2005 Nevada Revised Statutes - Chapter 695H — Medical Discount Plans

CHAPTER 695H - MEDICAL DISCOUNT PLANS

NRS 695H.010 Definitions.

NRS 695H.020 Administratordefined.

NRS 695H.030 Affiliateof an insurer defined.

NRS 695H.040 Insurerdefined.

NRS 695H.050 Medicaldiscount plan defined.

NRS 695H.060 Providerof health care defined.

NRS 695H.070 Medicaldiscount plans under exclusive jurisdiction of Commissioner.

NRS 695H.080 Registrationof medical discount plan required; exceptions.

NRS 695H.090 Applicationfor registration; forms; fees; contents; renewal of registration; regulations.

NRS 695H.100 Personresponsible for conducting business activities of medical discount planprohibited from engaging in certain acts.

NRS 695H.110 Requireddisclosures.

NRS 695H.120 Typesize for disclosures.

NRS 695H.130 Networth.

NRS 695H.140 Examinations;inspection of accounts, books and records by Commissioner.

NRS 695H.150 Records.

NRS 695H.160 Regulations.

NRS 695H.170 Administrativepenalty for commission of certain acts.

NRS 695H.180 Penalties.

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NRS 695H.010 Definitions. As used in this chapter, unless the context otherwiserequires, the words and terms defined in NRS695H.020 to 695H.060, inclusive,have the meanings ascribed to them in those sections.

(Added to NRS by 2005, 2101)

NRS 695H.020 Administratordefined. Administrator means a personauthorized pursuant to NRS 683A.0805to 683A.0893, inclusive, to conductbusiness in this State as an administrator.

(Added to NRS by 2005, 2101)

NRS 695H.030 Affiliateof an insurer defined. Affiliate of an insurermeans a person who directly, or indirectly through one or more intermediaries,controls, is controlled by or is under common control with an insurer.

(Added to NRS by 2005, 2101)

NRS 695H.040 Insurerdefined. Insurer means any insurer,fraternal benefit society, nonprofit corporation for hospital, medical anddental services, organization for dental care, health maintenance organizationor prepaid limited health service organization authorized pursuant to thistitle to conduct business in this State.

(Added to NRS by 2005, 2101)

NRS 695H.050 Medicaldiscount plan defined. Medical discountplan means a business arrangement or program evidenced by a membershipagreement, contract, card, certificate, device or mechanism in which a person,in exchange for fees, dues, charges or any other form of consideration, offersto provide or provides health care or medical services at a discount fromproviders of health care who are participating in the business arrangement orprogram or whom the person advertises as or claims to be participating in thebusiness arrangement or program.

(Added to NRS by 2005, 2101)

NRS 695H.060 Providerof health care defined. Provider of healthcare has the meaning ascribed to it in NRS629.031.

(Added to NRS by 2005, 2101)

NRS 695H.070 Medicaldiscount plans under exclusive jurisdiction of Commissioner. Notwithstanding any other provision of law, theCommissioner has exclusive jurisdiction to regulate medical discount plans inthis State.

(Added to NRS by 2005, 2101)

NRS 695H.080 Registrationof medical discount plan required; exceptions.

1. Except as otherwise provided in this section, it isunlawful for any person to offer, market, sell or engage in business as amedical discount plan in this State without first registering the medicaldiscount plan pursuant to the provisions of this chapter.

2. An insurer is not required to register any medicaldiscount plan pursuant to the provisions of this chapter unless the insureroffers, markets or sells the medical discount plan in this State for separate consideration.

3. If an affiliate of an insurer offers, markets,sells or engages in business as a medical discount plan in this State, theaffiliate is required to register the medical discount plan pursuant to theprovisions of this chapter.

4. The provisions of this chapter do not apply to anymedical discount plan that offers or provides discounts only on prescriptions.

(Added to NRS by 2005, 2101)

NRS 695H.090 Applicationfor registration; forms; fees; contents; renewal of registration; regulations.

1. An application for registration to engage inbusiness as a medical discount plan must be submitted on a form prescribed bythe Commissioner. The form must be signed by an officer or an authorizedrepresentative of the applicant. Except as otherwise provided in this section,the application must be accompanied by:

(a) A registration fee of $500.

(b) A copy of the organizational documents of theapplicant, if any.

(c) A list of names, addresses, positions of employmentand biographical information of each person who is responsible for conductingthe business activities of the medical discount plan of the applicant,including, but not limited to, all members of the board of directors, board oftrustees, officers and managers. The list must set forth the extent and natureof any contracts or other agreements between any person who is responsible forconducting the business activities of the applicant and the medical discountplan, including disclosure of any possible conflicts of interest.

(d) A complete biographical statement, on a formprescribed by the Commissioner, describing the facilities, employees andservices that will be offered by the applicant.

(e) A copy of all forms used for contracts between theapplicant and networks of providers of health care regarding the provision ofhealth care or medical services to members.

(f) A copy of the most recent financial statements ofthe applicant, audited by an independent certified public accountant.

(g) A description of the method of marketing proposedby the applicant.

(h) A description of the procedures for making acomplaint to be established and maintained by the applicant.

(i) Any other information required by the Commissioner.

2. Each person who registers a medical discount planmust renew the registration annually before the registration expires. Except asotherwise provided in this section, an application to renew the registrationmust include:

(a) An annual renewal fee of $500; and

(b) Any information set forth in subsection 1 that theCommissioner requires to be included in the application.

3. An administrator or insurer that registers amedical discount plan is not required to pay the fees for registering orrenewing the registration of the medical discount plan pursuant to thissection.

4. The Commissioner shall, by regulation, designatethe provisions of subsection 1 that shall be deemed satisfied by anadministrator, insurer or affiliate of an insurer that has complied withsubstantially similar requirements pursuant to other provisions of this title.

(Added to NRS by 2005, 2101)

NRS 695H.100 Personresponsible for conducting business activities of medical discount planprohibited from engaging in certain acts. A person who is responsiblefor conducting the business activities of a medical discount plan may not:

1. Use the word insurance or enrollment in anyadvertising or marketing material, brochures or discount cards for the medicaldiscount plan unless approved by the Commissioner;

2. Use in any advertising or marketing material,brochures or discount cards for the medical discount plan the terms coverage,copay, preexisting conditions, guaranteed issue, PPO, preferredprovider organization or any other term that could reasonably mislead a personinto believing the medical discount plan is a policy of health insurance;

3. Pay a provider of health care any fee for providingany health care or medical services; or

4. Collect or accept money from a member of themedical discount plan for payment to a provider of health care for specifichealth care or medical services that the provider has provided or will provideto the member unless the registration for the medical discount plan is held byan administrator or insurer.

(Added to NRS by 2005, 2102)

NRS 695H.110 Requireddisclosures.

1. The following disclosures must be made in writingto any prospective member of a medical discount plan and must be in clearlanguage and prominently displayed in any advertisements, marketing materialsand brochures relating to a medical discount plan:

(a) That the medical discount plan is not a policy ofhealth insurance;

(b) That the medical discount plan provides discountsfrom providers of health care who provide health care or medical services tomembers;

(c) That the medical discount plan does not makepayments directly to the providers of health care;

(d) That the member will be required to pay for allhealth care or medical services but will receive a discount from thoseproviders of health care who have contracted with the medical discount plan;

(e) The corporate name of the person offering themedical discount plan and the location and address of each office for themedical discount plan; and

(f) A telephone number where the member may obtaininformation and answers to questions or complaints.

2. Thedisclosures required pursuant to this section may be provided orally orelectronically if written disclosures are provided not later than the earlierof:

(a) Ten business days after the prospective memberelects to accept the medical discount plan; or

(b) The date on which any other written material isprovided by the medical discount plan to the member.

(Added to NRS by 2005, 2103)

NRS 695H.120 Typesize for disclosures. The disclosures requiredby this chapter must be printed in type that is not smaller than 12-point type.

(Added to NRS by 2005, 2103)

NRS 695H.130 Networth.

1. Each medical discount plan must at all timesmaintain a net worth of $100,000.

2. The Commissioner shall not issue a registration orrenewal of a registration for a medical discount plan unless the personregistering or renewing the registration certifies that the medical discountplan has a net worth of at least $100,000.

(Added to NRS by 2005, 2103)

NRS 695H.140 Examinations;inspection of accounts, books and records by Commissioner.

1. Except as otherwise provided in this subsection,the Commissioner may conduct examinations to enforce the provisions of thischapter pursuant to the provisions of NRS679B.230 to 679B.300, inclusive,at such times as he deems necessary. For the purposes of this chapter, theCommissioner is not required to comply with the requirement in NRS 679B.230 that insurers be examinednot less frequently than every 5 years.

2. A person who is responsible for conducting thebusiness activities of a medical discount plan shall, upon the request of theCommissioner, make available to the Commissioner for inspection any accounts,books and records concerning the medical discount plan which are reasonablynecessary to enable the Commissioner to determine whether the medical discountplan is in compliance with the provisions of this chapter.

(Added to NRS by 2005, 2104)

NRS 695H.150 Records.

1. A medical discount plan must maintain records ofthe transactions governed by this chapter. The records must include:

(a) A copy of each type of contract that the medicaldiscount plan issues, sells or offers for sale;

(b) The name and address of each member of the medicaldiscount plan;

(c) A copy of each contract that the medical discountplan enters into with providers of health care for purposes of providingmembers with health care or medical services at a discount; and

(d) A copy of the annual certification of net worth andsupporting documentation.

2. Except as otherwise provided in this subsection,each medical discount plan must retain all records for at least 7 years. Amedical discount plan which intends to discontinue doing business in this Statemust provide the Commissioner with satisfactory proof that it has dischargedits duties to the members in this State and must not destroy its recordswithout the prior approval of the Commissioner.

3. The records required to be maintained pursuant tothis section may be stored on a computer disc or other storage device for acomputer from which the records may be readily printed.

(Added to NRS by 2005, 2104)

NRS 695H.160 Regulations. The Commissioner may adopt regulations to carry out theprovisions of this chapter.

(Added to NRS by 2005, 2105)

NRS 695H.170 Administrativepenalty for commission of certain acts. Aperson is subject to the imposition of an administrative penalty pursuant tothis chapter if, in the course of the business of the person, the person:

1. Solicits, markets, advertises, promotes or sells toa person in this State a medical discount plan or a membership in connectionwith a medical discount plan unless the medical discount plan is registeredpursuant to this chapter.

2. Fails to provide any disclosure required pursuantto NRS 695H.110.

3. Fails to make available to an applicant formembership or to a member, through a toll-free telephone number, upon therequest of the applicant or member, a complete and accurate list of allparticipating providers of health care who have contracted with the medicaldiscount plan and who are located in the applicants or members local area, orwithin a radius of 50 miles, and a list of the health care or medical servicesfor which the discounts are applicable. The list must be made available, uponthe request of the applicant, at the time the applicant purchases a membershipand must be updated not less than once every 6 months.

4. Violates subsection 1 or 2 of NRS 695H.100 or otherwise usesadvertising or marketing material, brochures or discount cards that aremisleading, deceptive or fraudulent.

5. Offers discounted products or services to theapplicant or member that are not authorized by a contract with each provider ofhealth care listed in conjunction with the medical discount plan.

6. Fails to allow the applicant or member to cancelthe membership in the medical discount plan.

7. If appropriate, fails to refund any requiredportion of membership fees paid to the medical discount plan by the applicantor member within 30 days after the applicant or member provides timelynotification of the cancellation of the membership to the person administeringthe medical discount plan.

(Added to NRS by 2005, 2103)

NRS 695H.180 Penalties. A person who violates any provision of this chapter or anorder or regulation of the Commissioner issued or adopted pursuant thereto maybe assessed an administrative penalty by the Commissioner of not more than$2,000 for each act or violation, not to exceed an aggregate amount of $10,000for violations of a similar nature. For the purposes of this section,violations shall be deemed to be of a similar nature if the violations consistof the same or similar conduct, regardless of the number of times the conductoccurred.

(Added to NRS by 2005, 2104)

 

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