1. A carrier that offers coverage in the small employer group or individual market must, before making any network plan available for sale in this State, demonstrate the capacity to deliver services adequately by applying to the Commissioner for the issuance of a network plan and submitting a description of the procedures and programs to be implemented to meet the requirements described in subsection 2.
2. The Commissioner shall determine, within 90 days after receipt of the application required pursuant to subsection 1, if the carrier, with respect to the network plan:
(a) Has demonstrated the willingness and ability to ensure that health care services will be provided in a manner to ensure both availability and accessibility of adequate personnel and facilities in a manner that enhances availability, accessibility and continuity of service;
(b) Has organizational arrangements established in accordance with regulations promulgated by the Commissioner; and
(c) Has a procedure established in accordance with regulations promulgated by the Commissioner to develop, compile, evaluate and report statistics relating to the cost of its operations, the pattern of utilization of its services, the availability and accessibility of its services and such other matters as may be reasonably required by the Commissioner.
3. The Commissioner may certify that the carrier and the network plan meet the requirements of subsection 2, or may determine that the carrier and the network plan do not meet such requirements. Upon a determination that the carrier and the network plan do not meet the requirements of subsection 2, the Commissioner shall specify in what respects the carrier and the network plan are deficient.
4. A carrier approved to issue a network plan pursuant to this section must file annually with the Commissioner a summary of information compiled pursuant to subsection 2 in a manner determined by the Commissioner.
5. The Commissioner shall, not less than once each year, or more often if deemed necessary by the Commissioner for the protection of the interests of the people of this State, make a determination concerning the availability and accessibility of the health care services of any network plan approved pursuant to this section.
6. The expense of any determination made by the Commissioner pursuant to this section must be assessed against the carrier and remitted to the Commissioner.
7. When making any determination concerning the availability and accessibility of the services of any network plan or proposed network plan pursuant to this section, the Commissioner shall consider services that may be provided through telehealth, as defined in NRS 629.515, pursuant to the network plan or proposed network plan to be available services.
8. As used in this section:
(a) "Network plan" has the meaning ascribed to it in NRS 689B.570.
(b) "Small employer" has the meaning ascribed to it in NRS 689C.095.
(Added to NRS by 2013, 3607; A 2015, 636; 2017, 2355)
Structure Nevada Revised Statutes
Chapter 687B - Contracts of Insurance
NRS 687B.015 - "Binder" defined.
NRS 687B.030 - Waiver of payment of premium.
NRS 687B.040 - Insurable interest: Personal insurance.
NRS 687B.050 - Insurable interest: Exception when certain institutions designated beneficiary.
NRS 687B.060 - Insurable interest: Property.
NRS 687B.070 - Power to contract; purchase of insurance and annuities by minors.
NRS 687B.090 - Alteration of application: Life and health insurance.
NRS 687B.100 - Application as evidence.
NRS 687B.110 - Representations in applications.
NRS 687B.122 - Readability of policies: Applicability of requirements.
NRS 687B.128 - Readability of policies: Required approval by Commissioner in certain circumstances.
NRS 687B.130 - Grounds for disapproval or withdrawal of previous approval.
NRS 687B.140 - Standard provisions.
NRS 687B.160 - Execution of policies.
NRS 687B.170 - Underwriters’ and combination policies.
NRS 687B.180 - Validity and construction of noncomplying forms.
NRS 687B.182 - Binders: Issuance; period of effectiveness.
NRS 687B.183 - Binders: Forms; required statement related to certain policies; delivery of copies.
NRS 687B.185 - Binders: Prohibition of use to lower premiums.
NRS 687B.186 - Binders: Proof of insurance coverage; penalties for refusal to accept; exception.
NRS 687B.187 - Binders: Disapproval of insurer.
NRS 687B.200 - Assignability: Life or health insurance policy.
NRS 687B.220 - Forms for proof of loss required to be furnished by insurer to insured claimant.
NRS 687B.240 - Administration of claims not waiver.
NRS 687B.250 - Payment not to constitute admission of liability or waiver of defenses.
NRS 687B.255 - Insurer required to pay claim with negotiable instrument.
NRS 687B.260 - Exemption of proceeds of certain policies.
NRS 687B.270 - Exemption of proceeds: Health insurance.
NRS 687B.280 - Exemption of proceeds: Group insurance.
NRS 687B.290 - Exemption of proceeds: Annuities; assignability of rights.
NRS 687B.300 - Retention of proceeds of policy by insurer.
NRS 687B.310 - Cancellations and nonrenewals; scope of application.
NRS 687B.330 - Anniversary cancellation.
NRS 687B.345 - Annual review of coverage and benefits provided in policy.
NRS 687B.470 - "Health benefit plan" defined.
NRS 687B.500 - Basis for premium rate; exceptions.
NRS 687B.602 - "Administrator" defined.
NRS 687B.605 - "Covered person" defined.
NRS 687B.606 - "Dental care" defined.
NRS 687B.607 - "Direct notification" defined.
NRS 687B.610 - "Evidence of coverage" defined.
NRS 687B.615 - "Health benefit plan" defined.
NRS 687B.620 - "Health care services" defined.
NRS 687B.625 - "Health carrier" defined.
NRS 687B.630 - "Intermediary" defined.
NRS 687B.635 - "Medically necessary" defined.
NRS 687B.640 - "Network" defined.
NRS 687B.645 - "Network plan" defined.
NRS 687B.650 - "Participating provider of health care" defined.
NRS 687B.655 - "Primary care physician" defined.
NRS 687B.658 - "Provider network contract" defined.
NRS 687B.660 - "Provider of health care" defined.
NRS 687B.664 - "Third party" defined.
NRS 687B.665 - "Utilization review" defined.
NRS 687B.670 - Requirements to offer or issue network plan.
NRS 687B.675 - Provision of information to Office for Consumer Health Assistance.
NRS 687B.740 - Inducement to provide less than medically necessary health care services prohibited.
NRS 687B.760 - Health records; confidentiality.
NRS 687B.800 - Retaliation for good faith reporting to state or federal authority prohibited.
NRS 687B.820 - Procedures for resolution of disputes.
NRS 687B.862 - "Attachment point" defined.
NRS 687B.864 - "Group health plan" defined.
NRS 687B.866 - "Health care services" defined.
NRS 687B.868 - "Multiple employer welfare arrangement" defined.
NRS 687B.870 - "Network" defined.
NRS 687B.872 - "Policy of provider stop-loss insurance" defined.
NRS 687B.874 - "Policy of stop-loss insurance" defined.
NRS 687B.876 - "Provider of health care" defined.
NRS 687B.878 - Reporting of premiums written in this State for policies of stop-loss insurance.