Health Maintenance Organizations

  1. Law
  2. Nevada Revised Statutes
  3. Health Maintenance Organizations

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Section
695C.010

Short title.

Section
695C.020

Legislative declaration.

Section
695C.030

Definitions.

Section
695C.050

Applicability of certain provisions. [Effective through December 31, 2019.]

Section
695C.050

Applicability of certain provisions. [Effective January 1, 2020.]

Section
695C.055

Applicability of certain other provisions. [Effective through December 31, 2019.]

Section
695C.055

Applicability of certain other provisions. [Effective January 1, 2020.]

Section
695C.057

Applicability of certain provisions concerning portability and availability of health insurance.

Section
695C.060

Establishment of organization.

Section
695C.070

Certificate of authority: Application.

Section
695C.080

Certificate of authority: Evaluation of application.

Section
695C.090

Certificate of authority: Issuance.

Section
695C.100

Certificate of authority: Denial.

Section
695C.110

Governing body: Composition; participation by enrollees.

Section
695C.120

Powers of organization.

Section
695C.123

Contracts with certain federally qualified health centers.

Section
695C.125

Contract between health maintenance organization and provider of health care: Form to obtain information on provider of health care; modification; provision of schedule of fees.

Section
695C.128

Contracts to provide services pursuant to certain state programs: Payment of interest on claims.

Section
695C.130

Notice and approval required for exercise of powers; rules or regulations.

Section
695C.140

Notice and approval required for modification of operations; regulations.

Section
695C.145

Accounting principles required for certain reports and transactions; health maintenance organization subject to requirements for certain insurers.

Section
695C.150

Fiduciary responsibilities.

Section
695C.160

Investments.

Section
695C.161

Eligibility for coverage: Definitions.

Section
695C.163

Eligibility for coverage: Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency.

Section
695C.165

Eligibility for coverage: Organization prohibited from asserting certain grounds to deny enrollment of child pursuant to order if parent is enrolled in health care plan.

Section
695C.167

Eligibility for coverage: Certain accommodations to be made when child is covered under health care plan of noncustodial parent.

Section
695C.169

Eligibility for coverage: Organization to authorize enrollment of child of parent who is required by order to provide medical coverage under certain circumstances; termination of coverage of child.

Section
695C.170

Evidence of coverage: Issuance; form and contents.

Section
695C.171

Required provision concerning coverage relating to mastectomy.

Section
695C.172

Required provision concerning coverage relating to complications of pregnancy.

Section
695C.173

Required provision concerning coverage for newly born and adopted children and children placed for adoption. [Effective through December 31, 2019.]

Section
695C.173

Required provision concerning coverage for newly born and adopted children and children placed for adoption. [Effective January 1, 2020.]

Section
695C.176

Required provision concerning coverage for hospice care.

Section
695C.177

Reimbursement for treatments by licensed psychologist.

Section
695C.178

Reimbursement for treatment by chiropractor.

Section
695C.179

Reimbursement for services provided by certain nurses; prohibited limitations; exceptions.

Section
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. [Effective through December 31, 2019.]

Section
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 certificate of authority for failure to comply. [Effective January 1, 2020.]

Section
695C.187

Schedule for payment of claims: Mandatory inclusion in arrangements for provision of health care.

Section
695C.190

Commissioner may require submission of information.

Section
695C.194

Provision of health care services to recipients of Medicaid or enrollees in Children’s Health Insurance Program: Requirement to contract with psychiatric hospital for inclusion in network of providers. [Effective January 1, 2020.]

Section
695C.200

Approval of forms and schedules.

Section
695C.201

Offering policy of health insurance for purposes of establishing health savings account.

Section
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.

Section
695C.203

Denying coverage solely because person was victim of domestic violence prohibited.

Section
695C.205

Denying coverage solely because insured was intoxicated or under the influence of controlled substance prohibited; exceptions.

Section
695C.207

Requiring or using information concerning genetic testing. [Effective through December 31, 2019.]

Section
695C.207

Requiring or using information concerning genetic testing. [Effective January 1, 2020.]

Section
695C.210

Annual report of financial condition and financial statement; quarterly statement; administrative penalty for failure to file report or statement; extension of time.

Section
695C.215

Financial statement required to include report of net worth.

Section
695C.220

Applications, filings and reports open to public inspection.

Section
695C.230

Fees.

Section
695C.240

Information required to be available for inspection.

Section
695C.260

Complaint system.

Section
695C.265

Required procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations.

Section
695C.267

Provision requiring binding arbitration authorized; procedures for arbitration; declaratory relief.

Section
695C.270

Bond required; waiver.

Section
695C.275

Commissioner to adopt regulations for licensing of provider-sponsored organizations.

Section
695C.280

Commissioner authorized to adopt regulations for licensing of agents or brokers.

Section
695C.290

Insurance company may establish or contract with health maintenance organization.

Section
695C.300

Prohibited practices.

Section
695C.310

Examinations: Affairs of and compliance program used by health maintenance organization; submission of books and records; assessment of expenses; exception.

Section
695C.311

Periodic examination by Commissioner to determine financial condition of health maintenance organization.

Section
695C.313

Financial examination: Procedure; appointment of examiner; maintenance and use of records; penalty for obstruction or interference.

Section
695C.315

Financial examination: Payment of expense.

Section
695C.317

Statutory procedures required for examination and hearing.

Section
695C.318

Insolvency; determination of financial condition; regulations.

Section
695C.319

Power of Commissioner to order corrective action for hazardous operation or violation of law; regulations.

Section
695C.320

Rehabilitation, liquidation or conservation.

Section
695C.325

Authorization to offer health care plan to small employer for purpose of establishing medical savings accounts.

Section
695C.326

Health maintenance organization to provide data relating to claims and costs to person responsible for overseeing health care plan upon request; annual report; format.

Section
695C.328

Disclosure of data relating to claims and costs prohibited; exceptions; penalties for unauthorized disclosure.

Section
695C.330

Disciplinary proceedings: Grounds; effect of suspension or revocation.

Section
695C.340

Disciplinary proceedings: Notice; hearing; judicial review.

Section
695C.350

Violations: Remedies; penalties.

Section
695C.1691

Required provision concerning coverage for continued medical care.

Section
695C.1693

Required provision concerning coverage for treatment received as part of clinical trial or study.

Section
695C.1694

Required provision concerning coverage of hormone replacement therapy in certain circumstances; prohibited actions by health maintenance organization; exception.

Section
695C.1695

Required provision concerning coverage of health care services related to hormone replacement therapy in certain circumstances; prohibited actions by health maintenance organization.

Section
695C.1696

Required provision concerning coverage for drug or device for contraception and related health services; prohibited actions by health maintenance organization; exceptions.

Section
695C.1698

Required provision concerning coverage for certain services, screenings and tests relating to wellness; prohibited actions by health maintenance organization.

Section
695C.1701

Requirements regarding issuance of health benefit plans and adjustment of costs. [Effective January 1, 2020.]

Section
695C.1703

Coverage for prescription drugs: Provision of notice and information regarding use of formulary.

Section
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.

Section
695C.1708

Required provision concerning coverage for services provided through telehealth.

Section
695C.1709

Required provision concerning coverage for enrollee on leave without pay as result of total disability.

Section
695C.1712

Health care plan that includes coverage for maternity care must not deny coverage for gestational carrier; status of child in relation to intended parent. [Effective January 1, 2020.]

Section
695C.1713

Required provision concerning coverage of certain gynecological and obstetrical services without authorization or referral from primary care physician.

Section
695C.1717

Required provision concerning coverage for autism spectrum disorders.

Section
695C.1723

Required provision concerning coverage for treatment of certain inherited metabolic diseases.

Section
695C.1727

Required provision concerning coverage for management and treatment of diabetes.

Section
695C.1728

Required provision concerning coverage for management and treatment of sickle cell disease.

Section
695C.1731

Required provision concerning coverage for screening for colorectal cancer.

Section
695C.1733

Required provision concerning coverage for certain drugs for treatment of cancer.

Section
695C.1734

Required provision concerning coverage for prescription drug previously approved for medical condition of enrollee.

Section
695C.1735

Required provision concerning coverage for mammograms for certain women; prohibited acts.

Section
695C.1745

Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus; prohibited acts.

Section
695C.1751

Required provision concerning coverage for prostate cancer screening.

Section
695C.1755

Required provision concerning coverage for treatment of temporomandibular joint.

Section
695C.1757

Required provision concerning coverage for early refills of topical ophthalmic products.

Section
695C.1765

Reimbursement for acupuncture.

Section
695C.1773

Reimbursement for treatment by licensed marriage and family therapist or licensed clinical professional counselor.

Section
695C.1775

Reimbursement for treatment by licensed associate in social work, social worker, independent social worker or clinical social worker.

Section
695C.1783

Reimbursement for treatment by podiatrist.

Section
695C.1789

Reimbursement for treatment by licensed clinical alcohol and drug abuse counselor.

Section
695C.1795

Reimbursement to provider of medical transportation.

Section
695C.3175

Required contract with insurance company for provision of insurance, indemnity or reimbursement against cost of health care services; required provisions. [Effective through December 31, 2019.]

Section
695C.3185

Plan for continuation of benefits if health maintenance organization becomes insolvent or impaired; approval by Commissioner; contents. [Effective through December 31, 2019.]

Section
695C.3195

Conservation, rehabilitation or liquidation of health maintenance organization: Powers of Commissioner; claims of enrollees; distribution of general assets.

Section
695C.17335

Required provision concerning coverage for orally administered chemotherapy.

Section
695C.17345

Required provision concerning coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications.