[Rev. 11/21/2013 1:14:09 PM--2013]

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. [Effective through December 31, 2013.]

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

NRS 689C.025        “Carrier” defined.

NRS 689C.035        “Characteristics” defined. [Effective through December 31, 2013.]

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

NRS 689C.047        “Control” defined.

NRS 689C.051        “Converted policy” defined. [Effective through December 31, 2013.]

NRS 689C.053        “Creditable coverage” defined.

NRS 689C.055        “Dependent” defined. [Effective through December 31, 2013.]

NRS 689C.055        “Dependent” defined. [Effective January 1, 2014.]

NRS 689C.065        “Eligible employee” defined.

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

NRS 689C.067        “Established geographic service area” defined. [Effective through December 31, 2013.]

NRS 689C.071        “Geographic area” defined. [Effective through December 31, 2013.]

NRS 689C.071        “Geographic rating area” defined. [Effective January 1, 2014.]

NRS 689C.072        “Geographic service area” defined. [Effective January 1, 2014.]

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

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

NRS 689C.076        “Health status-related factor” defined. [Effective through December 31, 2013.]

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. [Effective through December 31, 2013.]

NRS 689C.085        “Rating period” defined.

NRS 689C.089        “Risk-assuming carrier” defined. [Effective through December 31, 2013.]

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. [Effective through December 31, 2013.]

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. [Effective through December 31, 2013.]

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. [Effective through December 31, 2013.]

NRS 689C.125        Rating factors for determining premiums. [Effective January 1, 2014.]

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. [Effective through December 31, 2013.]

NRS 689C.155        Regulations. [Effective through December 31, 2013.]

NRS 689C.155        Regulations. [Effective January 1, 2014.]

NRS 689C.156        Each health benefit plan marketed in this State required to be offered to small employers. [Effective through December 31, 2013.]

NRS 689C.156        Each health benefit plan marketed in this State required to be offered to small employers. [Effective January 1, 2014.]

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. [Effective through December 31, 2013.]

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. [Effective through December 31, 2013.]

NRS 689C.159        Certain provisions inapplicable to plan that carrier makes available only through bona fide association. [Effective January 1, 2014.]

NRS 689C.160        Carrier must uniformly apply requirements to determine whether to provide coverage. [Effective through December 31, 2013.]

NRS 689C.160        Carrier must uniformly apply requirements to determine whether to provide coverage. [Effective January 1, 2014.]

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. [Effective through December 31, 2013.]

NRS 689C.169        Coverage for severe mental illness. [Effective January 1, 2014.]

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; period of exclusion for preexisting condition; when health maintenance organization may require affiliation period. [Effective through December 31, 2013.]

NRS 689C.190        Coverage of preexisting conditions. [Effective January 1, 2014.]

NRS 689C.191        Determination of applicable creditable coverage of person; determining period of creditable coverage of person; required statement. [Effective through December 31, 2013.]

NRS 689C.191        Determination of applicable creditable coverage of person; determining period of creditable coverage of person; required statement; applicability. [Effective January 1, 2014.]

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. [Effective through December 31, 2013.]

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. [Effective January 1, 2014.]

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. [Effective through December 31, 2013.]

NRS 689C.200        When carrier is not required to offer coverage. [Effective January 1, 2014.]

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. [Effective through December 31, 2013.]

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

NRS 689C.230        Determination and application of index rate. [Effective through December 31, 2013.]

NRS 689C.240        Use of industry classifications as rating factor. [Effective through December 31, 2013.]

NRS 689C.250        Required disclosures to Commissioner; when disclosures constitute trade secret. [Effective through December 31, 2013.]

NRS 689C.250        Information considered to be trade secret; exception. [Effective January 1, 2014.]

NRS 689C.260        Manner in which carrier may establish separate class of business; transferring small employer into or out of class of business. [Effective through December 31, 2013.]

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. [Effective through December 31, 2013.]

NRS 689C.287        Election to act as risk-assuming carrier: Suspension by Commissioner; applicable statutes. [Effective through December 31, 2013.]

NRS 689C.290        Commissioner authorized to suspend restriction on increase of premiums for new rating period based on new business for policy. [Effective through December 31, 2013.]

NRS 689C.300        Carrier to file actuarial certification annually with Commissioner. [Effective through December 31, 2013.]

NRS 689C.310        Renewal of health benefit plan; discontinuing issuance and renewal of coverage, plan or form of product of health benefit plan. [Effective through December 31, 2013.]

NRS 689C.310        Renewal of health benefit plan; discontinuing issuance and renewal of coverage, plan or form of product of health benefit plan. [Effective January 1, 2014.]

NRS 689C.320        Required notification when carrier discontinues transacting insurance in this State; restrictions on carrier that discontinues transacting insurance. [Effective through December 31, 2013.]

NRS 689C.320        Required notification when carrier discontinues transacting insurance in this State; restrictions on carrier that discontinues transacting insurance. [Effective January 1, 2014.]

NRS 689C.325        Coverage offered through network plan not required to be offered to eligible employee who does not reside or work in established geographic service area or if carrier lacks capacity to deliver adequate service to additional employers and employees. [Effective through December 31, 2013.]

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. [Effective January 1, 2014.]

NRS 689C.327        Carrier that offers network plan: Contracts with certain federally qualified health centers. [Effective through December 31, 2013.]

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. [Effective through December 31, 2013.]

NRS 689C.342        Notice of election and payment of premium. [Effective through December 31, 2013.]

NRS 689C.344        Amount of premium for continuation of coverage; change in rates; payment to insurer; termination. [Effective through December 31, 2013.]

NRS 689C.346        Effect of change in insurer during period of continued coverage. [Effective through December 31, 2013.]

NRS 689C.348        Continued coverage ceases before end of established period under certain circumstances. [Effective through December 31, 2013.]

NRS 689C.350        Health benefit plan with preferred providers of health care: Deductible; percentage rate of payment; when coinsurance is no longer required; when service is deemed to be provided by preferred provider; processing claims of provider who is not preferred. [Effective through December 31, 2013.]

NRS 689C.350        Health benefit plan with preferred providers of health care: Deductible; when service is deemed to be provided by preferred provider. [Effective January 1, 2014.]

NRS 689C.355        Prohibited acts of carrier or producer; denial of application for coverage; violation may constitute unfair trade practice; applicability of section. [Effective through December 31, 2013.]

NRS 689C.355        Prohibited acts of carrier or producer; denial of application for coverage; violation may constitute unfair trade practice; applicability of section. [Effective January 1, 2014.]

VOLUNTARY PURCHASING GROUPS

NRS 689C.360        Definitions.

NRS 689C.380        “Contract” defined.

NRS 689C.390        “Dependent” defined. [Effective through December 31, 2013.]

NRS 689C.390        “Dependent” defined. [Effective January 1, 2014.]

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. [Effective through December 31, 2013.]

NRS 689C.610        Definitions. [Effective January 1, 2014.]

NRS 689C.620        “Board” defined. [Effective through December 31, 2013.]

NRS 689C.630        “Church plan” defined.

NRS 689C.640        “Committee” defined. [Effective through December 31, 2013.]

NRS 689C.650        “Eligible person” defined. [Effective through December 31, 2013.]

NRS 689C.660        “Individual carrier” defined.

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

NRS 689C.680        “Individual reinsuring carrier” defined. [Effective through December 31, 2013.]

NRS 689C.690        “Individual risk-assuming carrier” defined. [Effective through December 31, 2013.]

NRS 689C.700        “Plan of operation” defined. [Effective through December 31, 2013.]

NRS 689C.710        “Program of Reinsurance” defined. [Effective through December 31, 2013.]

NRS 689C.720        “Reinsuring carrier” defined. [Effective through December 31, 2013.]

NRS 689C.730        “Risk-assuming carrier” defined. [Effective through December 31, 2013.]

 

Program of Reinsurance for Small Employers and Eligible Persons

NRS 689C.740        Creation. [Effective through December 31, 2013.]

NRS 689C.750        Board of Directors: Creation; members; term; vacancy. [Effective through December 31, 2013.]

NRS 689C.760        Meetings of Board; Chair of Board. [Effective through December 31, 2013.]

NRS 689C.770        Plan of operation: Submission by Board; approval by Commissioner; temporary plan when plan not suitable or not submitted. [Effective through December 31, 2013.]

NRS 689C.780        Requirements of plan of operation and temporary plan of operation. [Effective through December 31, 2013.]

NRS 689C.790        Program deemed to have powers and authority of insurance companies and health maintenance organizations; exceptions; powers. [Effective through December 31, 2013.]

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. [Effective through December 31, 2013.]

NRS 689C.810        Premium rates: Methodology for determining; minimum rates; review of methodology. [Effective through December 31, 2013.]

NRS 689C.820        Premiums for certain health benefit plans that are reinsured with program required to meet established requirements for premium rates. [Effective through December 31, 2013.]

NRS 689C.830        Board required to determine, account for and report to Commissioner net loss. [Effective through December 31, 2013.]

NRS 689C.840        Net loss from reinsuring small employers and eligible employees and dependents required to be recouped by assessments against reinsuring carriers. [Effective through December 31, 2013.]

NRS 689C.850        Net loss from reinsuring individual eligible persons and dependents required to be recouped by assessments against individual reinsuring carriers. [Effective through December 31, 2013.]

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. [Effective through December 31, 2013.]

NRS 689C.870        Additional funding: Eligibility based on amount of assessment needed; Board to establish formula for additional assessments on all carriers. [Effective through December 31, 2013.]

NRS 689C.880        Use of excess assessments. [Effective through December 31, 2013.]

NRS 689C.890        Assessment against reinsuring carrier to be determined annually; penalty for late payment of assessments; deferment of assessment. [Effective through December 31, 2013.]

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. [Effective through December 31, 2013.]

NRS 689C.910        Adjustment of assessment on federally qualified health maintenance organizations. [Effective through December 31, 2013.]

NRS 689C.920        Immunity from liability of Program and reinsuring carriers for certain acts. [Effective through December 31, 2013.]

NRS 689C.930        Board to develop standards setting forth manner and levels of compensation paid to producers for sale of health benefit plans. [Effective through December 31, 2013.]

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. [Effective through December 31, 2013.]

NRS 689C.955        Member, agent or employee of Board immune from liability in certain circumstances. [Effective through December 31, 2013.]

 

Committee on Health Benefit Plans

NRS 689C.960        Creation; members; term; vacancy. [Effective through December 31, 2013.]

NRS 689C.970        Meetings; Chair; duties. [Effective through December 31, 2013.]

NRS 689C.980        Board and Committee to study and submit report concerning effectiveness of certain provisions. [Effective through December 31, 2013.]

_________

 

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. [Effective through December 31, 2013.]  “Basic health benefit plan” means the basic health benefit plan developed pursuant to NRS 689C.610 to 689C.980, inclusive.

      (Added to NRS by 1997, 2916; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]  “Characteristics” means demographic or other information concerning a small employer that is considered by a carrier in the determination of premium rates for the small employer, except claim experience, health status and duration of coverage.

      (Added to NRS by 1995, 978; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]  “Converted policy” means a basic or standard health benefit plan issued in accordance with NRS 689C.610 to 689C.980, inclusive.

      (Added to NRS by 1997, 2916; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]  “Dependent” means a spouse or:

      1.  An unmarried child under 19 years of age;

      2.  An unmarried child who is a full-time student under 24 years of age and who is financially dependent upon the parent; or

      3.  An unmarried child of any age who is medically certified as disabled and dependent upon the parent,

Ê who the parent claimed as his or her dependent on the form for income tax returns which the parent filed with the Internal Revenue Service for the previous fiscal year.

      (Added to NRS by 1995, 978)

      NRS 689C.055  “Dependent” defined. [Effective January 1, 2014.]  “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, effective January 1, 2014)

      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. [Effective through December 31, 2013.]  “Established geographic service area” means a geographic area, as approved by the Commissioner and based on the certificate of authority of the carrier to transact insurance in this state, within which the carrier is authorized to provide coverage.

      (Added to NRS by 1997, 2917)

      NRS 689C.071  “Geographic area” defined. [Effective through December 31, 2013.]  “Geographic 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)

      NRS 689C.071  “Geographic rating area” defined. [Effective January 1, 2014.]  “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, effective January 1, 2014)

      NRS 689C.072  “Geographic service area” defined. [Effective January 1, 2014.]  “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, effective January 1, 2014)—(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. [Effective through December 31, 2013.]  “Health status-related factor” means, with regard to a person who is or seeks to be insured:

      1.  Health status;

      2.  Any medical conditions, including physical or mental illness, or both;

      3.  Claims experience;

      4.  Receipt of health care;

      5.  Medical history;

      6.  Genetic information;

      7.  Evidence of insurability, including conditions arising out of acts of domestic violence; and

      8.  Disability.

      (Added to NRS by 1997, 2918; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]  “Program of Reinsurance” means the Program of Reinsurance for Small Employers and Eligible Persons established pursuant to NRS 689C.740.

      (Added to NRS by 1997, 2918; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]  “Risk-assuming carrier” means a small employer carrier that has elected to act as a risk-assuming carrier.

      (Added to NRS by 1997, 2918; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]  “Standard health benefit plan” means a standard health benefit plan developed pursuant to NRS 689C.610 to 689C.980, inclusive.

      (Added to NRS by 1997, 2918; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]

      1.  For the purposes of this chapter, and except as otherwise provided in subsection 2, two or more carriers which are affiliated companies or which are eligible to file a consolidated tax return shall be deemed to be one carrier, and any restrictions or limitations imposed by the provisions of this chapter apply as if the health benefit plans delivered or issued for delivery to small employers in this state by such carriers were issued by one carrier.

      2.  An affiliated carrier that is a health maintenance organization having a certificate of authority issued pursuant to the provisions of chapter 695C of NRS may be considered a separate carrier for the purposes of this chapter.

      3.  Unless otherwise authorized by the Commissioner, a carrier shall not enter into any ceding arrangement with respect to a health benefit plan delivered or issued for delivery to a small employer in this state if, as a result of the ceding arrangement, the ceding carrier retains less than 30 percent of the insurance obligation or risk for that health benefit plan.

      (Added to NRS by 1997, 2919; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]

      1.  A carrier serving small employers shall apply rating factors, including characteristics, consistently with respect to all small employers in a class of business. 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)

      NRS 689C.125  Rating factors for determining premiums. [Effective January 1, 2014.]

      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, effective January 1, 2014)

      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. [Effective through December 31, 2013.]  In determining the rating factors for establishing the premiums for a health benefit plan, a carrier serving small employers shall not use characteristics other than age, sex, industry, geographic area, composition of family, size of group and the amount contributed by the employer to the cost of coverage without the prior approval of the Commissioner.

      (Added to NRS by 1995, 980; R 2013, 3661, effective January 1, 2014)

      NRS 689C.155  Regulations. [Effective through December 31, 2013.]  The Commissioner may adopt regulations to carry out the provisions of NRS 689C.107 to 689C.145, 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.283, 689C.287, 689C.325, 689C.342 to 689C.348, inclusive, 689C.355 and 689C.610 to 689C.980, 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 characteristics may be used by such carriers.

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

      NRS 689C.155  Regulations. [Effective January 1, 2014.]  The Commissioner may adopt regulations to carry out the provisions of NRS 689C.109 to 689C.142, 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, effective January 1, 2014)

      NRS 689C.156  Each health benefit plan marketed in this State required to be offered to small employers. [Effective through December 31, 2013.]

      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. The health insurance plans marketed pursuant to this section by the carrier must include, without limitation, a basic health benefit plan and a standard health benefit plan. 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.980, 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)

      NRS 689C.156  Each health benefit plan marketed in this State required to be offered to small employers. [Effective January 1, 2014.]

      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, effective January 1, 2014)

      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. [Effective through December 31, 2013.]

      1.  Each carrier shall file with the Commissioner, in a format and manner prescribed by the Commissioner, the basic health benefit plans and the standard health benefit plans to be offered by the carrier. A health benefit plan filed pursuant to this section may not be offered by a carrier until the earlier of:

      (a) The date of approval by the Commissioner; or

      (b) Thirty days after the date on which the plans are filed, unless the Commissioner disapproves the use of the plans before the 30-day period expires.

      2.  The Commissioner may, at any time, after providing notice and an opportunity for a hearing, disapprove the continued use of a basic or standard health benefit plan by a carrier on the ground that the plan does not meet the requirements of NRS 689C.015 to 689C.355, inclusive, and 689C.610 to 689C.980, inclusive.

      (Added to NRS by 1997, 2920; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]  The provisions of NRS 689C.156, 689C.157 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)

      NRS 689C.159  Certain provisions inapplicable to plan that carrier makes available only through bona fide association. [Effective January 1, 2014.]  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, effective January 1, 2014)

      NRS 689C.160  Carrier must uniformly apply requirements to determine whether to provide coverage. [Effective through December 31, 2013.]  The requirements used by a carrier serving small employers to determine whether to provide coverage to a small employer, including, without limitation, standards for medical underwriting, 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)

      NRS 689C.160  Carrier must uniformly apply requirements to determine whether to provide coverage. [Effective January 1, 2014.]  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, effective January 1, 2014)

      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. [Effective through December 31, 2013.]

      1.  Notwithstanding any provisions of this title to the contrary, 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.  The coverage required by this section:

      (a) Must provide:

             (1) Benefits for at least 40 days of hospitalization as an inpatient per policy year and 40 visits for treatment as an outpatient per policy year, excluding visits for the management of medication; and

             (2) That two visits for partial or respite care, or a combination thereof, may be substituted for each 1 day of hospitalization not used by the insured. In no event is the policy required to provide coverage for more than 40 days of hospitalization as an inpatient per policy year.

      (b) Is not required to provide benefits for psychosocial rehabilitation or care received as a custodial inpatient.

      3.  Any deductibles and copayments required to be paid for the coverage required by this section must not be greater than 150 percent of the out-of-pocket expenses required to be paid for medical and surgical benefits provided pursuant to the policy of group health insurance.

      4.  The provisions of this section do not apply to a policy of group health insurance if, at the end of the policy year, the premiums charged for that policy, or a standard grouping of policies, increase by more than 2 percent as a result of providing the coverage required by this section and the insurer obtains an exemption from the Commissioner pursuant to subsection 5.

      5.  To obtain the exemption required by subsection 4, an insurer must submit to the Commissioner a written request therefor that is signed by an actuary and sets forth the reasons and actuarial assumptions upon which the request is based. To determine whether an exemption may be granted, the Commissioner shall subtract from the amount of premiums charged during the policy year the amount of premiums charged during the period immediately preceding the policy year and the amount of any increase in the premiums charged that is attributable to factors that are unrelated to providing the coverage required by this section. The Commissioner shall verify the information within 30 days after receiving the request. The request shall be deemed approved if the Commissioner does not deny the request within that time.

      6.  The provisions of this section do not:

      (a) Limit the provision of specialized services covered by Medicaid for persons with conditions relating to mental health or substance abuse.

      (b) Supersede any provision of federal law, any federal or state policy relating to Medicaid, or the terms and conditions imposed on any Medicaid waiver granted to this State with respect to the provisions of services to persons with conditions relating to mental health or substance abuse.

      7.  A policy of group health insurance subject to the provisions of this chapter which is delivered, issued for delivery or renewed on or after October 3, 2009, has the legal effect of including the coverage required by this section, and any provision of the policy or the renewal which is in conflict with this section is void, unless the policy is otherwise exempt from the provisions of this section pursuant to subsection 4.

      8.  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 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 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)

      NRS 689C.169  Coverage for severe mental illness. [Effective January 1, 2014.]

      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, effective January 1, 2014)

      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; period of exclusion for preexisting condition; when health maintenance organization may require affiliation period. [Effective through December 31, 2013.]

      1.  Except as otherwise provided in this section, a carrier serving small employers that issues a health benefit plan shall not deny, exclude or limit a benefit for a preexisting condition:

      (a) For more than 12 months after the effective date of coverage if the employee enrolls through open enrollment or after the first day of the waiting period for such enrollment, whichever is earlier; or

      (b) For more than 18 months after the effective date of coverage for a late enrollee. A carrier may not define a preexisting condition in its health benefit plan more restrictively than that term is defined in NRS 689C.082.

      2.  The period of any exclusion for a preexisting condition imposed by a health benefit plan on a person to be insured in accordance with the provisions of this chapter must be reduced by the aggregate period of creditable coverage of that person, if the creditable coverage was continuous to a date not more than 63 days before the effective date of the new coverage. The period of continuous coverage must not include:

      (a) Any waiting period for the effective date of the new coverage applied by the employer or the carrier; or

      (b) Any affiliation period, not to exceed 60 days for a new enrollee and 90 days for a late enrollee, required before becoming eligible to enroll in the health benefit plan.

      3.  A health maintenance organization authorized to transact insurance pursuant to chapter 695C of NRS that does not restrict coverage for a preexisting condition may require an affiliation period before coverage becomes effective under a plan of insurance if the affiliation period applies uniformly to all employees and without regard to any health status-related factors. During the affiliation period, the carrier shall not collect any premiums for coverage of the employee.

      4.  A carrier that restricts coverage for preexisting conditions shall not impose an affiliation period.

      5.  A carrier shall not impose any exclusion for a preexisting condition:

      (a) Relating to pregnancy.

      (b) In the case of a person who, as of the last day of the 30-day period beginning on the date of the person’s birth, is covered under creditable coverage.

      (c) In the case of a child who is adopted or placed for adoption before attaining the age of 18 years and who, as of the last day of the 30-day period beginning on the date of adoption or placement for adoption, whichever is earlier, is covered under creditable coverage. The provisions of this paragraph do not apply to coverage before the date of adoption or placement for adoption.

      (d) In the case of a condition for which medical advice, diagnosis, care or treatment was recommended or received for the first time while the covered person held creditable coverage, and the medical advice, diagnosis, care or treatment was a covered benefit under the plan, if the creditable coverage was continuous to a date not more than 90 days before the effective date of the new coverage.

Ê The provisions of paragraphs (b) and (c) do not apply to a person after the end of the first 63-day period during all of which the person was not covered under any creditable coverage.

      6.  As used in this section, “late enrollee” means an eligible employee, or a dependent of the eligible employee, who requests enrollment in a health benefit plan of a small employer following the initial period of enrollment, if the initial period of enrollment is at least 30 days, during which the person is entitled to enroll under the terms of the health benefit plan. The term does not include an eligible employee or a dependent of the eligible employee if:

      (a) The employee or dependent:

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

             (2) Lost coverage under creditable coverage as a result of cessation of employer contribution, termination of employment or eligibility, reduction in the number of hours of employment, involuntary termination of creditable coverage, or the death of, or divorce or legal separation from, a covered spouse; and

             (3) Requests enrollment not later than 30 days after the date on which his or her creditable coverage was terminated or on which the change in conditions that gave rise to the termination of the coverage occurred.

      (b) The person enrolls during the open enrollment period, as provided in the contract or as otherwise provided by specific statute.

      (c) The person is employed by an employer which offers multiple health benefit plans and the person elected a different plan during an open enrollment period.

      (d) A court has ordered coverage to be provided to the spouse or a minor or dependent child of an employee under a health benefit plan of the employee and a request for enrollment is made within 30 days after the issuance of the court order.

      (e) The person changes status from not being an eligible employee to being an eligible employee and requests enrollment, subject to any waiting period, within 30 days after the change in status.

      (f) The person has continued coverage in accordance with the Consolidated Omnibus Budget Reconciliation Act of 1985 and such coverage has been exhausted.

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

      NRS 689C.190  Coverage of preexisting conditions. [Effective January 1, 2014.]  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, effective January 1, 2014)

      NRS 689C.191  Determination of applicable creditable coverage of person; determining period of creditable coverage of person; required statement. [Effective through December 31, 2013.]

      1.  In determining the applicable creditable coverage of a person for the purposes of NRS 689C.190, 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 for the purposes of NRS 689C.190, 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.

      (Added to NRS by 1997, 2926)

      NRS 689C.191  Determination of applicable creditable coverage of person; determining period of creditable coverage of person; required statement; applicability. [Effective January 1, 2014.]

      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, effective January 1, 2014)

      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. [Effective through December 31, 2013.]

      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:

      (a) 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; or

      (b) Prevent a carrier from establishing limitations or restrictions on the amount, level, extent or nature of the benefits or coverage for similarly situated persons.

      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)

      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. [Effective January 1, 2014.]

      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, effective January 1, 2014)

      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. [Effective through December 31, 2013.]  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 established geographic area; or

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

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

      NRS 689C.200  When carrier is not required to offer coverage. [Effective January 1, 2014.]  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, effective January 1, 2014)

      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. [Effective through December 31, 2013.]

      1.  Except as otherwise provided in subsection 3, a carrier shall not increase the premium rate charged to a small employer for a new rating period by a percentage greater than the sum of:

      (a) The percentage of change in the premium rate for new business for the policy under which the small employer is covered, measured from the first day of the previous rating period to the first day of the new rating period;

      (b) An adjustment, not to exceed 15 percent annually, adjusted pro rata for rating periods of less than 1 year, on account of the claim experience, health status, or duration of coverage of the employees or dependents of the small employer as determined from the carrier’s rate manual for the class of business; and

      (c) Any adjustment on account of change in coverage or change in the characteristics of the small employer as determined from the carrier’s rate manual for the class of business.

      2.  If the carrier no longer issues new policies for that class of business, the carrier shall use the percentage of change in the premium rate for new business for the class of business which is most similar to the closed class of business and for which the carrier is issuing new policies.

      3.  In the case of health benefit plans delivered or issued for delivery before January 1, 1996, for groups with not fewer than 2 employees and not more than 25 employees, or before July 1, 1997, for groups with not fewer than 26 employees and not more than 50 employees, a premium rate for a rating period may exceed the ranges set forth in NRS 689C.230 for a period of 3 years following that date. In that case, the percentage of increase in the premium rate charged to a small employer for a new rating period may not exceed the sum of:

      (a) The percentage of change in the premium rate for new business measured from the first day of the previous rating period to the first day of the new rating period. In the case of a health benefit plan into which the carrier is no longer enrolling new small employers, the carrier shall use the percentage of change in the base premium rate if that change does not exceed, on a percentage basis, the change in the premium rate for new business for the most similar health benefit plan into which the carrier is actively enrolling new small employers.

      (b) Any adjustment on account of change in coverage or change in the characteristics of the small employer as determined from the carrier’s rate manual for the class of business.

      (Added to NRS by 1995, 983; A 1997, 2946; 1999, 2813; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]

      1.  The index rate for a rating period for any class of business may not exceed the index rate for any other class of business by more than 20 percent.

      2.  For a class of business, the premium rates charged during a rating period to small employers with similar characteristics for the same or similar coverage, or the rates that could be charged to such employers under the rating system for that class of business, may not vary, because of health status-related factors, from the index rate by more than 30 percent.

      3.  As used in this section:

      (a) “Base premium rate” means, for each class of business as to a rating period, the lowest premium rate charged or that could have been charged under a rating system for that class of business by the carrier to small employers with similar characteristics for health benefit plans subject to regulation by the Commissioner.

      (b) “Index rate” means, for each class of business as to a rating period for small employers with similar characteristics, the arithmetic average of the applicable base premium rate and the corresponding highest premium rate.

      (Added to NRS by 1995, 984; A 1997, 2947; R 2013, 3661, effective January 1, 2014)

      NRS 689C.240  Use of industry classifications as rating factor. [Effective through December 31, 2013.]  A carrier serving small employers may utilize industry classifications as a rating factor in establishing premium rates, but the highest rate factor associated with any industry classification may not exceed the lowest rate factor associated with any industry classification by more than 20 percent.

      (Added to NRS by 1995, 984; A 1995, 989; R 2013, 3661, effective January 1, 2014)

      NRS 689C.250  Required disclosures to Commissioner; when disclosures constitute trade secret. [Effective through December 31, 2013.]  A carrier serving small employers shall make the information and documents described in NRS 689C.210 to 689C.240, inclusive, available to the Commissioner upon request. Except in cases of violations of NRS 689C.015 to 689C.355, inclusive, the information is proprietary, constitutes a trade secret, and is 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.

      (Added to NRS by 1995, 984)

      NRS 689C.250  Information considered to be trade secret; exception. [Effective January 1, 2014.]

      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, effective January 1, 2014)

      NRS 689C.260  Manner in which carrier may establish separate class of business; transferring small employer into or out of class of business. [Effective through December 31, 2013.]

      1.  Except as otherwise provided in subsection 2, a carrier serving small employers may establish no more than nine separate classes of business, and each class must reflect substantial differences in expected claim experience or administrative costs related to the following:

      (a) The use of more than one type of system for the marketing and sale of health benefit plans to small employers;

      (b) The acquisition of a class of business from another carrier serving small employers; or

      (c) The provision of coverage to one or more groups that meet the requirements of NRS 689B.026.

      2.  The Commissioner may approve the establishment of additional classes of business upon application by a carrier and a finding by the Commissioner that this action would enhance the efficiency and fairness of the market for health insurance for small employers.

      3.  The Commissioner may adopt regulations to provide for a period of transition for a carrier serving small employers to comply with subsection 1 if the carrier acquires an additional class of business from another carrier serving small employers.

      4.  A carrier shall not transfer a small employer involuntarily into or out of a class of business. A carrier shall not offer to transfer a small employer into or out of a class of business unless the offer is to transfer all small employers in the class of business without regard to characteristics, claim experience, health status or duration of coverage.

      (Added to NRS by 1995, 984; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]

      1.  Within 30 days after the date on which a plan of operation is approved by the Commissioner pursuant to NRS 689C.770, or for a new carrier within 30 days after the date on which it enters the small employer market, each carrier shall elect to operate as either a risk-assuming carrier or a reinsuring carrier and shall notify the Commissioner of its election.

      2.  The initial election of a carrier to act as a risk-assuming or reinsuring carrier is effective on the carrier for 2 years after the date on which it notifies the Commissioner pursuant to subsection 1. After the initial 2-year period, such an election is effective for 5 years. The Commissioner may allow a carrier to modify its election at any time for good cause shown. The Commissioner may waive or modify the period during which the election of a carrier to operate as a risk-assuming or reinsuring carrier is effective.

      3.  A carrier may apply to the Commissioner, in a manner prescribed by the Commissioner by regulation, to change its status as a risk-assuming or reinsuring carrier.

      4.  A reinsuring carrier that elects or is subsequently authorized by the Commissioner to operate as a risk-assuming carrier:

      (a) Shall not continue to reinsure any small employer health benefit plan with the Program of Reinsurance.

      (b) Shall pay a prorated assessment based upon business issued as a reinsuring carrier for any portion of the year that the business was reinsured.

      5.  As used in this section:

      (a) “Plan of operation” means the plan of operation of the Program of Reinsurance established pursuant to NRS 689C.610 to 689C.980, inclusive.

      (b) “Reinsuring carrier” means a carrier participating in the Program of Reinsurance established pursuant to NRS 689C.610 to 689C.980, inclusive.

      (Added to NRS by 1997, 2922; R 2013, 3661, effective January 1, 2014)

      NRS 689C.287  Election to act as risk-assuming carrier: Suspension by Commissioner; applicable statutes. [Effective through December 31, 2013.]

      1.  The Commissioner may suspend the election of a carrier to act as a risk-assuming carrier if the Commissioner finds that:

      (a) The financial condition of the carrier will no longer support the assumption of risk from issuing coverage to small employers in compliance with NRS 689C.156 and 689C.190 without the protection afforded by the Program of Reinsurance;

      (b) The carrier has failed to market its health benefit plans fairly to all small employers in this state or in its established geographic service area, as applicable; or

      (c) The carrier has failed to provide coverage to eligible small employers as required pursuant to NRS 689C.156 and 689C.190.

      2.  A carrier that elects to be a risk-assuming carrier is subject to:

      (a) The provisions of NRS 689C.156, relating to the availability of coverage; and

      (b) The provisions of NRS 689C.260, relating to classes of businesses.

      (Added to NRS by 1997, 2923; R 2013, 3661, effective January 1, 2014)

      NRS 689C.290  Commissioner authorized to suspend restriction on increase of premiums for new rating period based on new business for policy. [Effective through December 31, 2013.]  The Commissioner may suspend for a specified period the application of paragraph (a) of subsection 1 and of subsection 2 of NRS 689C.210 as to the premium rates applicable to one or more small employers included within a class of business of a carrier serving small employers for one or more rating periods upon application by the carrier and a finding by the Commissioner that the suspension:

      1.  Is reasonable in light of the financial condition of the carrier; or

      2.  Would enhance the efficiency and fairness of the market for health insurance for small employers.

      (Added to NRS by 1995, 985; R 2013, 3661, effective January 1, 2014)

      NRS 689C.300  Carrier to file actuarial certification annually with Commissioner. [Effective through December 31, 2013.]

      1.  Each carrier serving small employers shall file with the Commissioner annually, on or before March 15, an actuarial certification that the carrier is in compliance with the provisions of NRS 689C.210 to 689C.260, inclusive, and that the rating methods of the carrier are actuarially sound. The certification must be made in a form and manner, and contain the information, specified by the Commissioner. A copy of the certification must be retained by the carrier at its principal place of business.

      2.  As used in this section, “actuarial certification” means a written statement by a member of the American Academy of Actuaries or other person acceptable to the Commissioner, based upon the certifier’s examination of the appropriate records of the carrier, including a review of the actuarial assumptions and methods used by the carrier in establishing premium rates for health benefit plans.

      (Added to NRS by 1995, 985; R 2013, 3661, effective January 1, 2014)

      NRS 689C.310  Renewal of health benefit plan; discontinuing issuance and renewal of coverage, plan or form of product of health benefit plan. [Effective through December 31, 2013.]

      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 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 established 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)

      NRS 689C.310  Renewal of health benefit plan; discontinuing issuance and renewal of coverage, plan or form of product of health benefit plan. [Effective January 1, 2014.]

      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, effective January 1, 2014)

      NRS 689C.320  Required notification when carrier discontinues transacting insurance in this State; restrictions on carrier that discontinues transacting insurance. [Effective through December 31, 2013.]

      1.  A carrier that discontinues transacting insurance in this State or in a particular geographic 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 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 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)

      NRS 689C.320  Required notification when carrier discontinues transacting insurance in this State; restrictions on carrier that discontinues transacting insurance. [Effective January 1, 2014.]

      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, effective January 1, 2014)

      NRS 689C.325  Coverage offered through network plan not required to be offered to eligible employee who does not reside or work in established geographic service area or if carrier lacks capacity to deliver adequate service to additional employers and employees. [Effective through December 31, 2013.]  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 established geographic service area of the network plan.

      2.  For a small employer whose eligible employees reside or work in the established 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 established 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)

      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. [Effective January 1, 2014.]  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, effective January 1, 2014)

      NRS 689C.327  Carrier that offers network plan: Contracts with certain federally qualified health centers. [Effective through December 31, 2013.]

      1.  A carrier that offers a network plan shall use its best efforts to contract with at least one health center in each established geographic service area to provide health care as a member of the carrier’s defined set of providers under the network plan if the health center:

      (a) Meets all conditions imposed by the carrier on similarly situated providers of health care that are members of the carrier’s defined set of providers, including, without limitation:

             (1) Certification for participation in the Medicaid or Medicare program; and

             (2) Requirements relating to the appropriate credentials for providers of health care; and

      (b) Agrees to reasonable reimbursement rates that are generally consistent with those offered by the carrier to similarly situated providers of health care that are members of the carrier’s defined set of providers.

      2.  As used in this section, “health center” has the meaning ascribed to it in 42 U.S.C. § 254b.

      (Added to NRS by 2001, 1923; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]

      1.  Except as otherwise provided in this section, if an employer who employs less than 20 employees maintains a health benefit plan which covers those employees, the plan must contain a provision which permits:

      (a) An employee to elect to continue identical coverage under the plan, excluding coverage provided for eye or dental care, if:

             (1) The employee’s employment is terminated for any reason other than gross misconduct; or

             (2) The number of his or her working hours is reduced so that the employee ceases to be eligible for coverage.

      (b) The spouse or dependent child of an employee to elect to continue coverage, excluding any coverage provided for eye or dental care, if:

             (1) The employee’s employment is terminated for any reason other than gross misconduct or the number of his or her working hours is reduced so that the employee ceases to be eligible for coverage;

             (2) The employee dies;

             (3) The employee and his or her spouse are divorced or legally separated;

             (4) The dependent child ceases to be eligible for coverage under the terms of the policy; or

             (5) The spouse ceases to be eligible for coverage after becoming eligible for Medicare.

      2.  The period of continued coverage is limited to:

      (a) Eighteen months for an employee.

      (b) Thirty-six months for the dependent of an employee.

      3.  An employee who voluntarily leaves his or her employment, or the dependent of that employee, is not eligible to continue coverage pursuant to this section.

      4.  An employee or a dependent of an employee who has not been covered under a health benefit plan of the employer for at least 12 consecutive months before the termination of his or her coverage is not eligible to continue coverage pursuant to this section.

      5.  A provision for continued coverage must include coverage for any child born to, legally adopted by or placed for adoption with the employee during the period of continued coverage. Such a child is eligible for continued coverage only to the end of the period of continued coverage as established pursuant to subsection 2.

      (Added to NRS by 1995, 987; A 1997, 2950; R 2013, 3661, effective January 1, 2014)

      NRS 689C.342  Notice of election and payment of premium. [Effective through December 31, 2013.]

      1.  An employee, spouse or dependent child shall notify the employer that the employee, spouse or dependent child is eligible to continue his or her coverage pursuant to NRS 689C.340 not later than 60 days after the employee, spouse or dependent child becomes eligible to do so.

      2.  The employer shall, within 14 days after receipt of notification pursuant to subsection 1, provide adequate information to the employee, spouse or dependent child regarding the election to continue coverage and the premium required to be paid.

      3.  If the employee, spouse or dependent child elects to continue coverage, the employee, spouse or dependent child shall notify the insurer of his or her election and pay to the insurer the premium required by NRS 689C.344 within 60 days after receipt of the information provided pursuant to subsection 2.

      (Added to NRS by 1997, 2928; R 2013, 3661, effective January 1, 2014)

      NRS 689C.344  Amount of premium for continuation of coverage; change in rates; payment to insurer; termination. [Effective through December 31, 2013.]

      1.  Any person who elects to continue coverage pursuant to NRS 689C.340 shall pay a premium for that coverage in an amount not to exceed 110 percent of the premium charged to the employer by the insurer for coverage of that person on the date on which that person became eligible for continued coverage.

      2.  If there is a change in the rate charged or benefits provided under the policy during the time of continued coverage, the premium may not exceed 110 percent of the new rate charged to the employer.

      3.  The premiums must be paid to the insurer on a monthly basis.

      4.  If the payment of a premium is not received by the insurer within 30 days after the date on which it is due, continued coverage must be terminated.

      (Added to NRS by 1997, 2928; A 2009, 2452; R 2013, 3661, effective January 1, 2014)

      NRS 689C.346  Effect of change in insurer during period of continued coverage. [Effective through December 31, 2013.]  If an employer changes his or her insurer during the period of a person’s continued coverage, the new insurer shall provide continued coverage for that person for the remainder of the continuation period in accordance with the provisions of NRS 689C.344.

      (Added to NRS by 1997, 2928; R 2013, 3661, effective January 1, 2014)

      NRS 689C.348  Continued coverage ceases before end of established period under certain circumstances. [Effective through December 31, 2013.]  Continued coverage pursuant to NRS 689C.340 ceases before the end of the period provided in that section if:

      1.  The employer discontinues group health insurance for his or her employees;

      2.  The employee, spouse or dependent child fails to pay the required premiums;

      3.  The employee, spouse or dependent child becomes covered under any other policy of group health insurance;

      4.  The employee or spouse qualifies for Medicare; or

      5.  The spouse remarries and becomes eligible for coverage under a policy of group health insurance of the new spouse.

      (Added to NRS by 1997, 2928; R 2013, 3661, effective January 1, 2014)

      NRS 689C.350  Health benefit plan with preferred providers of health care: Deductible; percentage rate of payment; when coinsurance is no longer required; when service is deemed to be provided by preferred provider; processing claims of provider who is not preferred. [Effective through December 31, 2013.]  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.  May not require a deductible of more than $600 difference per admission to a facility for inpatient treatment which is not a preferred provider of health care.

      2.  May not require a deductible of more than $500 difference per treatment, other than inpatient treatment at a hospital, by a provider which is not preferred.

      3.  May not provide for a difference in percentage rates of payment for coinsurance of more than 30 percentage points between the payment for coinsurance required to be paid by the insured to a preferred provider of health care and the payment for coinsurance required to be paid by the insured to a provider of health care who is not preferred.

      4.  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.

      5.  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 calendar 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.

      6.  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.

      7.  Must require the insurer to process a claim of a provider of health care who is not preferred not later than 30 working days after the date on which proof of the claim is received.

      (Added to NRS by 1995, 987)

      NRS 689C.350  Health benefit plan with preferred providers of health care: Deductible; when service is deemed to be provided by preferred provider. [Effective January 1, 2014.]  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, effective January 1, 2014)

      NRS 689C.355  Prohibited acts of carrier or producer; denial of application for coverage; violation may constitute unfair trade practice; applicability of section. [Effective through December 31, 2013.]

      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 established geographic service area or a provision for a restricted network of the carrier.

      3.  Except as otherwise provided in this subsection, 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. The provisions of this subsection do not apply to any arrangement for compensation that provides payment to a producer on the basis of percentage of premium, except that the percentage may not vary because of the health status, claims experience, industry, occupation or geographic area of 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 broker 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)

      NRS 689C.355  Prohibited acts of carrier or producer; denial of application for coverage; violation may constitute unfair trade practice; applicability of section. [Effective January 1, 2014.]

      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, effective January 1, 2014)

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. [Effective through December 31, 2013.]  “Dependent” means a spouse, an unmarried child who has not attained 19 years of age, an unmarried child who is a full-time student who has not attained 24 years of age and who is financially dependent upon the parent, and an unmarried child of any age who is medically certified as disabled and dependent upon the parent.

      (Added to NRS by 1995, 2677)

      NRS 689C.390  “Dependent” defined. [Effective January 1, 2014.]  “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, effective January 1, 2014)

      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. [Effective through December 31, 2013.]  As used in NRS 689C.610 to 689C.980, inclusive, unless the context otherwise requires, the words and terms defined in NRS 689C.620 to 689C.730, inclusive, have the meanings ascribed to them in those sections.

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

      NRS 689C.610  Definitions. [Effective January 1, 2014.]  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, effective January 1, 2014)

      NRS 689C.620  “Board” defined. [Effective through December 31, 2013.]  “Board” means the Board of Directors of the Program of Reinsurance established pursuant to NRS 689C.750.

      (Added to NRS by 1997, 2929; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]  “Committee” means the Committee on Health Benefit Plans that is created pursuant to NRS 689C.960.

      (Added to NRS by 1997, 2929; R 2013, 3661, effective January 1, 2014)

      NRS 689C.650  “Eligible person” defined. [Effective through December 31, 2013.]  “Eligible person” has the meaning ascribed to it in NRS 689A.515.

      (Added to NRS by 1997, 2929; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]  “Individual reinsuring carrier” means an individual carrier that has elected to reinsure eligible persons in the Program of Reinsurance.

      (Added to NRS by 1997, 2929; R 2013, 3661, effective January 1, 2014)

      NRS 689C.690  “Individual risk-assuming carrier” defined. [Effective through December 31, 2013.]  “Individual risk-assuming carrier” means an individual carrier that has elected to act as a risk-assuming carrier.

      (Added to NRS by 1997, 2929; R 2013, 3661, effective January 1, 2014)

      NRS 689C.700  “Plan of operation” defined. [Effective through December 31, 2013.]  “Plan of operation” means the plan of operation of the Program of Reinsurance.

      (Added to NRS by 1997, 2929; R 2013, 3661, effective January 1, 2014)

      NRS 689C.710  “Program of Reinsurance” defined. [Effective through December 31, 2013.]  “Program of Reinsurance” means the Program of Reinsurance for Small Employers and Eligible Persons created pursuant to NRS 689C.740.

      (Added to NRS by 1997, 2929; R 2013, 3661, effective January 1, 2014)

      NRS 689C.720  “Reinsuring carrier” defined. [Effective through December 31, 2013.]  “Reinsuring carrier” means a small employer carrier participating in the Program of Reinsurance.

      (Added to NRS by 1997, 2929; R 2013, 3661, effective January 1, 2014)

      NRS 689C.730  “Risk-assuming carrier” defined. [Effective through December 31, 2013.]  “Risk-assuming carrier” means a small employer carrier that has elected to act as a risk-assuming carrier.

      (Added to NRS by 1997, 2930; R 2013, 3661, effective January 1, 2014)

Program of Reinsurance for Small Employers and Eligible Persons

      NRS 689C.740  Creation. [Effective through December 31, 2013.]  There is hereby created a nonprofit entity to be known as the Program of Reinsurance for Small Employers and Eligible Persons.

      (Added to NRS by 1997, 2930; R 2013, 3661, effective January 1, 2014)

      NRS 689C.750  Board of Directors: Creation; members; term; vacancy. [Effective through December 31, 2013.]

      1.  The Board of Directors of the Program of Reinsurance is hereby created. The Board consists of:

      (a) Eight members to be appointed by the Commissioner as follows:

             (1) Six persons who represent carriers that provide health insurance coverage to small employers pursuant to the provisions of this chapter or to individuals pursuant to chapter 689A of NRS, or to both small employers and individuals; and

             (2) Two persons who represent small employers and eligible persons; and

      (b) The Commissioner, or a designated representative of the Commissioner, who is an ex officio, nonvoting member of the Board.

      2.  Members of the Board serve without compensation except that, while engaged in the business of the Board, each member is entitled to receive the per diem allowance or travel expenses provided for state officers and employees generally, to be paid from the proceeds of the assessments received by the Program of Reinsurance as an administrative expense of the Program of Reinsurance.

      3.  After the initial term, the term of each appointed member is 3 years. Members may be reappointed. A member may be removed from the Board by the Commissioner for good cause shown.

      4.  At the expiration of the term of a member of the Board, or if the member resigns or is otherwise unable to complete his or her term, the Commissioner shall appoint a replacement not later than 30 days after the vacancy occurs. All vacancies on the Board must be filled in the same manner of appointment as the member who created the vacancy.

      (Added to NRS by 1997, 2930; R 2013, 3661, effective January 1, 2014)

      NRS 689C.760  Meetings of Board; Chair of Board. [Effective through December 31, 2013.]

      1.  The Board shall meet:

      (a) Until a plan of operation, other than a temporary plan of operation, has been approved by the Commissioner, twice a year;

      (b) Once a plan of operation has been so approved, once a year; and

      (c) At such other times as the Commissioner deems necessary.

      2.  The Board shall elect from its membership a Chair who shall serve for a term of 2 years. Any vacancy occurring in this position must be filled by election of the members of the Board for the remainder of the unexpired term.

      (Added to NRS by 1997, 2930; R 2013, 3661, effective January 1, 2014)

      NRS 689C.770  Plan of operation: Submission by Board; approval by Commissioner; temporary plan when plan not suitable or not submitted. [Effective through December 31, 2013.]

      1.  Not later than 120 days after the initial appointment of the Board, the Board shall submit to the Commissioner a plan of operation that ensures the fair, reasonable and equitable administration of the Program of Reinsurance. Once a plan of operation has been approved by the Commissioner, the Board may amend the plan of operation as needed, subject to the approval of the Commissioner.

      2.  The Commissioner shall, after notice and a hearing, approve a plan of operation and any amendment to the plan of operation submitted for approval by the Commissioner if the Commissioner determines that the plan or amendment is suitable to:

      (a) Ensure the fair, reasonable and equitable administration of the Program of Reinsurance; and

      (b) Provide for the sharing of the gains and losses of the Program of Reinsurance on an equitable basis in accordance with the provisions of NRS 689C.610 to 689C.980, inclusive.

      3.  If the Board fails to submit a suitable plan of operation within 120 days after its appointment or if the Commissioner determines in accordance with subsection 2 that the plan of operation as submitted is not suitable, the Commissioner may, after notice and a hearing, adopt and carry out a temporary plan of operation which is effective only until the approval of a plan of operation submitted by the Board.

      4.  Before approving a plan of operation submitted by the Board, the Commissioner may amend the plan if the Commissioner determines that such an amendment is necessary to ensure that the plan is suitable pursuant to subsection 2.

      5.  A plan of operation becomes effective upon the written approval of the Commissioner.

      (Added to NRS by 1997, 2930; R 2013, 3661, effective January 1, 2014)

      NRS 689C.780  Requirements of plan of operation and temporary plan of operation. [Effective through December 31, 2013.]  A plan of operation and a temporary plan of operation must:

      1.  Establish procedures for the handling and accounting of the assets of the Program of Reinsurance and for an annual fiscal reporting to the Commissioner.

      2.  Establish procedures for selecting an administering carrier and set forth the powers and duties of the administering carrier.

      3.  Establish procedures for reinsuring risks pursuant to the Program of Reinsurance.

      4.  Establish procedures for collecting assessments to pay claims and administrative expenses incurred or estimated to be incurred by the Program of Reinsurance.

      5.  Establish a methodology for applying the minimum amount of claims and the maximum liability of the reinsuring or individual reinsuring carrier as set forth in NRS 689C.800.

      6.  Provide for any additional matters necessary to carry out and administer the Program of Reinsurance.

      (Added to NRS by 1997, 2931; R 2013, 3661, effective January 1, 2014)

      NRS 689C.790  Program deemed to have powers and authority of insurance companies and health maintenance organizations; exceptions; powers. [Effective through December 31, 2013.]  Notwithstanding any provision of this title to the contrary, the Program of Reinsurance shall be deemed to have the general powers and authority granted under the laws of this state to insurance companies and health maintenance organizations licensed to transact business in this state, except that the Program of Reinsurance shall not issue any health benefit plans directly to small employers or individuals, or both. The Program of Reinsurance may:

      1.  With the approval of the Commissioner, enter into such contracts as are necessary to carry out the provisions of this chapter and NRS 689A.470 to 689A.740, inclusive, including entering into contracts with similar programs of reinsurance of other states for the joint performance of common functions, or with persons or other organizations for the performance of administrative functions, relating to programs of reinsurance.

      2.  Take any legal action necessary or proper to recover assessments and penalties for or on behalf of the Program of Reinsurance, or to avoid the payment of improper claims against the Program of Reinsurance.

      3.  Sue or be sued by a reinsuring carrier or an individual reinsuring carrier relating to the carrier’s participation in the Program of Reinsurance.

      4.  Define the health benefit plans for which reinsurance will be provided and issue reinsurance policies, in accordance with the requirements of this chapter and NRS 689A.470 to 689A.740, inclusive.

      5.  Establish rules, conditions and procedures for reinsuring risks under the Program of Reinsurance.

      6.  Establish actuarial functions as appropriate for the operation of the Program of Reinsurance.

      7.  Make assessments in accordance with the provisions of NRS 689C.840, 689C.850 and 689C.870 and make advance interim assessments as may be reasonable and necessary to pay for any organizational and interim operating expenses. Any interim assessment must be credited as an offset against any assessments due after the close of the fiscal year.

      8.  Appoint appropriate legal, actuarial and other committees as necessary to provide technical assistance in the operation of the Program of Reinsurance, design of policies and other similar contract of insurance, and any other function within the authority of the Program of Reinsurance.

      9.  Borrow money to effect the purposes of the Program of Reinsurance. Any note or other evidence of indebtedness of the Program of Reinsurance not in default shall be deemed to be legal investments for carriers and may be carried as admitted assets.

      (Added to NRS by 1997, 2931; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]

      1.  The Program of Reinsurance must reinsure:

      (a) For a basic or standard health benefit plan, the level of coverage provided; and

      (b) For any other plan, up to the level of coverage provided in a basic or standard health benefit plan.

      2.  A reinsuring carrier may reinsure a small employer within 60 days after the beginning of coverage of the small employer under a health benefit plan, or for an eligible employee or a dependent of the eligible employee, within 60 days after the beginning of coverage of the employee or dependent under a health benefit plan. An individual reinsuring carrier may reinsure an eligible person or a dependent of the eligible person within 60 days after the effective date of coverage of the person or dependent under a health benefit plan.

      3.  The Program of Reinsurance may not reimburse a reinsuring carrier or an individual reinsuring carrier for a claim of a reinsured eligible employee or eligible person, or a dependent of such an employee or person, as appropriate, until the reinsuring or individual reinsuring carrier has incurred in a calendar year the minimum amount of claims of the eligible employee, eligible person or dependent of benefits covered by the Program of Reinsurance. After the amount of claims of the eligible employee, eligible person or dependent is equal to or greater than the required minimum amount, the reinsuring or individual reinsuring carrier is liable for 10 percent of the next $50,000 of payments of benefits that are paid during that calendar year and the Program of Reinsurance must reinsure the remainder of the benefit payments. The total liability of a carrier in a calendar year pursuant to this subsection may not exceed the maximum liability established by the Board.

      4.  For the purposes of subsection 3, the Board shall establish:

      (a) The minimum amount of claims, which must be in an amount that is equal to or greater than $5,000, that must be incurred before the Program of Reinsurance will reimburse the reinsuring or individual reinsuring carrier.

      (b) The maximum liability of a reinsuring or individual reinsuring carrier, which must be in an amount that is equal to or greater than $10,000.

Ê The Board shall annually adjust the minimum amount of claims and the maximum liability of a reinsuring or individual reinsuring carrier to reflect increases in the costs and utilization within the standard market for health benefit plans within this state. Unless the Board proposes and the Commissioner approves a factor that would provide for a lower adjustment, the adjustments must not be less than the annual change in the component for medical care of the Consumer Price Index for All Urban Consumers of the United States Department of Labor, Bureau of Labor Statistics.

      5.  A reinsuring carrier that provides health insurance coverage to small employers may terminate reinsurance with the Program of Reinsurance for a reinsured employee or dependent, and an individual reinsuring carrier may terminate reinsurance with the Program of Reinsurance for an eligible person or dependent, on the anniversary date of the health benefit plan.

      6.  The premium rates charged for reinsurance by the Program of Reinsurance to a health maintenance organization that is federally qualified pursuant to 42 U.S.C. §§ 300 et seq. and is subject to requirements limiting the amount of risk that may be ceded to a Program of Reinsurance that are more restrictive than the amounts set forth in subsection 5 must be reduced to reflect that portion of the risk above the amount determined pursuant to this section, if any, that may not be ceded to the Program of Reinsurance.

      7.  A reinsuring carrier or an individual reinsuring carrier purchasing reinsurance pursuant to this chapter or NRS 689A.470 to 689A.740, inclusive, shall apply its techniques for handling managed care and claims, including utilization review, individual case management, preferred provider provisions and other provisions or methods of operating relating to managed care, to the health benefit plans that are being reinsured pursuant to the Program of Reinsurance in a manner that is consistent with the business of the carrier that is not reinsured.

      8.  Nothing in this section prohibits a reinsuring carrier or an individual reinsuring carrier from terminating the coverage of a small employer or an eligible person on the grounds described in paragraph (c) of subsection 1 of NRS 687B.320.

      9.  The plan of operation must provide that:

      (a) A reinsuring carrier may reinsure a small employer or an eligible employee or a dependent of the eligible employee if coverage is written on or after July 1, 1997; and

      (b) An individual reinsuring carrier may reinsure an eligible person or a dependent of the eligible employee if coverage is written on or after January 1, 1998.

      (Added to NRS by 1997, 2932; R 2013, 3661, effective January 1, 2014)

      NRS 689C.810  Premium rates: Methodology for determining; minimum rates; review of methodology. [Effective through December 31, 2013.]

      1.  The plan of operation must include a methodology for determining premium rates to be charged by the Program of Reinsurance for Reinsuring Small Employers and Eligible Persons pursuant to NRS 689C.610 to 689C.980, inclusive. The methodology must:

      (a) Include a system for the classification of small employers which reflects the types of case characteristics commonly used by carriers that provide health insurance coverage to small employers pursuant to the provisions of this chapter; and

      (b) Provide for the development of initial base premium rates for reinsurance to be used pursuant to subsection 2 to determine the premium rates for the Program of Reinsurance. The Board shall establish such base rates, subject to the approval of the Commissioner, at levels that reasonably approximate the gross premiums charged to small employers by small employer carriers, to eligible employees and their dependents by small employer carriers, or to eligible persons by individual carriers, as appropriate, for health benefit plans with benefits similar to the standard health benefit plan, as adjusted to reflect the minimum amount of claims and the maximum liability established pursuant to NRS 689C.800.

      2.  Premiums for the Program of Reinsurance:

      (a) For an entire small employer group, must be at a rate that is at least 1 1/2 times the base premium rate established pursuant to subsection 1.

      (b) For an eligible employee and a dependent of the eligible employee, must be at a rate that is at least five times the base premium rate established pursuant to subsection 1.

      (c) For an eligible person, must be at a rate that is at least 1 1/2 times the base premium rate established pursuant to subsection 1.

      3.  The Board shall periodically review the methodology established pursuant to this section, including the system of classification and any rating factors, to ensure that the methodology reasonably reflects the claims experience of the Program of Reinsurance. The Board may, subject to the approval of the Commissioner, change the methodology as needed.

      4.  The Board may adjust the factor by which the base premium rate must be multiplied pursuant to this section to determine the premium rates to be charged for the Program of Reinsurance to reflect the use of effective measures of cost containment and any arrangements for managed care.

      (Added to NRS by 1997, 2933; R 2013, 3661, effective January 1, 2014)

      NRS 689C.820  Premiums for certain health benefit plans that are reinsured with program required to meet established requirements for premium rates. [Effective through December 31, 2013.]

      1.  If a health benefit plan for a small employer, an eligible employee or an eligible person is entirely or partially reinsured with the Program of Reinsurance, the premiums charged to the small employer, eligible employee or eligible person for any rating period during which such coverage is entirely or partially reinsured must meet the requirements for premium rates set forth in NRS 689A.680 to 689A.700, inclusive, or as established in accordance with NRS 689C.230, as appropriate.

      2.  As used in this section, “rating period” means the calendar period for which premium rates established by a carrier subject to this section and NRS 689C.810 are assumed to be in effect.

      (Added to NRS by 1997, 2934; R 2013, 3661, effective January 1, 2014)

      NRS 689C.830  Board required to determine, account for and report to Commissioner net loss. [Effective through December 31, 2013.]  On or before March 1 of each year, the Board shall determine, separately account for and report to the Commissioner the net loss of the Program of Reinsurance for the previous calendar year, including administrative expenses and incurred losses for that year. Such a determination and accounting must take into account any investment income and other appropriate gains and losses for reinsured small employers and eligible employees and their dependents and for reinsured eligible persons.

      (Added to NRS by 1997, 2934; R 2013, 3661, effective January 1, 2014)

      NRS 689C.840  Net loss from reinsuring small employers and eligible employees and dependents required to be recouped by assessments against reinsuring carriers. [Effective through December 31, 2013.]

      1.  Any net loss from reinsuring small employers and eligible employees and their dependents must be recouped by assessments against reinsuring carriers.

      2.  As part of the plan of operation, the Board shall establish a formula pursuant to which assessments may be made against reinsuring carriers to recover the net loss. The formula must be based on:

      (a) The share of each reinsuring carrier of the total premiums earned by all reinsuring carriers during the preceding calendar year from existing health benefit plans delivered or issued for delivery to small employers in this state; and

      (b) The share of each reinsuring carrier of the premiums earned by all reinsuring carriers in the preceding calendar year from newly issued health benefit plans delivered or issued for delivery during that year to small employers in this state.

      3.  An assessment made against a reinsuring carrier pursuant to this section must not be less than 50 percent nor more than 150 percent of an amount equal to the proportion of the total premium earned by the reinsuring carrier during the preceding calendar year from health benefit plans delivered or issued for delivery to small employers in this state to the total premiums earned by all such carriers in the preceding calendar year for such health benefit plans.

      4.  The Board may, with the approval of the Commissioner, change the formula for determining assessments against reinsuring carriers established pursuant to this section as necessary. The Board may provide that, during any transitional period, the shares of the assessment base attributable to the total premiums and to the premiums of the previous year may vary.

      5.  Subject to the approval of the Commissioner, the Board shall adjust the formula for assessing reinsuring carriers that are approved health maintenance organizations which are federally qualified under 42 U.S.C. §§ 300 et seq., to the extent that any restrictions are placed on such reinsuring carriers that are not imposed on other small employer carriers.

      6.  In determining the amount of net loss pursuant to this section, the Board shall include any expenses incurred by the Program of Reinsurance in providing such reinsurance.

      (Added to NRS by 1997, 2935; R 2013, 3661, effective January 1, 2014)

      NRS 689C.850  Net loss from reinsuring individual eligible persons and dependents required to be recouped by assessments against individual reinsuring carriers. [Effective through December 31, 2013.]

      1.  Any net loss from reinsuring individual eligible persons and their dependents must be recouped by assessments against individual reinsuring carriers.

      2.  As part of the plan of operation, the Board shall establish a formula pursuant to which assessments may be made against individual reinsuring carriers to recover the net loss. The formula must be based on:

      (a) The share of each individual reinsuring carrier of the total premiums earned by all individual reinsuring carriers during the preceding calendar year from existing health benefit plans delivered or issued for delivery to individuals in this state; and

      (b) The share of each individual reinsuring carrier of the premiums earned by all individual reinsuring carriers in the preceding calendar year from newly issued health benefit plans delivered or issued for delivery during that year to individuals in this state.

      3.  An assessment made against an individual reinsuring carrier pursuant to this section must not be less than 50 percent nor more than 150 percent of an amount equal to the proportion of the total premium earned by the individual reinsuring carrier during the preceding calendar year from health benefit plans delivered or issued for delivery to individuals in this state to the total premiums earned by all such carriers in the preceding calendar year for such health benefit plans.

      4.  The Board may, with the approval of the Commissioner, change the formula for determining assessments against individual reinsuring carriers established pursuant to this section as necessary. The Board may provide that, during any transitional period, the shares of the assessment base attributable to the total premiums and to the premiums of the previous year may vary.

      5.  Subject to the approval of the Commissioner, the Board shall adjust the formula for assessing individual reinsuring carriers that are approved health maintenance organizations which are federally qualified under 42 U.S.C. §§ 300 et seq., to the extent that any restrictions are placed on such individual reinsuring carriers that are not imposed on other individual carriers.

      6.  In determining the amount of net loss pursuant to this section, the Board shall include any expenses incurred by the Program of Reinsurance in providing such reinsurance.

      (Added to NRS by 1997, 2935; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]

      1.  On or before March 1 of each year, the Board shall determine, separately account for and file with the Commissioner an estimate of the assessments needed to fund the losses incurred by the Program of Reinsurance in the previous calendar year for:

      (a) Reinsured small employer groups, eligible employees and the dependents of such employees; and

      (b) Reinsured eligible persons.

      2.  If the Board determines that the amount of the assessments against reinsuring carriers needed to fund the losses incurred by the Program of Reinsurance in the previous calendar year will exceed 5 percent of the total premiums earned in the previous calendar year from health benefit plans delivered or issued for delivery in this state by reinsuring carriers and individual reinsuring carriers, the Board shall evaluate the operation of the Program of Reinsurance and report its findings, including any recommendations for changes to the plan of operation, to the Commissioner not later than 90 days after the end of the calendar year in which the losses were incurred. The evaluation must include an estimate of future assessments and administrative costs of the Program of Reinsurance, the appropriateness of the premium charged, the level of retention of insurers under the Program of Reinsurance and the costs of coverage for small employers. If the Board fails to file the report timely with the Commissioner, the Commissioner may evaluate the operations of the Program of Reinsurance and make such amendments to the plan of operation as the Commissioner determines to be necessary to reduce future losses and assessments.

      (Added to NRS by 1997, 2936; R 2013, 3661, effective January 1, 2014)

      NRS 689C.870  Additional funding: Eligibility based on amount of assessment needed; Board to establish formula for additional assessments on all carriers. [Effective through December 31, 2013.]

      1.  If, in each of 2 consecutive years, the Board determines that the amount of the assessment needed exceeds 5 percent of the total premiums earned in the previous calendar year from health benefit plans delivered or issued for delivery to small employers by reinsuring carriers, the Program of Reinsurance is eligible for additional funding pursuant to this section.

      2.  If, in each of 2 consecutive years, the Board determines that the amount of the assessment needed exceeds 5 percent of the total premiums earned in the previous calendar year from health benefit plans delivered or issued for delivery to individuals by individual reinsuring carriers, the Program of Reinsurance is eligible for additional funding pursuant to this section.

      3.  To raise the additional funding, the Board shall establish a formula pursuant to which additional assessments may be made on all carriers that offer a health benefit plan or provide stop-loss coverage for a health benefit plan which is an employer-sponsored plan or a plan established pursuant to the Labor-Management Relations Act, 1947, as amended. The total additional assessments on all such carriers combined may not exceed one-half of 1 percent of the total premiums earned from all health benefit plans and stop-loss coverage issued in this state in the previous calendar year.

      (Added to NRS by 1997, 2936; A 1999, 2814; R 2013, 3661, effective January 1, 2014)

      NRS 689C.880  Use of excess assessments. [Effective through December 31, 2013.]

      1.  If the amount of the assessments exceeds the net losses of the Program of Reinsurance from reinsuring small employers and eligible employees, the excess amount must be retained by the Board and used to offset future losses or to reduce the premiums of the reinsuring carriers.

      2.  If the amount of the assessments exceeds the net losses of the Program of Reinsurance from reinsuring eligible persons, the excess amount must be retained by the Board and used to offset future losses or to reduce the premiums of the individual reinsuring carriers.

      3.  As used in this section, “future losses” includes reserves for claims that have been incurred, but have not yet been reported.

      (Added to NRS by 1997, 2937; R 2013, 3661, effective January 1, 2014)

      NRS 689C.890  Assessment against reinsuring carrier to be determined annually; penalty for late payment of assessments; deferment of assessment. [Effective through December 31, 2013.]

      1.  Each assessment against a reinsuring carrier and individual reinsuring carrier must be determined annually by the Board based on annual statements and such other reports deemed relevant by the Board and filed by the reinsuring carriers with the Board.

      2.  The plan of operation must provide for the imposition of an interest penalty for late payment of assessments.

      3.  A reinsuring or individual reinsuring carrier may seek from the Commissioner a deferment of any part of an assessment imposed by the Board pursuant to NRS 689C.840. The Commissioner may defer any part of the assessment if the Commissioner determines that the payment of the assessment would place the carrier in a financially impaired condition. If any amount of an assessment against a carrier is deferred pursuant to this subsection, the amount so deferred must be assessed against the other participating carriers in a manner consistent with NRS 689C.840. A carrier receiving a deferment pursuant to this subsection remains liable to the Program of Reinsurance for the amount deferred and shall not reinsure any small employers, eligible employees or eligible persons with the Program of Reinsurance until the deferred assessment is paid.

      (Added to NRS by 1997, 2937; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]

      1.  The Board shall issue to each insurer paying an assessment under NRS 689C.870 a certificate of contribution, in a form prescribed by the Commissioner, for the amount so paid. All outstanding certificates are of equal dignity and priority without reference to the amounts or dates of issue. A member insurer may show a certificate of contribution as an asset in its financial statement in such form, for such amount, if any, and for such period as the Commissioner may approve.

      2.  A carrier may offset against its liability for premium tax to this state, accrued with respect to business transacted in a calendar year, an amount equal to 20 percent of the amount certified pursuant to subsection 1 in each of the 5 calendar years following the year in which the assessment was paid. If an insurer ceases to transact business, it may offset all uncredited assessments against its liability for premium tax for the year in which it ceases to transact business.

      (Added to NRS by 1997, 2937; R 2013, 3661, effective January 1, 2014)

      NRS 689C.910  Adjustment of assessment on federally qualified health maintenance organizations. [Effective through December 31, 2013.]  Subject to the approval of the Commissioner, the Board shall adjust the formula for assessing carriers that are approved health maintenance organizations which are federally qualified under 42 U.S.C. §§ 300 et seq., to the extent that any restrictions are placed on such carriers that are not imposed on other carriers.

      (Added to NRS by 1997, 2938; R 2013, 3661, effective January 1, 2014)

      NRS 689C.920  Immunity from liability of Program and reinsuring carriers for certain acts. [Effective through December 31, 2013.]  Except as otherwise provided in NRS 689C.790, neither participation in the Program of Reinsurance as a reinsuring carrier or individual reinsuring carrier, the establishment of rates, forms or procedures, nor any other joint or collective action required by NRS 689C.610 to 689C.980, inclusive, may be the basis of any legal action, civil liability or penalty against the Program of Reinsurance or any of the participating reinsuring carriers and individual reinsuring carriers, either jointly or separately.

      (Added to NRS by 1997, 2938; R 2013, 3661, effective January 1, 2014)

      NRS 689C.930  Board to develop standards setting forth manner and levels of compensation paid to producers for sale of health benefit plans. [Effective through December 31, 2013.]  As part of the plan of operation, the Board shall develop standards that set forth the manner and levels of compensation that may be paid to producers for the sale of basic and standard health benefit plans issued in accordance with the Program of Reinsurance. In establishing such standards, the Board shall consider:

      1.  The need to ensure the broad availability of coverages;

      2.  The objectives of the Program of Reinsurance;

      3.  The time and effort expended in placing the coverage;

      4.  The need to provide on-going service to small employers, eligible employees and eligible persons;

      5.  The level of compensation currently used in the industry; and

      6.  The overall cost of coverage to small employers, eligible employees and eligible persons selecting such coverage.

      (Added to NRS by 1997, 2938; R 2013, 3661, effective January 1, 2014)

      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. [Effective through December 31, 2013.]  Notwithstanding any specific statute to the contrary, a statute that requires the coverage of a specific health care service or benefit, or the reimbursement, utilization or inclusion of a specific category of licensed health care practitioner, is not applicable to a basic health benefit plan delivered or issued for delivery to small employers or eligible persons in this state pursuant to this chapter or chapter 689A of NRS.

      (Added to NRS by 1997, 2940; R 2013, 3661, effective January 1, 2014)

      NRS 689C.955  Member, agent or employee of Board immune from liability in certain circumstances. [Effective through December 31, 2013.]  No member, agent or employee of the Board may be held liable in a civil action for any act that the member, agent or employee performs in good faith in the execution of his or her duties pursuant to the provisions of this chapter.

      (Added to NRS by 1999, 2810; R 2013, 3661, effective January 1, 2014)

Committee on Health Benefit Plans

      NRS 689C.960  Creation; members; term; vacancy. [Effective through December 31, 2013.]

      1.  The Committee on Health Benefit Plans is hereby created consisting of eight members. The Commissioner shall appoint to the Committee representatives of carriers, small employers and eligible employees, eligible persons, health care providers, producers and third-party administrators.

      2.  Members of the Committee serve without compensation, but while engaged in the business of the Committee, each member is entitled to receive the per diem allowance or travel expenses provided for state officers and employees generally, to be paid from the proceeds of the assessments received by the Program of Reinsurance as an administrative expense of the Program of Reinsurance.

      3.  After the initial term, the term of each appointed member is 3 years. Members may be reappointed. A member may be removed from the Committee by the Commissioner for good cause shown.

      4.  At the expiration of the term of a member, or if the member resigns or is otherwise unable to complete his or her term, the Commissioner shall appoint a replacement not later than 30 days after the vacancy occurs.

      (Added to NRS by 1997, 2938; R 2013, 3661, effective January 1, 2014)

      NRS 689C.970  Meetings; Chair; duties. [Effective through December 31, 2013.]

      1.  The Committee shall meet:

      (a) Until a plan of operation, other than a temporary plan of operation, has been approved by the Commissioner, twice a year;

      (b) Once a plan of operation has been so approved, once a year; and

      (c) At such other times as the Commissioner deems necessary.

      2.  The Committee shall elect from its membership a Chair who shall serve for a term of 2 years. Any vacancy occurring in this position must be filled by election of the members of the Committee for the remainder of the unexpired term.

      3.  The Committee shall:

      (a) Recommend to the Board the form and level of coverages to be made available by small employers pursuant to NRS 689C.156, 689C.1565, 689C.157 and 689C.190, and by individual carriers pursuant to NRS 689A.680 to 689A.700, inclusive.

      (b) Recommend to the Board levels for benefits and cost sharing, exclusions and limitations for a basic health benefit plan and a standard health benefit plan.

      (c) Design a basic health benefit plan and a standard health benefit plan that are consistent with the basic method of operation and the benefit plans of health maintenance organizations authorized to transact insurance in this state, including any restrictions imposed by federal law.

      4.  The basic and standard health benefit plans recommended by the Committee may include features for the containment of costs, including:

      (a) Utilization review of health care services, including a review of the medical necessity of hospital and physician services;

      (b) Case management;

      (c) Selective contracting with hospitals, physicians and other providers of health care;

      (d) Reasonable benefit differentials applicable to providers that participate and providers that do not participate in arrangements using a provision for a restricted network; and

      (e) Other provisions relating to managed care.

      5.  The Committee shall submit its recommendations for a basic and a standard health benefit plan to the Commissioner not later than 120 days after the date on which the Committee is appointed.

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

      (Added to NRS by 1997, 2939; R 2013, 3661, effective January 1, 2014)

      NRS 689C.980  Board and Committee to study and submit report concerning effectiveness of certain provisions. [Effective through December 31, 2013.]

      1.  At least once every 3 years, the Board, in consultation with the Committee, shall study and submit a report to the Commissioner concerning the effectiveness of NRS 689C.610 to 689C.980, inclusive.

      2.  The report:

      (a) Must analyze the effectiveness of NRS 689C.610 to 689C.980, inclusive, in promoting the stability of rates, the availability of products and the affordability of coverage;

      (b) May contain recommendations for actions to improve the overall effectiveness, efficiency and fairness of the marketplace for health insurance for small employers and individuals;

      (c) Must address the issue of whether carriers and producers are fairly and actively marketing or issuing health benefit plans to small employers in accordance with the provisions of this chapter and to individuals in accordance with NRS 689A.470 to 689A.740, inclusive; and

      (d) May contain recommendations for the regulation of the marketplace for health insurance for small employers and individuals and other regulatory standards or actions.

      (Added to NRS by 1997, 2940; R 2013, 3661, effective January 1, 2014)