1. No health maintenance organization or representative thereof may cause or knowingly permit the use of advertising which is untrue or misleading, solicitation which is untrue or misleading or any form of evidence of coverage which is deceptive. For purposes of this chapter:
(a) A statement or item of information shall be deemed to be untrue if it does not conform to fact in any respect which is or may be significant to an enrollee of, or person considering enrollment in, a health care plan.
(b) A statement or item of information shall be deemed to be misleading, whether or not it may be literally untrue if, in the total context in which such statement is made or such item of information is communicated, such statement or item of information may be reasonably understood by a reasonable person not possessing special knowledge regarding health care coverage, as indicating any benefit or advantage or the absence of any exclusion, limitation or disadvantage of possible significance to an enrollee of, or person considering enrollment in, a health care plan if such benefit or advantage or absence of limitation, exclusion or disadvantage does not in fact exist.
(c) An evidence of coverage shall be deemed to be deceptive if the evidence of coverage taken as a whole, and with consideration given to typography and format as well as language, shall be such as to cause a reasonable person not possessing special knowledge regarding health care plans and evidences of coverage therefor to expect benefits, services, charges or other advantages which the evidence of coverage does not provide or which the health care plan issuing such evidence of coverage does not regularly make available for enrollees covered under such evidence of coverage.
2. NRS 686A.010 to 686A.310, inclusive, shall be construed to apply to health maintenance organizations, health care plans and evidences of coverage except to the extent that the nature of health maintenance organizations, health care plans and evidences of coverage render the sections therein clearly inappropriate.
3. An enrollee may not be cancelled or not renewed except for the failure to pay the charge for such coverage or for cause as determined in the master contract.
4. No health maintenance organization, unless licensed as an insurer, may use in its name, contracts, or literature any of the words "insurance," "casualty," "surety," "mutual" or any other words descriptive of the insurance, casualty or surety business or deceptively similar to the name or description of any insurance or surety corporation doing business in this State.
5. No person not certificated under this chapter shall use in its name, contracts or literature the phrase "health maintenance organization" or the initials "HMO."
(Added to NRS by 1973, 1253; A 2021, 901)
Structure Nevada Revised Statutes
Chapter 695C - Health Maintenance Organizations
NRS 695C.020 - Legislative declaration.
NRS 695C.050 - Applicability of certain provisions.
NRS 695C.055 - Applicability of certain other provisions.
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.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.150 - Fiduciary responsibilities.
NRS 695C.170 - Evidence of coverage: Issuance; form and contents.
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.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.200 - Approval of forms and schedules.
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.270 - Surety bond or deposit required; waiver.
NRS 695C.280 - Commissioner authorized to adopt regulations for licensing of agents or brokers.
NRS 695C.300 - Prohibited practices.
NRS 695C.315 - Financial examination: Payment of expense.
NRS 695C.317 - Procedures required for examination and hearing.
NRS 695C.320 - Rehabilitation, liquidation or conservation: Conduct.
NRS 695C.330 - Disciplinary proceedings: Grounds; effect of suspension or revocation.
NRS 695C.340 - Disciplinary proceedings: Notice; hearing; judicial review.