Nevada Revised Statutes
Chapter 689A - Individual Health Insurance
NRS 689A.745 - Establishment; approval; requirements; examination; exception.


1. Except as otherwise provided in subsection 4, each insurer that issues a policy of health insurance in this State shall establish a system for resolving any complaints of an insured concerning health care services covered under the policy. The system must be approved by the Commissioner.
2. A system for resolving complaints established pursuant to subsection 1 must include an initial investigation, a review of the complaint by a review board and a procedure for appealing a determination regarding the complaint. The majority of the members on a review board must be insureds who receive health care services pursuant to a policy of health insurance issued by the insurer.
3. The Commissioner may examine the system for resolving complaints established pursuant to subsection 1 at such times as the Commissioner deems necessary or appropriate.
4. Each insurer that issues a policy of health insurance in this State that provides, delivers, arranges for, pays for or reimburses any cost of health care services through managed care shall provide a system for resolving any complaints of an insured concerning those health care services that complies with the provisions of NRS 695G.200 to 695G.310, inclusive.
(Added to NRS by 1997, 307; A 2003, 774; 2011, 3381; 2017, 2365)

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Structure Nevada Revised Statutes

Nevada Revised Statutes

Chapter 689A - Individual Health Insurance

NRS 689A.010 - Short title.

NRS 689A.020 - Scope.

NRS 689A.030 - General requirements.

NRS 689A.032 - Insurer required to offer and issue plan regardless of health status of persons; prohibited acts.

NRS 689A.035 - Contracts between insurer and provider of health care: Prohibiting insurer from charging provider of health care fee for inclusion on list of providers given to insureds; insurer required to use form to obtain information on provider o...

NRS 689A.040 - Contents of policy; substitution of provisions; captions; omission or modification of provisions.

NRS 689A.0403 - Procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations. [Effective through December 31, 2021.] Procedure for arbitration of disputes concerning independent medical, dental or chiroprac...

NRS 689A.04033 - Coverage for certain treatment received as part of clinical trial or study for treatment of cancer or chronic fatigue syndrome required; authority of insurer to require certain information; immunity from liability.

NRS 689A.04036 - Coverage for continued medical treatment required in certain policies; exceptions; regulations.

NRS 689A.0404 - Coverage for use of certain drugs and related services for treatment of cancer required in certain policies.

NRS 689A.04041 - Policy covering prescription drug for treatment of cancer or cancer symptom that is part of step therapy protocol: Insurer required to allow insured or attending practitioner to apply for exemption from step therapy protocol in certa...

NRS 689A.04042 - Coverage for colorectal cancer screening required in policy covering treatment of colorectal cancer.

NRS 689A.04044 - Policy covering prescription drugs: Required actions by insurer related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared.

NRS 689A.04045 - Policy covering prescription drugs prohibited from limiting or excluding coverage for prescription drug previously approved for medical condition of insured; exception.

NRS 689A.04046 - Coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications required in policy covering prescription drugs; prohibited acts; exception.

NRS 689A.04047 - Policy covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products.

NRS 689A.04049 - Coverage for screening, genetic counseling and testing related to BRCA gene required in certain circumstances. [Effective January 1, 2022.]

NRS 689A.0405 - Coverage for mammograms for certain women required; prohibited acts.

NRS 689A.041 - Coverage relating to mastectomy required in policy covering mastectomies; prohibited acts.

NRS 689A.0412 - Coverage for examination of person who is pregnant for certain diseases required.

NRS 689A.0413 - Coverage for certain gynecological or obstetrical services without authorization or referral from primary care physician required.

NRS 689A.0415 - Coverage for hormone replacement therapy in certain circumstances required in policy covering prescription drugs or devices; prohibited acts; exception.

NRS 689A.0417 - Coverage for health care services related to hormone replacement therapy required in policy covering outpatient care; prohibited acts.

NRS 689A.0418 - Coverage for drug or device for contraception and related health services required; prohibited acts; exceptions. [Effective through December 31, 2021.] Coverage for drug or device for contraception and related health services required...

NRS 689A.0419 - Coverage for certain services, screenings and tests relating to wellness required; prohibited acts.

NRS 689A.042 - Policy containing exclusion, reduction or limitation of coverage relating to complications of pregnancy prohibited; exception.

NRS 689A.0423 - Coverage for treatment of certain inherited metabolic diseases required.

NRS 689A.0424 - Policy covering maternity care: Prohibited acts by insurer if insured is acting as gestational carrier; child deemed child of intended parent for purposes of policy.

NRS 689A.0425 - Individual health benefit plan that includes coverage for maternity care and pediatric care: Requirement to allow minimum stay in hospital in connection with childbirth; prohibited acts.

NRS 689A.0427 - Coverage for management and treatment of diabetes required in policy covering hospital, medical or surgical expenses.

NRS 689A.0428 - Coverage for management and treatment of sickle cell disease and its variants required; coverage for medically necessary prescription drugs to treat sickle cell disease and its variants required by plan covering prescription drugs.

NRS 689A.043 - Policy covering family on expense-incurred basis required to include certain coverage for insured’s newly born and adopted children and children placed with insured for adoption.

NRS 689A.0435 - Option of coverage for autism spectrum disorders for certain persons required; prohibited acts.

NRS 689A.0437 - Coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus required; reimbursement of pharmacist for certain services.

NRS 689A.044 - Coverage for certain tests and vaccines relating to human papillomavirus required; prohibited acts.

NRS 689A.0445 - Coverage for prostate cancer screening.

NRS 689A.0447 - Policy covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy.

NRS 689A.0455 - Coverage for treatment of conditions relating to severe mental illness required.

NRS 689A.046 - Benefits for treatment of alcohol or substance use disorder required.

NRS 689A.0463 - Coverage for services provided through telehealth required to same extent and in same amount as though provided in person or by other means; exception; prohibited acts. [Effective through 1 year after the date on which the Governor te...

NRS 689A.0464 - Policy covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by insurer if insured is person with disability.

NRS 689A.0465 - Policy prohibited from excluding coverage of treatment of temporomandibular joint; exception.

NRS 689A.0475 - Acupuncture.

NRS 689A.048 - Treatment by licensed psychologist.

NRS 689A.0483 - Treatment by licensed marriage and family therapist or licensed clinical professional counselor.

NRS 689A.0485 - Treatment by licensed associate in social work, social worker, master social worker, independent social worker or clinical social worker.

NRS 689A.0487 - Treatment by licensed podiatrist.

NRS 689A.049 - Treatment by licensed chiropractor; restriction on policy limitations. [Effective through December 31, 2021.] Treatment by licensed chiropractic physician; restriction on policy limitations. [Effective January 1, 2022.]

NRS 689A.0493 - Treatment by licensed clinical alcohol and drug counselor.

NRS 689A.0495 - Services provided by certain registered nurses.

NRS 689A.0497 - Provider of medical transportation.

NRS 689A.050 - Entire contract; changes.

NRS 689A.060 - Time limit on certain defenses.

NRS 689A.070 - Grace period.

NRS 689A.075 - Cancellation and rescission of short-term limited duration medical plan.

NRS 689A.080 - Reinstatement.

NRS 689A.090 - Notice of claim.

NRS 689A.100 - Claim forms: Required provision.

NRS 689A.105 - Claim forms: Uniform billing and claims forms.

NRS 689A.110 - Claim forms: Proofs of loss.

NRS 689A.120 - Time of payment of claims.

NRS 689A.130 - Payment of claims.

NRS 689A.135 - Assignment of benefits by insured to provider of health care.

NRS 689A.140 - Physical examination and autopsy.

NRS 689A.150 - Legal actions.

NRS 689A.160 - Change of beneficiary.

NRS 689A.170 - Right to examine and return policy.

NRS 689A.180 - Optional provisions: Requirements; substitution of provisions; captions.

NRS 689A.190 - Extended disability benefit.

NRS 689A.200 - Change of occupation.

NRS 689A.210 - Misstatement of age.

NRS 689A.220 - Coordination of benefits: Same insurer.

NRS 689A.230 - Coordination of benefits: All coverages.

NRS 689A.240 - Relation of earnings to insurance.

NRS 689A.250 - Unpaid premiums.

NRS 689A.260 - Conformity with state statutes.

NRS 689A.270 - Illegal occupation.

NRS 689A.290 - Renewability.

NRS 689A.300 - Order of certain provisions.

NRS 689A.310 - Ownership of policy by person other than insured.

NRS 689A.320 - Requirements of other jurisdictions.

NRS 689A.330 - Policies issued for delivery in another state.

NRS 689A.340 - Limitation on provisions not subject to chapter; effect of violation of chapter; conflict among provisions.

NRS 689A.350 - Age limit.

NRS 689A.380 - Definitions of terms used in policies.

NRS 689A.405 - Policy covering prescription drugs: Provision of notice and information regarding use of formulary.

NRS 689A.410 - Approval or denial of claims; payment of claims and interest; requests for additional information; award of costs and attorney’s fees; compliance with requirements; imposition of administrative fine or suspension or revocation of certi...

NRS 689A.413 - Insurer prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence.

NRS 689A.415 - Insurer prohibited from denying coverage solely because applicant or insured was intoxicated or under influence of controlled substance; exceptions.

NRS 689A.417 - Insurer prohibited from requiring or using information concerning genetic testing; exceptions.

NRS 689A.419 - Offering policy of health insurance for purposes of establishing health savings account.

NRS 689A.420 - Definitions.

NRS 689A.430 - Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency.

NRS 689A.440 - Insurer prohibited from asserting certain grounds to deny enrollment of child of insured pursuant to order.

NRS 689A.450 - Certain accommodations required to be made when child is covered under policy of noncustodial parent.

NRS 689A.460 - Insurer required to authorize enrollment of child of parent who is required by order to provide medical coverage under certain circumstances; termination of coverage of child.

NRS 689A.470 - Definitions.

NRS 689A.475 - "Affiliated" defined.

NRS 689A.485 - "Bona fide association" defined.

NRS 689A.490 - "Church plan" defined.

NRS 689A.495 - "Control" defined.

NRS 689A.505 - "Creditable coverage" defined.

NRS 689A.510 - "Dependent" defined.

NRS 689A.523 - "Exclusion for a preexisting condition" defined.

NRS 689A.525 - "Geographic rating area" defined.

NRS 689A.527 - "Geographic service area" defined.

NRS 689A.530 - "Governmental plan" defined.

NRS 689A.535 - "Group health plan" defined.

NRS 689A.540 - "Health benefit plan" defined.

NRS 689A.550 - "Individual carrier" defined.

NRS 689A.555 - "Individual health benefit plan" defined.

NRS 689A.570 - "Plan for coverage of a bona fide association" defined.

NRS 689A.580 - "Plan sponsor" defined.

NRS 689A.585 - "Preexisting condition" defined.

NRS 689A.590 - "Producer" defined.

NRS 689A.600 - "Provision for a restricted network" defined.

NRS 689A.615 - 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 689A.630 - Requirement to renew coverage at option of individual; exceptions; discontinuation of product; discontinuation of health benefit plan available through bona fide association.

NRS 689A.635 - Coverage offered through network plan not required to be offered to person who does not reside or work in geographic service area or geographic rating area.

NRS 689A.637 - Coverage offered through plan that provides for restricted network: Contracts with certain federally qualified health centers.

NRS 689A.696 - Information and documents required to be made available to Commissioner; proprietary information.

NRS 689A.700 - Regulations regarding rates.

NRS 689A.705 - Regulations concerning reissuance of health benefit plan.

NRS 689A.710 - Prohibited acts; denial of application for coverage; regulations; violation may constitute unfair trade practice; applicability of section.

NRS 689A.715 - Requirements for employee welfare benefit plan for providing benefits for employees of more than one employer.

NRS 689A.717 - Individual health benefit plan covering maternity care and pediatric care: Requirement to allow minimum stay in hospital in connection with childbirth; prohibited acts.

NRS 689A.720 - Written certification of coverage required for determining period of creditable coverage accumulated by person; provision of certificate to insured.

NRS 689A.725 - Requirements for plan for coverage.

NRS 689A.740 - Regulations.

NRS 689A.745 - Establishment; approval; requirements; examination; exception.

NRS 689A.750 - Annual report; insurer required to maintain records of and report complaints concerning something other than health care services.

NRS 689A.755 - Written notice required to be provided by insurer to insured explaining right to file complaint; written notice to insured required when insurer denies coverage of health care service.