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Nevada Chapter 689A — Individual Health Insurance

139 sections hosted, reproduced from the official public-domain source.

  • NRS 689A.010— Short title
  • NRS 689A.020— Scope
  • NRS 689A.030— General requirements
  • NRS 689A.032— Insurer required to offer and issue plan regardless of health status of persons; prohibited acts
  • NRS 689A.033— Insurer prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression
  • NRS 689A.035— Contracts between insurer and provider of health care: Prohibiting insurer from charging provider of health care fee for inclusion on list of providers given to insureds; insurer required to use form to obtain information on provider of health care; modification; submission by insurer of schedule of payments to provider
  • NRS 689A.040— Contents of policy; substitution of provisions; captions; omission or modification of provisions
  • NRS 689A.041— Coverage relating to mastectomy required in policy covering mastectomies; prohibited acts
  • NRS 689A.042— Policy containing exclusion, reduction or limitation of coverage relating to complications of pregnancy prohibited; exception
  • NRS 689A.043— Policy covering family on expense-incurred basis required to include certain coverage for insured’s newly born and adopted children and children placed with insured for adoption
  • NRS 689A.044— Coverage for certain tests and vaccines relating to human papillomavirus required; prohibited acts
  • NRS 689A.046— Benefits for treatment of alcohol or substance use disorder required
  • NRS 689A.048— Treatment by licensed psychologist
  • NRS 689A.049— Treatment by licensed chiropractic physician; restriction on policy limitations
  • NRS 689A.050— Entire contract; changes
  • NRS 689A.060— Time limit on certain defenses
  • NRS 689A.070— Grace period
  • NRS 689A.075— Cancellation and rescission of short-term limited duration medical plan
  • NRS 689A.080— Reinstatement
  • NRS 689A.090— Notice of claim
  • NRS 689A.100— Claim forms: Required provision
  • NRS 689A.105— Claim forms: Uniform billing and claims forms
  • NRS 689A.110— Claim forms: Proofs of loss
  • NRS 689A.120— Time of payment of claims
  • NRS 689A.130— Payment of claims
  • NRS 689A.135— Assignment of benefits by insured to provider of health care
  • NRS 689A.140— Physical examination and autopsy
  • NRS 689A.150— Legal actions
  • NRS 689A.160— Change of beneficiary
  • NRS 689A.170— Right to examine and return policy
  • NRS 689A.180— Optional provisions: Requirements; substitution of provisions; captions
  • NRS 689A.190— Extended disability benefit
  • NRS 689A.200— Change of occupation
  • NRS 689A.210— Misstatement of age
  • NRS 689A.220— Coordination of benefits: Same insurer
  • NRS 689A.230— Coordination of benefits: All coverages
  • NRS 689A.240— Relation of earnings to insurance
  • NRS 689A.250— Unpaid premiums
  • NRS 689A.260— Conformity with state statutes
  • NRS 689A.270— Illegal occupation
  • NRS 689A.290— Renewability
  • NRS 689A.300— Order of certain provisions
  • NRS 689A.310— Ownership of policy by person other than insured
  • NRS 689A.320— Requirements of other jurisdictions
  • NRS 689A.330— Policies issued for delivery in another state
  • NRS 689A.340— Limitation on provisions not subject to chapter; effect of violation of chapter; conflict among provisions
  • NRS 689A.350— Age limit
  • NRS 689A.380— Definitions of terms used in policies
  • NRS 689A.0403— Procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations
  • NRS 689A.0404— Coverage for use of certain drugs and related services for treatment of cancer required in certain policies
  • NRS 689A.0405— Coverage for certain screenings and tests for breast cancer required; prohibited acts
  • NRS 689A.405— Policy covering prescription drugs: Provision of notice and information regarding use of formulary
  • NRS 689A.410— 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; report of compliance by insurer
  • NRS 689A.0412— Coverage for examination of person who is pregnant for certain diseases required
  • NRS 689A.0413— Coverage for certain gynecological or obstetrical services without authorization or referral from primary care physician required; designation of obstetrician or gynecologist as primary care physician
  • NRS 689A.413— Insurer prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence
  • NRS 689A.0415— Coverage for hormone replacement therapy in certain circumstances required in policy covering prescription drugs or devices; prohibited acts; exception
  • NRS 689A.415— Insurer prohibited from denying coverage solely because applicant or insured was intoxicated or under influence of controlled substance; exceptions
  • NRS 689A.0417— Coverage for health care services related to hormone replacement therapy required in policy covering outpatient care; prohibited acts
  • NRS 689A.417— Insurer prohibited from requiring or using information concerning genetic testing; exceptions
  • NRS 689A.0418— Coverage for drug or device for contraception and related health services required; prohibited acts; exceptions
  • NRS 689A.0419— Coverage for certain services, screenings and tests relating to wellness required; prohibited acts
  • NRS 689A.419— Offering policy of health insurance for purposes of establishing health savings account
  • NRS 689A.420— Definitions
  • NRS 689A.0423— Coverage for treatment of certain inherited metabolic diseases required
  • NRS 689A.0424— Policy covering maternity care: Prohibited acts by insurer if insured is acting as gestational carrier; child deemed child of intended parent for purposes of policy
  • NRS 689A.0427— Coverage for management and treatment of diabetes required in policy covering hospital, medical or surgical expenses
  • NRS 689A.0428— Coverage for management and treatment of sickle cell disease and its variants required; coverage for medically necessary prescription drugs to treat sickle cell disease and its variants required by plan covering prescription drugs
  • NRS 689A.430— Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency
  • NRS 689A.0432— Coverage for medically necessary treatment of conditions relating to gender dysphoria and gender incongruence required; restriction on refusal to cover certain treatments; authority of insurer to prescribe requirements for covering surgical treatments for minors; determination of medical necessity
  • NRS 689A.0434— Coverage for habilitative speech-language pathology and rehabilitative speech-language pathology as treatment for stuttering for certain persons required; prohibited acts
  • NRS 689A.0435— Option of coverage for autism spectrum disorders for certain persons required; prohibited acts
  • NRS 689A.0437— Coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus and hepatitis C required; reimbursement of certain providers of health care for certain services; prohibited acts
  • NRS 689A.0438— Coverage for testing, treatment and prevention of sexually transmitted diseases required; coverage for condoms for certain insureds required
  • NRS 689A.440— Insurer prohibited from asserting certain grounds to deny enrollment of child of insured pursuant to order
  • NRS 689A.0445— Coverage for prostate cancer screening
  • NRS 689A.0446— Coverage for biomarker testing for diagnosis, treatment, management and monitoring of cancer required in certain circumstances; establishment of process to request exception or appeal denial of coverage; time for responding to request for prior authorization
  • NRS 689A.0447— Policy covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy
  • NRS 689A.450— Certain accommodations required to be made when child is covered under policy of noncustodial parent
  • NRS 689A.0455— Coverage for treatment of conditions relating to severe mental illness required
  • NRS 689A.0459— Coverage for certain drugs and services related to substance use disorder and opioid use disorder required; reimbursement of pharmacists and pharmacies for certain services; prohibited acts
  • NRS 689A.460— Insurer 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 689A.0463— Coverage for services provided through telehealth required to same extent as though provided in person or by other means; reimbursement for certain services provided through telehealth required in same amount as though provided in person or by other means; prohibited acts
  • NRS 689A.0464— Policy covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by insurer if insured is person with disability
  • NRS 689A.0465— Policy prohibited from excluding coverage of treatment of temporomandibular joint; exception
  • NRS 689A.470— Definitions
  • NRS 689A.0475— Acupuncture
  • NRS 689A.0483— Treatment by licensed marriage and family therapist or licensed clinical professional counselor
  • NRS 689A.0485— Treatment by licensed associate in social work, social worker, master social worker, independent social worker or clinical social worker
  • NRS 689A.485— “Bona fide association” defined
  • NRS 689A.0487— Treatment by licensed podiatrist
  • NRS 689A.0493— Treatment by licensed clinical alcohol and drug counselor
  • NRS 689A.0495— Services provided by certain registered nurses
  • NRS 689A.495— “Control” defined
  • NRS 689A.0497— Provider of medical transportation
  • NRS 689A.505— “Creditable coverage” defined
  • NRS 689A.510— “Dependent” defined
  • NRS 689A.525— “Geographic rating area” defined
  • NRS 689A.527— “Geographic service area” defined
  • NRS 689A.535— “Group health plan” defined
  • NRS 689A.540— “Health benefit plan” defined
  • NRS 689A.550— “Individual carrier” defined
  • NRS 689A.555— “Individual health benefit plan” defined
  • NRS 689A.570— “Plan for coverage of a bona fide association” defined
  • NRS 689A.580— “Plan sponsor” defined
  • NRS 689A.590— “Producer” defined
  • NRS 689A.600— “Provision for a restricted network” defined
  • NRS 689A.615— Certain plan, fund or program to be treated as employee welfare benefit plan which is group health plan; partnership deemed employer of each partner
  • NRS 689A.630— Requirement to renew coverage at option of individual; exceptions; discontinuation of product; discontinuation of health benefit plan available through bona fide association
  • NRS 689A.635— Coverage offered through network plan not required to be offered to person who does not reside or work in geographic service area or geographic rating area
  • NRS 689A.637— Coverage offered through plan that provides for restricted network: Contracts with certain federally qualified health centers
  • NRS 689A.696— Information and documents required to be made available to Commissioner; proprietary information
  • NRS 689A.700— Regulations regarding rates
  • NRS 689A.705— Regulations concerning reissuance of health benefit plan
  • NRS 689A.710— Prohibited acts; denial of application for coverage; regulations; violation may constitute unfair trade practice; applicability of section
  • NRS 689A.715— Requirements for employee welfare benefit plan for providing benefits for employees of more than one employer
  • NRS 689A.717— Individual health benefit plan covering maternity care and pediatric care: Requirement to allow minimum stay in hospital in connection with childbirth; prohibited acts
  • NRS 689A.720— Written certification of coverage required for determining period of creditable coverage accumulated by person; provision of certificate to insured
  • NRS 689A.725— Requirements for plan for coverage
  • NRS 689A.740— Regulations
  • NRS 689A.745— Establishment; approval; requirements; examination; exception
  • NRS 689A.750— Annual report; insurer required to maintain records of and report complaints concerning something other than health care services
  • NRS 689A.755— Written notice required to be provided by insurer to insured explaining right to file complaint; written notice to insured and provider of health care required when insurer denies coverage of health care service
  • NRS 689A.04032— Construction of provisions requiring certain coverage by policy of health insurance
  • NRS 689A.04033— Coverage for certain treatment received as part of clinical trial or study for treatment of cancer or chronic fatigue syndrome required; authority of insurer to require certain information; immunity from liability
  • NRS 689A.04036— Coverage for continued medical treatment required in certain policies; exceptions; regulations
  • NRS 689A.04041— Policy covering prescription drug for treatment of cancer or cancer symptom that is part of step therapy protocol: Insurer required to allow insured or attending practitioner to apply for exemption from step therapy protocol in certain circumstances; procedure for applying for and granting exemption
  • NRS 689A.04042— Coverage for colorectal cancer screening required in policy covering treatment of colorectal cancer
  • NRS 689A.04043— Policy covering prescription drug for treatment of medical condition that is part of step therapy protocol: Use of certain guidelines required; establishment of process to request exemption from step therapy protocol; granting of request; applicability of provisions
  • NRS 689A.04044— Policy covering prescription drugs: Required actions by insurer related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared
  • NRS 689A.04045— Policy covering prescription drugs prohibited from limiting or excluding coverage for prescription drug previously approved for medical condition of insured; exception
  • NRS 689A.04046— Coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications required in policy covering prescription drugs; prohibited acts; exception
  • NRS 689A.04047— Policy covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products
  • NRS 689A.04048— Policy covering prescription drugs: Submission to step therapy protocol for drug to treat psychiatric condition prohibited in certain circumstances
  • NRS 689A.04049— Coverage for screening, genetic counseling and testing related to BRCA gene required in certain circumstances
  • NRS 689A.04195— Coverage for procedure or service for preservation of fertility required in certain circumstances; exemption. [Effective January 1, 2027.]
  • NRS 689A.04645— Coverage for dental service provided by qualified dental hygienist required in certain circumstances
  • NRS 689A.040425— Coverage for screening for lung cancer required in policy providing coverage for treatment of lung cancer
  • NRS 689A.040485— Limitation on cost-sharing obligation for insulin covered by policy covering prescription insulin drugs