1. Following approval by the Commissioner, each insurer that issues a policy of health insurance in this State shall provide written notice to an insured, in clear and comprehensible language that is understandable to an ordinary layperson, explaining the right of the insured to file a written complaint. Such notice must be provided to an insured:
(a) At the time the insured receives his or her evidence of coverage;
(b) Any time that the insurer denies coverage of a health care service or limits coverage of a health care service to an insured; and
(c) Any other time deemed necessary by the Commissioner.
2. Any time that an insurer denies coverage of a health care service to an insured, including, without limitation, denying a claim relating to a policy of health insurance pursuant to NRS 689A.410, it shall notify the insured in writing within 10 working days after it denies coverage of the health care service of:
(a) The reason for denying coverage of the service;
(b) The criteria by which the insurer determines whether to authorize or deny coverage of the health care service; and
(c) The right of the insured to file a written complaint and the procedure for filing such a complaint.
3. A written notice which is approved by the Commissioner shall be deemed to be in clear and comprehensible language that is understandable to an ordinary layperson.
(Added to NRS by 1997, 308; A 1999, 3082)
Structure Nevada Revised Statutes
Chapter 689A - Individual Health Insurance
NRS 689A.030 - General requirements.
NRS 689A.0405 - Coverage for mammograms for certain women required; prohibited acts.
NRS 689A.0412 - Coverage for examination of person who is pregnant for certain diseases required.
NRS 689A.0423 - Coverage for treatment of certain inherited metabolic diseases required.
NRS 689A.0445 - Coverage for prostate cancer screening.
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.048 - Treatment by licensed psychologist.
NRS 689A.0487 - Treatment by licensed podiatrist.
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.075 - Cancellation and rescission of short-term limited duration medical plan.
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.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.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.380 - Definitions of terms used in policies.
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.700 - Regulations regarding rates.
NRS 689A.705 - Regulations concerning reissuance of health benefit plan.
NRS 689A.725 - Requirements for plan for coverage.
NRS 689A.745 - Establishment; approval; requirements; examination; exception.