2005 Nevada Revised Statutes - Chapter 695D — Plans for Dental Care

CHAPTER 695D - PLANS FOR DENTAL CARE

NRS 695D.010 Definitions.

NRS 695D.020 Commissionerdefined.

NRS 695D.030 Dentalcare defined.

NRS 695D.040 Dentistdefined.

NRS 695D.050 Memberdefined.

NRS 695D.060 Organizationfor dental care defined.

NRS 695D.070 Planfor dental care defined.

NRS 695D.080 Policydefined.

NRS 695D.090 Applicability.

NRS 695D.095 Applicabilityof other provisions to organizations for dental care.

NRS 695D.100 Regulationsof Commissioner.

NRS 695D.102 Summaryof coverage: Contents of disclosure; approval by Commissioner.

NRS 695D.104 Summaryof coverage: Copy to be provided before policy issued; policy not to be offeredunless summary approved by Commissioner.

NRS 695D.110 Certificateof authority: Required for plan for dental care.

NRS 695D.120 Certificateof authority: Application.

NRS 695D.130 Certificateof authority: Issuance.

NRS 695D.140 Certificateof authority: Notice of change of information; application for amendment; fee;approval.

NRS 695D.150 Certificateof authority: Expiration; renewal; fee for renewal.

NRS 695D.160 Compositionof board of directors for organization for dental care.

NRS 695D.170 Bondrequired; lien and payment on bond.

NRS 695D.180 Bondpayable to State; cancellation.

NRS 695D.190 Fiduciaryresponsibilities; disciplinary action.

NRS 695D.200 Policy:Issuance; form and contents; notice of change.

NRS 695D.203 Groupplan issued to replace discontinued policy or coverage: Requirements; notice ofreduction of benefits; statement of benefits; applicability to self-insuredemployer.

NRS 695D.205 Copaymentsand deductibles.

NRS 695D.210 Coveragefor newly born and adopted children and children placed for adoption.

NRS 695D.215 Claims:Approval or denial; request for additional information; payment; interest onunpaid claim.

NRS 695D.217 Organizationfor dental care prohibited from denying coverage solely because person wasvictim of domestic violence.

NRS 695D.219 Organizationfor dental care prohibited from denying coverage solely because member wasintoxicated or under the influence of controlled substance; exceptions. [EffectiveJuly 1, 2006.]

NRS 695D.220 Licensingof agents.

NRS 695D.230 Approvalof advertising or materials used to solicit members.

NRS 695D.240 Limitationon expenses for marketing and administration.

NRS 695D.250 Reserves;regulations.

NRS 695D.260 Annualreport, financial statement and tax; administrative penalty for failure to filereport or financial statement.

NRS 695D.270 Examinationof organization by Commissioner.

NRS 695D.280 Rehabilitation,liquidation or conservation.

NRS 695D.290 Tradepractices and frauds.

NRS 695D.300 Disciplinaryactions; penalties.

NRS 695D.310 Noticeof disciplinary action; hearing; order.

_________

NRS 695D.010 Definitions. As used in this chapter, unless the context otherwiserequires, the words and terms defined in NRS695D.020 to 695D.080, inclusive,have the meanings ascribed to them in those sections.

(Added to NRS by 1983, 2021)

NRS 695D.020 Commissionerdefined. Commissioner means the Commissionerof Insurance.

(Added to NRS by 1983, 2021)

NRS 695D.030 Dentalcare defined. Dental care means theservices ordinarily provided by dentists and includes appliances, drugs,medicines, supplies, prosthetic appliances, orthodontic appliances, and metal,ceramic or other restorations customarily used or provided by a dentist.

(Added to NRS by 1983, 2021)

NRS 695D.040 Dentistdefined. Dentist includes a dentalhygienist.

(Added to NRS by 1983, 2021)

NRS 695D.050 Memberdefined. Member includes the person enrolledin a plan for dental care and his dependents who may also be enrolled in theplan.

(Added to NRS by 1983, 2021)

NRS 695D.060 Organizationfor dental care defined. Organization fordental care means any person who agrees to provide coverage for dental carethrough one or more plans for dental care.

(Added to NRS by 1983, 2021)

NRS 695D.070 Planfor dental care defined. Plan for dentalcare means any agreement in which a person agrees to provide or arrange fordental care or pay for or reimburse any part of the cost of that care and themember agrees to prepay, make periodic payments or pay through insurance forthat care.

(Added to NRS by 1983, 2021; A 1985, 2098)

NRS 695D.080 Policydefined. Policy means the document given toa member which describes the dental care to which he is entitled under a planfor dental care and his obligations to the organization for dental care.

(Added to NRS by 1983, 2021)

NRS 695D.090 Applicability.

1. Except as otherwise specifically provided in thischapter or elsewhere in this title, the provisions of this title other thanthis chapter do not apply to organizations for dental care. This exemption doesnot apply to any insurer authorized pursuant to any other provision of thistitle except with respect to those activities authorized and regulated by thischapter.

2. The provisions of this chapter do not apply to:

(a) Any person, corporation or organization which mustbe authorized by the Commissioner to transact the business of insurancepursuant to chapter 680A, 695B or 695Cof NRS.

(b) Any plan established to provide health and welfarebenefits to employees pursuant to a collective bargaining agreement.

(Added to NRS by 1983, 2021)

NRS 695D.095 Applicabilityof other provisions to organizations for dental care. Anorganization for dental care is not exempt from the provisions of NRS 679B.700. If an organization is anadmitted health insurer, as that term is defined in NRS 449.450, it is not exempt from the feesimposed pursuant to NRS 449.465.

(Added to NRS by 1987, 470)

NRS 695D.100 Regulationsof Commissioner. The Commissioner may adoptany regulations necessary to carry out the provisions of this chapter.

(Added to NRS by 1983, 2022)

NRS 695D.102 Summaryof coverage: Contents of disclosure; approval by Commissioner.

1. The Commissioner shall adopt regulations whichrequire an organization for dental care to file with the Commissioner, for hisapproval, a disclosure summarizing the coverage provided by each plan fordental care offered by the organization for dental care. The disclosure mustinclude:

(a) Any significant exception, reduction or limitationthat applies to the plan; and

(b) Any other information,

that theCommissioner finds necessary to provide for full and fair disclosure of theprovisions of the plan.

2. The disclosure must be written in language which iseasily understood and must include a statement that the disclosure is a summaryof the policy only, and that the policy itself should be read to determine thegoverning contractual provisions.

3. The Commissioner shall not approve any proposeddisclosure submitted to him pursuant to this section which does not comply withthe requirements of this section and the applicable regulations.

(Added to NRS by 1989, 1254)

NRS 695D.104 Summaryof coverage: Copy to be provided before policy issued; policy not to be offeredunless summary approved by Commissioner. Anorganization for dental care shall provide to the group policyholder to whom itoffers a plan for dental care a copy of the disclosure approved for that planpursuant to NRS 695D.102 before thepolicy is issued. An organization for dental care shall not offer a plan fordental care unless the disclosure for that plan has been approved by theCommissioner.

(Added to NRS by 1989, 1254)

NRS 695D.110 Certificateof authority: Required for plan for dental care. Noperson may establish or operate a plan for dental care, act as an administratorof such a plan or sell or offer to sell such a plan without first obtaining acertificate of authority from the Commissioner.

(Added to NRS by 1983, 2022)

NRS 695D.120 Certificateof authority: Application. Each applicationfor a certificate of authority must be filed with the Commissioner on a formprescribed by him, must be verified by an officer or authorized representativeof the organization for dental care and must include:

1. A copy of any organizational document for theorganization and all amendments to that document.

2. A copy of any bylaws, rules or regulationsgoverning the internal affairs of the organization.

3. A list of the names, addresses and officialpositions of the persons responsible for operating the organization, includingthe members of the board of directors, board of trustees, executive committee,principal officers or partners.

4. A copy of the contracts made or proposed to be madebetween the applicant and those persons listed in subsection 3 and thedentists.

5. A statement describing the applicants plan fordental care, its facilities and personnel.

6. A copy of the policy to be issued to its members.

7. A copy of any contract for groups to be issued toemployers, unions, trustees or other organizations.

8. Certified financial statements showing theapplicants assets, liabilities and sources of support. A copy of theapplicants most recent certified financial statement satisfies thisrequirement unless the Commissioner requests additional information from theapplicant.

9. A description of the method to be used to marketthe plan for dental care, including a financial statement, a projection for theinitial 5 years of operation of the plan and a statement of the sources ofcapital for the organization.

10. A power of attorney executed by the applicant orits officers, which appoints the Commissioner as the attorney for the applicantupon whom service of process may be made in this State.

11. A statement describing the geographic area orareas to be served by the applicant.

12. A statement indicating that all the dentists forthe plan are licensed pursuant to chapter 631of NRS.

13. Any other information requested by theCommissioner.

(Added to NRS by 1983, 2022)

NRS 695D.130 Certificateof authority: Issuance. The Commissioner shallissue a certificate of authority to an organization for dental care after theorganization has paid an application fee of $2,450 and the Commissioner issatisfied that:

1. The persons responsible for operating theorganization are competent, trustworthy, have not been convicted of a felonyand have good reputations.

2. The plan for dental care includes care which isappropriate for the plan and the plan is appropriate for providing that care.

3. The organization is financially responsible and mayreasonably be expected to meet its obligations to its members. To determinefinancial responsibility the Commissioner may consider:

(a) The organizations arrangements for dental care andthe schedule of charges to be used;

(b) The agreements with an insurer, government or anyother organizations for ensuring payment for the dental care;

(c) Any provisions for alternative coverage if the planfor dental care is discontinued; and

(d) The agreements with the dentists providing dentalcare to the organizations members.

4. The appropriate deposits or bonds have been filedwith the Commissioner by the organization and its officers.

(Added to NRS by 1983, 2023; A 1991, 1634)

NRS 695D.140 Certificateof authority: Notice of change of information; application for amendment; fee;approval.

1. Except as otherwise provided in subsection 2, everyorganization issued a certificate of authority by the Commissioner shall notifyhim of any change in the information provided to obtain its certificate ofauthority within 10 days after the change.

2. Every such organization that wishes to make achange in the geographic areas which it serves, or to make any other materialmodification of the operations described in the information required by NRS 695D.120, shall file with the Commissioneran application for the amendment of the certificate of authority and pay to himan application fee of $100. If the Commissioner does not disapprove theapplication within 30 days after filing, it shall be deemed approved.

(Added to NRS by 1983, 2023; A 1991, 2205)

NRS 695D.150 Certificateof authority: Expiration; renewal; fee for renewal. Acertificate of authority expires at midnight on March 1 following the date itwas issued or previously renewed. The Commissioner shall renew the certificateof any organization for dental care which:

1. Continues to comply with the provisions of thischapter; and

2. Pays the fee for renewal of $2,450.

(Added to NRS by 1983, 2023; A 1987, 470; 1991, 1635;1993, 614)

NRS 695D.160 Compositionof board of directors for organization for dental care. If an organization for dental care is a corporation, itsboard of directors must include:

1. Dentists who have contracted with the organizationto provide dental care to its members; and

2. Members of the plan for dental care, who mustcomprise at least one-third of the membership of the board by the end of itsfirst year of operation.

(Added to NRS by 1983, 2023)

NRS 695D.170 Bondrequired; lien and payment on bond.

1. Before a certificate of authority may be issued toan organization for dental care:

(a) The officers responsible for operating theorganization must file with the Commissioner a collective fidelity bond for$1,000,000; and

(b) The organization must file with the Commissioner asurety bond in the sum of $250,000 or deposit with the Commissioner cash orsecurities acceptable to the Commissioner in the sum of $250,000,

to guaranteethe organizations performance pursuant to this chapter.

2. If the bond is furnished in:

(a) Cash, the Commissioner shall deposit the money inthe State Treasury for credit to the Fund for Bonds of Organizations for DentalCare which is hereby created as a trust fund.

(b) Negotiable securities, the principal must be placedwithout restriction at the disposal of the Commissioner, but any income mustinure to the benefit of the organization.

3. The Commissioner may reduce the organizations bondor deposit:

(a) To $125,000, if the obligations assumed by theorganization under the plan can be satisfied for less than $125,000.

(b) To any amount if the organization demonstrates thatit has commitments of money from federal, state or municipal governments ortheir political subdivisions or other comparable resources which are sufficientto ensure the ability of the organization to satisfy its obligations.

4. Any final judgment against the organization whichis unpaid is a lien on the bond or deposit and is subject to execution 30 daysafter entry of the judgment. Any bond or deposit which is reduced by this lienmust be increased by the organization to the amount required by this sectionwithin 90 days after the judgment is paid.

5. If an organization is dissolved, liquidated orotherwise terminated:

(a) That amount of the bond or deposit which isnecessary to satisfy the outstanding obligations of the organization may not bewithdrawn for at least 3 years after the certificate of authority has beenterminated.

(b) Any balance remaining after money has been withheldto pay the organizations debts and liens must be paid to the organization bythe Commissioner no later than 90 days after the certificate of authority hasbeen terminated.

(Added to NRS by 1983, 2023)

NRS 695D.180 Bondpayable to State; cancellation.

1. A bond by any organization for dental care or itsofficers under this chapter must be payable to the State of Nevada and must beconditioned on compliance with the provisions of this chapter. The surety shallpay all damages to any person by reason of any misstatement, misrepresentation,fraud or deceit, or any wrongful act or omission of any person or organizationmade, committed or omitted in the plan for dental care or caused by any otherviolation of the provisions of this chapter.

2. The organization must give notice to theCommissioner at least 90 days before such a bond may be cancelled.

(Added to NRS by 1983, 2024)

NRS 695D.190 Fiduciaryresponsibilities; disciplinary action. Anydirector, officer, partner or employee of an organization for dental care whoreceives, collects, disburses or invests money in connection with theactivities of that organization is responsible for that money and has afiduciary duty and relationship to the members of the organization. Any dentistwho breaches this fiduciary duty or fails to satisfy his contractual obligationto the organization or the members thereof is subject to disciplinary actionpursuant to NRS 631.350.

(Added to NRS by 1983, 2024)

NRS 695D.200 Policy:Issuance; form and contents; notice of change.

1. An organization for dental care shall:

(a) Hold a meeting for all prospective members toreview fully the policy being offered and describe the coverage under the planfor dental care before any contract is executed between the parties.

(b) Provide to each member a copy of the policydescribing his coverage under the plan for dental care.

2. The Commissioner must approve every policy andamendment to it before they are distributed to the members or any other person.If the Commissioner does not disapprove the policy within 30 days after it isfiled with him, it shall be deemed to be approved. If the Commissionerdisapproves a policy, he shall notify the organization of the reasons for hisdisapproval. The Commissioner shall grant a hearing on any disapproval of apolicy or amendment within 15 days after the organization requests, in writing,a hearing on the matter.

3. A policy must contain a clear and completestatement of the contract between the parties or a summary of the contractwhich describes:

(a) The dental care and other benefits to which themember is entitled;

(b) Any limitations on the care to be provided,including any deductibles or copayments to be paid by a member;

(c) Where information is available and how dental caremay be obtained; and

(d) The members obligations for payment under the planfor dental care.

4. The organization must give notice to theCommissioner and every member 30 days before any change is made in the memberspolicy.

(Added to NRS by 1983, 2025)

NRS 695D.203 Groupplan issued to replace discontinued policy or coverage: Requirements; notice ofreduction of benefits; statement of benefits; applicability to self-insuredemployer.

1. A group plan for dental care issued by anorganization for dental care to replace any discontinued policy or coverage fordental care must:

(a) Provide coverage for all persons who were coveredunder the previous policy or coverage on the date it was discontinued; and

(b) Except as otherwise provided in subsection 2,provide benefits which are at least as extensive as the benefits provided bythe previous policy or coverage, except that benefits may be reduced orexcluded to the extent that such a reduction or exclusion was permissible underthe terms of the previous policy or coverage,

if that planis issued within 60 days after the date on which the previous policy orcoverage was discontinued.

2. If an employer obtains a replacement plan pursuantto subsection 1 to cover his employees, any benefits provided by the previouspolicy or coverage may be reduced if notice of the reduction is given to hisemployees pursuant to NRS 608.1577.

3. Any organization for dental care which issues areplacement plan pursuant to subsection 1 may submit a written request to theinsurer which provided the previous policy or coverage for a statement ofbenefits which were provided under that policy or coverage. Upon receiving sucha request, the insurer shall give a written statement to the organizationindicating what benefits were provided and what exclusions or reductions werein effect under the previous policy or coverage.

4. The provisions of this section apply to aself-insured employer who provides benefits to his employees for dental careand replaces those benefits with a group plan for dental care.

(Added to NRS by 1987, 851)

NRS 695D.205 Copaymentsand deductibles.

1. Each copayment and deductible required to be paidby a member must be reasonable and reasonably related to the cost of theparticular service.

2. Every organization for dental care shall submit tothe Commissioner for his approval any proposal for copayment or deductiblebefore it is imposed on the members. The Commissioner shall approve ordisapprove the proposal within 30 days after it is submitted to him. If theCommissioner disapproves a copayment or deductible, he shall notify theorganization of the reasons for his disapproval. The Commissioner shall grant ahearing on any such disapproval within 15 days after the organization requests,in writing, a hearing on the matter.

3. The Commissioner may adopt regulations to define:

(a) Reasonable as it relates to copayments anddeductibles; and

(b) A reasonable relationship between the cost ofparticular services and the amount of related copayments and deductibles.

(Added to NRS by 1987, 1783)

NRS 695D.210 Coveragefor newly born and adopted children and children placed for adoption.

1. Any policy which provides coverage for a dependentof a member must provide that benefits for children are payable for a membersnewly born child, adopted child or child placed with the member for the purposeof adoption to the same extent that the coverage applies to other dependents.

2. The policy may require that to have coverage forthe newly born child, adopted child or child placed for adoption continuedbeyond 31 days after the childs birth, adoption or placement, the member mustnotify the organization for dental care within 31 days after the birth,adoption or placement.

3. For covered services provided to the child, theorganization for dental care shall reimburse noncontracted providers of healthcare to an amount equal to the average amount of payment for which theorganization has agreements, contracts or arrangements for those coveredservices.

(Added to NRS by 1983, 2025; A 1989, 742)

NRS 695D.215 Claims:Approval or denial; request for additional information; payment; interest onunpaid claim.

1. Except as otherwise provided in subsection 2, anorganization for dental care shall approve or deny a claim relating to a planfor dental care within 30 days after the organization for dental care receivesthe claim. If the claim is approved, the organization for dental care shall paythe claim within 30 days after it is approved. If the approved claim is notpaid within that period, the organization for dental care shall pay interest onthe claim at the rate of interest established pursuant to NRS 99.040. The interest must be calculatedfrom the date the payment is due until the claim is paid.

2. If the organization for dental care requiresadditional information to determine whether to approve or deny the claim, itshall notify the claimant of its request for the additional information within20 days after it receives the claim. The organization for dental care shallnotify the provider of dental care of the reason for the delay in approving ordenying the claim. The organization for dental care shall approve or deny theclaim within 30 days after receiving the additional information. If the claimis approved, the organization for dental care shall pay the claim within 30days after it receives the additional information. If the approved claim is notpaid within that period, the organization for dental care shall pay interest onthe claim in the manner prescribed in subsection 1.

(Added to NRS by 1991, 1332)

NRS 695D.217 Organizationfor dental care prohibited from denying coverage solely because person wasvictim of domestic violence. An organizationfor dental care shall not deny a claim, refuse to issue a policy or cancel apolicy solely because the claim involves an act that constitutes domesticviolence pursuant to NRS 33.018, orbecause the person applying for or covered by the policy was the victim of suchan act of domestic violence, regardless of whether the insured or applicantcontributed to any loss or injury.

(Added to NRS by 1997, 1097)

NRS 695D.219 Organizationfor dental care prohibited from denying coverage solely because member wasintoxicated or under the influence of controlled substance; exceptions.[Effective July 1, 2006.]

1. Except as otherwise provided in subsection 2, anorganization for dental care shall not:

(a) Deny a claim under a plan for dental care solelybecause the claim involves an injury sustained by a member as a consequence ofbeing intoxicated or under the influence of a controlled substance.

(b) Cancel participation under a plan for dental caresolely because a member has made a claim involving an injury sustained by themember as a consequence of being intoxicated or under the influence of acontrolled substance.

(c) Refuse participation under a plan for dental careto an eligible applicant solely because the applicant has made a claiminvolving an injury sustained by the applicant as a consequence of beingintoxicated or under the influence of a controlled substance.

2. Theprovisions of this section do not prohibit an organization for dental care fromenforcing a provision included in a plan for dental care to:

(a) Deny a claim which involves an injury to which acontributing cause was the insureds commission of or attempt to commit afelony;

(b) Cancel participation under a plan for dental caresolely because of such a claim; or

(c) Refuse participation under a plan for dental careto an eligible applicant solely because of such a claim.

(Added to NRS by 2005, 2346,effective July 1, 2006)

NRS 695D.220 Licensingof agents.

1. The provisions of chapter683A of NRS apply to the licensing of agents for an organization for dentalcare.

2. As used in this section, agent means any personwho is associated, directly or indirectly, with the organization and engages insoliciting or enrolling members.

(Added to NRS by 1983, 2027)

NRS 695D.230 Approvalof advertising or materials used to solicit members.

1. Every organization for dental care must submit anyadvertising, or other materials to be used to enroll or solicit members, to theCommissioner for his approval before they are used by the organization.

2. If the Commissioner does not disapprove theadvertising or other materials within 30 days after they are filed with theCommissioner, they shall be deemed to be approved. If the Commissionerdisapproves any of the advertising or other materials because they are false,deceptive, or misleading, he shall notify the organization of his reasons fordisapproving them. The Commissioner shall grant a hearing on the matter within15 days after the organization requests, in writing, a hearing on the matter.

3. If any advertising or other materials arecirculated, issued, displayed or used in any manner to enroll or solicitmembers before they are approved by the Commissioner or after he hasdisapproved them, the Commissioner may withdraw his approval, if any, of thepolicy and plan for dental care proposed by the organization or take any otherdisciplinary action permitted by this chapter against the organization.

(Added to NRS by 1983, 2025)

NRS 695D.240 Limitationon expenses for marketing and administration.

1. The organization for dental care shall use not morethan 25 percent of its prepaid charges or premiums for marketing andadministrative expenses, including all costs to solicit members or dentists.

2. The Commissioner may adopt regulations which definemarketing and administrative expenses for the purposes of subsection 1.

(Added to NRS by 1983, 2026; A 1993, 2401)

NRS 695D.250 Reserves;regulations.

1. An organization for dental care shall set aside areserve equal to 3 percent of the premiums collected from its members up to atotal of $500,000. This reserve is in addition to the bond or deposit filedwith the Commissioner.

2. This section does not apply to organizationsreceiving money from federal, state or municipal governments or their politicalsubdivisions or another comparable resource which have had their deposit orbond reduced by the Commissioner.

3. Every organization shall maintain the reservesrequired by NRS 681B.080, unless alarger amount is required by subsection 1 of this section.

4. The reserve required by subsection 1 is held by theorganization in a fiduciary capacity. The organization must deposit the reservein an interest-bearing trust account established in a bank, credit union orsavings and loan association in this state that is federally insured or insuredby a private insurer approved pursuant to NRS678.755. The account must be separate from all other accounts maintained bythe organization.

5. Any person who diverts or appropriates reservesheld in a fiduciary capacity pursuant to this section for his own use is guiltyof embezzlement.

6. The Commissioner may adopt reasonable regulationsrelated to the adequacy of a reserve required by this section and theestablishment and maintenance of a trust account pursuant to this section.

(Added to NRS by 1983, 2026; A 1993, 2401; 1999, 1554)

NRS 695D.260 Annualreport, financial statement and tax; administrative penalty for failure to filereport or financial statement.

1. Every organization for dental care shall file withthe Commissioner on or before March 1 of each year a report covering itsactivities for the preceding calendar year. The report must be verified by atleast two officers of the organization.

2. The report must be on a form prescribed by theCommissioner and must include:

(a) A financial statement of the organization,including its balance sheet and receipts and disbursements for the precedingcalendar year.

(b) Any material changes in the information given inthe previous report.

(c) The number of members enrolled in that year, thenumber of members whose coverage has been terminated in that year and the totalnumber of members at the end of the year.

(d) The costs of all goods, services and dental careprovided that year.

(e) Any other information relating to the plan fordental care requested by the Commissioner.

3. Every organization for dental care shall file withthe Commissioner annually an audited financial statement prepared by anindependent certified public accountant. The statement must cover the mostrecent fiscal year of the organization and must be filed with the Commissionerwithin 120 days after the end of that fiscal year.

4. If an organization fails to file timely the reportor financial statement required by this section, it shall pay an administrativepenalty of $100 per day until the report or statement is filed, except that thetotal penalty must not exceed $3,000. The Attorney General shall recover thepenalty in the name of the State of Nevada.

5. The Commissioner may grant a reasonable extensionof time for filing the report or financial statement required by this section,if the request for an extension is submitted in writing and shows good cause.

6. The organization shall pay the Department ofTaxation the annual tax, any penalty for nonpayment or delinquent payment ofthe tax imposed in chapter 680B of NRS, anda filing fee of $25 to the Commissioner, at the time the annual report isfiled.

(Added to NRS by 1983, 2026; A 1987, 471; 1991, 2206;1993, 1923; 1995, 1633, 2682)

NRS 695D.270 Examinationof organization by Commissioner.

1. The Commissioner shall, once:

(a) Every 6 months for the first 3 years after anorganization for dental care receives its certificate of authority; and

(b) Each year thereafter,

conduct anexamination of the organization pursuant to NRS679B.250 to 679B.300, inclusive.

2. The Commissioner may examine any organization whichholds a certificate of authority from this state or another state at any othertime he deems necessary. For those organizations transacting business in thisstate which are not organized in this state, the Commissioner may accept a fullreport of the last examination of the organization certified by the stateofficer who supervises those organizations in the other state, if thatexamination is equivalent to an examination conducted by the Commissioner.

3. The Commissioner shall, in like manner, examine allorganizations applying for a certificate of authority.

(Added to NRS by 1983, 2027)

NRS 695D.280 Rehabilitation,liquidation or conservation. Any rehabilitation,liquidation or conservation of an organization for dental care shall be deemedto be the rehabilitation, liquidation or conservation of an insurer and must beconducted pursuant to chapter 696B of NRS.

(Added to NRS by 1983, 2027)

NRS 695D.290 Tradepractices and frauds. The provisions of NRS 686A.010 to 686A.310, inclusive, relating to tradepractices and frauds apply to organizations for dental care.

(Added to NRS by 1983, 2027)

NRS 695D.300 Disciplinaryactions; penalties.

1. The Commissioner may suspend or revoke anycertificate of authority issued to an organization for dental care or impose afine of not more than $500 for each violation if he finds that:

(a) The organization is operating contrary to theinformation it submitted to him for its certificate of authority;

(b) The organization issued a policy to a member whichwas not approved by the Commissioner;

(c) The plan for dental care does not provide basicservices appropriate for such a plan;

(d) The organization can no longer meet its obligationsto members or prospective members;

(e) The organization or any person on its behalf hasadvertised its plan in an untrue, misleading, deceptive or unfair manner; or

(f) The organization has failed to comply substantiallywith this chapter or the regulations of the Commissioner.

2. If the certificate of authority of an organizationis suspended, the organization shall not, during the period of the suspension,accept any new members and shall not advertise for or solicit any new members.

3. If the certificate of authority of an organizationis revoked, the organization shall proceed, immediately following the order, toterminate its affairs and shall conduct no other business. The Commissioner, bywritten order, may approve the continued operation of the organization for aspecified time if the Commissioner finds that the members need that time toobtain coverage for dental care from another organization or insurer.

(Added to NRS by 1983, 2027)

NRS 695D.310 Noticeof disciplinary action; hearing; order.

1. If the Commissioner believes that grounds fordenying a certificate of authority or for suspending or revoking a certificateexist, he shall notify the organization for dental care in writing, specifyingthe grounds for the denial, suspension or revocation and fix a time for ahearing on the matter within 30 days after the notice.

2. After the hearing or upon the failure of theorganization to appear at the hearing, the Commissioner shall enter a writtenorder of his decision which must be mailed by certified mail to theorganization.

(Added to NRS by 1983, 2028)

 

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