Nevada Revised Statutes
Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service
NRS 695B.380 - Establishment; approval; requirements; examination.

1. Except as otherwise provided in subsection 4, each insurer that issues a contract for hospital or medical services 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 contract for hospital or medical services 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 contract specified in subsection 1 shall, if the contract provides, delivers, arranges for, pays for or reimburses any cost of health care services through managed care, 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, 310; A 2003, 776; 2011, 3395; 2017, 2390)

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.