[Rev. 6/26/2026 12:35:01 PM]
[NAC-695G Revised Date: 6-26]
695G.100 Requirements for approval.
695G.110 Annual report.
REVISER’S NOTE.
Pursuant to the provisions of NRS 0.024, former NAC 695G.020, 695G.030 and 695G.040 contained definitions that were deemed duplicative of those set forth in NRS 679A.060, 679A.085 and 695G.050, respectively, and were removed from chapter 695G of NAC in accordance with ch. 56, Stats. 2009, which contains the following provision not included in NRS:
“Sec. 2. The Legislative Counsel shall, in preparing supplements to the Nevada Administrative Code, appropriately change, move or remove any words and terms in the Nevada Administrative Code in a manner that the Legislative Counsel determines necessary to ensure consistency with the provisions of section 1 of this act [NRS 0.024].”
NAC 695G.100 Requirements for approval. (NRS 679B.130, 695G.200) To obtain approval of a system for resolving complaints of insureds from the Commissioner as required pursuant to NRS 695G.200, a managed care organization must:
1. Demonstrate that the system will include the external review of a final adverse determination.
2. Submit to the Division:
(a) The name and title of the employee responsible for the system;
(b) A description of the procedure used to notify an insured of the decision regarding his or her complaint; and
(c) A copy of the explanation of rights and procedures which is to be provided to insureds pursuant to NRS 695G.230.
(Added to NAC by Comm’r of Insurance by R132-98, eff. 3-30-99; A by R132-03, 4-16-2004)
NAC 695G.110 Annual report. (NRS 679B.130, 695G.220)
1. A managed care organization shall submit its annual report regarding its system for resolving complaints as required pursuant to NRS 695G.220 on or before June 1 of each year. The managed care organization shall retain a copy of the annual report for at least 3 years or until the next examination conducted by the Division, whichever is longer.
2. The managed care organization is not required to include in the annual report information concerning an oral inquiry by an insured relating to a misunderstanding or miscommunication if the misunderstanding or miscommunication was resolved within 1 working day after the inquiry was made. If the misunderstanding or miscommunication was not resolved within 1 working day, the managed care organization shall report it as a complaint in the annual report.
(Added to NAC by Comm’r of Insurance by R132-98, eff. 3-30-99; A by R008-02, 5-23-2002)