Nevada Revised Statutes
Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service
NRS 695B.170 - Acquisition costs and administrative expenses; effect of finding of excess costs.

All acquisition costs in connection with the solicitation of subscribers to such hospital, medical or dental service plan shall at all times be subject to the approval of the Commissioner, and the administrative expenses for any calendar year, excluding the first full year of operation, of any such corporation, including acquisition costs, shall be limited to 25 percent of the aggregate amount of rates, dues, fees and other periodic charges actually received during that year. If the Commissioner finds that acquisition costs of any corporation operating under the provisions of this chapter are excessive, or that the administrative expenses exceed the amount above stated, such finding shall be sufficient ground to justify the Commissioner in revoking the consent of the Commissioner to the establishment, maintenance and operation by such corporation of the hospital, medical or dental service plan.
(Added to NRS by 1971, 1869)

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Structure Nevada Revised Statutes

Nevada Revised Statutes

Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service

NRS 695B.010 - Short title.

NRS 695B.020 - Scope.

NRS 695B.030 - Definitions.

NRS 695B.035 - Contract between corporation and provider of health care: Prohibiting corporation from charging provider of health care fee for inclusion on list of providers given to insureds; corporation required to use form to obtain information on...

NRS 695B.040 - Corporations authorized to undertake and operate plans.

NRS 695B.050 - Manner of incorporation.

NRS 695B.060 - Directors: Qualifications.

NRS 695B.070 - Merger and consolidation: Procedure.

NRS 695B.080 - Merger and consolidation: Continuance of contracts and contribution certificates.

NRS 695B.090 - Merger and consolidation: Withdrawal of prior deposit of securities.

NRS 695B.110 - Certificate of authority: Required; fees.

NRS 695B.120 - Certificate of authority: Qualifications.

NRS 695B.130 - Certificate of authority: Application; issuance.

NRS 695B.135 - Certificate of authority: Expiration; renewal.

NRS 695B.140 - Reserve fund: Minimum amounts; computation; contracts with hospitals; participation of physicians or dentists.

NRS 695B.150 - Insolvency; determination of financial condition; actions by Commissioner; review; regulations.

NRS 695B.160 - Annual statement of condition and affairs; annual financial statement; quarterly statement; fees; examination by Commissioner.

NRS 695B.165 - Annual statement required to include report of net worth.

NRS 695B.170 - Acquisition costs and administrative expenses; effect of finding of excess costs.

NRS 695B.176 - Contract covering prescription drugs: Provision of notice and information regarding use of formulary.

NRS 695B.180 - Required provisions.

NRS 695B.181 - Provision in contract requiring binding arbitration authorized; procedures for arbitration; declaratory relief.

NRS 695B.182 - Required procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations. [Effective through December 31, 2021.] Required procedure for arbitration of disputes concerning independent medical, de...

NRS 695B.183 - Insurer required to offer and issue plan regardless of health status of persons; prohibited acts; authority to include wellness program in plan that offers discounts based on health status under certain circumstances.

NRS 695B.185 - Group contract which offers difference of payment between preferred providers of health care and providers who are not preferred: Limitations on deductibles and copayments; circumstances in which service is deemed to be provided by pre...

NRS 695B.187 - Group contract issued to replace discontinued policy or coverage: Requirements; notice of reduction of benefits; statement of benefits; applicability to self-insured employer.

NRS 695B.189 - Group contract: Required provision permitting continuation of coverage.

NRS 695B.190 - Family contracts.

NRS 695B.1901 - Required provision in certain policies concerning coverage for continued medical treatment; exceptions; regulations.

NRS 695B.1903 - Required provision concerning coverage for certain treatment as part of clinical trial or study for treatment of cancer or chronic fatigue syndrome; authority of corporation to require certain information; immunity from liability.

NRS 695B.1904 - Required provision concerning coverage for services provided through telehealth 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...

NRS 695B.19045 - Policy covering prescription drugs: Required actions by corporation related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared.

NRS 695B.1905 - Contract covering prescription drugs prohibited from limiting or excluding coverage for certain prescription drugs previously approved for medical condition of insured; exceptions.

NRS 695B.1906 - Required provision in policy covering prescription drugs concerning coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications; prohibited acts; exception.

NRS 695B.1907 - Required provision in policy covering treatment of colorectal cancer concerning coverage for colorectal cancer screening.

NRS 695B.1908 - Required provision in certain contracts concerning coverage for certain drugs and related services for treatment of cancer.

NRS 695B.19085 - Policy covering prescription drug for treatment of cancer or cancer symptom that is part of step therapy protocol: Corporation required to allow insured or attending practitioner to apply exemption from step therapy protocol in certa...

NRS 695B.1909 - Contract covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy.

NRS 695B.191 - Required provision in policy covering mastectomies concerning coverage relating to mastectomy; prohibited acts.

NRS 695B.1911 - Required provision concerning coverage for screening, genetic counseling and testing related to BRCA gene in certain circumstances. [Effective January 1, 2022.]

NRS 695B.1912 - Required provision concerning coverage for mammograms for certain women; prohibited acts.

NRS 695B.1913 - Required provision concerning coverage for examination of person who is pregnant for certain diseases.

NRS 695B.1914 - Required provision concerning coverage of certain gynecological and obstetrical services without authorization or referral from primary care physician.

NRS 695B.1916 - Required provision in contract covering prescription drugs or devices concerning coverage of hormone replacement therapy in certain circumstances; prohibited acts; exception.

NRS 695B.1918 - Required provision in contract covering outpatient care concerning coverage of health care services related to hormone replacement therapy; prohibited acts.

NRS 695B.1919 - Required provision concerning coverage for drug or device for contraception and related health services; prohibited acts; exceptions. [Effective through December 31, 2021.] Required provision concerning coverage for drug or device for...

NRS 695B.19195 - Required provision concerning coverage for certain services, screenings and tests relating to wellness; prohibited acts.

NRS 695B.192 - Contract containing exclusion, reduction or limitation of coverage relating to complications of pregnancy prohibited; exception.

NRS 695B.1923 - Required provision concerning coverage for treatment of certain inherited metabolic diseases.

NRS 695B.1924 - Required provision concerning coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus; reimbursement of pharmacist for certain services.

NRS 695B.1925 - Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus; prohibited acts.

NRS 695B.1927 - Required provision in contract covering hospital, medical or surgical expenses concerning coverage for management and treatment of diabetes.

NRS 695B.1929 - Required provision of coverage for management and treatment of sickle cell disease and its variants; policy covering prescription drugs required to provide coverage for medically necessary prescription drugs to treat sickle cell disea...

NRS 695B.193 - Contract covering family member of subscriber required to include certain coverage for subscriber’s newly born and adopted children and children placed with subscriber for adoption.

NRS 695B.1931 - Contract prohibited from excluding coverage relating to treatment of temporomandibular joint; exception.

NRS 695B.1932 - Policy covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products.

NRS 695B.1942 - Required provision in contract covering treatment of prostate cancer concerning coverage for prostate cancer screening; prohibited act.

NRS 695B.1944 - Required provision in certain group contracts concerning continuing coverage for employee or member on leave without pay as result of total disability.

NRS 695B.1948 - Contract covering maternity care: Prohibited acts by insurer if insured is acting as gestational carrier; child deemed child of intended parent for purposes of contract.

NRS 695B.1949 - Contract covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by insurer if insured is person with disability.

NRS 695B.1951 - Reimbursement for treatment by podiatrist.

NRS 695B.1955 - Reimbursement for treatment by licensed clinical alcohol and drug counselor.

NRS 695B.196 - Reimbursement for acupuncture.

NRS 695B.197 - Reimbursement for treatment by licensed psychologist.

NRS 695B.1973 - Reimbursement for treatment by licensed marriage and family therapist or licensed clinical professional counselor.

NRS 695B.1975 - Reimbursement for treatment by licensed associate in social work, social worker, master social worker, independent social worker or clinical social worker.

NRS 695B.198 - Reimbursement for treatment by chiropractor. [Effective through December 31, 2021.] Reimbursement for treatment by chiropractic physician. [Effective January 1, 2022.]

NRS 695B.199 - Reimbursement for services provided by certain nurses.

NRS 695B.1995 - Reimbursement to provider of medical transportation.

NRS 695B.200 - Group contracts written under master contract: Conditions required for issuance.

NRS 695B.210 - Group master service contract: Required provisions.

NRS 695B.220 - Blanket service contracts: Issuance to college, school or school personnel; pupils not to be compelled to accept service.

NRS 695B.225 - Policies of group insurance: Order of benefits.

NRS 695B.227 - Required contract with insurance company for provision of insurance, indemnity or reimbursement against cost of hospital, medical and dental services; required provisions.

NRS 695B.230 - Filing and approval of forms and schedules of premium rates.

NRS 695B.240 - Provision of group service coverage before approval of forms.

NRS 695B.250 - Extensions of time; automatic approval.

NRS 695B.2505 - 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 cert...

NRS 695B.251 - Group subscriber contracts required to contain provision for conversion to individual contracts; exceptions.

NRS 695B.252 - Conversion privilege available to spouse and children; conditions.

NRS 695B.253 - Denial of converted contract because of overinsurance; notice concerning cancellation of other coverage.

NRS 695B.254 - Choice of types of contracts required to be offered.

NRS 695B.255 - Benefits exceeding those provided under group contract not required; exclusions and limitations.

NRS 695B.2555 - Benefits payable under converted contract authorized to be reduced by amount payable under group contract; limitation.

NRS 695B.256 - Issuance and effective date of converted contract; premiums; persons covered.

NRS 695B.2565 - Renewal of converted contract: Request for information on sources of other benefits; grounds for refusal to renew; notice concerning cancellation of other coverage.

NRS 695B.257 - Notice of conversion privilege.

NRS 695B.2575 - Converted contract delivered outside Nevada: Form.

NRS 695B.258 - Extension of coverage under existing group contract.

NRS 695B.2585 - Provision of group coverage in lieu of converted individual contract.

NRS 695B.259 - Continuation of identical coverage in lieu of converted contract.

NRS 695B.260 - Suspension or revocation of permission to provide coverage before approval of forms.

NRS 695B.270 - Disapproval of forms; issuance unlawful.

NRS 695B.280 - Regulations; limitations.

NRS 695B.285 - Use of Uniform Billing and Claims Forms authorized.

NRS 695B.290 - Agent’s license required.

NRS 695B.300 - Contracts with agencies or political subdivisions of United States or State of Nevada; acceptance of money; subcontracts.

NRS 695B.310 - Corporation subject to same taxes, licenses, fees and supervision as domestic mutual insurer.

NRS 695B.315 - Provision of information regarding claims by policyholder for renewal of insurance policy required upon request; fee; regulations.

NRS 695B.316 - Corporation prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence.

NRS 695B.3165 - Corporation prohibited from denying coverage solely because applicant or insured was intoxicated or under the influence of controlled substance; exceptions.

NRS 695B.317 - Corporation that provides health insurance prohibited from requiring or using information concerning genetic testing; exceptions.

NRS 695B.318 - Applicability of certain provisions concerning portability and availability of health insurance.

NRS 695B.319 - Offering policy of health insurance for purposes of establishing health savings account.

NRS 695B.320 - Applicability of other provisions.

NRS 695B.330 - Definitions.

NRS 695B.340 - Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency.

NRS 695B.350 - Corporation prohibited from asserting certain grounds to deny enrollment of child of insured pursuant to order.

NRS 695B.360 - Certain accommodations required to be made when child is covered under policy of noncustodial parent.

NRS 695B.370 - Corporation 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 695B.380 - Establishment; approval; requirements; examination.

NRS 695B.390 - Annual report; insurer required to maintain records of complaints concerning something other than health care services.

NRS 695B.400 - Written notice to insured required to be provided by insurer explaining right to file complaint; written notice to insured required when insurer denies coverage of health care service.