurer that registers a medical discount plan is not required to pay the fees for registering or renewing the registration of the medical discount plan pursuant to this section.

      4.  The Commissioner shall, by regulation, designate the provisions of subsection 1 that shall be deemed satisfied by an administrator, insurer or affiliate of an insurer that has complied with substantially similar requirements pursuant to other provisions of this title.

      (Added to NRS by 2005, 2101; A 2009, 1821; 2011, 3416)

      NRS 695H.100  Person responsible for conducting business activities of medical discount plan prohibited from engaging in certain acts.  A person who is responsible for conducting the business activities of a medical discount plan may not:

      1.  Use the word “insurance” or “enrollment” in any advertising or marketing material, brochures or discount cards for the medical discount plan unless approved by the Commissioner;

      2.  Use in any advertising or marketing material, brochures or discount cards for the medical discount plan the terms “coverage,” “copay,” “preexisting conditions,” “guaranteed issue,” “PPO,” “preferred provider organization” or any other term that could reasonably mislead a person into believing the medical discount plan is a policy of health insurance;

      3.  Pay a provider of health care any fee for providing any health care or medical services; or

      4.  Collect or accept money from a member of the medical discount plan for payment to a provider of health care for specific health care or medical services that the provider has provided or will provide to the member unless the registration for the medical discount plan is held by an administrator or insurer.

      (Added to NRS by 2005, 2102)

      NRS 695H.110  Required disclosures.

      1.  The following disclosures must be made in writing to any prospective member of a medical discount plan and must be in clear language and prominently displayed in any advertisements, marketing materials and brochures relating to a medical discount plan:

      (a) That the medical discount plan is not a policy of health insurance;

      (b) That the medical discount plan provides discounts from providers of health care who provide health care or medical services to members;

      (c) That the medical discount plan does not make payments directly to the providers of health care;

      (d) That the member will be required to pay for all health care or medical services but will receive a discount from those providers of health care who have contracted with the medical discount plan;

      (e) The corporate name of the person offering the medical discount plan and the location and address of each office for the medical discount plan; and

      (f) A telephone number where the member may obtain information and answers to questions or complaints.

      2.  The disclosures required pursuant to this section may be provided orally or electronically if written disclosures are provided not later than the earlier of:

      (a) Ten business days after the prospective member elects to accept the medical discount plan; or

      (b) The date on which any other written material is provided by the medical discount plan to the member.

      (Added to NRS by 2005, 2103)

      NRS 695H.120  Type size for disclosures.  The disclosures required by this chapter must be printed in type that is not smaller than 12-point type.

      (Added to NRS by 2005, 2103)

      NRS 695H.130  Net worth.

      1.  Each medical discount plan must at all times maintain a net worth of $100,000.

      2.  The Commissioner shall not issue a registration or renewal of a registration for a medical discount plan unless the person registering or renewing the registration certifies that the medical discount plan has a net worth of at least $100,000.

      (Added to NRS by 2005, 2103)

      NRS 695H.140  Examinations; inspection of accounts, books and records by Commissioner.

      1.  Except as otherwise provided in this subsection, the Commissioner may conduct examinations to enforce the provisions of this chapter pursuant to the provisions of NRS 679B.230 to 679B.300, inclusive, at such times as the Commissioner deems necessary. For the purposes of this chapter, the Commissioner is not required to comply with the requirement in NRS 679B.230 that insurers be examined not less frequently than every 5 years.

      2.  A person who is responsible for conducting the business activities of a medical discount plan shall, upon the request of the Commissioner, make available to the Commissioner for inspection any accounts, books and records concerning the medical discount plan which are reasonably necessary to enable the Commissioner to determine whether the medical discount plan is in compliance with the provisions of this chapter.

      (Added to NRS by 2005, 2104)

      NRS 695H.150  Records.

      1.  A medical discount plan must maintain records of the transactions governed by this chapter. The records must include:

      (a) A copy of each type of contract that the medical discount plan issues, sells or offers for sale;

      (b) The name and address of each member of the medical discount plan;

      (c) A copy of each contract that the medical discount plan enters into with providers of health care for purposes of providing members with health care or medical services at a discount; and

      (d) A copy of the annual certification of net worth and supporting documentation.

      2.  Except as otherwise provided in this subsection, each medical discount plan must retain all records for at least 7 years. A medical discount plan which intends to discontinue doing business in this State must provide the Commissioner with satisfactory proof that it has discharged its duties to the members in this State and must not destroy its records without the prior approval of the Commissioner.

      3.  The records required to be maintained pursuant to this section may be stored on a computer disc or other storage device for a computer from which the records may be readily printed.

      (Added to NRS by 2005, 2104)

      NRS 695H.160  Regulations.  The Commissioner may adopt regulations to carry out the provisions of this chapter.

      (Added to NRS by 2005, 2105)

      NRS 695H.170  Administrative penalty for commission of certain acts.  A person is subject to the imposition of an administrative penalty pursuant to this chapter if, in the course of the business of the person, the person:

      1.  Solicits, markets, advertises, promotes or sells to a person in this State a medical discount plan or a membership in connection with a medical discount plan unless the medical discount plan is registered pursuant to this chapter.

      2.  Fails to provide any disclosure required pursuant to NRS 695H.110.

      3.  Fails to make available to an applicant for membership or to a member, through a toll-free telephone number, upon the request of the applicant or member, a complete and accurate list of all participating providers of health care who have contracted with the medical discount plan and who are located in the applicant’s or member’s local area, or within a radius of 50 miles, and a list of the health care or medical services for which the discounts are applicable. The list must be made available, upon the request of the applicant, at the time the applicant purchases a membership and must be updated not less than once every 6 months.

      4.  Violates subsection 1 or 2 of NRS 695H.100 or otherwise uses advertising or marketing material, brochures or discount cards that are misleading, deceptive or fraudulent.

      5.  Offers discounted products or services to the applicant or member that are not authorized by a contract with each provider of health care listed in conjunction with the medical discount plan.

      6.  Fails to allow the applicant or member to cancel the membership in the medical discount plan.

      7.  If appropriate, fails to refund any required portion of membership fees paid to the medical discount plan by the applicant or member within 30 days after the applicant or member provides timely notification of the cancellation of the membership to the person administering the medical discount plan.

      (Added to NRS by 2005, 2103)

      NRS 695H.180  Penalties.  A person who violates any provision of this chapter or an order or regulation of the Commissioner issued or adopted pursuant thereto may be assessed an administrative penalty by the Commissioner of not more than $2,000 for each act or violation.

      (Added to NRS by 2005, 2104; A 2011, 3416)