NRS 689C.107 Affiliatedcarriers deemed one carrier in certain circumstances; affiliated carrier thatis health maintenance organization considered separate carrier; ceding arrangementprohibited in certain circumstances.

NRS 689C.109 Certainplan, fund or program to be treated as employee welfare benefit plan which isgroup health plan; partnership deemed employer of each partner.

NRS 689C.111 Determinationof whether employer is small or large; applicability of provisions afteremployer is deemed large.

NRS 689C.113 Requirementsfor employee welfare benefit plan for providing benefits for employees of morethan one employer.

NRS 689C.115 Mandatoryand optional coverage.

NRS 689C.125 Ratingfactors for determining premiums.

NRS 689C.135 Effectof provision in health benefit plan for restricted network on determination ofrates.

NRS 689C.143 Offeringof policy of health insurance for purposes of establishing health savingsaccount.

NRS 689C.145 Characteristicsthat carrier may use to determine rating factors for establishing premiums.

NRS 689C.155 Regulations.

NRS 689C.156 Eachhealth benefit plan marketed in this State required to be offered to smallemployers.

NRS 689C.1565 Coverageto small employers not required under certain circumstances; notice toCommissioner of and prohibition on writing new business after election not tooffer new coverage required.

NRS 689C.157 Requirementto file basic and standard health benefit plans with Commissioner; disapprovalof plan.

NRS 689C.158 Producermay only sign up small employers and eligible employees in bona fide associationsif employers and employees are actively engaged in or related to bona fideassociation.

NRS 689C.159 Certainprovisions inapplicable to plan that carrier makes available only through bonafide association.

NRS 689C.160 Carriermust uniformly apply requirements to determine whether to provide coverage.

NRS 689C.165 Carrierprohibited from modifying plan to restrict or exclude coverage for certainservices.

NRS 689C.168 Coveragefor prescription drug previously approved for medical condition of insured.

NRS 689C.170 Authorizedvariation of minimum participation and contributions; denial of coverage basedon industry prohibited.

NRS 689C.180 Carrierto offer same coverage to all eligible employees; denial of coverage tootherwise eligible employee.

NRS 689C.183 Planand carrier required to permit employee or dependent of employee to enroll forcoverage under certain circumstances.

NRS 689C.187 Mannerand period for enrolling dependent of covered employee; period of special enrollment.

NRS 689C.190 Coverageof preexisting conditions; period of exclusion for preexisting condition; whenhealth maintenance organization may require affiliation period.

NRS 689C.191 Determinationof applicable creditable coverage of person; determining period of creditablecoverage of person; required statement.

NRS 689C.192 Writtencertification of coverage required for purpose of determining period ofcreditable coverage accumulated by person.

NRS 689C.193 Carrierprohibited from imposing restriction on participation inconsistent with certainsections; restrictions on rules of eligibility that may be established;premiums to be equitable.

NRS 689C.194 Planthat includes coverage for maternity and pediatric care: Required to allowminimum stay in hospital in connection with childbirth; prohibited acts.

NRS 689C.196 Insurerprohibited from denying coverage solely because person was victim of domesticviolence.

NRS 689C.197 Carrierprohibited from denying coverage because insured was intoxicated or underinfluence of controlled substance; exceptions. [Effective July 1, 2006.]

NRS 689C.198 Insurerprohibited from requiring or using information concerning genetic testing;exceptions.

NRS 689C.200 Whencarrier is not required to offer coverage.

NRS 689C.203 Denialof application for coverage from small employer; regulations.

NRS 689C.207 Regulationsconcerning reissuance of health benefit plan.

NRS 689C.210 Procedurefor increasing premium rates.

NRS 689C.220 Adjustmentin rates to be applied uniformly.

NRS 689C.230 Determinationand application of index rate.

NRS 689C.240 Useof industry classifications as rating factor.

NRS 689C.250 Requireddisclosures to Commissioner; when disclosures constitute trade secret.

NRS 689C.260 Mannerin which carrier may establish separate class of business; transferring smallemployer into or out of class of business.

NRS 689C.265 Carrierauthorized to modify coverage for insurance product under certaincircumstances.

NRS 689C.270 Regulationsconcerning disclosures by carrier to small employer; copy of disclosure to bemade available to small employer.

NRS 689C.280 Carrierto provide required disclosures to small employer before issuing policy of insurance.

NRS 689C.281 Coveragefor prescription drugs: Provision of notice and information regarding use offormulary.

NRS 689C.283 Electionto operate as risk-assuming carrier or reinsuring carrier: Notice toCommissioner; effective date; change in status.

NRS 689C.287 Electionto act as risk-assuming carrier: Suspension by Commissioner; applicablestatutes.

NRS 689C.290 Commissionerauthorized to suspend restriction on increase of premiums for new rating periodbased on new business for policy.

NRS 689C.300 Carrierto file actuarial certification annually with Commissioner.

NRS 689C.310 Renewalof health benefit plan; discontinuing issuance and renewal of coverage, plan orform of product of health benefit plan.

NRS 689C.320 Requirednotification when carrier discontinues transacting insurance in this State;restrictions on carrier that discontinues transacting insurance.

NRS 689C.327 Carrierthat offers network plan: Contracts with certain federally qualified healthcenters.

NRS 689C.330 Wheninsurer is required to allow employee to continue coverage after he is nolonger covered by health benefit plan.

NRS 689C.340 Requiredprovisions in health benefit plan of employer who employs less than 20employees related to continuation of coverage.

NRS 689C.342 Noticeof election and payment of premium.

NRS 689C.344 Amountof premium for continuation of coverage; change in rates; payment to insurer;termination.

NRS 689C.346 Effectof change in insurer during period of continued coverage.

NRS 689C.348 Continuedcoverage ceases before end of established period under certain circumstances.

NRS 689C.355 Prohibitedacts of carrier or producer; denial of application for coverage; violation mayconstitute unfair trade practice; applicability of section.

VOLUNTARY PURCHASING GROUPS

NRS 689C.360 Definitions.

NRS 689C.380 Contractdefined.

NRS 689C.390 Dependentdefined.

NRS 689C.420 Voluntarypurchasing group defined.

NRS 689C.425 Applicabilityof other provisions.

NRS 689C.430 Entitieswhich are authorized to offer contracts to voluntary purchasing groups.

NRS 689C.435 Contractsbetween carrier and providers of health care: Prohibiting carrier from chargingprovider of health care fee for inclusion on list of providers given toinsureds; form to obtain information on provider of health care; modification;schedule of fees.

NRS 689C.440 Regulationsregarding required disclosures by carrier.

NRS 689C.450 Carrierto provide disclosure before issuing contract.

NRS 689C.455 Coveragefor prescription drugs: Provision of notice and information regarding use offormulary.

NRS 689C.460 Carrierto offer same coverage to all eligible employees; denial of coverage tootherwise eligible employee.

NRS 689C.470 Renewalof contract; discontinuing issuance and renewal of form of product of healthbenefit plan or health benefit plan.

NRS 689C.480 Requirednotification when carrier ceases to renew all contracts; restrictions oncarrier that ceases to renew all contracts.

NRS 689C.485 Approvalor denial of claims; payment of claims and interest; requests for additionalinformation; award of costs and attorneys fees; compliance with requirements.

NRS 689C.490 Formationof voluntary purchasing group by small employers; requirements when affiliateof group ceases to qualify as small employer.

NRS 689C.500 Requirementsfor registration as voluntary purchasing group; application.

NRS 689C.510 Feefor application; response to application.

NRS 689C.520 Additionalrequirements for registration.

NRS 689C.530 Filingreports; annual renewal fee.

NRS 689C.540 Duties.

NRS 689C.550 Collectionof premiums; trust account for deposit of premiums.

NRS 689C.560 Regulationsgoverning security to be maintained by voluntary purchasing group.

NRS 689C.570 Organizerprohibited from acquiring financial interest in groups business.

NRS 689C.580 Prohibitedacts.

NRS 689C.590 Disciplinaryaction for violation of provisions.

NRS 689C.600 Regulations.

REINSURANCE

General Provisions

NRS 689C.610 Definitions.

NRS 689C.620 Boarddefined.

NRS 689C.630 Churchplan defined.

NRS 689C.640 Committeedefined.

NRS 689C.650 Eligibleperson defined.

NRS 689C.660 Individualcarrier defined.

NRS 689C.670 Individualhealth benefit plan defined.

NRS 689C.680 Individualreinsuring carrier defined.

NRS 689C.690 Individualrisk-assuming carrier defined.

NRS 689C.700 Planof operation defined.

NRS 689C.710 Programof Reinsurance defined.

NRS 689C.720 Reinsuringcarrier defined.

NRS 689C.730 Risk-assumingcarrier defined.

Program of Reinsurance for Small Employers and Eligible Persons

NRS 689C.740 Creation.

NRS 689C.750 Boardof Directors: Creation; members; term; vacancy.

NRS 689C.760 Meetingsof Board; Chairman of Board.

NRS 689C.770 Planof operation: Submission by Board; approval by Commissioner; temporary planwhen plan not suitable or not submitted.

NRS 689C.780 Requirementsof plan of operation and temporary plan of operation.

NRS 689C.790 Programdeemed to have powers and authority of insurance companies and healthmaintenance organizations; exceptions; powers.

NRS 689C.800 Amountof coverage to be reinsured; time within which reinsurance may begin;limitation on reimbursement to reinsuring carrier; termination of reinsurance;premium rate charged to federally qualified health maintenance organization;manner of handling managed care and claims by reinsuring carrier.

NRS 689C.810 Premiumrates: Methodology for determining; minimum rates; review of methodology.

NRS 689C.820 Premiumsfor certain health benefit plans that are reinsured with program required tomeet established requirements for premium rates.

NRS 689C.830 Boardrequired to determine, account for and report to Commissioner net loss.

NRS 689C.840 Netloss from reinsuring small employers and eligible employees and dependentsrequired to be recouped by assessments against reinsuring carriers.

NRS 689C.850 Netloss from reinsuring individual eligible persons and dependents required to berecouped by assessments against individual reinsuring carriers.

NRS 689C.860 Boardrequired to determine, account for and report to Commissioner estimate ofassessments needed to pay for losses; evaluation of operation of Program.

NRS 689C.870 Additionalfunding: Eligibility based on amount of assessment needed; Board to establishformula for additional assessments on all carriers.

NRS 689C.880 Useof excess assessments.

NRS 689C.890 Assessmentagainst reinsuring carrier to be determined annually; penalty for late paymentof assessments; deferment of assessment.

NRS 689C.900 Insurerto receive certificate of contribution for paying additional assessment;certain amount of contribution may be shown as asset and may offset liabilityfor premium tax.

NRS 689C.910 Adjustmentof assessment on federally qualified health maintenance organizations.

NRS 689C.920 Immunityfrom liability of Program and reinsuring carriers for certain acts.

NRS 689C.930 Boardto develop standards setting forth manner and levels of compensation paid toproducers for sale of health benefit plans.

NRS 689C.940 Regulationsconcerning determination of status of stop-loss policy.

NRS 689C.950 Certainprovisions inapplicable to certain basic health benefit plan delivered to smallemployers or eligible persons.

NRS 689C.955 Member,agent or employee of Board immune from liability in certain circumstances.

Committee on Health Benefit Plans

NRS 689C.960 Creation;members; term; vacancy.

NRS 689C.970 Meetings;Chairman; duties.

NRS 689C.980 Boardand Committee to study and submit report concerning effectiveness of certainprovisions.

_________

HEALTH BENEFIT PLANS

NRS 689C.015 Definitions. Except as otherwise provided in this chapter, as used inthis chapter, unless the context otherwise requires, the words and terms definedin NRS 689C.017 to 689C.106, inclusive, have the meaningsascribed to them in those sections.

(Added to NRS by 1995, 978; A 1997, 1096, 2940)

NRS 689C.017 Affiliateddefined. Affiliated means any entity or personwho directly, or indirectly through one or more intermediaries, controls or iscontrolled by or is under common control with a specified entity or person.

(Added to NRS by 1997, 2916)

NRS 689C.019 Affiliationperiod defined. Affiliation period means aperiod, not to exceed 60 days for new enrollees and 90 days for late enrollees,during which no premiums may be collected from, and coverage issued would notbecome effective for, a small employer or an eligible employee or hisdependent, if the affiliation period is applied uniformly and without regard toany health status-related factors.

(Added to NRS by 1997, 2916)

NRS 689C.021 Basichealth benefit plan defined. Basic healthbenefit plan means the basic health benefit plan developed pursuant to NRS 689C.610 to 689C.980, inclusive.

(Added to NRS by 1997, 2916)

NRS 689C.023 Bonafide association defined. Bona fideassociation has the meaning ascribed to it in NRS 689A.485.

(Added to NRS by 1997, 2916)

NRS 689C.025 Carrierdefined. Carrier means any person who provideshealth insurance in this state, including a fraternal benefit society, a healthmaintenance organization, a nonprofit hospital and health service corporation,a health insurance company and any other person providing a plan of healthinsurance or health benefits subject to this title.

(Added to NRS by 1995, 978)

NRS 689C.035 Characteristicsdefined. Characteristics means demographicor other information concerning a small employer that is considered by acarrier in the determination of premium rates for the small employer, exceptclaim experience, health status and duration of coverage.

(Added to NRS by 1995, 978)

NRS 689C.045 Classof business defined. Class of businessmeans all or a distinct grouping of small employers as shown in the records ofa carrier serving small employers.

(Added to NRS by 1995, 978)

NRS 689C.047 Controldefined. Control has the meaning ascribed toit in NRS 692C.050.

(Added to NRS by 1997, 2916)

NRS 689C.051 Convertedpolicy defined. Converted policy means abasic or standard health benefit plan issued in accordance with NRS 689C.610 to 689C.980, inclusive.

(Added to NRS by 1997, 2916)

NRS 689C.053 Creditablecoverage defined. Creditable coverage meanshealth benefits or coverage provided to a person pursuant to:

1. A group health plan;

2. A health benefit plan;

3. Part A or Part B of Title XVIII of the SocialSecurity Act, 42 U.S.C. 1395c et seq., also known as Medicare;

4. Title XIX of the Social Security Act, 42 U.S.C. 1396 et seq., also known as Medicaid, other than coverage consisting solely ofbenefits under section 1928 of that Title, 42 U.S.C. 1396s;

5. The Civilian Health and Medical Program of UniformedServices, CHAMPUS, 10 U.S.C. 1071 et seq.;

6. A medical care program of the Indian Health Serviceor of a tribal organization;

7. A state health benefit risk pool;

8. A health plan offered pursuant to the FederalEmployees Health Benefits Program, FEHBP, 5 U.S.C. 8901 et seq.;

9. A public health plan as defined in federalregulations authorized by the Public Health Service Act, 42 U.S.C. 300gg(c)(1)(I);

10. A health benefit plan under section 5(e) of thePeace Corps Act, 22 U.S.C. 2504(e);

11. The Childrens Health Insurance Programestablished pursuant to 42 U.S.C. 1397aa to 1397jj, inclusive;

12. A short-term health insurance policy; or

13. A blanket student accident and health insurancepolicy.

(Added to NRS by 1997, 2916; A 1999, 2240, 2811)

NRS 689C.055 Dependentdefined. Dependent means a spouse or:

1. An unmarried child under 19 years of age;

2. An unmarried child who is a full-time student under24 years of age and who is financially dependent upon the parent; or

3. An unmarried child of any age who is medicallycertified as disabled and dependent upon the parent,

who theparent claimed as his dependent on the form for income tax returns which hefiled with the Internal Revenue Service for the previous fiscal year.

(Added to NRS by 1995, 978)

NRS 689C.065 Eligibleemployee defined. Eligible employee means apermanent employee who has a regular working week of 30 or more hours. The termincludes a sole proprietor or a partner of a partnership, if the soleproprietor or partner is included as an employee under a health benefit plan ofa small employer.

(Added to NRS by 1995, 978)

NRS 689C.067 Establishedgeographic service area defined. Established geographic service areameans a geographic area, as approved by the Commissioner and based on thecertificate of authority of the carrier to transact insurance in this state,within which the carrier is authorized to provide coverage.

(Added to NRS by 1997, 2917)

NRS 689C.071 Geographicarea defined. Geographic area means an areaestablished by the Commissioner for use in adjusting the rates for a health benefitplan.

(Added to NRS by 1997, 2917)

NRS 689C.073 Grouphealth plan defined.

1. Group health plan means an employee welfarebenefit plan, as defined in section 3(1) of the Employee Retirement IncomeSecurity Act of 1974, as that section existed on July 16, 1997, to the extentthat the plan provides medical care to employees or their dependents as definedunder the terms of the plan directly, or through insurance, reimbursement orotherwise.

2. The term does not include:

(a) Coverage that is only for accident or disabilityincome insurance, or any combination thereof;

(b) Coverage issued as a supplement to liabilityinsurance;

(d) Workers compensation or similar insurance;

(e) Coverage for medical payments under a policy ofautomobile insurance;

(f) Credit insurance;

(g) Coverage for on-site medical clinics; and

(h) Other similar insurance coverage specified infederal regulations adopted pursuant to Public Law 104-191 under which benefitsfor medical care are secondary or incidental to other insurance benefits.

3. The term does not include the following benefits ifthe benefits are provided under a separate policy, certificate or contract ofinsurance or are otherwise not an integral part of a health benefit plan:

(a) Limited-scope dental or vision benefits;

(b) Benefits for long-term care, nursing home care,home health care or community-based care, or any combination thereof; and

4. The term does not include the following benefits ifthe benefits are provided under a separate policy, certificate or contract ofinsurance, there is no coordination between the provision of the benefits andany exclusion of benefits under any group health plan maintained by the sameplan sponsor, and such benefits are paid for a claim without regard to whetherbenefits are provided for such a claim under any group health plan maintainedby the same plan sponsor:

(a) Coverage that is only for a specified disease orillness; and

(b) Hospital indemnity or other fixed indemnityinsurance.

5. The term does not include any of the following, ifoffered as a separate policy, certificate or contract of insurance:

(a) Medicare supplemental health insurance as definedin section 1882(g)(1) of the Social Security Act, as that section existed onJuly 16, 1997;

(b) Coverage supplemental to the coverage providedpursuant to chapter 55 of Title 10, United States Code (Civilian Health andMedical Program of Uniformed Services (CHAMPUS)); and

(Added to NRS by 1997, 2917)

NRS 689C.075 Healthbenefit plan defined.

1. Health benefit planmeans a policy or certificate for hospital or medical expenses, a contract fordental, hospital or medical services, or a health care plan of a healthmaintenance organization available for use, offered or sold to a small employer.Except as otherwise provided in this section, the term includes short-term andcatastrophic health insurance policies, and a policy that pays on acost-incurred basis.

2. The term does not include:

(a) Coverage that is only for accident or disabilityincome insurance, or any combination thereof;

(b) Coverage issued as a supplement to liabilityinsurance;

(d) Workers compensation or similar insurance;

(e) Coverage for medical payments under a policy ofautomobile insurance;

(f) Credit insurance;

(g) Coverage for on-site medical clinics;

(h) Coverage under a short-term health insurancepolicy;

(i) Coverage under a blanket student accident andhealth insurance policy; and

(j) Other similar insurance coverage specified infederal regulations issued pursuant to the Health Insurance Portability andAccountability Act of 1996, Public Law 104-191, under which benefits formedical care are secondary or incidental to other insurance benefits.

3. If the benefits are provided under a separatepolicy, certificate or contract of insurance or are otherwise not an integralpart of a health benefit plan, the term does not include the followingbenefits:

(a) Limited-scope dental or vision benefits;

(b) Benefits for long-term care, nursing home care,home health care or community-based care, or any combination thereof; and

(c) Such other similar benefits as are specified in anyfederal regulations adopted pursuant to the Health Insurance Portability andAccountability Act of 1996, Public Law 104-191.

4. If the benefits are provided under a separatepolicy, certificate or contract of insurance, there is no coordination betweenthe provision of the benefits and any exclusion of benefits under any grouphealth plan maintained by the same plan sponsor, and the benefits are paid fora claim without regard to whether benefits are provided for such a claim underany group health plan maintained by the same plan sponsor, the term does notinclude:

(a) Coverage that is only for a specified disease orillness; and

(b) Hospital indemnity or other fixed indemnityinsurance.

5. If offered as a separate policy, certificate orcontract of insurance, the term does not include:

(a) Medicare supplemental health insurance as definedin section 1882(g)(1) of the Social Security Act, 42 U.S.C. 1395ss, as thatsection existed on July 16, 1997;

(b) Coverage supplemental to the coverage providedpursuant to the Civilian Health and Medical Program of Uniformed Services,CHAMPUS, 10 U.S.C. 1071 et seq.; and

(Added to NRS by 1995, 978; A 1997, 2940; 1999, 2811)

NRS 689C.076 Healthstatus-related factor defined. Healthstatus-related factor means, with regard to a person who is or seeks to beinsured:

1. Health status;

2. Any medical conditions, including physical ormental illness, or both;

3. Claims experience;

4. Receipt of health care;

5. Medical history;

6. Genetic information;

7. Evidence of insurability, including conditionsarising out of acts of domestic violence; and

8. Disability.

(Added to NRS by 1997, 2918)

NRS 689C.077 Networkplan defined. Network plan means a healthbenefit plan offered by a health carrier under which the financing and deliveryof medical care, including items and services paid for as medical care, areprovided, in whole or in part, through a defined set of providers undercontract with the carrier. The term does not include an arrangement for thefinancing of premiums.

(Added to NRS by 1997, 2918)

NRS 689C.078 Openenrollment defined. Open enrollment meansthe period designated for enrollment in a health benefit plan.

(Added to NRS by 1997, 2918)

NRS 689C.079 Planfor coverage of a bona fide association defined. Planfor coverage of a bona fide association has the meaning ascribed to it in NRS 689A.570.

(Added to NRS by 1997, 2918)

NRS 689C.081 Plansponsor defined. Plan sponsor has themeaning ascribed to it in section 3(16)(B) of the Employee Retirement IncomeSecurity Act of 1974, as that section existed on July 16, 1997.

(Added to NRS by 1997, 2918)

NRS 689C.082 Preexistingcondition defined. Preexisting conditionmeans a condition, regardless of the cause of the condition, for which medicaladvice, diagnosis, care or treatment was recommended or received during the 6months immediately preceding the effective date of the new coverage. The termdoes not include genetic information in the absence of a diagnosis of thecondition related to such information.

(Added to NRS by 1997, 2918)

NRS 689C.083 Producerdefined. Producer means an agent or brokerlicensed pursuant to this title.

(Added to NRS by 1997, 2918)

NRS 689C.084 Programof Reinsurance defined. Program of Reinsurancemeans the Program of Reinsurance for Small Employers and Eligible Personsestablished pursuant to NRS 689C.740.

(Added to NRS by 1997, 2918)

NRS 689C.085 Ratingperiod defined. Rating period means theperiod for which premium rates established by a carrier are assumed to be ineffect.

(Added to NRS by 1995, 979)

NRS 689C.089 Risk-assumingcarrier defined. Risk-assuming carriermeans a small employer carrier that has elected to act as a risk-assumingcarrier.

(Added to NRS by 1997, 2918)

NRS 689C.095 Smallemployer defined.

1. Small employer means, with respect to a calendaryear and a plan year, an employer who employed on business days during thepreceding calendar year an average of at least 2 employees, but not more than50 employees, who have a normal workweek of 30 hours or more, and who employsat least 2 employees on the first day of the plan year. For the purposes ofdetermining the number of eligible employees, organizations which areaffiliated or which are eligible to file a combined tax return for the purposesof taxation constitute one employer.

2. For the purposes of this section, organizations areaffiliated if one directly, or indirectly, through one or moreintermediaries, controls or is controlled by, or is under common control with,the other, as determined pursuant to the provisions of NRS 692C.050.

(Added to NRS by 1995, 979; A 1997, 2941; 1999, 2812)

NRS 689C.099 Standardhealth benefit plan defined. Standard healthbenefit plan means a standard health benefit plan developed pursuant to NRS 689C.610 to 689C.980, inclusive.

(Added to NRS by 1997, 2918)

NRS 689C.105 Supplementalcoverage defined. Supplemental coverage isnot a health benefit plan if:

1. The carrier files on or before March 1 of each yeara certification with the Commissioner that contains:

(a) A statement from the carrier certifying that thepolicies or certificates described are being offered and marketed assupplemental health insurance and not as a substitute for hospital or medicalexpense insurance or major medical expense insurance; and

(b) A summary description of each policy or certificatedescribed, including the average annual premium rates, or range of premiumrates in cases where premiums vary by age, sex or other factors, charged forthe policies and certificates in this state.

2. In the case of a policy or certificate that isoffered for the first time in this state on or after January 1, 1996, thecarrier files with the Commissioner the information and statement required insubsection 1 at least 30 days before the date the policy or certificate isissued or delivered in this state.

(Added to NRS by 1995, 979)

NRS 689C.106 Waitingperiod defined. Waiting period means theperiod established by a plan of health insurance that must pass before a personwho is an eligible participant or beneficiary in a plan is covered for benefitsunder the terms of the plan. The term includes the period from the date aperson submits an application to an individual carrier for coverage under ahealth benefit plan until the first day of coverage under that health benefitplan.

(Added to NRS by 1997, 2919; A 1999, 2813)

NRS 689C.1065 Applicability. The provisions of this chapter apply to health benefitplans that provide coverage to the employees of small employers in this stateand to carriers that offer those health benefit plans if:

1. A portion of the premium or benefits are paid by oron behalf of the small employer;

2. An eligible employee or his dependent is reimbursedfor a portion of the premium, whether by wage adjustments or otherwise, by oron behalf of the small employer; or

3. The health benefit plan is considered by the smallemployer or any of his eligible employees or dependents as part of a plan orprogram for the purposes of section 106, 125 or 162 of the Internal RevenueCode, 26 U.S.C. 106, 125 or 162.

(Added to NRS by 1999, 2810)

1. For the purposes of this chapter, and except asotherwise provided in subsection 2, two or more carriers which are affiliatedcompanies or which are eligible to file a consolidated tax return shall bedeemed to be one carrier, and any restrictions or limitations imposed by theprovisions of this chapter apply as if the health benefit plans delivered orissued for delivery to small employers in this state by such carriers wereissued by one carrier.

2. An affiliated carrier that is a health maintenanceorganization having a certificate of authority issued pursuant to theprovisions of chapter 695C of NRS may beconsidered a separate carrier for the purposes of this chapter.

3. Unless otherwise authorized by the Commissioner, acarrier shall not enter into any ceding arrangement with respect to a healthbenefit plan delivered or issued for delivery to a small employer in this stateif, as a result of the ceding arrangement, the ceding carrier retains less than30 percent of the insurance obligation or risk for that health benefit plan.

(Added to NRS by 1997, 2919)

NRS 689C.109 Certainplan, fund or program to be treated as employee welfare benefit plan which isgroup health plan; partnership deemed employer of each partner. For the purposes of this chapter:

1. Any plan, fund or program which would not be, butfor section 2721(e) of the Public Health Service Act, as amended by Public Law 104-191,as that section existed on July 16, 1997, an employee welfare benefit plan andwhich is established or maintained by a partnership to the extent that theplan, fund or program provides medical care to current or former partners in apartnership, or to their dependents, as defined under the terms of the plan,fund or program, directly, or through insurance, reimbursement or otherwise,must be treated, subject to the provisions of subsection 2, as an employeewelfare benefit plan that is a group health plan.

2. In the case of a group health plan, a partnershipshall be deemed to be the employer of each partner.

(Added to NRS by 1997, 2919)

NRS 689C.111 Determinationof whether employer is small or large; applicability of provisions afteremployer is deemed large.

1. If an employer was not in existence throughout theentire preceding calendar year, the determination of whether the employer is asmall or large employer must be based on the average number of employeesreasonably expected to be employed on business days in the current calendaryear.

2. Except as otherwise provided by specific statute,the provisions of this chapter that apply to a small employer at the time thata carrier issues a health benefit plan to the small employer pursuant to theprovisions of this chapter continue to apply at least until the plananniversary following the date on which the small employer no longer meets therequirements of being a small employer.

(Added to NRS by 1997, 2919)

NRS 689C.113 Requirementsfor employee welfare benefit plan for providing benefits for employees of morethan one employer.

1. An employee welfare benefit plan for providingbenefits for employees of more than one employer under which health insurancecoverage is provided to small employers must comply with the provisions of thischapter and with NRS 679B.139 and theregulations adopted by the Commissioner pursuant thereto.

2. As used in this section, the term employee welfarebenefit plan for providing benefits for employees of more than one employer isintended to be equivalent to the term employee welfare benefit plan which is amultiple employer welfare arrangement as used in federal statutes andregulations.

(Added to NRS by 1997, 2928)

NRS 689C.115 Mandatoryand optional coverage.

1. A health benefit plan offered by a carrier pursuantto this chapter must include coverage of basic medical and hospital care.

2. In addition to the coverage required by subsection1, a carrier may offer additional coverage for an additional cost upon theapproval of the Commissioner.

(Added to NRS by 1995, 979)

NRS 689C.125 Ratingfactors for determining premiums.

1. A carrier serving small employers shall applyrating factors, including characteristics, consistently with respect to allsmall employers in a class of business. Rating factors must produce premiumsfor identical groups that differ only by the amounts attributable to the designof the plans and the terms of the coverage and do not reflect differences basedon the nature of the groups that will select particular health benefit plans.As used in this subsection, premium means all money paid by a small employerand eligible employees to a carrier as a condition of receiving coverage from acarrier, including any fees or other contributions associated with the healthbenefit plan.

2. A carrier serving small employers shall treat allhealth benefit plans issued or renewed in the same calendar month as having thesame rating period, if the terms of coverage provided in the plans are thesame.

(Added to NRS by 1995, 979)

NRS 689C.135 Effectof provision in health benefit plan for restricted network on determination ofrates.

1. For the purposes of determining rates charged forhealth benefit plans, a health benefit plan that contains a provision for arestricted network is not similar coverage to a health benefit plan that doesnot contain such a provision if the restriction of benefits results in materialdifferences in cost of claims.

2. As used in this section, provision for arestricted network means any provision of a group health benefit plan thatconditions the payment of benefits, in whole or in part, on the use ofproviders of health care who have entered into a contractual arrangement withthe carrier to provide health care to persons covered by the plan.

(Added to NRS by 1995, 980)

NRS 689C.143 Offeringof policy of health insurance for purposes of establishing health savingsaccount. A carrier may, subject to regulationby the Commissioner, offer a policy of health insurance that has a highdeductible and is in compliance with 26 U.S.C. 223 for the purposes ofestablishing a health savings account.

(Added to NRS by 2005, 2137)

NRS 689C.145 Characteristicsthat carrier may use to determine rating factors for establishing premiums. In determining the rating factors for establishing thepremiums for a health benefit plan, a carrier serving small employers shall notuse characteristics other than age, sex, industry, geographic area, compositionof family, size of group and the amount contributed by the employer to the costof coverage without the prior approval of the Commissioner.

(Added to NRS by 1995, 980)

NRS 689C.155 Regulations. The Commissioner may adopt regulations to carry out theprovisions of NRS 689C.107 to 689C.145, inclusive, 689C.156 to 689C.159, inclusive, 689C.165, 689C.183, 689C.187, 689C.191 to 689C.198, inclusive, 689C.203, 689C.207, 689C.265, 689C.283, 689C.287, 689C.325, 689C.342 to 689C.348, inclusive, 689C.355 and 689C.610 to 689C.980, inclusive, and to ensure thatrating practices used by carriers serving small employers are consistent withthose sections, including regulations that:

1. Ensure that differences in rates charged for healthbenefit plans by such carriers are reasonable and reflect only differences inthe designs of the plans, the terms of the coverage, the amount contributed bythe employers to the cost of coverage and differences based on the ratingfactors established by the carrier.

2. Prescribe the manner in which characteristics maybe used by such carriers.

(Added to NRS by 1995, 980; A 1997, 2942)

NRS 689C.156 Eachhealth benefit plan marketed in this State required to be offered to smallemployers.

1. As a condition of transacting business in thisState with small employers, a carrier shall actively market to a small employereach health benefit plan which is actively marketed in this State by thecarrier to any small employer in this State. The health insurance plans marketedpursuant to this section by the carrier must include, without limitation, abasic health benefit plan and a standard health benefit plan. A carrier shallbe deemed to be actively marketing a health benefit plan when it makesavailable any of its plans to a small employer that is not currently receivingcoverage under a health benefit plan issued by that carrier.

2. A carrier shall issue to a small employer anyhealth benefit plan marketed in accordance with this section if the eligiblesmall employer applies for the plan and agrees to make the required premiumpayments and satisfy the other reasonable provisions of the health benefit planthat are not inconsistent with NRS689C.015 to 689C.355, inclusive,and 689C.610 to 689C.980, inclusive, except that acarrier is not required to issue a health benefit plan to a self-employedperson who is covered by, or is eligible for coverage under, a health benefitplan offered by another employer.

3. If a health benefit plan marketed pursuant to thissection provides, delivers, arranges for, pays for or reimburses any cost ofhealth care services through managed care, the carrier shall provide a systemfor resolving any complaints of an employee concerning those health careservices that complies with the provisions of NRS 695G.200 to 695G.310, inclusive.

(Added to NRS by 1997, 2920; A 2003, 775)

NRS 689C.1565 Coverageto small employers not required under certain circumstances; notice toCommissioner of and prohibition on writing new business after election not tooffer new coverage required.

1. A carrier is not required to provide coverage tosmall employers pursuant to NRS 689C.156:

(a) During any period in which the Commissionerdetermines that requiring the carrier to provide such coverage would place thecarrier in a financially impaired condition.

(b) If the carrier elects not to offer any new coverageto any small employers in this State. A carrier that elects not to offer newcoverage in accordance with this paragraph may maintain its existing policiesissued to small employers in this State, subject to the requirements of NRS 689C.310 and 689C.320.

2. A carrier that elects not to offer new coveragepursuant to paragraph (b) of subsection 1 shall notify the Commissionerforthwith of that election and shall not thereafter write any new business tosmall employers in this State for 5 years after the date of the notification.

(Added to NRS by 1997, 2920)

NRS 689C.157 Requirementto file basic and standard health benefit plans with Commissioner; disapprovalof plan.

1. Each carrier shall file with the Commissioner, in aformat and manner prescribed by the Commissioner, the basic health benefitplans and the standard health benefit plans to be offered by the carrier. Ahealth benefit plan filed pursuant to this section may not be offered by acarrier until the earlier of:

(a) The date of approval by the Commissioner; or

(b) Thirty days after the date on which the plans arefiled, unless the Commissioner disapproves the use of the plans before the30-day period expires.

2. The Commissioner may, at any time, after providingnotice and an opportunity for a hearing, disapprove the continued use of abasic or standard health benefit plan by a carrier on the ground that the plandoes not meet the requirements of NRS689C.015 to 689C.355, inclusive,and 689C.610 to 689C.980, inclusive.

(Added to NRS by 1997, 2920)

NRS 689C.158 Producermay only sign up small employers and eligible employees in bona fideassociations if employers and employees are actively engaged in or related tobona fide association. For the purposes ofproviding coverage under a health benefit plan pursuant to the provisions ofthis chapter, a producer may only market association memberships to smallemployers and eligible employees, accept applications for such membership orsign up such members in a bona fide association if the small employers andeligible employees being marketed are actively engaged in, or directly relatedto, the bona fide association.

(Added to NRS by 1997, 2919)

NRS 689C.159 Certainprovisions inapplicable to plan that carrier makes available only through bonafide association. The provisions of NRS 689C.156, 689C.157 and 689C.190 do not apply to health benefitplans offered by a carrier if the carrier makes the health benefit planavailable in the small employer market only through a bona fide association.

(Added to NRS by 1997, 2921)

NRS 689C.160 Carriermust uniformly apply requirements to determine whether to provide coverage. The requirements used by a carrier serving small employersto determine whether to provide coverage to a small employer, including,without limitation, standards for medical underwriting, requirements forminimum participation of eligible employees and minimum employerscontributions, must be applied uniformly among all small employers with thesame number of eligible employees applying for coverage or receiving coveragefrom the carrier.

(Added to NRS by 1995, 980)

NRS 689C.165 Carrierprohibited from modifying plan to restrict or exclude coverage for certainservices. Except as otherwise provided in NRS 689C.170 and 689C.180, a carrier shall not modify ahealth benefit plan with respect to a small employer or any eligible employeeor dependent of an eligible employee, through riders or endorsements, orotherwise, to restrict or exclude coverage or benefits for specific diseases,medical conditions or services otherwise covered by the plan.

(Added to NRS by 1997, 2921)

NRS 689C.168 Coveragefor prescription drug previously approved for medical condition of insured.

1. Except as otherwise provided in this section, ahealth benefit plan which provides coverage for prescription drugs must notlimit or exclude coverage for a drug if the drug:

(a) Had previously been approved for coverage by thecarrier for a medical condition of an insured and the insureds provider ofhealth care determines, after conducting a reasonable investigation, that noneof the drugs which are otherwise currently approved for coverage are medicallyappropriate for the insured; and

(b) Is appropriately prescribed and considered safe andeffective for treating the medical condition of the insured.

2. The provisions of subsection 1 do not:

(a) Apply to coverage for any drug that is prescribedfor a use that is different from the use for which that drug has been approvedfor marketing by the Food and Drug Administration;

(b) Prohibit:

(1) The carrier from charging a deductible,copayment or coinsurance for the provision of benefits for prescription drugsto the insured or from establishing, by contract, limitations on the maximumcoverage for prescription drugs;

(2) A provider of health care from prescribinganother drug covered by the plan that is medically appropriate for the insured;or

(3) The substitution of another drug pursuant toNRS 639.23286 or 639.2583 to 639.2597, inclusive; or

3. Any provision of a health benefit plan subject tothe provisions of this chapter that is delivered, issued for delivery orrenewed on or after October 1, 2001, which is in conflict with this section isvoid.

(Added to NRS by 2001, 859; A 2003, 2299)

NRS 689C.170 Authorizedvariation of minimum participation and contributions; denial of coverage basedon industry prohibited.

1. A carrier serving small employers may vary theapplication of requirements for minimum participation of eligible employees andminimum employers contributions only by the size of the small employersgroup.

2. In applying requirements for minimum participationwith respect to a small employer, a carrier shall not consider employees ordependents who have creditable coverage when determining whether the applicablepercentage of participation is met, but may consider employees or dependentswho have coverage under another health benefit plan that is sponsored by theemployer.

3. A carrier shall not deny an application for coveragesolely because the applicant works in a certain industry.

4. After a small employer has been accepted forcoverage, a carrier shall not increase any requirement for minimum employeeparticipation or modify any requirement for minimum employer contributionapplicable to the small employer.

(Added to NRS by 1995, 980; A 1997, 2942)

NRS 689C.180 Carrierto offer same coverage to all eligible employees; denial of coverage tootherwise eligible employee.

1. If a carrier serving small employers offers coverageto a small employer, the carrier shall offer the same coverage to all of theeligible employees of the small employer and their dependents. A carrier shallnot offer coverage to only certain members of a small employers group or toonly part of the group, but may exclude an otherwise eligible employee, or hisdependent, who requests enrollment in a health benefit plan after the end ofthe initial period during which the employee or dependent is entitled to enrollunder the terms of the plan, if the initial period is at least 30 days.

2. A carrier shall not exclude an eligible employee ordependent if:

(a) The employee or dependent:

(1) Was covered under other creditable coverageat the time of the initial period for enrollment;

(2) Lost coverage under the other creditablecoverage as a result of termination of employment or eligibility, theinvoluntary termination of the creditable coverage, the death of a spouse ordivorce; and

(3) Requests enrollment within 30 days aftertermination of the other creditable coverage;

(b) The employee is employed by an employer that offersmultiple health benefit plans and elects a different plan during an open periodfor enrollment; or

(c) A court has ordered that coverage be provided for adependent under a covered employees health benefit plan and the request forenrollment is made within 30 days after issuance of the court order.

(Added to NRS by 1995, 981; A 1997, 2942)

NRS 689C.183 Planand carrier required to permit employee or dependent of employee to enroll forcoverage under certain circumstances. A healthbenefit plan and a carrier offering such a plan shall permit an employee or adependent of an employee covered by the health benefit plan who is eligible,but not enrolled, for coverage in connection with the health benefit plan toenroll for coverage under the terms of the health benefit plan if:

1. The employee or dependent was covered under adifferent health benefit plan or had other health insurance coverage at thetime coverage was previously offered to the employee or dependent;

2. The employee stated in writing at that time thatthe other coverage was the reason for declining enrollment, but only if theplan sponsor or carrier required such a written statement and informed the employeeof that requirement and the consequences of the requirement; and

3. The employee or his dependent:

(a) Was covered under any provision of the ConsolidatedOmnibus Budget Reconciliation Act of 1985 relating to the continuation ofcoverage and such continuation of coverage was exhausted; or

(b) Was not covered under such a provision and hisinsurance coverage was lost as a result of cessation of contributions by hisemployer, termination of employment or eligibility, reduction in the number ofhours of employment, or the death of, or divorce or legal separation from, acovered spouse.

(Added to NRS by 1997, 2921)

NRS 689C.187 Mannerand period for enrolling dependent of covered employee; period of specialenrollment.

1. A health benefit plan and a carrier of such a planthat makes coverage available to the dependent of a covered employee shallpermit the employee to enroll a dependent after the close of a period of openenrollment if:

(a) The employee is a participant in the health benefitplan, or has met any waiting period applicable to becoming a participant and iseligible to be enrolled under the plan, except for a failure to enroll during aprevious period of open enrollment; and

(b) The person to be enrolled became a dependent of theemployee through marriage, birth, adoption or placement for adoption.

2. The health benefit plan or carrier shall provide aperiod of special enrollment for the enrollment of a dependent of an employeepursuant to this section. Such a period must be not less than 30 days and mustbegin on:

(a) The date specified by the health benefit plan orcarrier for the period of special enrollment; or

(b) The date of the marriage, birth, adoption orplacement for adoption, as appropriate.

3. If an employee seeks to enroll a dependent duringthe first 30 days of the period for special enrollment provided pursuant tosubsection 2, the coverage of the dependent becomes effective:

(a) In the case of a marriage, not later than the firstday of the first month beginning after the date on which the completed requestfor enrollment is received;

(b) In the case of a birth, on the date of the birth;and

4. In the case of a birth, an adoption or a placementfor adoption of a child of an employee, the spouse of the employee may beenrolled as a dependent pursuant to this section if the spouse is otherwiseeligible for coverage under the health benefit plan.

(Added to NRS by 1997, 2922)

NRS 689C.190 Coverageof preexisting conditions; period of exclusion for preexisting condition; whenhealth maintenance organization may require affiliation period.

1. Except as otherwise provided in this section, acarrier serving small employers that issues a health benefit plan shall notdeny, exclude or limit a benefit for a preexisting condition:

(a) For more than 12 months after the effective date ofcoverage if the employee enrolls through open enrollment or after the first dayof the waiting period for such enrollment, whichever is earlier; or

(b) For more than 18 months after the effective date ofcoverage for a late enrollee. A carrier may not define a preexisting conditionin its health benefit plan more restrictively than that term is defined in NRS 689C.082.

2. The period of any exclusion for a preexistingcondition imposed by a health benefit plan on a person to be insured inaccordance with the provisions of this chapter must be reduced by the aggregateperiod of creditable coverage of that person, if the creditable coverage wascontinuous to a date not more than 63 days before the effective date of the newcoverage. The period of continuous coverage must not include:

(a) Any waiting period for the effective date of thenew coverage applied by the employer or the carrier; or

(b) Any affiliation period, not to exceed 60 days for anew enrollee and 90 days for a late enrollee, required before becoming eligibleto enroll in the health benefit plan.

3. A health maintenance organization authorized totransact insurance pursuant to chapter 695Cof NRS that does not restrict coverage for a preexisting condition may requirean affiliation period before coverage becomes effective under a plan ofinsurance if the affiliation period applies uniformly to all employees andwithout regard to any health status-related factors. During the affiliationperiod, the carrier shall not collect any premiums for coverage of theemployee.

4. A carrier that restricts coverage for preexistingconditions shall not impose an affiliation period.

5. A carrier shall not impose any exclusion for apreexisting condition:

(a) Relating to pregnancy.

(b) In the case of a person who, as of the last day ofthe 30-day period beginning on the date of his birth, is covered undercreditable coverage.

(c) In the case of a child who is adopted or placed foradoption before attaining the age of 18 years and who, as of the last day ofthe 30-day period beginning on the date of adoption or placement for adoption,whichever is earlier, is covered under creditable coverage. The provisions ofthis paragraph do not apply to coverage before the date of adoption orplacement for adoption.

(d) In the case of a condition for which medicaladvice, diagnosis, care or treatment was recommended or received for the firsttime while the covered person held creditable coverage, and the medical advice,diagnosis, care or treatment was a covered benefit under the plan, if the creditablecoverage was continuous to a date not more than 90 days before the effectivedate of the new coverage.

Theprovisions of paragraphs (b) and (c) do not apply to a person after the end ofthe first 63-day period during all of which the person was not covered underany creditable coverage.

6. As used in this section, late enrollee means aneligible employee, or his dependent, who requests enrollment in a healthbenefit plan of a small employer following the initial period of enrollment, ifthe initial period of enrollment is at least 30 days, during which the personis entitled to enroll under the terms of the health benefit plan. The term doesnot include an eligible employee or his dependent if:

(a) The employee or dependent:

(1) Was covered under creditable coverage at thetime of the initial enrollment;

(2) Lost coverage under creditable coverage as aresult of cessation of employer contribution, termination of employment oreligibility, reduction in the number of hours of employment, involuntarytermination of creditable coverage, or the death of, or divorce or legalseparation from, a covered spouse; and

(3) Requests enrollment not later than 30 daysafter the date on which his creditable coverage was terminated or on which thechange in conditions that gave rise to the termination of the coverageoccurred.

(b) The person enrolls during the open enrollmentperiod, as provided in the contract or as otherwise provided by specificstatute.

(c) The person is employed by an employer which offersmultiple health benefit plans and the person elected a different plan during anopen enrollment period.

(d) A court has ordered coverage to be provided to thespouse or a minor or dependent child of an employee under a health benefit planof the employee and a request for enrollment is made within 30 days after theissuance of the court order.

(e) The person changes status from not being aneligible employee to being an eligible employee and requests enrollment,subject to any waiting period, within 30 days after the change in status.

(f) The person has continued coverage in accordancewith the Consolidated Omnibus Budget Reconciliation Act of 1985 and suchcoverage has been exhausted.

(Added to NRS by 1995, 981; A 1997, 2943)

NRS 689C.191 Determinationof applicable creditable coverage of person; determining period of creditablecoverage of person; required statement.

1. In determining the applicable creditable coverageof a person for the purposes of NRS689C.190, a period of creditable coverage must not be included if, afterthe expiration of that period but before the enrollment date, there was a63-day period during all of which the person was not covered under any creditablecoverage. To establish a period of creditable coverage, an eligible employeemust present any certificates of coverage provided to him in accordance with NRS 689C.192 and such other evidence ofcoverage as required by regulations adopted by the Commissioner. For thepurposes of this subsection, any waiting period for coverage or an affiliationperiod must not be considered in determining the applicable period ofcreditable coverage.

2. In determining the period of creditable coverage ofa person for the purposes of NRS 689C.190,a carrier shall include each applicable period of creditable coverage withoutregard to the specific benefits covered during that period, except that thecarrier may elect to include applicable periods of creditable coverage based oncoverage of specific benefits as specified by the United States Department ofHealth and Human Services by regulation, if such an election is made on auniform basis for all participants and beneficiaries of the health benefit planor coverage. Pursuant to such an election, the carrier shall include eachapplicable period of creditable coverage with respect to any class or categoryof benefits if any level of benefits is covered within that class or category,as specified by those regulations.

3. Regardless of whether coverage is actuallyprovided, if a carrier elects in accordance with subsection 2 to determine creditablecoverage based on specified benefits, a statement that such an election hasbeen made and a description of the effect of the election must be:

(a) Included prominently in any disclosure statementconcerning the health benefit plan; and

(b) Provided to each eligible employee at the time ofenrollment in the health benefit plan.

(Added to NRS by 1997, 2926)

NRS 689C.192 Writtencertification of coverage required for purpose of determining period ofcreditable coverage accumulated by person.

1. For the purposes of determining the period ofcreditable coverage of a person accumulated under a health benefit plan orgroup health insurance, the insurer shall provide written certification ofcoverage on a form prescribed by the Commissioner to the person which certifiesthe length of:

(a) The period of creditable coverage that the personaccumulated under the plan and any coverage under any provision of theConsolidated Omnibus Budget Reconciliation Act of 1985, as that act existed onJuly 16, 1997, relating to the continuation of coverage; and

(b) Any waiting and affiliation period imposed on theperson pursuant to that coverage.

2. The certification of coverage must be provided tothe person who was insured:

(a) At the time that he ceases to be covered under theplan, if he does not otherwise become covered under any provision of theConsolidated Omnibus Budget Reconciliation Act of 1985, as that act existed onJuly 16, 1997, relating to the continuation of coverage;

(b) If he becomes covered under such a provision, atthe time that he ceases to be covered by that provision; and

(c) Upon request, if the request is made not later than24 months after the date on which he ceased to be covered as described inparagraphs (a) and (b).

(Added to NRS by 1997, 2927)

NRS 689C.193 Carrierprohibited from imposing restriction on participation inconsistent with certainsections; restrictions on rules of eligibility that may be established;premiums to be equitable.

1. A carrier shall not place any restriction on asmall employer or an eligible employee or his dependent as a condition of beinga participant in or a beneficiary of a health benefit plan that is inconsistentwith NRS 689C.015 to 689C.355, inclusive.

2. A carrier that offers health insurancecoverage to small employers pursuant to this chapter shall not establish rulesof eligibility, including, but not limited to, rules which define applicablewaiting periods, for the initial or continued enrollment under a health benefitplan offered by the carrier that are based on the following factors relating tothe eligible employee or his dependent:

(a) Health status.

(b) Medical condition, including physical and mentalillnesses, or both.

(d) Receipt of health care.

(e) Medical history.

(f) Genetic information.

(g) Evidence of insurability, including conditionswhich arise out of acts of domestic violence.

(h) Disability.

3. Except as otherwise provided in NRS 689C.190, the provisions ofsubsection 1 do not:

(a) Require a carrier to provide particular benefitsother than those that would otherwise be provided under the terms of the healthbenefit plan or coverage; or

(b) Prevent a carrier from establishing limitations orrestrictions on the amount, level, extent or nature of the benefits or coveragefor similarly situated persons.

4. As a condition of enrollment or continuedenrollment under a health benefit plan, a carrier shall not require any personto pay a premium or contribution that is greater than the premium orcontribution for a similarly situated person covered by similar coverage on thebasis of any factor described in subsection 2 in relation to the person or hisdependent.

5. Nothing in this section:

(a) Restricts the amount that a small employer may becharged for coverage by a carrier;

(b) Prevents a carrier from establishing premiumdiscounts or rebates or from modifying otherwise applicable copayments ordeductibles in return for adherence by the insured person to programs of healthpromotion and disease prevention; or

(c) Precludes a carrier from establishing rulesrelating to employer contribution or group participation when offering healthinsurance coverage to small employers in this State.

6. As used in this section:

(a) Contribution means the minimum employercontribution toward the premium for enrollment of participants andbeneficiaries in a health benefit plan.

(b) Group participation means the minimum number ofparticipants or beneficiaries that must be enrolled in a health benefit plan inrelation to a specified percentage or number of eligible persons or employeesof the employer.

(Added to NRS by 1997, 2925)

NRS 689C.194 Planthat includes coverage for maternity and pediatric care: Required to allowminimum stay in hospital in connection with childbirth; prohibited acts.

1. Except as otherwise provided in this subsection, ahealth benefit plan issued pursuant to this chapter that includes coverage formaternity care and pediatric care for newborn infants may not restrict benefitsfor any length of stay in a hospital in connection with childbirth for a motheror newborn infant covered by the plan to:

(a) Less than 48 hours after a normal vaginal delivery;and

(b) Less than 96 hours after a cesarean section.

If adifferent length of stay is provided in the guidelines established by the AmericanCollege of Obstetricians and Gynecologists, or its successor organization, andthe American Academy of Pediatrics, or its successor organization, the healthbenefit plan may follow such guidelines in lieu of following the length of stayset forth above. The provisions of this subsection do not apply to any healthbenefit plan in any case in which the decision to discharge the mother ornewborn infant before the expiration of the minimum length of stay set forth inthis subsection is made by the attending physician of the mother or newborninfant.

2. Nothing in this section requires a mother to:

(a) Deliver her baby in a hospital; or

(b) Stay in a hospital for a fixed period following thebirth of her child.

3. A health benefit plan that offers coverage formaternity care and pediatric care of newborn infants may not:

(a) Deny a mother or her newborn infant coverage orcontinued coverage under the terms of the plan if the sole purpose of thedenial of coverage or continued coverage is to avoid the requirements of thissection;

(b) Provide monetary payments or rebates to a mother toencourage her to accept less than the minimum protection available pursuant tothis section;

(c) Penalize, or otherwise reduce or limit, thereimbursement of an attending provider of health care because he provided careto a mother or newborn infant in accordance with the provisions of thissection;

(d) Provide incentives of any kind to an attendingphysician to induce him to provide care to a mother or newborn infant in amanner that is inconsistent with the provisions of this section; or

(e) Except as otherwise provided in subsection 4,restrict benefits for any portion of a hospital stay required pursuant to theprovisions of this section in a manner that is less favorable than the benefitsprovided for any preceding portion of that stay.

4. Nothing in this section:

(a) Prohibits a health benefit plan or carrier fromimposing a deductible, coinsurance or other mechanism for sharing costsrelating to benefits for hospital stays in connection with childbirth for a motheror newborn child covered by the plan, except that such coinsurance or othermechanism for sharing costs for any portion of a hospital stay required by thissection may not be greater than the coinsurance or other mechanism for anypreceding portion of that stay.

(b) Prohibits an arrangement for payment between ahealth benefit plan or carrier and a provider of health care that usescapitation or other financial incentives, if the arrangement is designed toprovide services efficiently and consistently in the best interest of themother and her newborn infant.

(c) Prevents a health benefit plan or carrier fromnegotiating with a provider of health care concerning the level and type ofreimbursement to be provided in accordance with this section.

(Added to NRS by 1997, 2924)

NRS 689C.196 Insurerprohibited from denying coverage solely because person was victim of domesticviolence. An insurer shall not deny a claim,refuse to issue a health benefit plan or cancel a health benefit plan solelybecause the claim involves an act that constitutes domestic violence pursuantto NRS 33.018, or because the personapplying for or covered by the health benefit plan was the victim of such anact of domestic violence, regardless of whether the insured or applicant contributedto any loss or injury.

(Added to NRS by 1997, 1096)

NRS 689C.197 Carrierprohibited from denying coverage because insured was intoxicated or underinfluence of controlled substance; exceptions. [Effective July 1, 2006.]

1. Except as otherwise provided in subsection 2, acarrier shall not:

(a) Deny a claim under a health benefit plan solelybecause the claim involves an injury sustained by an insured as a consequenceof being intoxicated or under the influence of a controlled substance.

(b) Cancel participation under a health benefit plansolely because an insured has made a claim involving an injury sustained by theinsured as a consequence of being intoxicated or under the influence of acontrolled substance.

(c) Refuse participation under a health benefit plan toan eligible applicant solely because the applicant has made a claim involvingan injury sustained by the applicant as a consequence of being intoxicated orunder the influence of a controlled substance.

2. Theprovisions of this section do not prohibit a carrier from enforcing a provisionincluded in a health benefit plan 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 in a health benefit plansolely because of such a claim; or

(Added to NRS by 2005, 2344,effective July 1, 2006)

NRS 689C.198 Insurerprohibited from requiring or using information concerning genetic testing;exceptions.

1. Except as otherwise provided in subsection 2, acarrier serving small employers shall not:

(a) Require an insured person or any member of hisfamily to take a genetic test;

(b) Require an insured person to disclose whether he orany member of his family has taken a genetic test or any genetic information ofthe insured person or a member of his family; or

(c) Determine the rates or any other aspect of thecoverage or benefits for health care provided to an insured person based on:

(1) Whether the insured person or any member ofhis family has taken a genetic test; or

(2) Any genetic information of the insuredperson or any member of his family.

2. The provisions of this section do not apply to acarrier serving small employers who issues a policy of health insurance thatprovides coverage for long-term care or disability income.

3. As used in this section:

(a) Genetic information means any information that isobtained from a genetic test.

(b) Genetic test means a test, including a laboratorytest that uses deoxyribonucleic acid extracted from the cells of a person or adiagnostic test, to determine the presence of abnormalities or deficiencies,including carrier status, that:

(1) Are linked to physical or mental disordersor impairments; or

(2) Indicate a susceptibility to illness,disease, impairment or any other disorder, whether physical or mental.

(Added to NRS by 1997, 1460)

NRS 689C.200 Whencarrier is not required to offer coverage. Acarrier serving small employers is not required to accept applications from oroffer coverage to:

1. A small employer if the employer is not physicallylocated in the carriers established geographic area; or

2. An employee if the employee does not work or residewithin the carriers established geographic area.

(Added to NRS by 1995, 982; A 1997, 2946)

NRS 689C.203 Denialof application for coverage from small employer; regulations.

1. A denial by a carrier of an application forcoverage from a small employer must be in writing and must state the reason forthe denial.

2. The Commissioner may adopt regulations that setforth standards to provide for the fair marketing and broad availability ofhealth benefit plans to small employers in this state.

(Added to NRS by 1997, 2924)

NRS 689C.207 Regulationsconcerning reissuance of health benefit plan. TheCommissioner may adopt regulations to require a carrier, as a condition oftransacting insurance with small employers in this state after July 16, 1997,to reissue a health benefit plan to any small employer whose health benefitplan has been terminated or not renewed by the carrier after July 1, 1997. TheCommissioner may prescribe such terms for the reissue of coverage as he findsare reasonable and necessary to provide continuity of coverage to smallemployers.

(Added to NRS by 1997, 2924)

NRS 689C.210 Procedurefor increasing premium rates.

1. Except as otherwise provided in subsection 3, acarrier shall not increase the premium rate charged to a small employer for anew rating period by a percentage greater than the sum of:

(a) The percentage of change in the premium rate fornew business for the policy under which the small employer is covered, measuredfrom the first day of the previous rating period to the first day of the newrating period;

(b) An adjustment, not to exceed 15 percent annually,adjusted pro rata for rating periods of less than 1 year, on account of theclaim experience, health status, or duration of coverage of the employees ordependents of the small employer as determined from the carriers rate manualfor the class of business; and

(c) Any adjustment on account of change in coverage orchange in the characteristics of the small employer as determined from thecarriers rate manual for the class of business.

2. If the carrier no longer issues new policies forthat class of business, the carrier shall use the percentage of change in thepremium rate for new business for the class of business which is most similarto the closed class of business and for which the carrier is issuing newpolicies.

3. In the case of health benefit plans delivered orissued for delivery before January 1, 1996, for groups with not fewer than 2employees and not more than 25 employees, or before July 1, 1997, for groupswith not fewer than 26 employees and not more than 50 employees, a premium ratefor a rating period may exceed the ranges set forth in NRS 689C.230 for a period of 3 yearsfollowing that date. In that case, the percentage of increase in the premiumrate charged to a small employer for a new rating period may not exceed the sumof:

(a) The percentage of change in the premium rate fornew business measured from the first day of the previous rating period to thefirst day of the new rating period. In the case of a health benefit plan intowhich the carrier is no longer enrolling new small employers, the carrier shalluse the percentage of change in the base premium rate if that change does notexceed, on a percentage basis, the change in the premium rate for new businessfor the most similar health benefit plan into which the carrier is activelyenrolling new small employers.

(b) Any adjustment on account of change in coverage orchange in the characteristics of the small employer as determined from thecarriers rate manual for the class of business.

(Added to NRS by 1995, 983; A 1997, 2946; 1999, 2813)

NRS 689C.220 Adjustmentin rates to be applied uniformly. A carrierserving small employers shall not charge adjustments in rates for claimexperience, health status and duration of coverage to individual employees ordependents. Any such adjustment must be applied uniformly to the rates chargedfor all employees and dependents of a small employer.

(Added to NRS by 1995, 984)

NRS 689C.230 Determinationand application of index rate.

1. The index rate for a rating period for any class ofbusiness may not exceed the index rate for any other class of business by morethan 20 percent.

2. For a class of business, the premium rates chargedduring a rating period to small employers with similar characteristics for thesame or similar coverage, or the rates that could be charged to such employersunder the rating system for that class of business, may not vary, because ofhealth status-related factors, from the index rate by more than 30 percent.

3. As used in this section:

(a) Base premium rate means, for each class ofbusiness as to a rating period, the lowest premium rate charged or that couldhave been charged under a rating system for that class of business by thecarrier to small employers with similar characteristics for health benefitplans subject to regulation by the Commissioner.

(b) Index rate means, for each class of business asto a rating period for small employers with similar characteristics, thearithmetic average of the applicable base premium rate and the correspondinghighest premium rate.

(Added to NRS by 1995, 984; A 1997, 2947)

NRS 689C.240 Useof industry classifications as rating factor. Acarrier serving small employers may utilize industry classifications as a ratingfactor in establishing premium rates, but the highest rate factor associatedwith any industry classification may not exceed the lowest rate factorassociated with any industry classification by more than 20 percent.

(Added to NRS by 1995, 984; A 1995, 989)

NRS 689C.250 Requireddisclosures to Commissioner; when disclosures constitute trade secret. A carrier serving small employers shall make the informationand documents described in NRS 689C.210to 689C.240, inclusive, available tothe Commissioner upon request. Except in cases of violations of NRS 689C.015 to 689C.355, inclusive, the information isproprietary, constitutes a trade secret, and is not subject to disclosure bythe Commissioner to persons outside of the Division except as agreed to by thecarrier or as ordered by a court of competent jurisdiction.

(Added to NRS by 1995, 984)

NRS 689C.260 Mannerin which carrier may establish separate class of business; transferring smallemployer into or out of class of business.

1. Except as otherwise provided in subsection 2, acarrier serving small employers may establish no more than nine separateclasses of business, and each class must reflect substantial differences inexpected claim experience or administrative costs related to the following:

(a) The use of more than one type of system for themarketing and sale of health benefit plans to small employers;

(b) The acquisition of a class of business from anothercarrier serving small employers; or

2. The Commissioner may approve the establishment ofadditional classes of business upon application by a carrier and a finding bythe Commissioner that this action would enhance the efficiency and fairness ofthe market for health insurance for small employers.

3. The Commissioner may adopt regulations to providefor a period of transition for a carrier serving small employers to comply withsubsection 1 if the carrier acquires an additional class of business fromanother carrier serving small employers.

4. A carrier shall not transfer a small employerinvoluntarily into or out of a class of business. A carrier shall not offer totransfer a small employer into or out of a class of business unless the offeris to transfer all small employers in the class of business without regard tocharacteristics, claim experience, health status or duration of coverage.

(Added to NRS by 1995, 984)

NRS 689C.265 Carrierauthorized to modify coverage for insurance product under certaincircumstances. A carrier may modify the healthinsurance coverage for a product offered to small employers pursuant to a grouphealth plan if, for coverage that is available in that market other thanthrough one or more bona fide associations, the modification is consistent withthe provisions of this title and is effective on a uniform basis among suchgroup health plans.

(Added to NRS by 1997, 2927)

NRS 689C.270 Regulationsconcerning disclosures by carrier to small employer; copy of disclosure to bemade available to small employer.

1. The Commissioner shall adopt regulations whichrequire a carrier to file with the Commissioner, for his approval, a disclosureoffered by the carrier to a small employer. The disclosure must include:

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

(b) Any restrictions on payments for emergency care,including, without limitation, related definitions of an emergency and medicalnecessity;

(c) The provision of the health benefit plan concerningthe carriers right to change premium rates and the characteristics, other thanclaim experience, that affect changes in premium rates;

(d) The provisions relating to renewability of policiesand contracts;

(e) The provisions relating to any preexistingcondition; and

(f) Any other information that the Commissioner findsnecessary to provide for full and fair disclosure of the provisions of a policyor contract of insurance issued pursuant to this chapter.

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.

4. The carrier shall make available to a smallemployer or a producer acting on behalf of a small employer, upon request, acopy of the disclosure approved by the Commissioner pursuant to this sectionfor policies of health insurance for which that employer may be eligible.

(Added to NRS by 1995, 985; A 1997, 2947; 1999, 2814)

NRS 689C.280 Carrierto provide required disclosures to small employer before issuing policy ofinsurance. A carrier shall provide to a smallemployer to whom it has offered a health benefit plan a copy of the disclosureapproved for that plan pursuant to NRS689C.270 before any policy or contract of insurance under a health benefitplan is issued. A carrier shall not offer a health benefit plan to a smallemployer unless the disclosure for the plan has been approved by theCommissioner.

(Added to NRS by 1995, 985)

NRS 689C.281 Coveragefor prescription drugs: Provision of notice and information regarding use offormulary.

1. A carrier that offers or issues a health benefitplan which provides coverage for prescription drugs shall include with anysummary, certificate or evidence of that coverage provided to an insured,notice of whether a formulary is used and, if so, of the opportunity to secureinformation regarding the formulary from the carrier pursuant to subsection 2.The notice required by this subsection must:

(a) Be in a language that is easily understood and in aformat that is easy to understand;

(b) Include an explanation of what a formulary is; and

(1) An explanation of:

(I) How often the contents of theformulary are reviewed; and

(II) The procedure and criteria fordetermining which prescription drugs are included in and excluded from theformulary; and

(2) The telephone number of the carrier formaking a request for information regarding the formulary pursuant to subsection2.

2. If a carrier offers or issues a health benefit planwhich provides coverage for prescription drugs and a formulary is used, thecarrier shall:

(a) Provide to any insured or participating provider ofhealth care, upon request:

(1) Information regarding whether a specificdrug is included in the formulary.

(2) Access to the most current list ofprescription drugs in the formulary, organized by major therapeutic category,with an indication of whether any listed drugs are preferred over other listeddrugs. If more than one formulary is maintained, the carrier shall notify therequester that a choice of formulary lists is available.

(b) Notify each person who requests informationregarding the formulary, that the inclusion of a drug in the formulary does notguarantee that a provider of health care will prescribe that drug for aparticular medical condition.

(Added to NRS by 2001, 858)

NRS 689C.283 Electionto operate as risk-assuming carrier or reinsuring carrier: Notice toCommissioner; effective date; change in status.

1. Within 30 days after the date on which a plan ofoperation is approved by the Commissioner pursuant to NRS 689C.770, or for a new carrier within30 days after the date on which it enters the small employer market, eachcarrier shall elect to operate as either a risk-assuming carrier or areinsuring carrier and shall notify the Commissioner of its election.

2. The initial election of a carrier to act as arisk-assuming or reinsuring carrier is effective on the carrier for 2 yearsafter the date on which it notifies the Commissioner pursuant to subsection 1.After the initial 2-year period, such an election is effective for 5 years. TheCommissioner may allow a carrier to modify its election at any time for goodcause shown. The Commissioner may waive or modify the period during which theelection of a carrier to operate as a risk-assuming or reinsuring carrier iseffective.

3. A carrier may apply to the Commissioner, in amanner prescribed by the Commissioner by regulation, to change its status as arisk-assuming or reinsuring carrier.

4. A reinsuring carrier that elects or is subsequentlyauthorized by the Commissioner to operate as a risk-assuming carrier:

(a) Shall not continue to reinsure any small employerhealth benefit plan with the Program of Reinsurance.

(b) Shall pay a prorated assessment based upon businessissued as a reinsuring carrier for any portion of the year that the businesswas reinsured.

5. As used in this section:

(a) Plan of operation means the plan of operation ofthe Program of Reinsurance established pursuant to NRS 689C.610 to 689C.980, inclusive.

(b) Reinsuring carrier means a carrier participatingin the Program of Reinsurance established pursuant to NRS 689C.610 to 689C.980, inclusive.

(Added to NRS by 1997, 2922)

NRS 689C.287 Electionto act as risk-assuming carrier: Suspension by Commissioner; applicablestatutes.

1. The Commissioner may suspend the election of acarrier to act as a risk-assuming carrier if the Commissioner finds that:

(a) The financial condition of the carrier will nolonger support the assumption of risk from issuing coverage to small employersin compliance with NRS 689C.156 and 689C.190 without the protection affordedby the Program of Reinsurance;

(b) The carrier has failed to market its health benefitplans fairly to all small employers in this state or in its establishedgeographic service area, as applicable; or

(c) The carrier has failed to provide coverage toeligible small employers as required pursuant to NRS 689C.156 and 689C.190.

2. A carrier that elects to be a risk-assuming carrieris subject to:

(a) The provisions of NRS 689C.156, relating to theavailability of coverage; and

(b) The provisions of NRS 689C.260, relating to classes ofbusinesses.

(Added to NRS by 1997, 2923)

NRS 689C.290 Commissionerauthorized to suspend restriction on increase of premiums for new rating periodbased on new business for policy. TheCommissioner may suspend for a specified period the application of paragraph(a) of subsection 1 and of subsection 2 of NRS689C.210 as to the premium rates applicable to one or more small employersincluded within a class of business of a carrier serving small employers forone or more rating periods upon application by the carrier and a finding by theCommissioner that the suspension:

1. Is reasonable in light of the financial conditionof the carrier; or

2. Would enhance the efficiency and fairness of themarket for health insurance for small employers.

(Added to NRS by 1995, 985)

NRS 689C.300 Carrierto file actuarial certification annually with Commissioner.

1. Each carrier serving small employers shall filewith the Commissioner annually, on or before March 15, an actuarialcertification that the carrier is in compliance with the provisions of NRS 689C.210 to 689C.260, inclusive, and that the ratingmethods of the carrier are actuarially sound. The certification must be made ina form and manner, and contain the information, specified by the Commissioner.A copy of the certification must be retained by the carrier at its principalplace of business.

2. As used in this section, actuarial certificationmeans a written statement by a member of the American Academy of Actuaries orother person acceptable to the Commissioner, based upon the certifiersexamination of the appropriate records of the carrier, including a review ofthe actuarial assumptions and methods used by the carrier in establishingpremium rates for health benefit plans.

(Added to NRS by 1995, 985)

NRS 689C.310 Renewalof health benefit plan; discontinuing issuance and renewal of coverage, plan orform of product of health benefit plan.

1. Except as otherwise provided in subsections 2 and3, a carrier shall renew a health benefit plan at the option of the smallemployer who purchased the plan.

2. A carrier may refuse to issue or to renew a healthbenefit plan if:

(a) The carrier discontinues transacting insurance inthis state or in the geographic area of this state where the employer islocated;

(b) The employer fails to pay the premiums orcontributions required by the terms of the plan;

(c) The employer misrepresents any informationregarding the employees covered under the plan or other information regardingeligibility for coverage under the plan;

(d) The plan sponsor has engaged in an act or practicethat constitutes fraud to obtain or maintain coverage under the plan;

(e) The employer is not in compliance with the minimumrequirements for participation or employer contribution as set forth in theplan; or

(f) The employer fails to comply with any of theprovisions of this chapter.

3. A carrier may require a small employer to exclude aparticular employee or his dependent from coverage under a health benefit planas a condition to renewal of the plan if the employee or his dependent commitsfraud upon the carrier or misrepresents a material fact which affects hiscoverage under the plan.

4. A carrier shall discontinue the issuance andrenewal of coverage to a small employer if the Commissioner finds that thecontinuation of the coverage would not be in the best interests of thepolicyholders or certificate holders of the carrier in this state or wouldimpair the ability of the carrier to meet its contractual obligations. If theCommissioner makes such a finding, the Commissioner shall assist the affectedsmall employers in finding replacement coverage.

5. A carrier may discontinue the issuance and renewalof a form of a product of a health benefit plan offered to small employerspursuant to this chapter if the Commissioner finds that the form of the productoffered by the carrier is obsolete and is being replaced with comparablecoverage. A form of a product of a health benefit plan may be discontinued by acarrier pursuant to this subsection only if:

(a) The carrier notifies the Commissioner and the chiefregulatory officer for insurance in each state in which it is licensed of itsdecision pursuant to this subsection to discontinue the issuance and renewal ofthe form of the product at least 60 days before the carrier notifies theaffected small employers pursuant to paragraph (b).

(b) The carrier notifies each affected small employerand the Commissioner and the chief regulatory officer for insurance in eachstate in which any affected small employer is located or eligible employeeresides of the decision of the carrier to discontinue offering the form of theproduct. The notice must be made at least 180 days before the date on which thecarrier will discontinue offering the form of the product.

(c) The carrier offers to each affected small employerthe option to purchase any other health benefit plan currently offered by thecarrier to small employers in this state.

(d) In exercising the option to discontinue theparticular form of the product and in offering the option to purchase othercoverage pursuant to paragraph (c), the carrier acts uniformly without regardto the claims experience of the affected small employers or any healthstatus-related factor relating to any participant or beneficiary covered by thediscontinued product or any new participant or beneficiary who may becomeeligible for such coverage.

6. A carrier may discontinue the issuance and renewalof a health benefit plan offered to a small employer or an eligible employeepursuant to this chapter only through a bona fide association if:

(a) The membership of the small employer or eligibleemployee in the association was the basis for the provision of coverage;

(b) The membership of the small employer or eligibleemployee in the association ceases; and

(c) The coverage is terminated pursuant to thissubsection uniformly without regard to any health status-related factorrelating to the small employer or eligible employee or his dependent.

7. If a carrier does business in only one establishedgeographic service area of this state, the provisions of this section applyonly to the operations of the carrier in that service area.

(Added to NRS by 1995, 986; A 1997, 2948)

NRS 689C.320 Requirednotification when carrier discontinues transacting insurance in this State;restrictions on carrier that discontinues transacting insurance.

1. A carrier that discontinues transacting insurancein this State or in a particular geographic area of this State shall:

(a) Notify the Commissioner and the chief regulatoryofficer for insurance in each state in which the carrier is licensed totransact insurance at least 60 days before a notice of cancellation ornonrenewal is delivered or mailed to the affected small employers pursuant toparagraph (b).

(b) Notify the Commissioner and each small employeraffected not less than 180 days before the expiration of any policy or contractof insurance under any health benefit plan issued to a small employer pursuantto this chapter.

2. A carrier that cancels any health benefit planbecause it has discontinued transacting insurance in this State or in aparticular geographic area of this State:

(a) Shall discontinue the issuance and delivery forissuance of all health benefit plans pursuant to this chapter in this State andnot renew coverage under any health benefit plan issued to a small employer;and

(b) May not issue any health benefit plans pursuant tothis chapter in this State or in the particular geographic area for 5 yearsafter it gives notice to the Commissioner pursuant to paragraph (b) ofsubsection 1.

(Added to NRS by 1995, 986; A 1997, 2949)

NRS 689C.325 Coverageoffered through network plan not required to be offered to eligible employeewho does not reside or work in established geographic service area or ifcarrier lacks capacity to deliver adequate service to additional employers andemployees. A carrier that offers coveragethrough a network plan is not required to offer coverage to or accept anyapplications for coverage from the eligible employees of a small employerpursuant to NRS 689C.310 and 689C.320 if:

1. The eligible employees do not reside or work in theestablished geographic service area of the network plan.

2. For a small employer whose eligible employeesreside or work in the established geographic service area of the network plan,the carrier demonstrates to the satisfaction of the Commissioner that thecarrier does not have the capacity to deliver adequate service to additionalsmall employers and eligible employees because of the existing obligations ofthe carrier. If a carrier is authorized by the Commissioner not to offercoverage pursuant to this subsection, the carrier shall not thereafter offercoverage to additional small employers and eligible employees within that establishedgeographic service area until the carrier demonstrates to the satisfaction ofthe Commissioner that it has regained the capacity to deliver adequate serviceto additional small employers and eligible employees within that service area.

(Added to NRS by 1997, 2921)

NRS 689C.327 Carrierthat offers network plan: Contracts with certain federally qualified healthcenters.

1. A carrier that offers a network plan shall use itsbest efforts to contract with at least one health center in each establishedgeographic service area to provide health care as a member of the carriersdefined set of providers under the network plan if the health center:

(a) Meets all conditions imposed by the carrier onsimilarly situated providers of health care that are members of the carriersdefined set of providers, including, without limitation:

(1) Certification for participation in theMedicaid or Medicare program; and

(2) Requirements relating to the appropriatecredentials for providers of health care; and

(b) Agrees to reasonable reimbursement rates that aregenerally consistent with those offered by the carrier to similarly situatedproviders of health care that are members of the carriers defined set ofproviders.

2. As used in this section, health center has themeaning ascribed to it in 42 U.S.C. 254b.

(Added to NRS by 2001, 1923)

NRS 689C.330 Wheninsurer is required to allow employee to continue coverage after he is nolonger covered by health benefit plan.

1. Any policy or contract of insurance delivered orissued for delivery in this state under a health benefit plan which providesfor coverage of benefits under the plan on an expense-incurred basis mustcontain a provision that the employee is entitled to have issued to him by theinsurer a policy of health insurance when the employee is no longer covered bythe health benefit plan.

2. The requirement in subsection 1 only applies to apolicy or contract of insurance issued under a health benefit plan if:

(a) The termination of coverage is not because oftermination of the health benefit plan, unless the termination of the healthbenefit plan resulted from the failure of the employer to remit the requiredpremiums;

(b) The termination is not because of failure of theemployee to remit any required contributions;

(c) The employee has been continuously insured underany health benefit plan of the employer for at least 3 consecutive monthsimmediately preceding the termination; and

(d) The employee applies in writing for the convertedpolicy and pays his first premium to the insurer not later than 31 days afterthe termination.

(Added to NRS by 1995, 986)

NRS 689C.340 Requiredprovisions in health benefit plan of employer who employs less than 20employees related to continuation of coverage.

1. Except as otherwise provided in this section, if anemployer who employs less than 20 employees maintains a health benefit planwhich covers those employees, the plan must contain a provision which permits:

(a) An employee to elect to continue identical coverageunder the plan, excluding coverage provided for eye or dental care, if:

(1) His employment is terminated for any reasonother than gross misconduct; or

(2) The number of his working hours is reducedso that he ceases to be eligible for coverage.

(b) The spouse or dependent child of an employee toelect to continue coverage, excluding any coverage provided for eye or dentalcare, if:

(1) The employees employment is terminated forany reason other than gross misconduct or the number of his working hours isreduced so that he ceases to be eligible for coverage;

(2) The employee dies;

(3) The employee and his spouse are divorced orlegally separated;

(4) The dependent child ceases to be eligiblefor coverage under the terms of the policy; or

(5) The spouse ceases to be eligible forcoverage after becoming eligible for Medicare.

2. The period of continued coverage is limited to:

(a) Eighteen months for an employee.

(b) Thirty-six months for the dependent of an employee.

3. An employee who voluntarily leaves his employment,or the dependent of that employee, is not eligible to continue coveragepursuant to this section.

4. An employee or his dependent who has not beencovered under a health benefit plan of the employer for at least 12 consecutivemonths before the termination of his coverage is not eligible to continue coveragepursuant to this section.

5. A provision for continued coverage must includecoverage for any child born to, legally adopted by or placed for adoption withthe employee during the period of continued coverage. Such a child is eligiblefor continued coverage only to the end of the period of continued coverage asestablished pursuant to subsection 2.

(Added to NRS by 1995, 987; A 1997, 2950)

NRS 689C.342 Noticeof election and payment of premium.

1. An employee, spouse or dependent child shall notifythe employer that he is eligible to continue his coverage pursuant to NRS 689C.340 not later than 60 days afterhe becomes eligible to do so.

2. The employer shall, within 14 days after receipt ofnotification pursuant to subsection 1, provide adequate information to theemployee, spouse or dependent child regarding the election to continue coverageand the premium required to be paid.

3. If the employee, spouse or dependent child electsto continue coverage, he shall notify the insurer of his election and pay tothe insurer the premium required by NRS689C.344 within 60 days after receipt of the information provided pursuantto subsection 2.

(Added to NRS by 1997, 2928)

NRS 689C.344 Amountof premium for continuation of coverage; change in rates; payment to insurer;termination.

1. Any person who elects to continue coverage pursuantto NRS 689C.340 shall pay a premiumfor that coverage in an amount not to exceed 125 percent of the premium chargedto the employer by the insurer for coverage of that person on the date on whichthat person became eligible for continued coverage.

2. If there is a change in the rate charged orbenefits provided under the policy during the time of continued coverage, thepremium may not exceed 125 percent of the new rate charged to the employer.

3. The premiums must be paid to the insurer on aquarterly basis.

4. If the payment of a premium is not received by theinsurer within 30 days after the date on which it is due, continued coveragemust be terminated.

(Added to NRS by 1997, 2928)

NRS 689C.346 Effectof change in insurer during period of continued coverage. If an employer changes his insurer during the period of apersons continued coverage, the new insurer shall provide continued coveragefor that person for the remainder of the continuation period in accordance withthe provisions of NRS 689C.344.

(Added to NRS by 1997, 2928)

NRS 689C.348 Continuedcoverage ceases before end of established period under certain circumstances. Continued coverage pursuant to NRS 689C.340 ceases before the end of theperiod provided in that section if:

1. The employer discontinues group health insurancefor his employees;

2. The employee, spouse or dependent child fails topay the required premiums;

3. The employee, spouse or dependent child becomescovered under any other policy of group health insurance;

4. The employee or spouse qualifies for Medicare; or

5. The spouse remarries and becomes eligible forcoverage under a policy of group health insurance of the new spouse.

(Added to NRS by 1997, 2928)

NRS 689C.350 Healthbenefit plan with preferred providers of health care: Deductible; percentagerate of payment; when coinsurance is no longer required; when service is deemedto be provided by preferred provider; processing claims of provider who is notpreferred. A health benefit plan which offersa difference of payment between preferred providers of health care andproviders of health care who are not preferred:

1. May not require a deductible of more than $600difference per admission to a facility for inpatient treatment which is not apreferred provider of health care.

2. May not require a deductible of more than $500difference per treatment, other than inpatient treatment at a hospital, by aprovider which is not preferred.

3. May not provide for a difference in percentagerates of payment for coinsurance of more than 30 percentage points between thepayment for coinsurance required to be paid by the insured to a preferred providerof health care and the payment for coinsurance required to be paid by theinsured to a provider of health care who is not preferred.

4. Must require that the deductible and payment forcoinsurance paid by the insured to a preferred provider of health care beapplied to the negotiated reduced rates of that provider.

5. Must include for providers of health care who arenot preferred a provision establishing the point at which an insureds paymentfor coinsurance is no longer required to be paid if such a provision isincluded for preferred providers of health care. Such provisions must be basedon a calendar year. The point at which an insureds payment for coinsurance isno longer required to be paid for providers of health care who are not preferredmust not be greater than twice the amount for preferred providers of healthcare, regardless of the method of payment.

6. Must provide that if there is a particular servicewhich a preferred provider of health care does not provide and the provider ofhealth care who is treating the insured requests the service and the insurerdetermines that the use of the service is necessary for the health of theinsured, the service shall be deemed to be provided by the preferred providerof health care.

7. Must require the insurer to process a claim of aprovider of health care who is not preferred not later than 30 working daysafter the date on which proof of the claim is received.

(Added to NRS by 1995, 987)

NRS 689C.355 Prohibitedacts of carrier or producer; denial of application for coverage; violation mayconstitute unfair trade practice; applicability of section.

1. Except as otherwise provided in this section, acarrier or a producer shall not, directly or indirectly:

(a) Encourage or direct a small employer to refrainfrom filing an application for coverage with the carrier because of the healthstatus, claims experience, industry, occupation or geographic location of thesmall employer.

(b) Encourage or direct a small employer to seekcoverage from another carrier because of the health status, claims experience,industry, occupation or geographic location of the small employer.

2. The provisions of subsection 1 do not apply toinformation provided to a small employer by a carrier or a producer relating tothe established geographic service area or a provision for a restricted networkof the carrier.

3. Except as otherwise provided in this subsection, acarrier shall not, directly or indirectly, enter into any contract, agreementor arrangement with a producer if the contract, agreement or arrangementprovides for or results in a variation to the compensation that is paid to aproducer for the sale of a health benefit plan because of the health status,claims experience, industry, occupation or geographic location of the smallemployer at the time that the health benefit plan is issued to or renewed bythe small employer. The provisions of this subsection do not apply to any arrangementfor compensation that provides payment to a producer on the basis of percentageof premium, except that the percentage may not vary because of the healthstatus, claims experience, industry, occupation or geographic area of the smallemployer.

4. A carrier shall not terminate, fail to renew, orlimit its contract or agreement of representation with a producer for anyreason related to the health status, claims experience, occupation orgeographic location of a small employer at the time that the health benefitplan is issued to or renewed by the small employer placed by the producer withthe carrier.

5. A carrier or producer shall not induce or otherwiseencourage a small employer to separate or otherwise exclude an employee or adependent of the employee from health coverage or benefits provided inconnection with the employment of the employee.

6. A violation of any provision of this section by acarrier may constitute an unfair trade practice for the purposes of chapter 686A of NRS.

7. The provisions of this section apply to athird-party administrator if the third-party administrator enters into acontract, agreement or other arrangement with a carrier to provideadministrative, marketing or other services related to the offering of a healthbenefit plan to small employers in this state.

8. Nothing in this section interferes with the rightand responsibility of a broker to advise and represent the best interests of asmall employer who is seeking health insurance coverage from a small employercarrier.

(Added to NRS by 1997, 2923)

VOLUNTARY PURCHASING GROUPS

NRS 689C.360 Definitions. As used in NRS689C.360 to 689C.600, inclusive,unless the context otherwise requires, the words and terms defined in NRS 689C.380 to 689C.420, inclusive, have the meaningsascribed to them in those sections.

(Added to NRS by 1995, 2677; A 1997, 2951)

NRS 689C.380 Contractdefined. Contract means a policy or certificatefor hospital or medical expenses, a contract for dental, hospital or medical services,or a health care plan of a health maintenance organization available for use byor offered or sold to a small employer. The term does not include coverageissued as a supplement to liability insurance, workers compensation or similarinsurance, automobile medical payment insurance, coverage for a specifieddisease, hospital confinement indemnity or limited-benefit health insurance.

(Added to NRS by 1995, 2677)

NRS 689C.390 Dependentdefined. Dependent means a spouse, anunmarried child who has not attained 19 years of age, an unmarried child who isa full-time student who has not attained 24 years of age and who is financiallydependent upon the parent, and an unmarried child of any age who is medicallycertified as disabled and dependent upon the parent.

(Added to NRS by 1995, 2677)

NRS 689C.420 Voluntarypurchasing group defined. Voluntary purchasinggroup means the employers and their eligible employees and dependents who forma group pursuant to NRS 689C.360 to 689C.600, inclusive, and hold acertificate of registration issued by the Commission pursuant to NRS 689C.510.

(Added to NRS by 1995, 2677)

NRS 689C.425 Applicabilityof other provisions. A voluntary purchasinggroup and any contract issued to such a group pursuant to NRS 689C.360 to 689C.600, inclusive, are subject to theprovisions of NRS 689C.015 to 689C.355, inclusive, to the extentapplicable and not in conflict with the express provisions of NRS 689C.360 to 689C.600, inclusive.

(Added to NRS by 1997, 2929; A 2001, 860)

NRS 689C.430 Entitieswhich are authorized to offer contracts to voluntary purchasing groups. Every insurer, fraternal benefit society, corporation providinghospital or medical services or health maintenance organization, whose policiesor activities relating to health insurance are governed by the provisions of chapter 689B, 695A,695B or 695Cof NRS, may offer contracts to voluntary purchasing groups and, if it does so,shall comply with the provisions of NRS689C.360 to 689C.600, inclusive.

(Added to NRS by 1995, 2677)

1. A carrier serving small employers and a carrierthat offers a contract to a voluntary purchasing group shall not charge aprovider of health care a fee to include the name of the provider on a list ofproviders of health care given by the carrier to its insureds.

2. A carrier specified in subsection 1 shall notcontract with a provider of health care to provide health care to an insuredunless the carrier uses the form prescribed by the Commissioner pursuant to NRS 629.095 to obtain any informationrelated to the credentials of the provider of health care.

3. A contract between a carrier specified insubsection 1 and a provider of health care may be modified:

(a) At any time pursuant to a written agreementexecuted by both parties.

(b) Except as otherwise provided in this paragraph, bythe carrier upon giving to the provider 30 days written notice of themodification. If the provider fails to object in writing to the modificationwithin the 30-day period, the modification becomes effective at the end of thatperiod. If the provider objects in writing to the modification within the 30-dayperiod, the modification must not become effective unless agreed to by bothparties as described in paragraph (a).

4. If a carrier specified in subsection 1 contractswith a provider of health care to provide health care to an insured, thecarrier shall:

(a) If requested by the provider of health care at thetime the contract is made, submit to the provider of health care the scheduleof payments applicable to the provider of health care; or

(b) If requested by the provider of health care at anyother time, submit to the provider of health care the schedule of paymentsspecified in paragraph (a) within 7 days after receiving the request.

5. As used in this section, provider of health caremeans a provider of health care who is licensed pursuant to chapter 630, 631,632 or 633 ofNRS.

(Added to NRS by 1999, 1648; A 2001, 2731; 2003, 3359)

NRS 689C.440 Regulationsregarding required disclosures by carrier.

1. The Commissioner shall adopt regulations whichrequire a carrier to file with the Commissioner, for his approval, a disclosureoffered by the carrier to a voluntary purchasing group. The disclosure mustinclude:

(a) Any significant exception, prior authorization,reduction or limitation that applies to a contract;

(b) Any restrictions on payments for emergency care,including, without limitation, related definitions of an emergency and medicalnecessity;

(c) Any provision of a contract concerning thecarriers right to change premium rates and the characteristics, other thanclaim experience, that affect changes in premium rates;

(d) The provisions relating to renewability ofcontracts;

(e) The provisions relating to any preexistingcondition; and

(f) Any other information that the Commissioner findsnecessary to provide for full and fair disclosure of the provisions of acontract.

2. The disclosure must be written in a language whichis easily understood and must include a statement that the disclosure is asummary of the contract only, and that the contract itself should be read todetermine the governing 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 1995, 2678)

NRS 689C.450 Carrierto provide disclosure before issuing contract. Acarrier shall provide to a voluntary purchasing group to which it has offered acontract a copy of the disclosure approved for that contract pursuant to NRS 689C.440 before the contract isissued. A carrier shall not offer a contract to a voluntary purchasing groupunless the disclosure for the contract has been approved by the Commissioner.

(Added to NRS by 1995, 2678)

NRS 689C.455 Coveragefor prescription drugs: Provision of notice and information regarding use offormulary.

1. A carrier that offers or issues a contract whichprovides coverage for prescription drugs shall include with any summary,certificate or evidence of that coverage provided to an insured, notice ofwhether a formulary is used and, if so, of the opportunity to secureinformation regarding the formulary from the carrier pursuant to subsection 2.The notice required by this subsection must:

(a) Be in a language that is easily understood and in aformat that is easy to understand;

(b) Include an explanation of what a formulary is; and

(1) An explanation of:

(I) How often the contents of theformulary are reviewed; and

(II) The procedure and criteria fordetermining which prescription drugs are included in and excluded from theformulary; and

(2) The telephone number of the carrier formaking a request for information regarding the formulary pursuant to subsection2.

2. If a carrier offers or issues a contract whichprovides coverage for prescription drugs and a formulary is used, the carriershall:

(a) Provide to any insured or participating provider ofhealth care, upon request:

(1) Information regarding whether a specificdrug is included in the formulary.

(Added to NRS by 2001, 859)

NRS 689C.460 Carrierto offer same coverage to all eligible employees; denial of coverage tootherwise eligible employee.

1. If a carrier offers a contract to a voluntarypurchasing group, the carrier shall offer the same coverage to all of theeligible employees of the small employers that are members of the voluntarypurchasing group and their dependents. A carrier shall not offer coverage toonly certain members of that group or to only part of that group, but mayexclude an otherwise eligible employee, or his dependent, who requestsenrollment in the contract after the end of the initial period during which theemployee or dependent is entitled to enroll under the terms of the contract, ifthe initial period is at least 30 days.

2. A carrier shall not exclude an eligible employee ordependent if:

(a) The employee or dependent:

(1) Was covered under other creditable coverageat the time of the initial period for enrollment;

(3) Requests enrollment within 30 days aftertermination of the other creditable coverage;

(b) The employee is employed by an employer that offersmultiple contracts and elects a different contract during an open period forenrollment; or

(c) A court has ordered that coverage be provided for adependent under a covered employees contract and the request for enrollment ismade within 30 days after issuance of the court order.

(Added to NRS by 1995, 2678; A 1997, 2951)

NRS 689C.470 Renewalof contract; discontinuing issuance and renewal of form of product of healthbenefit plan or health benefit plan.

1. Except as otherwiseprovided in NRS 689C.360 to 689C.600, inclusive, a carrier shallrenew a contract as to all insured small employers that are members of avoluntary purchasing group and their employees and dependents at the request ofthe purchaser unless:

(a) Required premiums are not paid;

(b) The insured employer or other purchaser is guiltyof fraud or misrepresentation;

(d) The number or percentage of employees covered underthe contract is less than the number or percentage of eligible employeesrequired by the contract;

(e) The employer or purchaser is no longer engaged inthe business in which it was engaged on the effective date of the contract; or

(f) The Commissioner finds that the continuation of thecoverage is not in the best interests of the persons insured under the contractor would impair the carriers ability to meet its contractual obligations. If nonrenewaloccurs as a result of findings pursuant to this subsection, the Commissionershall assist affected persons in replacing coverage.

2. A carrier may discontinue issuance and renewal of aform of a product of a health benefit plan offered to a small employer orpurchasers pursuant to NRS 689C.360 to689C.600, inclusive, if theCommissioner finds that the form of the product offered by the carrier isobsolete and is being replaced with comparable coverage. A form of a product ofa health benefit plan may be discontinued by a carrier pursuant to thissubsection only if:

(a) The carrier notifies the Commissioner and the chiefregulatory officer for insurance in each state in which it is licensed of itsdecision pursuant to this subsection to discontinue offering and renewing theform of the product at least 60 days before the carrier notifies the affectedsmall employers and purchasers pursuant to paragraph (b).

(b) The carrier notifies each affected small employerand purchaser, and the Commissioner and the chief regulatory officer forinsurance in each state in which any affected small employer is located oremployee resides, of the decision of the carrier to discontinue offering theform of the product. The notice must be made at least 180 days before the dateon which the carrier will discontinue offering the form of the product.

(c) The carrier offers to each affected small employerand purchaser the option to purchase any other health benefit plan currentlyoffered by the carrier to small employers in this state.

(d) In exercising the option to discontinue theparticular form of the product and in offering the option to purchase othercoverage pursuant to paragraph (c), the carrier acts uniformly without regardto the claim experience of the affected small employers and any healthstatus-related factor relating to any participant or beneficiary covered by thediscontinued product or any new participant or beneficiary who may becomeeligible for such coverage.

3. A carrier may discontinue the issuance and renewalof a health benefit plan offered to a voluntary purchasing group pursuant tothis chapter only through a bona fide association if:

(a) The membership of the small employer who employsthe members of the voluntary purchasing group or the purchaser in theassociation was the basis for the provision of coverage;

(b) The membership of that small employer or thepurchaser in the association ceases; and

(c) The coverage is terminated pursuant to thissubsection uniformly without regard to any health status-related factorrelating to the small employer or the purchaser or his dependent.

(Added to NRS by 1995, 2679; A 1997, 2951)

NRS 689C.480 Requirednotification when carrier ceases to renew all contracts; restrictions oncarrier that ceases to renew all contracts.

1. A carrier may cease to renew all contracts coveringvoluntary purchasing groups and discontinue issuing and delivering for issuanceany such contracts. The carrier shall provide notice:

(a) At least 60 days before the notice of terminationis provided pursuant to paragraph (b), to the Commissioner and the chiefregulatory officer for insurance of each state in which the carrier is licensedto transact insurance; and

(b) At least 180 days before termination of coverage toholders of all affected contracts and to the Commissioner and the chiefregulatory officer for insurance in each state in which an affected insuredperson is known to reside.

2. A carrier that exercises its right to cease torenew all contracts covering voluntary purchasing groups shall not transfer orotherwise provide coverage to any of the insureds from a nonrenewed voluntarypurchasing group unless the carrier offers to transfer or provide coverage toall affected employers and eligible employees and dependents without regard tocharacteristics of the insured, experience as to claims, health or duration ofcoverage.

3. A carrier that decides to terminate its contractsand to discontinue issuing and delivering for issuance any contracts pursuantto this section:

(a) Shall discontinue issuance and delivery forissuance all health benefit plans pursuant to this chapter in this state and,except as otherwise provided in this section, not renew any such contracts; and

(b) Shall not enter into any new contract with avoluntary purchasing group for 5 years after the date on which the carrierterminated its contracts with voluntary purchasing groups.

(Added to NRS by 1995, 2679; A 1997, 2953)

NRS 689C.485 Approvalor denial of claims; payment of claims and interest; requests for additionalinformation; award of costs and attorneys fees; compliance with requirements.

1. Except as otherwise provided in subsection 2, acarrier serving small employers and a carrier that offers a contract to avoluntary purchasing group shall approve or deny a claim relating to a policyof health insurance within 30 days after the carrier receives the claim. If theclaim is approved, the carrier shall pay the claim within 30 days after it isapproved. Except as otherwise provided in this section, if the approved claimis not paid within that period, the carrier shall pay interest on the claim ata rate of interest equal to the prime rate at the largest bank in Nevada, asascertained by the Commissioner of Financial Institutions, on January 1 or July1, as the case may be, immediately preceding the date on which the payment wasdue, plus 6 percent. The interest must be calculated from 30 days after thedate on which the claim is approved until the date on which the claim is paid.

2. If the carrier requires additional information todetermine whether to approve or deny the claim, it shall notify the claimant ofits request for the additional information within 20 days after it receives theclaim. The carrier shall notify the provider of health care of all the specificreasons for the delay in approving or denying the claim. The carrier shallapprove or deny the claim within 30 days after receiving the additionalinformation. If the claim is approved, the carrier shall pay the claim within30 days after it receives the additional information. If the approved claim isnot paid within that period, the carrier shall pay interest on the claim in themanner prescribed in subsection 1.

3. A carrier shall not request a claimant to resubmitinformation that the claimant has already provided to the carrier, unless thecarrier provides a legitimate reason for the request and the purpose of therequest is not to delay the payment of the claim, harass the claimant ordiscourage the filing of claims.

4. A carrier shall not pay only part of a claim thathas been approved and is fully payable.

5. A court shall award costs and reasonable attorneysfees to the prevailing party in an action brought pursuant to this section.

6. The payment of interest provided for in thissection for the late payment of an approved claim may be waived only if thepayment was delayed because of an act of God or another cause beyond thecontrol of the carrier.

7. The Commissioner may require a carrier to provideevidence which demonstrates that the carrier has substantially complied withthe requirements set forth in this section, including, without limitation,payment within 30 days of at least 95 percent of approved claims or at least 90percent of the total dollar amount for approved claims.

8. If the Commissioner determines that a carrier isnot in substantial compliance with the requirements set forth in this section,the Commissioner may require the carrier to pay an administrative fine in anamount to be determined by the Commissioner. Upon a second or subsequentdetermination that a carrier is not in substantial compliance with therequirements set forth in this section, the Commissioner may suspend or revokethe certificate of authority of the carrier.

(Added to NRS by 1999, 1648; A 2001, 2731; 2003, 3359)

NRS 689C.490 Formationof voluntary purchasing group by small employers; requirements when affiliateof group ceases to qualify as small employer.

1. A small employer may, in accordance with theprovisions of NRS 689C.490 to 689C.600, inclusive, choose to affiliatevoluntarily with other small employers as a voluntary purchasing group topurchase health benefits for eligible employees and their dependents.

2. An employer who affiliates with a voluntarypurchasing group shall notify the carrier for that group when the employer hasless than 2 or more than 50 employees. The carrier shall:

(a) Upon receiving such a notification, inform theemployer of the provisions of paragraph (b).

(b) If the employer ceases to be a small employer,refuse to renew the coverage of that employer and his employees and theirdependents under any contract provided through the voluntary purchasing group.

(Added to NRS by 1995, 2679; A 1997, 2953)

NRS 689C.500 Requirementsfor registration as voluntary purchasing group; application.

1. An organization seeking to be registered as avoluntary purchasing group:

(a) Must be incorporated as a Nevada corporation notfor profit for the purpose of securing health benefits for its members andtheir eligible employees and dependents;

(b) Shall file articles of incorporation with theSecretary of State and provide a copy of the articles to the Commissioner insuch a form as the Commissioner may require; and

(c) Must apply to the Commissioner for and obtain acertificate of registration to operate as a voluntary purchasing group.

2. The contents of the application must be establishedby the Commissioner and include at least:

(a) The name of the voluntary purchasing group and anyagent for service of process;

(b) Provisions to govern the business and affairs ofthe group, including the management and organizational structure;

(c) An affidavit by an officer of the organization thatthe group is in compliance with the requirements of NRS 689C.490 to 689C.600, inclusive; and

(d) The names of managing personnel of the voluntarypurchasing group.

(Added to NRS by 1995, 2680)

NRS 689C.510 Feefor application; response to application.

1. The application must be accompanied by a fee in anamount to be established by the Commissioner by regulation to cover the directcosts of examining the qualifications of an applicant.

2. The Commissioner shall respond to each applicationfor a certificate of registration within 30 days after receipt. TheCommissioner shall either approve the application or shall inform theorganization of specific changes to the application necessary to permitapproval.

(Added to NRS by 1995, 2680)

NRS 689C.520 Additionalrequirements for registration.

1. Before the issuance of a certificate ofregistration, each voluntary purchasing group shall, to the satisfaction of theCommissioner:

(a) Establish the conditions of membership in the groupand require as a condition of membership that all employers include all theireligible employees. The group may not differentiate among classes of membershipon the basis of the kind of employment, race, religion, sex, education, healthor income. The group shall set reasonable fees for membership which willfinance all reasonable and necessary costs incurred in administering the group.

(b) Provide to members of the group and their eligibleemployees information meeting the requirements of NRS 689C.440 regarding any proposedcontracts.

2. In addition to the information required pursuant tosubsection 1, a voluntary purchasing group shall provide annually to members ofthe group information regarding available benefits and carriers.

(Added to NRS by 1995, 2680)

NRS 689C.530 Filingreports; annual renewal fee. A voluntarypurchasing group shall:

1. File any reports required by the Commissioner; and

2. Pay a renewal fee established by the Commissionerby regulation to recover the direct costs to the Division to determine annuallythat a voluntary purchasing group is in compliance with NRS 689C.490 to 689C.600, inclusive.

(Added to NRS by 1995, 2680)

NRS 689C.540 Duties. A voluntary purchasing group shall:

1. Establish administrative and accounting proceduresfor the operation of the group and the provision of services to members,prepare an annual budget and annual operational fiscal reports;

2. Provide for internal and independent audits; and

3. Maintain all records, reports and other informationof the group and may contract with qualified third-party administrators,licensed insurance agents or brokers as needed.

(Added to NRS by 1995, 2681)

NRS 689C.550 Collectionof premiums; trust account for deposit of premiums. Avoluntary purchasing group shall offer to collect premiums for contractsoffered through the purchasing group and maintain a trust account for thedeposit of premiums collected to be paid to carriers for coverage offeredthrough the purchasing group. A voluntary purchasing group is a fiduciary withrespect to any premiums so collected.

(Added to NRS by 1995, 2681)

NRS 689C.560 Regulationsgoverning security to be maintained by voluntary purchasing group. A voluntary purchasing group shall post a bond for thebenefit of members of the group and their eligible employees and dependents, ordeposit a certificate of deposit or securities, in such a manner and amount asthe Commissioner establishes by regulation.

(Added to NRS by 1995, 2681)

NRS 689C.570 Organizerprohibited from acquiring financial interest in groups business. No person who organizes a voluntary purchasing group mayacquire or attempt to acquire a financial interest in the groups business fora period of 3 years after organization of the group.

(Added to NRS by 1995, 2681)

NRS 689C.580 Prohibitedacts. A voluntary purchasing group shall notperform any activity included in the definition of transacting insurance inthis state as defined in NRS 679A.130,perform any activity for which it is subject to regulation pursuant to NRS 685B.120 or establish or otherwiseengage in the activities of a health maintenance organization as provided in chapter 695C of NRS.

(Added to NRS by 1995, 2681)

NRS 689C.590 Disciplinaryaction for violation of provisions. The Commissionermay deny, revoke or suspend a certificate of registration of any voluntarypurchasing group found to be in violation of NRS 689C.490 to 689C.600, inclusive.

(Added to NRS by 1995, 2681)

NRS 689C.600 Regulations. The Commissioner shall adopt such regulations as areneeded to carry out the requirements of NRS689C.490 to 689C.600, inclusive.

(Added to NRS by 1995, 2681)

REINSURANCE

General Provisions

NRS 689C.610 Definitions. As used in NRS689C.610 to 689C.980, inclusive,unless the context otherwise requires, the words and terms defined in NRS 689C.620 to 689C.730, inclusive, have the meaningsascribed to them in those sections.

(Added to NRS by 1997, 2929; A 1999, 2814)

NRS 689C.620 Boarddefined. Board means the Board of Directorsof the Program of Reinsurance established pursuant to NRS 689C.750.

(Added to NRS by 1997, 2929)

NRS 689C.630 Churchplan defined. Church plan has the meaningascribed to it in section 3(33) of the Employee Retirement Income Security Actof 1974, as that section existed on July 16, 1997.

(Added to NRS by 1997, 2929)

NRS 689C.640 Committeedefined. Committee means the Committee onHealth Benefit Plans that is created pursuant to NRS 689C.960.

(Added to NRS by 1997, 2929)

NRS 689C.650 Eligibleperson defined. Eligible person has the meaningascribed to it in NRS 689A.515.

(Added to NRS by 1997, 2929)

NRS 689C.660 Individualcarrier defined. Individual carrier meansany entity subject to the provisions of this title and the regulations adoptedpursuant thereto, that contracts or offers to contract to provide for, deliverpayment for, arrange for payment of, pay for or reimburse any cost of healthcare services, including a sickness and accident health service corporation,and any other entity providing a plan of health insurance, health benefits orhealth services to individuals and their dependents in this state.

(Added to NRS by 1997, 2929)

NRS 689C.670 Individualhealth benefit plan defined. Individualhealth benefit plan means:

1. A health benefit plan, other than a convertedpolicy or a plan for coverage of a bona fide association, for individuals andtheir dependents; and

2. A certificate issued to an individual thatevidences coverage under a policy or contract issued to a trust, an associationor other similar group of persons, other than a plan for coverage of a bonafide association, regardless of the situs of delivery of the policy orcontract, if the eligible person pays the premium and is not being coveredunder the policy or contract pursuant to any provision for the continuation ofbenefits applicable under federal or state law.

(Added to NRS by 1997, 2929)

NRS 689C.680 Individualreinsuring carrier defined. Individual reinsuringcarrier means an individual carrier that has elected to reinsure eligible personsin the Program of Reinsurance.

(Added to NRS by 1997, 2929)

NRS 689C.690 Individualrisk-assuming carrier defined. Individualrisk-assuming carrier means an individual carrier that has elected to act as arisk-assuming carrier.

(Added to NRS by 1997, 2929)

NRS 689C.700 Planof operation defined. Plan of operationmeans the plan of operation of the Program of Reinsurance.

(Added to NRS by 1997, 2929)

NRS 689C.710 Programof Reinsurance defined. Program of Reinsurancemeans the Program of Reinsurance for Small Employers and Eligible Personscreated pursuant to NRS 689C.740.

(Added to NRS by 1997, 2929)

NRS 689C.720 Reinsuringcarrier defined. Reinsuring carrier means asmall employer carrier participating in the Program of Reinsurance.

(Added to NRS by 1997, 2929)

NRS 689C.730 Risk-assumingcarrier defined. Risk-assuming carriermeans a small employer carrier that has elected to act as a risk-assumingcarrier.

(Added to NRS by 1997, 2930)

Program of Reinsurance for Small Employers and EligiblePersons

NRS 689C.740 Creation. There is hereby created a nonprofit entity to be known asthe Program of Reinsurance for Small Employers and Eligible Persons.

(Added to NRS by 1997, 2930)

NRS 689C.750 Boardof Directors: Creation; members; term; vacancy.

1. The Board of Directors of the Program ofReinsurance is hereby created. The Board consists of:

(a) Eight members to be appointed by the Commissioneras follows:

(1) Six persons who represent carriers thatprovide health insurance coverage to small employers pursuant to the provisionsof this chapter or to individuals pursuant to chapter689A of NRS, or to both small employers and individuals; and

(2) Two persons who represent small employersand eligible persons; and

(b) The Commissioner, or his designated representative,who is an ex officio, nonvoting member of the Board.

2. Members of the Board serve without compensationexcept that, while engaged in the business of the Board, each member isentitled to receive the per diem allowance or travel expenses provided forstate officers and employees generally, to be paid from the proceeds of theassessments received by the Program of Reinsurance as an administrative expenseof the Program of Reinsurance.

3. After the initial term, the term of each appointedmember is 3 years. Members may be reappointed. A member may be removed from theBoard by the Commissioner for good cause shown.

4. At the expiration of the term of a member of theBoard, or if the member resigns or is otherwise unable to complete his term,the Commissioner shall appoint a replacement not later than 30 days after thevacancy occurs. All vacancies on the Board must be filled in the same manner ofappointment as the member who created the vacancy.

(Added to NRS by 1997, 2930)

NRS 689C.760 Meetingsof Board; Chairman of Board.

1. The Board shall meet:

(a) Until a plan of operation, other than a temporaryplan of operation, has been approved by the Commissioner, twice a year;

(b) Once a plan of operation has been so approved, oncea year; and

2. The Board shall elect from its membership aChairman who shall serve for a term of 2 years. Any vacancy occurring in thisposition must be filled by election of the members of the Board for theremainder of the unexpired term.

(Added to NRS by 1997, 2930)

NRS 689C.770 Planof operation: Submission by Board; approval by Commissioner; temporary planwhen plan not suitable or not submitted.

1. Not later than 120 days after the initialappointment of the Board, the Board shall submit to the Commissioner a plan ofoperation that ensures the fair, reasonable and equitable administration of theProgram of Reinsurance. Once a plan of operation has been approved by theCommissioner, the Board may amend the plan of operation as needed, subject tothe approval of the Commissioner.

2. The Commissioner shall, after notice and a hearing,approve a plan of operation and any amendment to the plan of operationsubmitted for his approval if he determines that the plan or amendment issuitable to:

(a) Ensure the fair, reasonable and equitableadministration of the Program of Reinsurance; and

(b) Provide for the sharing of the gains and losses ofthe Program of Reinsurance on an equitable basis in accordance with theprovisions of NRS 689C.610 to 689C.980, inclusive.

3. If the Board fails to submit a suitable plan ofoperation within 120 days after its appointment or if the Commissionerdetermines in accordance with subsection 2 that the plan of operation assubmitted is not suitable, the Commissioner may, after notice and a hearing,adopt and carry out a temporary plan of operation which is effective only untilthe approval of a plan of operation submitted by the Board.

4. Before approving a plan of operation submitted bythe Board, the Commissioner may amend the plan if he determines that such anamendment is necessary to ensure that the plan is suitable pursuant tosubsection 2.

5. A plan of operation becomes effective upon thewritten approval of the Commissioner.

(Added to NRS by 1997, 2930)

NRS 689C.780 Requirementsof plan of operation and temporary plan of operation. Aplan of operation and a temporary plan of operation must:

1. Establish procedures for the handling andaccounting of the assets of the Program of Reinsurance and for an annual fiscalreporting to the Commissioner.

2. Establish procedures for selecting an administeringcarrier and set forth the powers and duties of the administering carrier.

3. Establish procedures for reinsuring risks pursuantto the Program of Reinsurance.

4. Establish procedures for collecting assessments topay claims and administrative expenses incurred or estimated to be incurred bythe Program of Reinsurance.

5. Establish a methodology for applying the minimumamount of claims and the maximum liability of the reinsuring or individualreinsuring carrier as set forth in NRS689C.800.

6. Provide for any additional matters necessary tocarry out and administer the Program of Reinsurance.

(Added to NRS by 1997, 2931)

NRS 689C.790 Programdeemed to have powers and authority of insurance companies and healthmaintenance organizations; exceptions; powers. Notwithstandingany provision of this title to the contrary, the Program of Reinsurance shallbe deemed to have the general powers and authority granted under the laws ofthis state to insurance companies and health maintenance organizations licensedto transact business in this state, except that the Program of Reinsuranceshall not issue any health benefit plans directly to small employers orindividuals, or both. The Program of Reinsurance may:

1. With the approval of the Commissioner, enter intosuch contracts as are necessary to carry out the provisions of this chapter andNRS 689A.470 to 689A.740, inclusive, including enteringinto contracts with similar programs of reinsurance of other states for thejoint performance of common functions, or with persons or other organizationsfor the performance of administrative functions, relating to programs ofreinsurance.

2. Take any legal action necessary or proper torecover assessments and penalties for or on behalf of the Program ofReinsurance, or to avoid the payment of improper claims against the Program ofReinsurance.

3. Sue or be sued by a reinsuring carrier or anindividual reinsuring carrier relating to the carriers participation in theProgram of Reinsurance.

4. Define the health benefit plans for whichreinsurance will be provided and issue reinsurance policies, in accordance withthe requirements of this chapter and NRS689A.470 to 689A.740, inclusive.

5. Establish rules, conditions and procedures forreinsuring risks under the Program of Reinsurance.

6. Establish actuarial functions as appropriate forthe operation of the Program of Reinsurance.

7. Make assessments in accordance with the provisionsof NRS 689C.840, 689C.850 and 689C.870 and make advance interimassessments as may be reasonable and necessary to pay for any organizationaland interim operating expenses. Any interim assessment must be credited as anoffset against any assessments due after the close of the fiscal year.

8. Appoint appropriate legal, actuarial and othercommittees as necessary to provide technical assistance in the operation of theProgram of Reinsurance, design of policies and other similar contract ofinsurance, and any other function within the authority of the Program ofReinsurance.

9. Borrow money to effect the purposes of the Programof Reinsurance. Any note or other evidence of indebtedness of the Program ofReinsurance not in default shall be deemed to be legal investments for carriersand may be carried as admitted assets.

(Added to NRS by 1997, 2931)

1. The Program of Reinsurance must reinsure:

(a) For a basic or standard health benefit plan, thelevel of coverage provided; and

(b) For any other plan, up to the level of coverageprovided in a basic or standard health benefit plan.

2. A reinsuring carrier may reinsure a small employerwithin 60 days after the beginning of coverage of the small employer under ahealth benefit plan, or for an eligible employee or his dependent, within 60days after the beginning of coverage of the employee or dependent under ahealth benefit plan. An individual reinsuring carrier may reinsure an eligibleperson or his dependent within 60 days after the effective date of coverage ofthe person or dependent under a health benefit plan.

3. The Program of Reinsurance may not reimburse areinsuring carrier or an individual reinsuring carrier for a claim of areinsured eligible employee or eligible person, or a dependent of such anemployee or person, as appropriate, until the reinsuring or individualreinsuring carrier has incurred in a calendar year the minimum amount of claimsof the eligible employee, eligible person or dependent of benefits covered bythe Program of Reinsurance. After the amount of claims of the eligibleemployee, eligible person or dependent is equal to or greater than the requiredminimum amount, the reinsuring or individual reinsuring carrier is liable for10 percent of the next $50,000 of payments of benefits that are paid duringthat calendar year and the Program of Reinsurance must reinsure the remainderof the benefit payments. The total liability of a carrier in a calendar yearpursuant to this subsection may not exceed the maximum liability established bythe Board.

4. For the purposes of subsection 3, the Board shallestablish:

(a) The minimum amount of claims, which must be in anamount that is equal to or greater than $5,000, that must be incurred beforethe Program of Reinsurance will reimburse the reinsuring or individualreinsuring carrier.

(b) The maximum liability of a reinsuring or individualreinsuring carrier, which must be in an amount that is equal to or greater than$10,000.

The Boardshall annually adjust the minimum amount of claims and the maximum liability ofa reinsuring or individual reinsuring carrier to reflect increases in the costsand utilization within the standard market for health benefit plans within thisstate. Unless the Board proposes and the Commissioner approves a factor thatwould provide for a lower adjustment, the adjustments must not be less than theannual change in the component for medical care of the Consumer Price Index forAll Urban Consumers of the United States Department of Labor, Bureau of LaborStatistics.

5. A reinsuring carrier that provides health insurancecoverage to small employers may terminate reinsurance with the Program ofReinsurance for a reinsured employee or dependent, and an individual reinsuringcarrier may terminate reinsurance with the Program of Reinsurance for aneligible person or dependent, on the anniversary date of the health benefitplan.

6. The premium rates charged for reinsurance by theProgram of Reinsurance to a health maintenance organization that is federallyqualified pursuant to 42 U.S.C. 300 et seq. and is subject to requirementslimiting the amount of risk that may be ceded to a Program of Reinsurance thatare more restrictive than the amounts set forth in subsection 5 must be reducedto reflect that portion of the risk above the amount determined pursuant tothis section, if any, that may not be ceded to the Program of Reinsurance.

7. A reinsuring carrier or an individual reinsuringcarrier purchasing reinsurance pursuant to this chapter or NRS 689A.470 to 689A.740, inclusive, shall apply itstechniques for handling managed care and claims, including utilization review,individual case management, preferred provider provisions and other provisionsor methods of operating relating to managed care, to the health benefit plansthat are being reinsured pursuant to the Program of Reinsurance in a mannerthat is consistent with the business of the carrier that is not reinsured.

8. Nothing in this section prohibits a reinsuringcarrier or an individual reinsuring carrier from terminating the coverage of asmall employer or an eligible person on the grounds described in paragraph (c)of subsection 1 of NRS 687B.320.

9. The plan of operation must provide that:

(a) A reinsuring carrier may reinsure a small employer oran eligible employee or his dependent if coverage is written on or after July1, 1997; and

(b) An individual reinsuring carrier may reinsure aneligible person or his dependent if coverage is written on or after January 1,1998.

(Added to NRS by 1997, 2932)

NRS 689C.810 Premiumrates: Methodology for determining; minimum rates; review of methodology.

1. The plan of operation must include a methodologyfor determining premium rates to be charged by the Program of Reinsurance forReinsuring Small Employers and Eligible Persons pursuant to NRS 689C.610 to 689C.980, inclusive. The methodologymust:

(a) Include a system for the classification of smallemployers which reflects the types of case characteristics commonly used bycarriers that provide health insurance coverage to small employers pursuant tothe provisions of this chapter; and

(b) Provide for the development of initial base premiumrates for reinsurance to be used pursuant to subsection 2 to determine thepremium rates for the Program of Reinsurance. The Board shall establish suchbase rates, subject to the approval of the Commissioner, at levels that reasonablyapproximate the gross premiums charged to small employers by small employercarriers, to eligible employees and their dependents by small employercarriers, or to eligible persons by individual carriers, as appropriate, forhealth benefit plans with benefits similar to the standard health benefit plan,as adjusted to reflect the minimum amount of claims and the maximum liabilityestablished pursuant to NRS 689C.800.

2. Premiums for the Program of Reinsurance:

(a) For an entire small employer group, must be at arate that is at least 1 1/2 times the base premium rate established pursuant tosubsection 1.

(b) For an eligible employee and his dependent, must beat a rate that is at least five times the base premium rate establishedpursuant to subsection 1.

(c) For an eligible person, must be at a rate that isat least 1 1/2 times the base premium rate established pursuant to subsection1.

3. The Board shall periodically review the methodologyestablished pursuant to this section, including the system of classificationand any rating factors, to ensure that the methodology reasonably reflects theclaims experience of the Program of Reinsurance. The Board may, subject to theapproval of the Commissioner, change the methodology as needed.

4. The Board may adjust the factor by which the basepremium rate must be multiplied pursuant to this section to determine thepremium rates to be charged for the Program of Reinsurance to reflect the useof effective measures of cost containment and any arrangements for managedcare.

(Added to NRS by 1997, 2933)

NRS 689C.820 Premiumsfor certain health benefit plans that are reinsured with program required tomeet established requirements for premium rates.

1. If a health benefit plan for a small employer, aneligible employee or an eligible person is entirely or partially reinsured withthe Program of Reinsurance, the premiums charged to the small employer,eligible employee or eligible person for any rating period during which suchcoverage is entirely or partially reinsured must meet the requirements forpremium rates set forth in NRS 689A.680to 689A.700, inclusive, or asestablished in accordance with NRS689C.230, as appropriate.

2. As used in this section, rating periodmeans the calendar period for which premium rates established by a carriersubject to this section and NRS 689C.810are assumed to be in effect.

(Added to NRS by 1997, 2934)

NRS 689C.830 Boardrequired to determine, account for and report to Commissioner net loss. On or before March 1 of each year, the Board shall determine,separately account for and report to the Commissioner the net loss of theProgram of Reinsurance for the previous calendar year, including administrativeexpenses and incurred losses for that year. Such a determination and accountingmust take into account any investment income and other appropriate gains andlosses for reinsured small employers and eligible employees and their dependentsand for reinsured eligible persons.

(Added to NRS by 1997, 2934)

NRS 689C.840 Netloss from reinsuring small employers and eligible employees and dependentsrequired to be recouped by assessments against reinsuring carriers.

1. Any net loss from reinsuring small employers andeligible employees and their dependents must be recouped by assessments againstreinsuring carriers.

2. As part of the plan of operation, the Board shallestablish a formula pursuant to which assessments may be made against reinsuringcarriers to recover the net loss. The formula must be based on:

(a) The share of each reinsuring carrier of the totalpremiums earned by all reinsuring carriers during the preceding calendar yearfrom existing health benefit plans delivered or issued for delivery to smallemployers in this state; and

(b) The share of each reinsuring carrier of thepremiums earned by all reinsuring carriers in the preceding calendar year fromnewly issued health benefit plans delivered or issued for delivery during thatyear to small employers in this state.

3. An assessment made against a reinsuring carrierpursuant to this section must not be less than 50 percent nor more than 150percent of an amount equal to the proportion of the total premium earned by thereinsuring carrier during the preceding calendar year from health benefit plansdelivered or issued for delivery to small employers in this state to the totalpremiums earned by all such carriers in the preceding calendar year for suchhealth benefit plans.

4. The Board may, with the approval of theCommissioner, change the formula for determining assessments against reinsuringcarriers established pursuant to this section as necessary. The Board mayprovide that, during any transitional period, the shares of the assessment baseattributable to the total premiums and to the premiums of the previous year mayvary.

5. Subject to the approval of the Commissioner, theBoard shall adjust the formula for assessing reinsuring carriers that areapproved health maintenance organizations which are federally qualified under42 U.S.C. 300 et seq., to the extent that any restrictions are placed onsuch reinsuring carriers that are not imposed on other small employer carriers.

6. In determining the amount of net loss pursuant tothis section, the Board shall include any expenses incurred by the Program ofReinsurance in providing such reinsurance.

(Added to NRS by 1997, 2935)

NRS 689C.850 Netloss from reinsuring individual eligible persons and dependents required to berecouped by assessments against individual reinsuring carriers.

1. Any net loss from reinsuring individual eligiblepersons and their dependents must be recouped by assessments against individualreinsuring carriers.

2. As part of the plan of operation, the Board shallestablish a formula pursuant to which assessments may be made againstindividual reinsuring carriers to recover the net loss. The formula must bebased on:

(a) The share of each individual reinsuring carrier ofthe total premiums earned by all individual reinsuring carriers during thepreceding calendar year from existing health benefit plans delivered or issuedfor delivery to individuals in this state; and

(b) The share of each individual reinsuring carrier ofthe premiums earned by all individual reinsuring carriers in the precedingcalendar year from newly issued health benefit plans delivered or issued fordelivery during that year to individuals in this state.

3. An assessment made against an individual reinsuringcarrier pursuant to this section must not be less than 50 percent nor more than150 percent of an amount equal to the proportion of the total premium earned bythe individual reinsuring carrier during the preceding calendar year fromhealth benefit plans delivered or issued for delivery to individuals in thisstate to the total premiums earned by all such carriers in the precedingcalendar year for such health benefit plans.

4. The Board may, with the approval of theCommissioner, change the formula for determining assessments against individualreinsuring carriers established pursuant to this section as necessary. TheBoard may provide that, during any transitional period, the shares of theassessment base attributable to the total premiums and to the premiums of theprevious year may vary.

5. Subject to the approval of the Commissioner, theBoard shall adjust the formula for assessing individual reinsuring carriersthat are approved health maintenance organizations which are federallyqualified under 42 U.S.C. 300 et seq., to the extent that any restrictionsare placed on such individual reinsuring carriers that are not imposed on otherindividual carriers.

6. In determining the amount of net loss pursuant tothis section, the Board shall include any expenses incurred by the Program ofReinsurance in providing such reinsurance.

(Added to NRS by 1997, 2935)

NRS 689C.860 Boardrequired to determine, account for and report to Commissioner estimate ofassessments needed to pay for losses; evaluation of operation of Program.

1. On or before March 1 of each year, the Board shalldetermine, separately account for and file with the Commissioner an estimate ofthe assessments needed to fund the losses incurred by the Program ofReinsurance in the previous calendar year for:

(a) Reinsured small employer groups, eligible employeesand the dependents of such employees; and

(b) Reinsured eligible persons.

2. If the Board determines that the amount of theassessments against reinsuring carriers needed to fund the losses incurred bythe Program of Reinsurance in the previous calendar year will exceed 5 percentof the total premiums earned in the previous calendar year from health benefitplans delivered or issued for delivery in this state by reinsuring carriers andindividual reinsuring carriers, the Board shall evaluate the operation of theProgram of Reinsurance and report its findings, including any recommendationsfor changes to the plan of operation, to the Commissioner not later than 90days after the end of the calendar year in which the losses were incurred. Theevaluation must include an estimate of future assessments and administrativecosts of the Program of Reinsurance, the appropriateness of the premiumcharged, the level of retention of insurers under the Program of Reinsuranceand the costs of coverage for small employers. If the Board fails to file thereport timely with the Commissioner, the Commissioner may evaluate theoperations of the Program of Reinsurance and make such amendments to the plan ofoperation as he determines to be necessary to reduce future losses andassessments.

(Added to NRS by 1997, 2936)

NRS 689C.870 Additionalfunding: Eligibility based on amount of assessment needed; Board to establishformula for additional assessments on all carriers.

1. If, in each of 2 consecutive years, the Boarddetermines that the amount of the assessment needed exceeds 5 percent of thetotal premiums earned in the previous calendar year from health benefit plansdelivered or issued for delivery to small employers by reinsuring carriers, theProgram of Reinsurance is eligible for additional funding pursuant to thissection.

2. If, in each of 2 consecutive years, the Boarddetermines that the amount of the assessment needed exceeds 5 percent of thetotal premiums earned in the previous calendar year from health benefit plansdelivered or issued for delivery to individuals by individual reinsuringcarriers, the Program of Reinsurance is eligible for additional fundingpursuant to this section.

3. To raise the additional funding, the Board shallestablish a formula pursuant to which additional assessments may be made on allcarriers that offer a health benefit plan or provide stop-loss coverage for ahealth benefit plan which is an employer-sponsored plan or a plan establishedpursuant to the Labor-Management Relations Act, 1947, as amended. The totaladditional assessments on all such carriers combined may not exceed one-half of1 percent of the total premiums earned from all health benefit plans andstop-loss coverage issued in this state in the previous calendar year.

(Added to NRS by 1997, 2936; A 1999, 2814)

NRS 689C.880 Useof excess assessments.

1. If the amount of the assessments exceeds the netlosses of the Program of Reinsurance from reinsuring small employers andeligible employees, the excess amount must be retained by the Board and used tooffset future losses or to reduce the premiums of the reinsuring carriers.

2. If the amount of the assessments exceeds the netlosses of the Program of Reinsurance from reinsuring eligible persons, theexcess amount must be retained by the Board and used to offset future losses orto reduce the premiums of the individual reinsuring carriers.

3. As used in this section, future losses includesreserves for claims that have been incurred, but have not yet been reported.

(Added to NRS by 1997, 2937)

NRS 689C.890 Assessmentagainst reinsuring carrier to be determined annually; penalty for late paymentof assessments; deferment of assessment.

1. Each assessment against a reinsuring carrier andindividual reinsuring carrier must be determined annually by the Board based onannual statements and such other reports deemed relevant by the Board and filedby the reinsuring carriers with the Board.

2. The plan of operation must provide for theimposition of an interest penalty for late payment of assessments.

3. A reinsuring or individual reinsuring carrier mayseek from the Commissioner a deferment of any part of an assessment imposed bythe Board pursuant to NRS 689C.840.The Commissioner may defer any part of the assessment if he determines that thepayment of the assessment would place the carrier in a financially impairedcondition. If any amount of an assessment against a carrier is deferred pursuantto this subsection, the amount so deferred must be assessed against the otherparticipating carriers in a manner consistent with NRS 689C.840. A carrier receiving adeferment pursuant to this subsection remains liable to the Program ofReinsurance for the amount deferred and shall not reinsure any small employers,eligible employees or eligible persons with the Program of Reinsurance untilthe deferred assessment is paid.

(Added to NRS by 1997, 2937)

NRS 689C.900 Insurerto receive certificate of contribution for paying additional assessment;certain amount of contribution may be shown as asset and may offset liabilityfor premium tax.

1. The Board shall issue to each insurer paying anassessment under NRS 689C.870 a certificateof contribution, in a form prescribed by the Commissioner, for the amount sopaid. All outstanding certificates are of equal dignity and priority withoutreference to the amounts or dates of issue. A member insurer may show acertificate of contribution as an asset in its financial statement in suchform, for such amount, if any, and for such period as the Commissioner mayapprove.

2. A carrier may offset against its liability forpremium tax to this state, accrued with respect to business transacted in acalendar year, an amount equal to 20 percent of the amount certified pursuantto subsection 1 in each of the 5 calendar years following the year in which theassessment was paid. If an insurer ceases to transact business, it may offsetall uncredited assessments against its liability for premium tax for the yearin which it ceases to transact business.

(Added to NRS by 1997, 2937)

NRS 689C.910 Adjustmentof assessment on federally qualified health maintenance organizations. Subject to the approval of the Commissioner, the Boardshall adjust the formula for assessing carriers that are approved health maintenanceorganizations which are federally qualified under 42 U.S.C. 300 et seq., tothe extent that any restrictions are placed on such carriers that are notimposed on other carriers.

(Added to NRS by 1997, 2938)

NRS 689C.920 Immunityfrom liability of Program and reinsuring carriers for certain acts. Except as otherwise provided in NRS 689C.790, neither participation inthe Program of Reinsurance as a reinsuring carrier or individual reinsuringcarrier, the establishment of rates, forms or procedures, nor any other jointor collective action required by NRS689C.610 to 689C.980, inclusive,may be the basis of any legal action, civil liability or penalty against theProgram of Reinsurance or any of the participating reinsuring carriers andindividual reinsuring carriers, either jointly or separately.

(Added to NRS by 1997, 2938)

NRS 689C.930 Boardto develop standards setting forth manner and levels of compensation paid toproducers for sale of health benefit plans. Aspart of the plan of operation, the Board shall develop standards that set forththe manner and levels of compensation that may be paid to producers for thesale of basic and standard health benefit plans issued in accordance with theProgram of Reinsurance. In establishing such standards, the Board shallconsider:

1. The need to ensure the broad availability ofcoverages;

2. The objectives of the Program of Reinsurance;

3. The time and effort expended in placing thecoverage;

4. The need to provide on-going service to smallemployers, eligible employees and eligible persons;

5. The level of compensation currently used in theindustry; and

6. The overall cost of coverage to small employers,eligible employees and eligible persons selecting such coverage.

(Added to NRS by 1997, 2938)

NRS 689C.940 Regulationsconcerning determination of status of stop-loss policy. The Commissioner may, by regulation, prescribe standardsfor determining whether a policy issued as a stop-loss policy is a healthbenefit plan for the purposes of this chapter.

(Added to NRS by 1997, 2938)

NRS 689C.950 Certainprovisions inapplicable to certain basic health benefit plan delivered to smallemployers or eligible persons. Notwithstandingany specific statute to the contrary, a statute that requires the coverage of aspecific health care service or benefit, or the reimbursement, utilization orinclusion of a specific category of licensed health care practitioner, is notapplicable to a basic health benefit plan delivered or issued for delivery tosmall employers or eligible persons in this state pursuant to this chapter or chapter 689A of NRS.

(Added to NRS by 1997, 2940)

NRS 689C.955 Member,agent or employee of Board immune from liability in certain circumstances. No member, agent or employee of the Board may be heldliable in a civil action for any act that he performs in good faith in theexecution of his duties pursuant to the provisions of this chapter.

(Added to NRS by 1999, 2810)

Committee on Health Benefit Plans

NRS 689C.960 Creation;members; term; vacancy.

1. The Committee on Health Benefit Plans is herebycreated consisting of eight members. The Commissioner shall appoint to theCommittee representatives of carriers, small employers and eligible employees,eligible persons, health care providers, producers and third-party administrators.

2. Members of the Committee serve withoutcompensation, but while engaged in the business of the Committee, each memberis entitled to receive the per diem allowance or travel expenses provided forstate officers and employees generally, to be paid from the proceeds of theassessments received by the Program of Reinsurance as an administrative expenseof the Program of Reinsurance.

3. After the initial term, the term of each appointedmember is 3 years. Members may be reappointed. A member may be removed from theCommittee by the Commissioner for good cause shown.

4. At the expiration of the term of a member, or ifthe member resigns or is otherwise unable to complete his term, theCommissioner shall appoint a replacement not later than 30 days after thevacancy occurs.

(Added to NRS by 1997, 2938)

NRS 689C.970 Meetings;Chairman; duties.

1. The Committee shall meet:

(a) Until a plan of operation, other than a temporaryplan of operation, has been approved by the Commissioner, twice a year;

(b) Once a plan of operation has been so approved, oncea year; and

2. The Committee shall elect from its membership aChairman who shall serve for a term of 2 years. Any vacancy occurring in thisposition must be filled by election of the members of the Committee for theremainder of the unexpired term.

3. The Committee shall:

(a) Recommend to the Board the form and level ofcoverages to be made available by small employers pursuant to NRS 689C.156, 689C.1565, 689C.157 and 689C.190, and by individual carrierspursuant to NRS 689A.680 to 689A.700, inclusive.

(b) Recommend to the Board levels for benefits and costsharing, exclusions and limitations for a basic health benefit plan and astandard health benefit plan.

(c) Design a basic health benefit plan and a standardhealth benefit plan that are consistent with the basic method of operation andthe benefit plans of health maintenance organizations authorized to transactinsurance in this state, including any restrictions imposed by federal law.

4. The basic and standard health benefit plansrecommended by the Committee may include features for the containment of costs,including:

(a) Utilization review of health care services,including a review of the medical necessity of hospital and physician services;

(b) Case management;

(d) Reasonable benefit differentials applicable toproviders that participate and providers that do not participate inarrangements using a provision for a restricted network; and

(e) Other provisions relating to managed care.

5. The Committee shall submit its recommendations fora basic and a standard health benefit plan to the Commissioner not later than120 days after the date on which the Committee is appointed.

6. As used in this section, provision for arestricted network means any provision of a health benefit plan thatconditions the payment of benefits, in whole or in part, on the use of healthcare providers that have entered into a contractual arrangement with thecarrier to provide health care services to persons covered by the plan.

(Added to NRS by 1997, 2939)

NRS 689C.980 Boardand Committee to study and submit report concerning effectiveness of certainprovisions.

1. At least once every 3 years, the Board, inconsultation with the Committee, shall study and submit a report to theCommissioner concerning the effectiveness of NRS 689C.610 to 689C.980, inclusive.

2. The report:

(a) Must analyze the effectiveness of NRS 689C.610 to 689C.980, inclusive, in promoting thestability of rates, the availability of products and the affordability ofcoverage;

(b) May contain recommendations for actions to improvethe overall effectiveness, efficiency and fairness of the marketplace forhealth insurance for small employers and individuals;

(c) Must address the issue of whether carriers andproducers are fairly and actively marketing or issuing health benefit plans tosmall employers in accordance with the provisions of this chapter and to individualsin accordance with NRS 689A.470 to 689A.740, inclusive; and

(d) May contain recommendations for the regulation ofthe marketplace for health insurance for small employers and individuals andother regulatory standards or actions.

(Added to NRS by 1997, 2940)

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