Current through February 27, 2024
1. A society that issues a benefit
contract shall not require an insured to pay a higher deductible or
any copayment, coinsurance or other form of cost-sharing for or use
any medical management technique to restrict access by an insured to:
(a) A visit to the office of a
provider of health care, an urgent care center, an independent center
for emergency medical care, the emergency room of a hospital or a
COVID-19 screening or testing site, if the purpose of the visit is to
determine whether the insured has COVID-19;
(b) A test to determine whether the
insured has COVID-19 if the attending provider of health care
determines, in accordance with generally accepted medical standards,
that the test is appropriate; or
(c) A vaccine to prevent the
insured from contracting COVID-19.
2. A society that issues a benefit
contract shall provide information concerning available benefits,
options for medical advice and treatment through telehealth and
preventative measures related to COVID-19 to each insured and
provider of health care that participates in the network plan of the
society.
3. A society
that issues a benefit contract that provides coverage for
prescription drugs and uses a formulary shall cover a prescription
drug that is not included in the formulary at no additional cost to
the insured if:
(a) No prescription
drug that is effective in treating the insured and included in the
formulary is available; and
(b) The prescription drug is not
available because of a disruption in the supply of those
drugs.
4. As
used in this section:
(a) "Hospital"
has the meaning ascribed to it in NRS 449.012.
(b) "Independent center for
emergency medical care" has the meaning ascribed to it in NRS 449.013.
(c) "Medical
management technique" means a practice which is used to control the
cost or utilization of health care services. The term includes,
without limitation, the use of step therapy, prior authorization or
categorizing drugs and devices based on cost, type or method of
administration.
(d)
"Network plan" means a benefit contract offered by a society under
which the financing and delivery of medical care, including items and
services paid for as medical care, are provided, in whole or in part,
through a defined set of providers under contract with the society.
The term does not include an arrangement for the financing of
premiums.
(e) "Provider
of health care" has the meaning ascribed to it in NRS 629.031.
(f) "Telehealth"
has the meaning ascribed to it in NRS 629.515.
Added to NAC by Comm'r of Insurance by
R054-20A,
eff. 7/2/2020
NRS 414.070,
679B.120 and 679B.130
