2024 Nevada Revised Statutes
Chapter 689A - Individual Health Insurance

GENERAL PROVISIONS

• 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.

REQUIRED PROVISIONS

• NRS 689A.040 - Contents of policy; substitution of provisions; captions; omission or modification of provisions.
• NRS 689A.0403 - Procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations.
• 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.0404 - Coverage for use of certain drugs and related services for treatment of cancer required in certain policies.
• 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.0405 - Coverage for certain screenings and tests for breast cancer required; prohibited acts.
• NRS 689A.041 - Coverage relating to mastectomy required in policy covering mastectomies; prohibited acts.
• 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.
• NRS 689A.0415 - Coverage for hormone replacement therapy in certain circumstances required in policy covering prescription drugs or devices; prohibited acts; exception.
• NRS 689A.0417 - Coverage for health care services related to hormone replacement therapy required in policy covering outpatient care; prohibited acts.
• 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.042 - Policy containing exclusion, reduction or limitation of coverage relating to complications of pregnancy prohibited; exception.
• 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.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.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.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.044 - Coverage for certain tests and vaccines relating to human papillomavirus required; prohibited acts.
• 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.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.046 - Benefits for treatment of alcohol or substance use disorder required.
• 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.

REIMBURSEMENT FOR CERTAIN MEDICALLY RELATED TREATMENT AND SERVICES

• NRS 689A.0475 - Acupuncture.
• NRS 689A.048 - Treatment by licensed psychologist.
• 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.0487 - Treatment by licensed podiatrist.
• NRS 689A.049 - Treatment by licensed chiropractic physician; restriction on policy limitations.
• NRS 689A.0493 - Treatment by licensed clinical alcohol and drug counselor.
• NRS 689A.0495 - Services provided by certain registered nurses.
• NRS 689A.0497 - Provider of medical transportation.

MISCELLANEOUS PROVISIONS

• 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.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.
• 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.415 - Insurer prohibited from denying coverage solely because applicant or insured was intoxicated or under influence of controlled substance; exceptions.
• NRS 689A.417 - Insurer prohibited from requiring or using information concerning genetic testing; exceptions.
• NRS 689A.419 - Offering policy of health insurance for purposes of establishing health savings account.

ELIGIBILITY FOR COVERAGE

• NRS 689A.420 - Definitions.
• NRS 689A.430 - Effect of eligibility for medical assistance under Medicaid; assignment of rights to state agency.
• NRS 689A.440 - Insurer prohibited from asserting certain grounds to deny enrollment of child of insured pursuant to order.
• NRS 689A.450 - Certain accommodations required to be made when child is covered under policy of noncustodial parent.
• 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.

PORTABILITY AND ACCOUNTABILITY

General Provisions

• NRS 689A.470 - Definitions.
• NRS 689A.475 - "Affiliated" defined.
• NRS 689A.485 - "Bona fide association" defined.
• NRS 689A.490 - "Church plan" defined.
• NRS 689A.495 - "Control" defined.
• 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.530 - "Governmental plan" 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.

Individual Carriers

• 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.

Individual Health Insurance Coverage

• 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.

Bona Fide Associations

• NRS 689A.725 - Requirements for plan for coverage.

Miscellaneous Provisions

• NRS 689A.740 - Regulations.

SYSTEM FOR RESOLVING COMPLAINTS OF INSUREDS

• 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 required when insurer denies coverage of health care service.