Nevada Revised Statutes
Chapter 695C - Health Maintenance Organizations

NRS 695C.057 - Applicability of certain provisions concerning portability and availability of health insurance. - 1. A health maintenance organization is subject to the provisions...

NRS 695C.060 - Establishment of health maintenance organization. - 1. Any person may apply to the Commissioner for and...

NRS 695C.070 - Certificate of authority: Application. - Each application for a certificate of authority must be verified...

NRS 695C.080 - Certificate of authority: Evaluation of application. - 1. The Commissioner shall determine whether the applicant for a...

NRS 695C.090 - Certificate of authority: Issuance. - The Commissioner shall issue or deny a certificate of authority...

NRS 695C.100 - Certificate of authority: Denial. - A certificate of authority shall be denied only after compliance...

NRS 695C.110 - Governing body: Composition; participation by enrollees. - 1. The governing body of any health maintenance organization may...

NRS 695C.120 - Powers of health maintenance organization. - The powers of a health maintenance organization include, but are...

NRS 695C.123 - Contracts with certain federally qualified health centers. - 1. Except as otherwise provided in NRS 422.273, a health...

NRS 695C.125 - Contract between health maintenance organization and provider of health care: Organization required to use form to obtain information on provider of health care; modification; submission by organization of schedule of payments to provi... - 1. A health maintenance organization shall not contract with a...

NRS 695C.128 - Contracts to provide services pursuant to certain state programs: Payment of interest on claims. - Any contract or other agreement entered into or renewed by...

NRS 695C.130 - Notice and approval required for exercise of powers; rules or regulations. - 1. A health maintenance organization shall file notice, with adequate...

NRS 695C.140 - Notice and approval required for modification of operations; regulations. - 1. A health maintenance organization shall, unless otherwise provided for...

NRS 695C.145 - Accounting principles required for certain reports and transactions; health maintenance organization subject to requirements for certain insurers. - 1. A health maintenance organization shall use accounting principles that...

NRS 695C.150 - Fiduciary responsibilities. - Any director, officer, partner, member or employee of a health...

NRS 695C.160 - Investments. - With the exception of investments made in accordance with subsections...

NRS 695C.161 - Definitions. - As used in NRS 695C.161 to 695C.169, inclusive, unless the...

NRS 695C.163 - Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency. - 1. A health maintenance organization shall not, when considering eligibility...

NRS 695C.165 - Health maintenance organization prohibited from asserting certain grounds to deny enrollment of child pursuant to order if parent is enrolled in health care plan. - An organization shall not deny the enrollment of a child...

NRS 695C.167 - Certain accommodations required to be made when child is covered under health care plan of noncustodial parent. - If a child has coverage under a health care plan...

NRS 695C.169 - Health maintenance organization 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. - If a parent is required by an order for medical...

NRS 695C.1691 - Required provision in certain plans concerning coverage for continued medical treatment; exceptions; regulations. - 1. The provisions of this section apply to a health...

NRS 695C.1693 - Required provision concerning coverage for certain treatment received as part of clinical trial or study for treatment of cancer or chronic fatigue syndrome; authority of health maintenance organization to require certain information;... - 1. Except as otherwise provided in NRS 695C.050, a health...

NRS 695C.1694 - Required provision in plan covering prescription drugs or devices concerning coverage of hormone replacement therapy in certain circumstances; prohibited acts; exception. - 1. A health maintenance organization which offers or issues a...

NRS 695C.16945 - Plan covering prescription drugs: Required actions by health maintenance organization related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared. - 1. If the Governor or the Legislature proclaims the existence...

NRS 695C.1695 - Required provision in plan covering outpatient care concerning coverage of health care services related to hormone replacement therapy; prohibited acts. - 1. A health maintenance organization that offers or issues a...

NRS 695C.1696 - 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... - 1. Except as otherwise provided in subsection 7, a health...

NRS 695C.1698 - Required provision concerning coverage for certain services, screenings and tests relating to wellness; prohibited acts. - 1. A health maintenance organization that offers or issues a...

NRS 695C.170 - Evidence of coverage: Issuance; form and contents. - 1. Every enrollee residing in this state is entitled to...

NRS 695C.1701 - Health maintenance organization 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 circums... - 1. A health maintenance organization shall offer and issue a...

NRS 695C.1703 - Evidence of coverage covering prescription drugs: Provision of notice and information regarding use of formulary. - 1. A health maintenance organization or insurer that offers or...

NRS 695C.1705 - Group health care plan issued to replace discontinued policy or coverage: Requirements; notice of reduction of benefits; statement of benefits; applicability to self-insured employer. - Except as otherwise provided in the provisions of NRS 689B.340...

NRS 695C.1708 - 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... - 1. A health care plan of a health maintenance organization...

NRS 695C.1709 - Required provision in group insurance policy concerning continuing coverage for enrollee on leave without pay as result of total disability. - 1. As used in this section, "total disability" and "totally...

NRS 695C.171 - Required provision in plan covering mastectomies concerning coverage relating to mastectomy; prohibited acts. - 1. A health maintenance plan which provides coverage for the...

NRS 695C.1712 - Health care plan covering maternity care: Prohibited acts by organization if enrollee is acting as gestational carrier; child deemed child of intended parent for purposes of plan. - 1. A health maintenance organization that offers or issues a...

NRS 695C.1713 - Required provision concerning coverage of certain gynecological and obstetrical services without authorization or referral from primary care physician. - 1. A health care plan must include a provision authorizing...

NRS 695C.1717 - Required provision concerning coverage for autism spectrum disorders for certain persons; prohibited acts. - 1. A health care plan issued by a health maintenance...

NRS 695C.172 - Evidence of coverage containing exclusion, reduction or limitation of coverage relating to complications of pregnancy; prohibited acts; exception. - 1. No health maintenance organization may issue evidence of coverage...

NRS 695C.1723 - Required provision concerning coverage for treatment of certain inherited metabolic diseases. - 1. A health maintenance plan must provide coverage for: (a)...

NRS 695C.1727 - Required provision in evidence of coverage covering hospital, medical or surgical expenses concerning coverage for management and treatment of diabetes. - 1. No evidence of coverage that provides coverage for hospital,...

NRS 695C.1728 - Required provision concerning coverage for management and treatment of sickle cell disease and its variants; plan covering prescription drugs required to provide coverage for medically necessary prescription drugs to treat sickle cell... - 1. A health maintenance organization that issues a health care...

NRS 695C.173 - Plan covering family member of enrollee required to include certain coverage for enrollee’s newly born and adopted children and children placed with enrollee for adoption. - 1. All individual and group health care plans which provide...

NRS 695C.1731 - Required provision in plan covering treatment of colorectal cancer concerning coverage for colorectal cancer screening. - 1. A health care plan issued by a health maintenance...

NRS 695C.1733 - Required provision in certain evidences of coverage concerning coverage for certain drugs and related services for treatment of cancer. - Except as otherwise provided in NRS 695C.1693: 1. No evidence...

NRS 695C.17333 - Plan covering prescription drug for treatment of cancer or cancer symptom that is part of step therapy protocol: Health maintenance organization required to allow enrollee or attending practitioner to apply for exemption from step th... - 1. A health maintenance organization that offers or issues a...

NRS 695C.17335 - Plan covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy. - 1. A health maintenance organization that offers or issues a...

NRS 695C.1734 - Evidence of coverage covering prescription drugs prohibited from limiting or excluding coverage for certain prescription drugs previously approved for medical condition of enrollee; exceptions. - 1. Except as otherwise provided in this section, evidence of...

NRS 695C.17345 - Required provision in plan covering prescription drugs concerning coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications; prohibited acts; exception. - 1. A health maintenance organization that offers or issues a...

NRS 695C.17347 - Required provision concerning coverage for screening, genetic counseling and testing related to BRCA gene in certain circumstances. [Effective January 1, 2022.] - 1. A health maintenance organization that issues a health care...

NRS 695C.1735 - Required provision concerning coverage for mammograms for certain women; prohibited acts. - 1. A health care plan of a health maintenance organization...

NRS 695C.1737 - Required provision concerning coverage for examination of person who is pregnant for certain diseases. - 1. A health maintenance organization that issues a health care...

NRS 695C.1743 - Required provision concerning coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus; reimbursement of pharmacist for certain services. - 1. A health maintenance organization that offers or issues a...

NRS 695C.1745 - Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus; prohibited acts. - 1. A health care plan of a health maintenance organization...

NRS 695C.1751 - Required provision in plan covering treatment of prostate cancer concerning coverage for prostate cancer screening; prohibited act. - 1. A health care plan of a health maintenance organization...

NRS 695C.1755 - Evidence of coverage prohibited from excluding coverage for treatment of temporomandibular joint; exception. - 1. Except as otherwise provided in this section, no evidence...

NRS 695C.1757 - Plan covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products. - 1. A health maintenance organization which offers or issues a...

NRS 695C.1759 - Plan covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by health maintenance organization if insured is person with disability. - 1. A health maintenance organization that offers or issues a...

NRS 695C.176 - Required provision concerning coverage for hospice care. - Each health care plan must provide benefits for hospice care....

NRS 695C.1765 - Reimbursement for acupuncture. - If any evidence of coverage provides coverage for acupuncture performed...

NRS 695C.177 - Reimbursement for treatments by licensed psychologist. - If any evidence of coverage provides coverage for treatment of...

NRS 695C.1773 - Reimbursement for treatment by licensed marriage and family therapist or licensed clinical professional counselor. - If any evidence of coverage provides coverage for treatment of...

NRS 695C.1775 - Reimbursement for treatment by licensed associate in social work, social worker, master social worker, independent social worker or clinical social worker. - If any evidence of coverage provides coverage for treatment of...

NRS 695C.178 - Reimbursement for treatment by chiropractor. [Effective through December 31, 2021.] Reimbursement for treatment by chiropractic physician. [Effective January 1, 2022.] - 1. If any evidence of coverage provides coverage for treatment...

NRS 695C.1783 - Reimbursement for treatment by podiatrist. - 1. If any evidence of coverage provides coverage for treatment...

NRS 695C.1789 - Reimbursement for treatment by licensed clinical alcohol and drug counselor. - If any evidence of coverage provides coverage for treatment of...

NRS 695C.179 - Reimbursement for services provided by certain nurses. - 1. If any evidence of coverage provides coverage for services...

NRS 695C.1795 - Reimbursement to provider of medical transportation. - 1. Except as otherwise provided in subsection 3, every evidence...

NRS 695C.185 - 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... - 1. Except as otherwise provided in subsection 2 and NRS...

NRS 695C.187 - Schedule for payment of claims: Mandatory inclusion in arrangements for provision of health care. - 1. A health maintenance organization shall not: (a) Enter into...

NRS 695C.190 - Commissioner authorized to require submission of information necessary to determine approval or disapproval of filing. - The Commissioner may require the submission of whatever relevant information...

NRS 695C.194 - Provision of health care services to recipients of Medicaid or enrollees in Children’s Health Insurance Program: Requirement to contract with hospital with certain endorsement for inclusion in network of providers. - A health maintenance organization that provides health care services to...

NRS 695C.200 - Approval of forms and schedules. - The Commissioner shall within a reasonable period approve any form...

NRS 695C.201 - Offering policy of health insurance for purposes of establishing health savings account. - A health maintenance organization may, subject to regulation by the...

NRS 695C.202 - Provision of health care services to recipients of Medicaid: Notice to recipients if Department of Health and Human Services obtains waiver to provide dental care to persons with diabetes; coordination to ensure receipt of such care. - If the Department of Health and Human Services obtains a...

NRS 695C.203 - Health maintenance organization prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence. - A health maintenance organization shall not deny a claim, refuse...

NRS 695C.205 - Health maintenance organization prohibited from denying coverage solely because applicant or insured was intoxicated or under the influence of controlled substance; exceptions. - 1. Except as otherwise provided in subsection 2, a health...

NRS 695C.207 - Health maintenance organization prohibited from requiring or using information concerning genetic testing. - 1. A health maintenance organization shall not: (a) Require an...

NRS 695C.210 - Annual report of financial condition and financial statement; quarterly statement; administrative penalty for failure to file timely report or statement; extension of time. - 1. Every health maintenance organization shall file with the Commissioner...

NRS 695C.215 - Financial statement required to include report of net worth. - A health maintenance organization which has been issued a certificate...

NRS 695C.220 - Applications, filings and reports open to public inspection; exception. - All applications, filings and reports required under this chapter shall...

NRS 695C.230 - Fees; forwarding of premium tax. - 1. Every health maintenance organization subject to this chapter shall...

NRS 695C.240 - Information required to be available for inspection. - Every health maintenance organization shall have available for inspection the...

NRS 695C.260 - Establishment of system for resolving complaints and system for conducting external review of adverse determinations required. - Each health maintenance organization shall establish: 1. A system for...

NRS 695C.265 - 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... - 1. If a health maintenance organization, for any final determination...

NRS 695C.267 - Provision requiring binding arbitration authorized; procedures for arbitration; declaratory relief. - 1. Except as otherwise provided in NRS 695C.265 and subject...

NRS 695C.270 - Surety bond or deposit required; waiver. - Each health maintenance organization shall furnish a surety bond in...

NRS 695C.275 - Commissioner required to adopt regulations for licensing of provider-sponsored organizations to extent authorized by federal law. - 1. To the extent authorized by federal law, the Commissioner...

NRS 695C.280 - Commissioner authorized to adopt regulations for licensing of agents or brokers. - The Commissioner may adopt such reasonable regulations as are necessary...

NRS 695C.290 - Insurance company authorized to establish or contract with health maintenance organization. - 1. An insurance company licensed in this State may either...

NRS 695C.300 - Prohibited practices. - 1. No health maintenance organization or representative thereof may cause...

NRS 695C.310 - Examinations by Commissioner: Affairs of and compliance program used by health maintenance organization; submission of books and records; assessment of expenses; exception. - 1. The Commissioner shall make an examination of the affairs...

NRS 695C.311 - Examinations by Commissioner: Financial condition of health maintenance organization; application for initial certificate of authority; exception. - 1. For the purpose of determining its financial condition, fulfillment...

NRS 695C.313 - Financial examination: Procedure; appointment of examiner; maintenance and use of records; penalty for obstruction or interference. - 1. If the Commissioner determines to examine a health maintenance...

NRS 695C.315 - Financial examination: Payment of expense. - 1. The health maintenance organization being examined shall pay the...

NRS 695C.317 - Procedures required for examination and hearing. - The Commissioner shall use the procedures required by: 1. NRS...

NRS 695C.3175 - Required contract with insurance company for provision of insurance, indemnity or reimbursement against cost of health care services; required provisions. - Repealed. (See chapter 201, Statutes of Nevada 2019, at page...

NRS 695C.318 - Insolvency; determination of financial condition; actions by Commissioner; review; regulations. - 1. A health maintenance organization shall be deemed to be...

NRS 695C.3185 - Plan for continuation of benefits if health maintenance organization becomes insolvent or impaired; approval by Commissioner; contents. - Repealed. (See chapter 201, Statutes of Nevada 2019, at page...

NRS 695C.319 - Power of Commissioner to order corrective action for hazardous operation or violation of law; regulations. - 1. If the Commissioner determines that, because of the financial...

NRS 695C.3195 - Conservation, rehabilitation or liquidation of health maintenance organization: Powers of Commissioner; claims of enrollees; distribution of general assets. - 1. Any conservation, rehabilitation or liquidation of a health maintenance...

NRS 695C.320 - Rehabilitation, liquidation or conservation: Conduct. - Any rehabilitation, liquidation or conservation of a health maintenance organization...

NRS 695C.325 - Offering health care plan to certain small employers for purposes of establishing medical savings accounts. - A health maintenance organization may offer to a small employer...

NRS 695C.326 - Health maintenance organization required to provide data relating to claims and costs to person responsible for overseeing health care plan upon request; annual report; format. - 1. Notwithstanding any other provision of law that provides for...

NRS 695C.328 - Disclosure of data relating to claims and costs prohibited; exceptions; penalties for unauthorized disclosure. - 1. Except as otherwise provided in subsection 2: (a) A...

NRS 695C.330 - Disciplinary proceedings: Grounds; effect of suspension or revocation. - 1. The Commissioner may suspend or revoke any certificate of...

NRS 695C.340 - Disciplinary proceedings: Notice; hearing; judicial review. - 1. When the Commissioner has cause to believe that grounds...

NRS 695C.350 - Violations: Remedies; penalties. - 1. The Commissioner may, in lieu of suspension or revocation...

<< Previous

Next >>

Nevada Revised Statutes Chapter 695C - Health Maintenance Organizations

Nevada Revised Statutes
Chapter 695C - Health Maintenance Organizations