Nevada Revised Statutes
Chapter 695C - Health Maintenance Organizations
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 of coverage may be delivered or issued for delivery in this state if it contains an exclusion of coverage of the treatment of the temporomandibular joint whether by specific language in the evidence of coverage or by a claims settlement practice. An evidence of coverage may exclude coverage of those methods of treatment which are recognized as dental procedures, including, but not limited to, the extraction of teeth and the application of orthodontic devices and splints.
2. The health maintenance organization may limit its liability on the treatment of the temporomandibular joint to:
(a) No more than 50 percent of the usual and customary charges for such treatment actually received by an enrollee, but in no case more than 50 percent of the maximum benefits provided by the evidence of coverage for such treatment; and
(b) Treatment which is medically necessary.
3. Any provision of an evidence of coverage subject to the provisions of this chapter and issued or delivered on or after January 1, 1990, which is in conflict with this section is void.
(Added to NRS by 1989, 2139)

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Structure Nevada Revised Statutes

Nevada Revised Statutes

Chapter 695C - Health Maintenance Organizations

NRS 695C.010 - Short title.

NRS 695C.020 - Legislative declaration.

NRS 695C.030 - Definitions.

NRS 695C.050 - Applicability of certain provisions.

NRS 695C.055 - Applicability of certain other provisions.

NRS 695C.057 - Applicability of certain provisions concerning portability and availability of health insurance.

NRS 695C.060 - Establishment of health maintenance organization.

NRS 695C.070 - Certificate of authority: Application.

NRS 695C.080 - Certificate of authority: Evaluation of application.

NRS 695C.090 - Certificate of authority: Issuance.

NRS 695C.100 - Certificate of authority: Denial.

NRS 695C.110 - Governing body: Composition; participation by enrollees.

NRS 695C.120 - Powers of health maintenance organization.

NRS 695C.123 - Contracts with certain federally qualified health centers.

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...

NRS 695C.128 - Contracts to provide services pursuant to certain state programs: Payment of interest on claims.

NRS 695C.130 - Notice and approval required for exercise of powers; rules or regulations.

NRS 695C.140 - Notice and approval required for modification of operations; regulations.

NRS 695C.145 - Accounting principles required for certain reports and transactions; health maintenance organization subject to requirements for certain insurers.

NRS 695C.150 - Fiduciary responsibilities.

NRS 695C.160 - Investments.

NRS 695C.161 - Definitions.

NRS 695C.163 - Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency.

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.

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

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.

NRS 695C.1691 - Required provision in certain plans concerning coverage for continued medical treatment; exceptions; regulations.

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;...

NRS 695C.1694 - Required provision in plan covering prescription drugs or devices concerning coverage of hormone replacement therapy in certain circumstances; prohibited acts; exception.

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.

NRS 695C.1695 - Required provision in plan covering outpatient care concerning coverage of health care services related to hormone replacement therapy; prohibited acts.

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...

NRS 695C.1698 - Required provision concerning coverage for certain services, screenings and tests relating to wellness; prohibited acts.

NRS 695C.170 - Evidence of coverage: Issuance; form and contents.

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...

NRS 695C.1703 - Evidence of coverage covering prescription drugs: Provision of notice and information regarding use of formulary.

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.

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...

NRS 695C.1709 - Required provision in group insurance policy concerning continuing coverage for enrollee on leave without pay as result of total disability.

NRS 695C.171 - Required provision in plan covering mastectomies concerning coverage relating to mastectomy; prohibited acts.

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.

NRS 695C.1713 - Required provision concerning coverage of certain gynecological and obstetrical services without authorization or referral from primary care physician.

NRS 695C.1717 - Required provision concerning coverage for autism spectrum disorders for certain persons; prohibited acts.

NRS 695C.172 - Evidence of coverage containing exclusion, reduction or limitation of coverage relating to complications of pregnancy; prohibited acts; exception.

NRS 695C.1723 - Required provision concerning coverage for treatment of certain inherited metabolic diseases.

NRS 695C.1727 - Required provision in evidence of coverage covering hospital, medical or surgical expenses concerning coverage for management and treatment of diabetes.

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...

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.

NRS 695C.1731 - Required provision in plan covering treatment of colorectal cancer concerning coverage for colorectal cancer screening.

NRS 695C.1733 - Required provision in certain evidences of coverage concerning coverage for certain drugs and related services for treatment of cancer.

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...

NRS 695C.17335 - Plan covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy.

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.

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.

NRS 695C.17347 - Required provision concerning coverage for screening, genetic counseling and testing related to BRCA gene in certain circumstances. [Effective January 1, 2022.]

NRS 695C.1735 - Required provision concerning coverage for mammograms for certain women; prohibited acts.

NRS 695C.1737 - Required provision concerning coverage for examination of person who is pregnant for certain diseases.

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.

NRS 695C.1745 - Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus; prohibited acts.

NRS 695C.1751 - Required provision in plan covering treatment of prostate cancer concerning coverage for prostate cancer screening; prohibited act.

NRS 695C.1755 - Evidence of coverage prohibited from excluding coverage for treatment of temporomandibular joint; exception.

NRS 695C.1757 - Plan covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products.

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.

NRS 695C.176 - Required provision concerning coverage for hospice care.

NRS 695C.1765 - Reimbursement for acupuncture.

NRS 695C.177 - Reimbursement for treatments by licensed psychologist.

NRS 695C.1773 - Reimbursement for treatment by licensed marriage and family therapist or licensed clinical professional counselor.

NRS 695C.1775 - Reimbursement for treatment by licensed associate in social work, social worker, master social worker, independent social worker or clinical social worker.

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

NRS 695C.1783 - Reimbursement for treatment by podiatrist.

NRS 695C.1789 - Reimbursement for treatment by licensed clinical alcohol and drug counselor.

NRS 695C.179 - Reimbursement for services provided by certain nurses.

NRS 695C.1795 - Reimbursement to provider of medical transportation.

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...

NRS 695C.187 - Schedule for payment of claims: Mandatory inclusion in arrangements for provision of health care.

NRS 695C.190 - Commissioner authorized to require submission of information necessary to determine approval or disapproval of filing.

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.

NRS 695C.200 - Approval of forms and schedules.

NRS 695C.201 - Offering policy of health insurance for purposes of establishing health savings account.

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.

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.

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.

NRS 695C.207 - Health maintenance organization prohibited from requiring or using information concerning genetic testing.

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.

NRS 695C.215 - Financial statement required to include report of net worth.

NRS 695C.220 - Applications, filings and reports open to public inspection; exception.

NRS 695C.230 - Fees; forwarding of premium tax.

NRS 695C.240 - Information required to be available for inspection.

NRS 695C.260 - Establishment of system for resolving complaints and system for conducting external review of adverse determinations required.

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...

NRS 695C.267 - Provision requiring binding arbitration authorized; procedures for arbitration; declaratory relief.

NRS 695C.270 - Surety bond or deposit required; waiver.

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

NRS 695C.280 - Commissioner authorized to adopt regulations for licensing of agents or brokers.

NRS 695C.290 - Insurance company authorized to establish or contract with health maintenance organization.

NRS 695C.300 - Prohibited practices.

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.

NRS 695C.311 - Examinations by Commissioner: Financial condition of health maintenance organization; application for initial certificate of authority; exception.

NRS 695C.313 - Financial examination: Procedure; appointment of examiner; maintenance and use of records; penalty for obstruction or interference.

NRS 695C.315 - Financial examination: Payment of expense.

NRS 695C.317 - Procedures required for examination and hearing.

NRS 695C.3175 - Required contract with insurance company for provision of insurance, indemnity or reimbursement against cost of health care services; required provisions.

NRS 695C.318 - Insolvency; determination of financial condition; actions by Commissioner; review; regulations.

NRS 695C.3185 - Plan for continuation of benefits if health maintenance organization becomes insolvent or impaired; approval by Commissioner; contents.

NRS 695C.319 - Power of Commissioner to order corrective action for hazardous operation or violation of law; regulations.

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

NRS 695C.320 - Rehabilitation, liquidation or conservation: Conduct.

NRS 695C.325 - Offering health care plan to certain small employers for purposes of establishing medical savings accounts.

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.

NRS 695C.328 - Disclosure of data relating to claims and costs prohibited; exceptions; penalties for unauthorized disclosure.

NRS 695C.330 - Disciplinary proceedings: Grounds; effect of suspension or revocation.

NRS 695C.340 - Disciplinary proceedings: Notice; hearing; judicial review.

NRS 695C.350 - Violations: Remedies; penalties.