Nevada Administrative Code
Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service
SYSTEM FOR RESOLVING COMPLAINTS OF INSUREDS
Section 695B.200 - Requirements for approval
Universal Citation: NV Admin Code 695B.200
Current through December 12, 2024
To obtain approval of a system for resolving complaints of insureds concerning health care services covered by an insurer from the Commissioner as required pursuant to NRS 695B.380, an insurer must:
1. Demonstrate that the system will resolve oral and written complaints concerning:
(a) Payment or reimbursement for covered health care services;
(b) The availability, delivery or quality of covered health care services, including, without limitation, an adverse determination made pursuant to utilization review; and
(c) The terms and conditions of the health care plan of insureds.
2. Submit to the Division:
(a) The name and title of the employee responsible for the system;
(b) A description of the procedure used to notify an insured of the decision regarding his complaint; and
(c) A copy of the explanation of rights and procedures which is to be provided to insureds pursuant to NRS 695B.400.
Added to NAC by Comm'r of Insurance by R132-98, eff. 3-30-99
NRS 679B.130, 695B.380
Disclaimer: These regulations may not be the most recent version. Nevada may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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