1-3 that issues a policy of health insurance in this state shall provide written

1-4 notice to an insured, in clear and comprehensible language that is

1-5 understandable to an ordinary layperson, explaining the right of the insured

1-6 to file a written complaint. Such notice must be provided to an insured:

1-7 (a) At the time he receives his evidence of coverage;

1-8 (b) Any time that the insurer denies coverage of a health care service or

1-9 limits coverage of a health care service to an insured; and

1-10 (c) Any other time deemed necessary by the commissioner.

1-11 2. Any time that an insurer denies coverage of a health care service to

1-12 an insured , including, without limitation, denying a claim relating to a

1-13 policy of health insurance pursuant to NRS 689A.410, it shall notify the

1-14 insured in writing within 10 working days after it denies coverage of the

1-15 health care service of:

2-10 that issues a policy of group health insurance in this state shall provide

2-11 written notice to an insured, in clear and comprehensible language that is

2-12 understandable to an ordinary layperson, explaining the right of the insured

2-13 to file a written complaint. Such notice must be provided to an insured:

2-14 (a) At the time he receives his certificate of coverage or evidence of

2-15 coverage;

2-16 (b) Any time that the insurer denies coverage of a health care service or

2-17 limits coverage of a health care service to an insured; and

2-18 (c) Any other time deemed necessary by the commissioner.

2-19 2. Any time that an insurer denies coverage of a health care service ,

2-20 including, without limitation, denying a claim relating to a policy of

2-21 group health insurance or blanket insurance pursuant to NRS 689B.255,

2-22 to an insured it shall notify the insured in writing within 10 working days

2-23 after it denies coverage of the health care service of:

2-24 (a) The reason for denying coverage of the service;

2-25 (b) The criteria by which the insurer determines whether to authorize or

2-26 deny coverage of the health care service; and

2-27 (c) His right to file a written complaint [.] and the procedure for filing

2-28 such a complaint.

2-29 3. A written notice which is approved by the commissioner shall be

2-30 deemed to be in clear and comprehensible language that is understandable

2-34 that issues a contract for hospital or medical services in this state shall

2-35 provide written notice to an insured, in clear and comprehensible language

2-36 that is understandable to an ordinary layperson, explaining the right of the

2-37 insured to file a written complaint. Such notice must be provided to an

2-38 insured:

2-39 (a) At the time he receives his certificate of coverage or evidence of

2-40 coverage;

2-41 (b) Any time that the insurer denies coverage of a health care service or

2-42 limits coverage of a health care service to an insured; and

3-17 care organization shall provide written notice to an insured, in clear and

3-18 comprehensible language that is understandable to an ordinary layperson,

3-19 explaining the right of the insured to file a written complaint and to obtain

3-20 an expedited review pursuant to NRS 695G.210. Such notice must be

3-21 provided to an insured:

3-22 (a) At the time he receives his certificate of coverage or evidence of

3-23 coverage;

3-24 (b) Any time that the managed care organization denies coverage of a

3-25 health care service or limits coverage of a health care service to an insured;

3-26 and

3-27 (c) Any other time deemed necessary by the commissioner.

3-28 2. Any time that a managed care organization denies coverage of a

3-29 health care service to an insured , including, without limitation, a health

3-30 maintenance organization that denies a claim related to a health care

3-31 plan pursuant to NRS 695C.185, it shall notify the insured in writing

3-32 within 10 working days after it denies coverage of the health care service

3-33 of:

3-34 (a) The reason for denying coverage of the service;

3-35 (b) The criteria by which the managed care organization or insurer

3-36 determines whether to authorize or deny coverage of the health care

3-37 service; and

3-38 (c) His right to file a written complaint [.] and the procedure for filing

3-39 such a complaint.

3-40 3. A written notice which is approved by the commissioner shall be

3-41 deemed to be in clear and comprehensible language that is understandable

4-3 for medically necessary emergency services [.] provided at any hospital.

4-4 2. A managed care organization shall not require prior authorization

4-5 for medically necessary emergency services.

4-6 3. As used in this section, "medically necessary emergency services"

4-7 means health care services that are provided to an insured by a provider of

4-8 health care after the sudden onset of a medical condition that manifests

4-9 itself by symptoms of such sufficient severity that a prudent person would

4-10 believe that the absence of immediate medical attention could result in:

4-11 (a) Serious jeopardy to the health of an insured;

4-12 (b) Serious jeopardy to the health of an unborn child;

4-13 (c) Serious impairment of a bodily function; or

4-14 (d) Serious dysfunction of any bodily organ or part.

4-15 4. A health care plan subject to the provisions of this section that is

4-16 delivered, issued for delivery or renewed on or after October 1, [1997,]

4-17 1999, has the legal effect of including the coverage required by this section,

4-18 and any provision of the plan or the renewal which is in conflict with this

4-19 section is void.