Assembly Bill No. 293–Assemblymen Nolan, Beers, Brower, de Braga, Chowning, Evans, Leslie, Hettrick, Cegavske, Gustavson and Angle

February 22, 1999

____________

Referred to Committee on Commerce and Labor

 

SUMMARY—Makes various changes concerning health insurers. (BDR 57-1429)

FISCAL NOTE: Effect on Local Government: No.

Effect on the State or on Industrial Insurance: No.

~

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. Green numbers along left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).

 

AN ACT relating to insurance; providing for the revision of the provisions governing parity for insurance benefits for the treatment of conditions relating to mental health; exempting certain group health coverage provided by public agencies from certain provisions governing required benefits; making various changes concerning the notice required to be provided to an insured when an insurer denies coverage of a health care service; requiring a managed care organization to provide coverage for medically necessary emergency services provided to an insured at any hospital; and providing other matters properly relating thereto.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

1-1 Section 1. Chapter 689A of NRS is hereby amended by adding thereto

1-2 a new section to read as follows:

1-3 1. Notwithstanding any provision of this Title to the contrary, a

1-4 policy of health insurance issued or delivered for issuance in this state

1-5 pursuant to this chapter must provide coverage for the treatment of

1-6 conditions relating to mental health and must not establish any rate, term

1-7 or condition that places a greater financial burden on the insured person

1-8 for access to treatment for conditions relating to mental health than for

1-9 access to treatment for conditions relating to physical health. Any limits

1-10 required under the policy of health insurance for deductibles and out-of-

1-11 pocket expenses must be comprehensive for coverage of both conditions

1-12 relating to mental health and conditions relating to physical health.

2-1 2. A policy of health insurance that does not otherwise provide for

2-2 managed care, or that does not provide for the same degree of managed

2-3 care for all health conditions, may provide coverage for the treatment of

2-4 conditions relating to mental health through a managed care

2-5 organization if the managed care organization is in compliance with

2-6 regulations adopted by the commissioner which ensure that the system

2-7 for delivery of the treatment for conditions relating to mental health does

2-8 not diminish or negate the purpose of this section. The regulations

2-9 adopted by the commissioner must ensure that:

2-10 (a) Timely and appropriate access to care is available;

2-11 (b) The distribution of providers of health care who provide services

2-12 relating to mental health is adequate to serve the needs of persons in this

2-13 state, considering the quality, location and area of specialization of such

2-14 providers; and

2-15 (c) Administrative or clinical protocols do not reduce access to

2-16 medically necessary treatment for the insured person.

2-17 3. A policy of health insurance shall be deemed to be in compliance

2-18 with this section if the policy provides to the insured person at least one

2-19 option for treatment of conditions relating to mental health which has

2-20 rates, terms and conditions that impose no greater financial burden on

2-21 the insured person than that imposed for treatment of conditions relating

2-22 to the physical health of the insured person. The commissioner may

2-23 disapprove any policy of health insurance if he determines that the policy

2-24 is inconsistent with this section.

2-25 4. Benefits provided pursuant to this section by a policy of health

2-26 insurance for conditions relating to mental health must be paid in the

2-27 same manner as benefits for any other illness covered by the policy.

2-28 5. Benefits for conditions relating to mental health are not required

2-29 by this section if the treatment for the condition relating to mental health

2-30 is not provided:

2-31 (a) By a person who is licensed or certified to provide treatment for

2-32 conditions relating to mental health; or

2-33 (b) In a mental health facility or institution designated as a division

2-34 facility pursuant to NRS 433.233, or in a medical or other facility

2-35 licensed by the state board of health pursuant to chapter 449 of NRS that

2-36 provides programs for the treatment of conditions relating to mental

2-37 health, and pursuant to an individualized written plan developed for the

2-38 insured person.

2-39 6. The provisions of this section must not be construed to:

2-40 (a) Limit the provision of specialized services covered by Medicaid for

2-41 persons with conditions relating to mental health or substance abuse.

2-42 (b) Supersede any provision of federal law, any federal or state policy

2-43 relating to Medicaid, or the terms and conditions imposed on any

3-1 Medicaid waiver granted to this state with respect to the provision of

3-2 services to persons with conditions relating to mental health or substance

3-3 abuse.

3-4 (c) Affect any existing policy of health insurance until its date of

3-5 renewal or, if the policy of health insurance is governed by a collective

3-6 bargaining agreement or employment contract, until the expiration of

3-7 that agreement or contract.

3-8 7. As used in this section:

3-9 (a) "Condition relating to mental health" means a condition or

3-10 disorder involving mental illness that falls within any of the diagnostic

3-11 categories listed in the section on mental disorders in the "International

3-12 Classification of Diseases," published by the United States Department of

3-13 Health and Human Services.

3-14 (b) "Managed care" has the meaning ascribed to it in NRS 695G.040.

3-15 (c) "Managed care organization" has the meaning ascribed to it in

3-16 NRS 695G.050.

3-17 (d) "Rate, term or condition" means any lifetime or annual limit on

3-18 payments, any requirement concerning deductibles, copayments,

3-19 coinsurance or other forms of cost sharing, any limit on out-of-pocket

3-20 costs or on visits to a provider of treatment, and any other financial

3-21 component of health insurance coverage that affects the insured person.

3-22 Sec. 2. NRS 689A.040 is hereby amended to read as follows:

3-23 689A.040 1. Except as otherwise provided in subsections 2 and 3,

3-24 each such policy delivered or issued for delivery to any person in this state

3-25 must contain the provisions specified in NRS 689A.050 to 689A.170,

3-26 inclusive, and section 1 of this act, in the words in which the provisions

3-27 appear, except that the insurer may, at its option, substitute for one or more

3-28 of the provisions corresponding provisions of different wording approved

3-29 by the commissioner which are in each instance not less favorable in any

3-30 respect to the insured or the beneficiary. Each such provision must be

3-31 preceded individually by the applicable caption shown, or, at the option of

3-32 the insurer, by such appropriate individual or group captions or subcaptions

3-33 as the commissioner may approve.

3-34 2. Each policy delivered or issued for delivery in this state after

3-35 November 1, 1973, must contain a provision, if applicable, setting forth the

3-36 provisions of NRS 689A.045.

3-37 3. If any such provision is in whole or in part inapplicable to or

3-38 inconsistent with the coverage provided by a particular form of policy, the

3-39 insurer, with the approval of the commissioner, may omit from the policy

3-40 any inapplicable provision or part of a provision, and shall modify any

3-41 inconsistent provision or part of a provision in such a manner as to make

3-42 the provision as contained in the policy consistent with the coverage

3-43 provided by the policy.

4-1 Sec. 3. NRS 689A.755 is hereby amended to read as follows:

4-2 689A.755 1. Following approval by the commissioner, each insurer

4-3 that issues a policy of health insurance in this state shall provide written

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

4-5 understandable to an ordinary layperson, explaining the right of the insured

4-6 to file a written complaint. Such notice must be provided to an insured:

4-7 (a) At the time he receives his evidence of coverage;

4-8 (b) Any time that the insurer denies coverage of a health care service or

4-9 limits coverage of a health care service to an insured; and

4-10 (c) Any other time deemed necessary by the commissioner.

4-11 2. Any time that an insurer denies coverage of a health care service to

4-12 an insured , including, without limitation, denying a claim relating to a

4-13 policy of health insurance pursuant to NRS 689A.410, it shall notify the

4-14 insured in writing within 10 working days after it denies coverage of the

4-15 health care service of:

4-16 (a) The reason for denying coverage of the service;

4-17 (b) The criteria by which the insurer determines whether to authorize or

4-18 deny coverage of the health care service; and

4-19 (c) His right to file a written complaint [.] and the procedure for filing

4-20 such a complaint.

4-21 3. A written notice which is approved by the commissioner shall be

4-22 deemed to be in clear and comprehensible language that is understandable

4-23 to an ordinary layperson.

4-24 Sec. 4. Chapter 689B of NRS is hereby amended by adding thereto a

4-25 new section to read as follows:

4-26 1. Notwithstanding any provision of this Title to the contrary, a

4-27 policy of group health insurance issued or delivered for issuance in this

4-28 state pursuant to this chapter must provide coverage for the treatment of

4-29 conditions relating to mental health and must not establish any rate, term

4-30 or condition that places a greater financial burden on the insured person

4-31 for access to treatment for conditions relating to mental health than for

4-32 access to treatment for conditions relating to physical health. Any limits

4-33 required under the policy of group health insurance for deductibles and

4-34 out-of-pocket expenses must be comprehensive for coverage of both

4-35 conditions relating to mental health and conditions relating to physical

4-36 health.

4-37 2. A policy of group health insurance that does not otherwise provide

4-38 for managed care, or that does not provide for the same degree of

4-39 managed care for all health conditions, may provide coverage for the

4-40 treatment of conditions relating to mental health through a managed

4-41 care organization if the managed care organization is in compliance with

4-42 regulations adopted by the commissioner which ensure that the system

4-43 for delivery of the treatment for conditions relating to mental health does

5-1 not diminish or negate the purpose of this section. The regulations

5-2 adopted by the commissioner must ensure that:

5-3 (a) Timely and appropriate access to care is available;

5-4 (b) The distribution of providers of health care who provide services

5-5 relating to mental health is adequate to serve the needs of persons in this

5-6 state, considering the quality, location and area of specialization of such

5-7 providers; and

5-8 (c) Administrative or clinical protocols do not reduce access to

5-9 medically necessary treatment for the insured person.

5-10 3. A policy of group health insurance shall be deemed to be in

5-11 compliance with this section if the policy provides to the insured person

5-12 at least one option for treatment of conditions relating to mental health

5-13 which has rates, terms and conditions that impose no greater financial

5-14 burden on the insured person than that imposed for treatment of

5-15 conditions relating to the physical health of the insured person. The

5-16 commissioner may disapprove any policy of group health insurance if he

5-17 determines that the policy is inconsistent with this section.

5-18 4. Benefits provided pursuant to this section by a policy of group

5-19 health insurance for conditions relating to mental health must be paid in

5-20 the same manner as benefits for any other illness covered by the policy.

5-21 5. Benefits for conditions relating to mental health are not required

5-22 by this section if the treatment for the condition relating to mental health

5-23 is not provided:

5-24 (a) By a person who is licensed or certified to provide treatment for

5-25 conditions relating to mental health; or

5-26 (b) In a mental health facility or institution designated as a division

5-27 facility pursuant to NRS 433.233, or in a medical or other facility

5-28 licensed by the state board of health pursuant to chapter 449 of NRS that

5-29 provides programs for the treatment of conditions relating to mental

5-30 health, and pursuant to an individualized written plan developed for the

5-31 insured person.

5-32 6. The provisions of this section must not be construed to:

5-33 (a) Limit the provision of specialized services covered by Medicaid for

5-34 persons with conditions relating to mental health or substance abuse.

5-35 (b) Supersede any provision of federal law, any federal or state policy

5-36 relating to Medicaid, or the terms and conditions imposed on any

5-37 Medicaid waiver granted to this state with respect to the provision of

5-38 services to persons with conditions relating to mental health or substance

5-39 abuse.

5-40 (c) Affect any existing policy of group health insurance until its date

5-41 of renewal or, if the policy of group health insurance is governed by a

5-42 collective bargaining agreement or employment contract, until the

5-43 expiration of that agreement or contract.

6-1 7. As used in this section:

6-2 (a) "Condition relating to mental health" means a condition or

6-3 disorder involving mental illness that falls within any of the diagnostic

6-4 categories listed in the section on mental disorders in the "International

6-5 Classification of Diseases," published by the United States Department of

6-6 Health and Human Services.

6-7 (b) "Managed care" has the meaning ascribed to it in NRS 695G.040.

6-8 (c) "Managed care organization" has the meaning ascribed to it in

6-9 NRS 695G.050.

6-10 (d) "Rate, term or condition" means any lifetime or annual limit on

6-11 payments, any requirement concerning deductibles, copayments,

6-12 coinsurance or other forms of cost sharing, any limit on out-of-pocket

6-13 costs or on visits to a provider of treatment, and any other financial

6-14 component of health insurance coverage that affects the insured person.

6-15 Sec. 5. NRS 689B.0295 is hereby amended to read as follows:

6-16 689B.0295 1. Following approval by the commissioner, each insurer

6-17 that issues a policy of group health insurance in this state shall provide

6-18 written notice to an insured, in clear and comprehensible language that is

6-19 understandable to an ordinary layperson, explaining the right of the insured

6-20 to file a written complaint. Such notice must be provided to an insured:

6-21 (a) At the time he receives his certificate of coverage or evidence of

6-22 coverage;

6-23 (b) Any time that the insurer denies coverage of a health care service or

6-24 limits coverage of a health care service to an insured; and

6-25 (c) Any other time deemed necessary by the commissioner.

6-26 2. Any time that an insurer denies coverage of a health care service ,

6-27 including, without limitation, denying a claim relating to a policy of

6-28 group health insurance or blanket insurance pursuant to NRS 689B.255,

6-29 to an insured it shall notify the insured in writing within 10 working days

6-30 after it denies coverage of the health care service of:

6-31 (a) The reason for denying coverage of the service;

6-32 (b) The criteria by which the insurer determines whether to authorize or

6-33 deny coverage of the health care service; and

6-34 (c) His right to file a written complaint [.] and the procedure for filing

6-35 such a complaint.

6-36 3. A written notice which is approved by the commissioner shall be

6-37 deemed to be in clear and comprehensible language that is understandable

6-38 to an ordinary layperson.

6-39 Sec. 6. NRS 689B.030 is hereby amended to read as follows:

6-40 689B.030 Each group health insurance policy must contain in

6-41 substance the following provisions:

6-42 1. A provision that, in the absence of fraud, all statements made by

6-43 applicants or the policyholders or by an insured person are representations

7-1 and not warranties, and that no statement made for the purpose of effecting

7-2 insurance voids the insurance or reduces its benefits unless the statement is

7-3 contained in a written instrument signed by the policyholder or the insured

7-4 person, a copy of which has been furnished to him or his beneficiary.

7-5 2. A provision that the insurer will furnish to the policyholder for

7-6 delivery to each employee or member of the insured group a statement in

7-7 summary form of the essential features of the insurance coverage of that

7-8 employee or member and to whom benefits thereunder are payable. If

7-9 dependents are included in the coverage, only one statement need be issued

7-10 for each family.

7-11 3. A provision that to the group originally insured may be added from

7-12 time to time eligible new employees or members or dependents, as the case

7-13 may be, in accordance with the terms of the policy.

7-14 4. A provision for benefits for [expense] expenses arising from care at

7-15 home or health supportive services if the care or service was prescribed by

7-16 a physician and would have been covered by the policy if performed in a

7-17 medical facility or facility for the dependent as defined in chapter 449 of

7-18 NRS.

7-19 5. A provision for benefits [payable] for expenses incurred for the

7-20 treatment of the abuse of alcohol or drugs, as provided in NRS 689B.036.

7-21 6. A provision for benefits for expenses arising from hospice care.

7-22 7. A provision for benefits for expenses incurred for the treatment of

7-23 conditions relating to mental health, as provided in section 4 of this act.

7-24 Sec. 7. NRS 689B.340 is hereby amended to read as follows:

7-25 689B.340 As used in NRS 689B.340 to [689B.600,] 689B.590,

7-26 inclusive, unless the context otherwise requires, the words and terms

7-27 defined in NRS 689B.350 to 689B.460, inclusive, have the meanings

7-28 ascribed to them in those sections.

7-29 Sec. 8. NRS 689B.410 is hereby amended to read as follows:

7-30 689B.410 1. "Health benefit plan" means a policy, contract,

7-31 certificate or agreement offered by a carrier to provide for, arrange for the

7-32 payment of, pay for or reimburse any of the costs of health care services.

7-33 Except as otherwise provided in this section, the term includes short-term

7-34 and catastrophic health insurance policies, and a policy that pays on a cost-

7-35 incurred basis.

7-36 2. The term does not include:

7-37 (a) Coverage that is only for accident or disability income insurance, or

7-38 any combination thereof;

7-39 (b) Coverage issued as a supplement to liability insurance;

7-40 (c) Liability insurance, including general liability insurance and

7-41 automobile liability insurance;

7-42 (d) Workers’ compensation or similar insurance;

8-1 (e) Coverage for medical payments under a policy of automobile

8-2 insurance;

8-3 (f) Credit insurance;

8-4 (g) Coverage for on-site medical clinics; and

8-5 (h) Other similar insurance coverage specified in federal regulations

8-6 issued pursuant to the Health Insurance Portability and Accountability

8-7 Act of 1996, Public Law 104-191 , under which benefits for medical care

8-8 are secondary or incidental to other insurance benefits.

8-9 3. If the benefits are provided under a separate policy, certificate or

8-10 contract of insurance or are otherwise not an integral part of a health

8-11 benefit plan, the term does not include the following benefits:

8-12 (a) Limited-scope dental or vision benefits;

8-13 (b) Benefits for long-term care, nursing home care, home health care or

8-14 community-based care, or any combination thereof; and

8-15 (c) Such other similar benefits as are specified in any federal regulations

8-16 adopted pursuant to the Health Insurance Portability and Accountability

8-17 Act of 1996, Public Law 104-191.

8-18 4. For the purposes of NRS 689B.340 to [689B.600,] 689B.590,

8-19 inclusive, if the benefits are provided under a separate policy, certificate or

8-20 contract of insurance, there is no coordination between the provision of the

8-21 benefits and any exclusion of benefits under any group health plan

8-22 maintained by the same plan sponsor, and such benefits are paid for a claim

8-23 without regard to whether benefits are provided for such a claim under any

8-24 group health plan maintained by the same plan sponsor, the term does not

8-25 include:

8-26 (a) Coverage that is only for a specified disease or illness; and

8-27 (b) Hospital indemnity or other fixed indemnity insurance.

8-28 5. For the purposes of NRS 689B.340 to [689B.600,] 689B.590,

8-29 inclusive, if offered as a separate policy, certificate or contract of

8-30 insurance, the term does not include:

8-31 (a) Medicare supplemental health insurance as defined in section

8-32 1882(g)(1) of the Social Security Act, 42 U.S.C. § 1395ss, as that section

8-33 existed on July 16, 1997;

8-34 (b) Coverage supplemental to the coverage provided pursuant to

8-35 [chapter 55 of Title 10, United States Code (] the Civilian Health and

8-36 Medical Program of Uniformed Services [(CHAMPUS));] , CHAMPUS,

8-37 10 U.S.C. §§ 1071 et seq.; and

8-38 (c) Similar supplemental coverage provided under a group health plan.

8-39 Sec. 9. NRS 689B.470 is hereby amended to read as follows:

8-40 689B.470 For the purposes of NRS 689B.340 to [689B.600,]

8-41 689B.590, inclusive:

8-42 1. Any plan, fund or program which would not be, but for section

8-43 2721(e) of the Public Health Service Act, 42 U.S.C. § 300gg-21(e), as

9-1 amended by Public Law 104-191, as that section existed on July 16, 1997,

9-2 an employee welfare benefit plan and which is established or maintained by

9-3 a partnership to the extent that the plan, fund or program provides medical

9-4 care, including items and services paid for as medical care, to current or

9-5 former partners in the partnership, or to their dependents, as defined under

9-6 the terms of the plan, fund or program, directly or through insurance,

9-7 reimbursement, or otherwise, must be treated, subject to the provisions of

9-8 subsection 2, as an employee welfare benefit plan that is a group health

9-9 plan.

9-10 2. In the case of a group health plan, a partnership shall be deemed to

9-11 be the employer of each partner.

9-12 Sec. 10. NRS 689B.480 is hereby amended to read as follows:

9-13 689B.480 1. In determining the applicable creditable coverage of a

9-14 person for the purposes of NRS 689B.340 to [689B.600,] 689B.590,

9-15 inclusive, a period of creditable coverage must not be included if, after the

9-16 expiration of that period but before the enrollment date, there was a 63-day

9-17 period during all of which the person was not covered under any creditable

9-18 coverage. To establish a period of creditable coverage, a person must

9-19 present any certificates of coverage provided to him in accordance with

9-20 NRS 689B.490 and such other evidence of coverage as required by

9-21 regulations adopted by the commissioner. For the purposes of this

9-22 subsection, any waiting period for coverage or an affiliation period must

9-23 not be considered in determining the applicable period of creditable

9-24 coverage.

9-25 2. In determining the period of creditable coverage of a person for the

9-26 purposes of NRS 689B.500, a carrier shall include each applicable period

9-27 of creditable coverage without regard to the specific benefits covered

9-28 during that period, except that the carrier may elect to include applicable

9-29 periods of creditable coverage based on coverage of specific benefits as

9-30 specified in the regulations of the United States Department of Health and

9-31 Human Services, if such an election is made on a uniform basis for all

9-32 participants and beneficiaries of the health benefit plan or coverage.

9-33 Pursuant to such an election, the carrier shall include each applicable

9-34 period of creditable coverage with respect to any class or category of

9-35 benefits if any level of benefits is covered within that class or category, as

9-36 specified by those regulations.

9-37 3. Regardless of whether coverage is actually provided, if a carrier

9-38 elects in accordance with subsection 2 to determine creditable coverage

9-39 based on specified benefits, a statement that such an election has been made

9-40 and a description of the effect of the election must be:

9-41 (a) Included prominently in any disclosure statement concerning the

9-42 health benefit plan; and

10-1 (b) Provided to each person at the time of enrollment in the health

10-2 benefit plan.

10-3 Sec. 11. NRS 689B.580 is hereby amended to read as follows:

10-4 689B.580 1. A plan sponsor of a governmental plan that is a group

10-5 health plan to which the provisions of NRS 689B.340 to [689B.600,]

10-6 689B.590, inclusive, otherwise apply may elect to exclude the

10-7 governmental plan from compliance with those sections. Such an election:

10-8 (a) Must be made in such a form and in such a manner as the

10-9 commissioner prescribes by regulation.

10-10 (b) Is effective for a single specified year of the plan or, if the plan is

10-11 provided pursuant to a collective bargaining agreement, for the term of that

10-12 agreement.

10-13 (c) May be extended by subsequent elections.

10-14 (d) Excludes the governmental plan from those provisions in this

10-15 chapter that apply only to group health plans.

10-16 2. If a plan sponsor of a governmental plan makes an election pursuant

10-17 to this section, the plan sponsor shall:

10-18 (a) Annually and at the time of enrollment, notify the enrollees in the

10-19 plan of the election and the consequences of the election; and

10-20 (b) Provide certification and disclosure of creditable coverage under the

10-21 plan with respect to those enrollees pursuant to NRS 689B.490.

10-22 3. As used in this section, "governmental plan" has the meaning

10-23 ascribed to in section 3(32) of the Employee Retirement Income Security

10-24 Act of 1974, 29 U.S.C. § 1002(32), as that section existed on July 16,

10-25 1997.

10-26 Sec. 12. Chapter 689C of NRS is hereby amended by adding thereto a

10-27 new section to read as follows:

10-28 1. Notwithstanding any provision of this Title to the contrary, a

10-29 health benefit plan issued or delivered for issuance in this state pursuant

10-30 to this chapter must provide coverage for the treatment of conditions

10-31 relating to mental health and must not establish any rate, term or

10-32 condition that places a greater financial burden on the insured person

10-33 for access to treatment for conditions relating to mental health than for

10-34 access to treatment for conditions relating to physical health. Any limits

10-35 required under the health benefit plan for deductibles and out-of-pocket

10-36 expenses must be comprehensive for coverage of both conditions relating

10-37 to mental health and conditions relating to physical health.

10-38 2. A health benefit plan that does not otherwise provide for managed

10-39 care, or that does not provide for the same degree of managed care for

10-40 all health conditions, may provide coverage for the treatment of

10-41 conditions relating to mental health through a managed care

10-42 organization if the managed care organization is in compliance with

10-43 regulations adopted by the commissioner which ensure that the system

11-1 for delivery of the treatment for conditions relating to mental health does

11-2 not diminish or negate the purpose of this section. The regulations

11-3 adopted by the commissioner must ensure that:

11-4 (a) Timely and appropriate access to care is available;

11-5 (b) The distribution of providers of health care who provide services

11-6 relating to mental health is adequate to serve the needs of persons in this

11-7 state, considering the quality, location and area of specialization of such

11-8 providers; and

11-9 (c) Administrative or clinical protocols do not reduce access to

11-10 medically necessary treatment for the insured person.

11-11 3. A health benefit plan shall be deemed to be in compliance with

11-12 this section if the health benefit plan provides to the insured person at

11-13 least one option for treatment of conditions relating to mental health

11-14 which has rates, terms and conditions that impose no greater financial

11-15 burden on the insured person than that imposed for treatment of

11-16 conditions relating to the physical health of the insured person. The

11-17 commissioner may disapprove any health benefit plan if he determines

11-18 that the plan is inconsistent with this section.

11-19 4. Benefits provided pursuant to this section by a health benefit plan

11-20 for conditions relating to mental health must be paid in the same manner

11-21 as benefits for any other illness covered by the health benefit plan.

11-22 5. Benefits for conditions relating to mental health are not required

11-23 by this section if the treatment for the condition relating to mental health

11-24 is not provided:

11-25 (a) By a person who is licensed or certified to provide treatment for

11-26 conditions relating to mental health; or

11-27 (b) In a mental health facility or institution designated as a division

11-28 facility pursuant to NRS 433.233, or in a medical or other facility

11-29 licensed by the state board of health pursuant to chapter 449 of NRS that

11-30 provides programs for the treatment of conditions relating to mental

11-31 health, and pursuant to an individualized written plan developed for the

11-32 insured person.

11-33 6. The provisions of this section must not be construed to:

11-34 (a) Limit the provision of specialized services covered by Medicaid for

11-35 persons with conditions relating to mental health or substance abuse.

11-36 (b) Supersede any provision of federal law, any federal or state policy

11-37 relating to Medicaid, or the terms and conditions imposed on any

11-38 Medicaid waiver granted to this state with respect to the provision of

11-39 services to persons with conditions relating to mental health or substance

11-40 abuse.

11-41 (c) Affect any existing health benefit plan until its date of renewal or,

11-42 if the health benefit plan is governed by a collective bargaining

12-1 agreement or employment contract, until the expiration of that

12-2 agreement or contract.

12-3 7. As used in this section:

12-4 (a) "Condition relating to mental health" means a condition or

12-5 disorder involving mental illness that falls within any of the diagnostic

12-6 categories listed in the section on mental disorders in the "International

12-7 Classification of Diseases," published by the United States Department of

12-8 Health and Human Services.

12-9 (b) "Managed care" has the meaning ascribed to it in NRS 695G.040.

12-10 (c) "Managed care organization" has the meaning ascribed to it in

12-11 NRS 695G.050.

12-12 (d) "Rate, term or condition" means any lifetime or annual limit on

12-13 payments, any requirement concerning deductibles, copayments,

12-14 coinsurance or other forms of cost sharing, any limit on out-of-pocket

12-15 costs or on visits to a provider of treatment, and any other financial

12-16 component of health insurance coverage that affects the insured person.

12-17 Sec. 13. NRS 689C.155 is hereby amended to read as follows:

12-18 689C.155 The commissioner may adopt regulations to carry out the

12-19 provisions of section 12 of this act and NRS 689C.107 to 689C.145,

12-20 inclusive, 689C.156 to 689C.159, inclusive, 689C.165, 689C.183,

12-21 689C.187, 689C.191 to 689C.198, inclusive, 689C.203, 689C.207,

12-22 689C.265, 689C.283, 689C.287, 689C.325, 689C.342 to 689C.348,

12-23 inclusive, 689C.355 and 689C.610 to 689C.980, inclusive, and to ensure

12-24 that rating practices used by carriers serving small employers are consistent

12-25 with those sections, including regulations that:

12-26 1. Ensure that differences in rates charged for health benefit plans by

12-27 such carriers are reasonable and reflect only differences in the designs of

12-28 the plans, the terms of the coverage, the amount contributed by the

12-29 employers to the cost of coverage and differences based on the rating

12-30 factors established by the carrier.

12-31 2. Prescribe the manner in which characteristics may be used by such

12-32 carriers.

12-33 Sec. 14. NRS 689C.156 is hereby amended to read as follows:

12-34 689C.156 1. As a condition of transacting business in this state with

12-35 small employers, a carrier shall actively market to a small employer each

12-36 health benefit plan which is actively marketed in this state by the carrier to

12-37 any small employer in this state. The health insurance plans marketed

12-38 pursuant to this section by the carrier must include, without limitation, a

12-39 basic health benefit plan and a standard health benefit plan. A carrier shall

12-40 be deemed to be actively marketing a health benefit plan when it makes

12-41 available any of its plans to a small employer that is not currently receiving

12-42 coverage under a health benefit plan issued by that carrier.

13-1 2. A carrier shall issue to a small employer any health benefit plan

13-2 marketed in accordance with this section if the eligible small employer

13-3 applies for the plan and agrees to make the required premium payments and

13-4 satisfy the other reasonable provisions of the health benefit plan that are not

13-5 inconsistent with NRS 689C.015 to 689C.355, inclusive, and section 12 of

13-6 this act, and NRS 689C.610 to 689C.980, inclusive, except that a carrier is

13-7 not required to issue a health benefit plan to a self-employed person who is

13-8 covered by, or is eligible for coverage under, a health benefit plan offered

13-9 by another employer.

13-10 Sec. 15. NRS 695A.152 is hereby amended to read as follows:

13-11 695A.152 1. To the extent reasonably applicable, a fraternal benefit

13-12 society shall comply with the provisions of NRS 689B.340 to [698B.600,]

13-13 689B.590, inclusive, and chapter 689C of NRS relating to the portability

13-14 and availability of health insurance offered by the society to its members. If

13-15 there is a conflict between the provisions of this chapter and the provisions

13-16 of NRS 689B.340 to [698B.600,] 689B.590, inclusive, and chapter 689C of

13-17 NRS, the provisions of NRS 689B.340 to [698B.600,] 689B.590, inclusive,

13-18 and chapter 689C of NRS control.

13-19 2. For the purposes of subsection 1, unless the context requires that a

13-20 provision apply only to a group health plan or a carrier that provides

13-21 coverage under a group health plan, any reference in those sections to

13-22 "group health plan" or "carrier" must be replaced by "fraternal benefit

13-23 society."

13-24 Sec. 16. NRS 695A.159 is hereby amended to read as follows:

13-25 695A.159 1. If a person:

13-26 (a) Adopts a dependent child; or

13-27 (b) Assumes and retains a legal obligation for the total or partial support

13-28 of a dependent child in anticipation of adopting the child,

13-29 while the person is eligible for group coverage under a certificate for health

13-30 benefits, the society issuing that certificate shall not restrict the coverage, in

13-31 accordance with NRS 689B.340 to [689B.600,] 689B.590, inclusive, and

13-32 chapter 689C of NRS relating to the portability and availability of health

13-33 insurance, of the child solely because of a preexisting condition the child

13-34 has at the time he would otherwise become eligible for coverage pursuant

13-35 to that policy.

13-36 2. For the purposes of this section, "child" means a person who is

13-37 under 18 years of age at the time of his adoption or the assumption of a

13-38 legal obligation for his support in anticipation of his adoption.

13-39 Sec. 17. NRS 695B.180 is hereby amended to read as follows:

13-40 695B.180 A contract for hospital, medical or dental services must not

13-41 be entered into between a corporation proposing to furnish or provide any

13-42 one or more of the services authorized under this chapter and a subscriber:

13-43 1. Unless the entire consideration therefor is expressed in the contract.

14-1 2. Unless the times at which the benefits or services to the subscriber

14-2 take effect and terminate are stated in a portion of the contract above the

14-3 evidence of its execution.

14-4 3. If the contract purports to entitle more than one person to benefits or

14-5 services, except for family contracts issued under NRS 695B.190, group

14-6 contracts issued under NRS 695B.200, and blanket contracts issued under

14-7 NRS 695B.220.

14-8 4. Unless every printed portion and any endorsement or attached

14-9 papers are plainly printed in type of which the face is not smaller than 10

14-10 points.

14-11 5. Except for group contracts and blanket contracts issued under NRS

14-12 695B.220, unless the exceptions of the contract are printed with greater

14-13 prominence than the benefits to which they apply.

14-14 6. Except for group contracts and blanket contracts issued under NRS

14-15 695B.230, unless, if any portion of the contract purports, by reason of the

14-16 circumstances under which an illness, injury or disablement is incurred to

14-17 reduce any service to less than that provided for the same illness, injury or

14-18 disablement incurred under ordinary circumstances, that portion is printed

14-19 in boldface type and with greater prominence than any other text of the

14-20 contract.

14-21 7. If the contract contains any provisions purporting to make any

14-22 portion of the charter, constitution or bylaws of a nonprofit corporation a

14-23 part of the contract unless that portion is set forth in full in the contract.

14-24 8. Unless the contract, if it is a group contract, contains a provision for

14-25 benefits payable for expenses incurred for the treatment of [the] :

14-26 (a) The abuse of alcohol or drugs, as provided in NRS 695B.194 [.] ;

14-27 and

14-28 (b) Conditions relating to mental health, as provided in section 4 of

14-29 this act.

14-30 9. Unless the contract provides benefits for expenses incurred for

14-31 hospice care.

14-32 10. Unless the contract for service in a hospital contains in blackface

14-33 type, not less than 10 points, the following provisions:

14-34 This contract does not restrict or interfere with the right of any

14-35 person entitled to service and care in a hospital to select the

14-36 contracting hospital or to make a free choice of his attending

14-37 physician, who must be the holder of a valid and unrevoked

14-38 physician’s license and a member of, or acceptable to, the attending

14-39 staff and board of directors of the hospital in which the services are to

14-40 be provided.

15-1 Sec. 18. NRS 695B.187 is hereby amended to read as follows:

15-2 695B.187 Except as otherwise provided by the provisions of NRS

15-3 689B.340 to [689B.600,] 689B.590, inclusive, and chapter 689C of NRS

15-4 relating to the portability and availability of health insurance:

15-5 1. A group contract for hospital, medical or dental services issued by a

15-6 nonprofit hospital, medical or dental service corporation to replace any

15-7 discontinued policy or coverage for group health insurance must:

15-8 (a) Provide coverage for all persons who were covered under the

15-9 previous policy or coverage on the date it was discontinued; and

15-10 (b) Except as otherwise provided in subsection 2, provide benefits

15-11 which are at least as extensive as the benefits provided by the previous

15-12 policy or coverage, except that the benefits may be reduced or excluded to

15-13 the extent that such a reduction or exclusion was permissible under the

15-14 terms of the previous policy or coverage,

15-15 if that contract is issued within 60 days after the date on which the previous

15-16 policy or coverage was discontinued.

15-17 2. If an employer obtains a replacement contract pursuant to subsection

15-18 1 to cover his employees, any benefits provided by the previous policy or

15-19 coverage may be reduced if notice of the reduction is given to his

15-20 employees pursuant to NRS 608.1577.

15-21 3. Any corporation which issues a replacement contract pursuant to

15-22 subsection 1 may submit a written request to the insurer which provided the

15-23 previous policy or coverage for a statement of benefits which were

15-24 provided under that policy or coverage. Upon receiving such a request, the

15-25 insurer shall give a written statement to the corporation which indicates

15-26 what benefits were provided and what exclusions or reductions were in

15-27 effect under the previous policy or coverage.

15-28 4. The provisions of this section apply to a self-insured employer who

15-29 provides health benefits to his employees and replaces those benefits with a

15-30 group contract for hospital, medical or dental services issued by a nonprofit

15-31 hospital, medical or dental service corporation.

15-32 Sec. 19. NRS 695B.189 is hereby amended to read as follows:

15-33 695B.189 A group contract issued by a corporation under the

15-34 provisions of this chapter must contain a provision which permits the

15-35 continuation of coverage pursuant to the provisions of NRS 689B.245 to

15-36 689B.249, inclusive, and 689B.340 to [689B.600,] 689B.590, inclusive,

15-37 and chapter 689C of NRS relating to the portability and availability of

15-38 health insurance.

15-39 Sec. 20. NRS 695B.192 is hereby amended to read as follows:

15-40 695B.192 1. No hospital, medical or dental service contract issued

15-41 by a corporation pursuant to the provisions of this chapter may contain any

15-42 exclusion, reduction or other limitation of coverage relating to

15-43 complications of pregnancy, unless the provision applies generally to all

16-1 benefits payable under the contract and complies with the provisions of

16-2 NRS 689B.340 to NRS [689B.600,] 689B.590, inclusive, and chapter

16-3 689C of NRS relating to the portability and availability of health insurance.

16-4 2. As used in this section, the term "complications of pregnancy"

16-5 includes any condition which requires hospital confinement for medical

16-6 treatment and:

16-7 (a) If the pregnancy is not terminated, is caused by an injury or sickness

16-8 not directly related to the pregnancy or by acute nephritis, nephrosis,

16-9 cardiac decompensation, missed abortion or similar medically diagnosed

16-10 conditions; or

16-11 (b) If the pregnancy is terminated, results in nonelective cesarean

16-12 section, ectopic pregnancy or spontaneous termination.

16-13 3. A contract subject to the provisions of this chapter which is issued or

16-14 delivered on or after July 1, 1977, has the legal effect of including the

16-15 coverage required by this section, and any provision of the contract which

16-16 is in conflict with this section is void.

16-17 Sec. 21. NRS 695B.251 is hereby amended to read as follows:

16-18 695B.251 1. Except as otherwise provided in the provisions of this

16-19 section, NRS 689B.340 to [389B.600,] 689B.590, inclusive, and chapter

16-20 689C of NRS relating to the portability and availability of health insurance,

16-21 all group subscriber contracts delivered or issued for delivery in this state

16-22 providing for hospital, surgical or major medical coverage, or any

16-23 combination of these coverages, on a service basis or an expense-incurred

16-24 basis, or both, must contain a provision that the employee or member is

16-25 entitled to have issued to him a subscriber contract of health coverage when

16-26 the employee or member is no longer covered by the group subscriber

16-27 contract.

16-28 2. The requirement in subsection 1 does not apply to contracts

16-29 providing benefits only for specific diseases or accidental injuries.

16-30 3. If an employee or member was a recipient of benefits under the

16-31 coverage provided pursuant to NRS 695B.1944, he is not entitled to have

16-32 issued to him by a replacement insurer a subscriber contract of health

16-33 coverage unless he has reported for his normal employment for a period of

16-34 90 consecutive days after last being eligible to receive any benefits under

16-35 the coverage provided pursuant to NRS 695B.1944.

16-36 Sec. 22. NRS 695B.318 is hereby amended to read as follows:

16-37 695B.318 1. Nonprofit hospital, medical or dental service

16-38 corporations are subject to the provisions of NRS 689B.340 to [689B.600,]

16-39 689B.590, inclusive, and chapter 689C of NRS relating to the portability

16-40 and availability of health insurance offered by such organizations. If there

16-41 is a conflict between the provisions of this chapter and the provisions of

16-42 NRS 689B.340 to [689B.600,] 689B.590, inclusive, and chapter 689C of

17-1 NRS, the provisions of NRS 689B.340 to [689B.600,] 689B.590, inclusive,

17-2 and chapter 689C of NRS control.

17-3 2. For the purposes of subsection 1, unless the context requires that a

17-4 provision apply only to a group health plan or a carrier that provides

17-5 coverage under a group health plan, any reference in those sections to:

17-6 (a) "Carrier" must be replaced by "corporation."

17-7 (b) "Group health plan" must be replaced by "group contract for

17-8 hospital, medical or dental services."

17-9 Sec. 23. NRS 695B.400 is hereby amended to read as follows:

17-10 695B.400 1. Following approval by the commissioner, each insurer

17-11 that issues a contract for hospital or medical services in this state shall

17-12 provide written notice to an insured, in clear and comprehensible language

17-13 that is understandable to an ordinary layperson, explaining the right of the

17-14 insured to file a written complaint. Such notice must be provided to an

17-15 insured:

17-16 (a) At the time he receives his certificate of coverage or evidence of

17-17 coverage;

17-18 (b) Any time that the insurer denies coverage of a health care service or

17-19 limits coverage of a health care service to an insured; and

17-20 (c) Any other time deemed necessary by the commissioner.

17-21 2. Any time that an [insured] insurer denies coverage of a health care

17-22 service to a beneficiary or subscriber , including, without limitation,

17-23 denying a claim relating to a contract for dental, hospital or medical

17-24 services pursuant to NRS 695B.2505, it shall notify the beneficiary or

17-25 subscriber in writing within 10 working days after it denies coverage of

17-26 the health care service of:

17-27 (a) The reason for denying coverage of the service;

17-28 (b) The criteria by which the insurer determines whether to authorize or

17-29 deny coverage of the health care service; and

17-30 (c) His right to file a written complaint [.] and the procedure for filing

17-31 such a complaint.

17-32 3. A written notice which is approved by the commissioner shall be

17-33 deemed to be in clear and comprehensible language that is understandable

17-34 to an ordinary layperson.

17-35 Sec. 24. NRS 695C.057 is hereby amended to read as follows:

17-36 695C.057 1. A health maintenance organization is subject to the

17-37 provisions of NRS 689B.340 to [689B.600,] 689B.590, inclusive, and

17-38 chapter 689C of NRS relating to the portability and availability of health

17-39 insurance offered by such organizations. If there is a conflict between the

17-40 provisions of this chapter and the provisions of NRS 689B.340 to

17-41 [689B.600,] 689B.590, inclusive, and chapter 689C of NRS, the provisions

17-42 of NRS 689B.340 to [689B.600,] 689B.590, inclusive, and chapter 689C of

17-43 NRS control.

18-1 2. For the purposes of subsection 1, unless the context requires that a

18-2 provision apply only to a group health plan or a carrier that provides

18-3 coverage under a group health plan, any reference in those sections to

18-4 "group health plan" or "carrier" must be replaced by "health maintenance

18-5 organization."

18-6 Sec. 25. NRS 695C.170 is hereby amended to read as follows:

18-7 695C.170 1. Every enrollee residing in this state is entitled to

18-8 evidence of coverage under a health care plan. If the enrollee obtains

18-9 coverage under a health care plan through an insurance policy, whether by

18-10 option or otherwise, the insurer shall issue the evidence of coverage.

18-11 Otherwise, the health maintenance organization shall issue the evidence of

18-12 coverage.

18-13 2. Evidence of coverage or amendment thereto must not be issued or

18-14 delivered to any person in this state until a copy of the form of the evidence

18-15 of coverage or amendment thereto has been filed with and approved by the

18-16 commissioner.

18-17 3. An evidence of coverage:

18-18 (a) Must not contain any provisions or statements which are unjust,

18-19 unfair, inequitable, misleading, deceptive, which encourage

18-20 misrepresentation or which are untrue, misleading or deceptive as defined

18-21 in subsection 1 of NRS 695C.300; and

18-22 (b) Must contain a clear and complete statement, if a contract, or a

18-23 reasonably complete summary if a certificate, of:

18-24 (1) The health care services and the insurance or other benefits, if

18-25 any, to which the enrollee is entitled under the health care plan;

18-26 (2) Any limitations on the services, kind of services, benefits, or kind

18-27 of benefits, to be provided, including any deductible or copayment feature;

18-28 (3) Where and in what manner the services may be obtained;

18-29 (4) The total amount of payment for health care services and the

18-30 indemnity or service benefits, if any, which the enrollee is obligated to pay;

18-31 and

18-32 (5) A provision for benefits payable for expenses incurred for the

18-33 treatment of [the] :

18-34 (I) The abuse of alcohol or drugs, as provided in NRS 695C.174 [.]

18-35 ; and

18-36 (II) Conditions relating to mental health, as provided in section 4

18-37 of this act.

18-38 Any subsequent change may be evidenced in a separate document issued to

18-39 the enrollee.

18-40 4. A copy of the form of the evidence of coverage to be used in this

18-41 state and any amendment thereto is subject to the requirements for filing

18-42 and approval of subsection 2 unless it is subject to the jurisdiction of the

18-43 commissioner under the laws governing health insurance, in which event

19-1 the provisions for filing and approval of those laws apply. To the extent

19-2 that such provisions do not apply to the requirements in subsection 3, such

19-3 provisions are amended to incorporate the requirements of subsection 3 in

19-4 approving or disapproving an evidence of coverage required by subsection

19-5 2.

19-6 Sec. 26. NRS 695C.1705 is hereby amended to read as follows:

19-7 695C.1705 Except as otherwise provided in the provisions of NRS

19-8 689B.340 to [689B.600,] 689B.590, inclusive, and chapter 689C of NRS

19-9 relating to the portability and accountability of health insurance:

19-10 1. A group health care plan issued by a health maintenance

19-11 organization to replace any discontinued policy or coverage for group

19-12 health insurance must:

19-13 (a) Provide coverage for all persons who were covered under the

19-14 previous policy or coverage on the date it was discontinued; and

19-15 (b) Except as otherwise provided in subsection 2, provide benefits

19-16 which are at least as extensive as the benefits provided by the previous

19-17 policy or coverage, except that benefits may be reduced or excluded to the

19-18 extent that such a reduction or exclusion was permissible under the terms of

19-19 the previous policy or coverage,

19-20 if that plan is issued within 60 days after the date on which the previous

19-21 policy or coverage was discontinued.

19-22 2. If an employer obtains a replacement plan pursuant to subsection 1

19-23 to cover his employees, any benefits provided by the previous policy or

19-24 coverage may be reduced if notice of the reduction is given to his

19-25 employees pursuant to NRS 608.1577.

19-26 3. Any health maintenance organization which issues a replacement

19-27 plan pursuant to subsection 1 may submit a written request to the insurer

19-28 which provided the previous policy or coverage for a statement of benefits

19-29 which were provided under that policy or coverage. Upon receiving such a

19-30 request, the insurer shall give a written statement to the organization

19-31 indicating what benefits were provided and what exclusions or reductions

19-32 were in effect under the previous policy or coverage.

19-33 4. If an employee or enrollee was a recipient of benefits under the

19-34 coverage provided pursuant to NRS 695C.1709, he is not entitled to have

19-35 issued to him by a health maintenance organization a replacement plan

19-36 unless he has reported for his normal employment for a period of 90

19-37 consecutive days after last being eligible to receive any benefits under the

19-38 coverage provided pursuant to NRS 695C.1709.

19-39 5. The provisions of this section apply to a self-insured employer who

19-40 provides health benefits to his employees and replaces those benefits with a

19-41 group health care plan issued by a health maintenance organization.

20-1 Sec. 27. NRS 695C.1707 is hereby amended to read as follows:

20-2 695C.1707 Any policy of group insurance to which an enrollee is

20-3 entitled under a health care plan provided by a health maintenance

20-4 organization must contain a provision which permits the continuation of

20-5 coverage pursuant to the provisions of NRS 689B.245 to 689B.249,

20-6 inclusive, NRS 689B.340 to [689B.600,] 689B.590, inclusive, and chapter

20-7 689C of NRS relating to the portability and accountability of health

20-8 insurance.

20-9 Sec. 28. NRS 695C.172 is hereby amended to read as follows:

20-10 695C.172 1. No health maintenance organization may issue evidence

20-11 of coverage under a health care plan to any enrollee in this state if it

20-12 contains any exclusion, reduction or other limitation of coverage relating to

20-13 complications of pregnancy unless the provision applies generally to all

20-14 benefits payable under the policy and complies with the provisions of NRS

20-15 689B.340 to [689B.600,] 689B.590, inclusive, and chapter 689C of NRS

20-16 relating to the portability and accountability of health insurance.

20-17 2. As used in this section, the term "complications of pregnancy"

20-18 includes any condition which requires hospital confinement for medical

20-19 treatment and:

20-20 (a) If the pregnancy is not terminated, is caused by an injury or sickness

20-21 not directly related to the pregnancy or by acute nephritis, nephrosis,

20-22 cardiac decompensation, missed abortion or similar medically diagnosed

20-23 conditions; or

20-24 (b) If the pregnancy is terminated, results in nonelective cesarean

20-25 section, ectopic pregnancy or spontaneous termination.

20-26 3. Evidence of coverage under a health care plan subject to the

20-27 provisions of this chapter which is issued on or after July 1, 1977, has the

20-28 legal effect of including the coverage required by this section, and any

20-29 provision which is in conflict with this section is void.

20-30 Sec. 29. NRS 695F.090 is hereby amended to read as follows:

20-31 695F.090 Prepaid limited health service organizations are subject to

20-32 the provisions of this chapter and to the following provisions, to the extent

20-33 reasonably applicable:

20-34 1. NRS 687B.310 to 687B.420, inclusive, concerning cancellation and

20-35 nonrenewal of policies.

20-36 2. NRS 687B.122 to 687B.128, inclusive, concerning readability of

20-37 policies.

20-38 3. The requirements of NRS 679B.152.

20-39 4. The fees imposed pursuant to NRS 449.465.

20-40 5. NRS 686A.010 to 686A.310, inclusive, concerning trade practices

20-41 and frauds.

20-42 6. The assessment imposed pursuant to subsection 3 of NRS 679B.158.

20-43 7. Chapter 683A of NRS.

21-1 8. To the extent applicable, the provisions of NRS 689B.340 to

21-2 [689B.600,] 689B.590, inclusive, and chapter 689C of NRS relating to the

21-3 portability and availability of health insurance.

21-4 9. NRS 689A.413.

21-5 10. NRS 680B.025 to 680B.039, inclusive, concerning premium tax,

21-6 premium tax rate, annual report and estimated quarterly tax payments. For

21-7 the purposes of this subsection, unless the context otherwise requires that a

21-8 section apply only to insurers, any reference in those sections to "insurer"

21-9 must be replaced by a reference to "prepaid limited health service

21-10 organization."

21-11 11. Chapter 692C of NRS, concerning holding companies.

21-12 Sec. 30. NRS 695G.230 is hereby amended to read as follows:

21-13 695G.230 1. Following approval by the commissioner, each managed

21-14 care organization shall provide written notice to an insured, in clear and

21-15 comprehensible language that is understandable to an ordinary layperson,

21-16 explaining the right of the insured to file a written complaint and to obtain

21-17 an expedited review pursuant to NRS 695G.210. Such notice must be

21-18 provided to an insured:

21-19 (a) At the time he receives his certificate of coverage or evidence of

21-20 coverage;

21-21 (b) Any time that the managed care organization denies coverage of a

21-22 health care service or limits coverage of a health care service to an insured;

21-23 and

21-24 (c) Any other time deemed necessary by the commissioner.

21-25 2. Any time that a managed care organization denies coverage of a

21-26 health care service to an insured , including, without limitation, a health

21-27 maintenance organization that denies a claim related to a health care

21-28 plan pursuant to NRS 695C.185, it shall notify the insured in writing

21-29 within 10 working days after it denies coverage of the health care service

21-30 of:

21-31 (a) The reason for denying coverage of the service;

21-32 (b) The criteria by which the managed care organization or insurer

21-33 determines whether to authorize or deny coverage of the health care

21-34 service; and

21-35 (c) His right to file a written complaint [.] and the procedure for filing

21-36 such a complaint.

21-37 3. A written notice which is approved by the commissioner shall be

21-38 deemed to be in clear and comprehensible language that is understandable

21-39 to an ordinary layperson.

21-40 Sec. 31. NRS 695G.170 is hereby amended to read as follows:

21-41 695G.170 1. Each managed care organization shall provide coverage

21-42 for medically necessary emergency services [.] provided at any hospital.

22-1 2. A managed care organization shall not require prior authorization

22-2 for medically necessary emergency services.

22-3 3. As used in this section, "medically necessary emergency services"

22-4 means health care services that are provided to an insured by a provider of

22-5 health care after the sudden onset of a medical condition that manifests

22-6 itself by symptoms of such sufficient severity that a prudent person would

22-7 believe that the absence of immediate medical attention could result in:

22-8 (a) Serious jeopardy to the health of an insured;

22-9 (b) Serious jeopardy to the health of an unborn child;

22-10 (c) Serious impairment of a bodily function; or

22-11 (d) Serious dysfunction of any bodily organ or part.

22-12 4. A health care plan subject to the provisions of this section that is

22-13 delivered, issued for delivery or renewed on or after October 1, [1997,]

22-14 1999, has the legal effect of including the coverage required by this section,

22-15 and any provision of the plan or the renewal which is in conflict with this

22-16 section is void.

22-17 Sec. 32. NRS 287.010 is hereby amended to read as follows:

22-18 287.010 1. The governing body of any county, school district,

22-19 municipal corporation, political subdivision, public corporation or other

22-20 public agency of the State of Nevada may:

22-21 (a) Adopt and carry into effect a system of group life, accident or health

22-22 insurance, or any combination thereof, for the benefit of its officers and

22-23 employees, and the dependents of officers and employees who elect to

22-24 accept the insurance and who, where necessary, have authorized the

22-25 governing body to make deductions from their compensation for the

22-26 payment of premiums on the insurance.

22-27 (b) Purchase group policies of life, accident or health insurance, or any

22-28 combination thereof, for the benefit of such officers and employees, and the

22-29 dependents of such officers and employees, as have authorized the

22-30 purchase, from insurance companies authorized to transact the business of

22-31 such insurance in the State of Nevada, and, where necessary, deduct from

22-32 the compensation of officers and employees the premiums upon insurance

22-33 and pay the deductions upon the premiums.

22-34 (c) Provide group life, accident or health coverage through a self-

22-35 insurance reserve fund and, where necessary, deduct contributions to the

22-36 maintenance of the fund from the compensation of officers and employees

22-37 and pay the deductions into the fund. The money accumulated for this

22-38 purpose through deductions from the compensation of officers and

22-39 employees and contributions of the governing body must be maintained as

22-40 an internal service fund as defined by NRS 354.543. The money must be

22-41 deposited in a state or national bank authorized to transact business in the

22-42 State of Nevada. Any independent administrator of a fund created under

22-43 this section is subject to the licensing requirements of chapter 683A of

23-1 NRS, and must be a resident of this state. Any contract with an independent

23-2 administrator must be approved by the commissioner of insurance as to the

23-3 reasonableness of administrative charges in relation to contributions

23-4 collected and benefits provided. The provisions of NRS 689B.030 to

23-5 689B.050, inclusive, apply to coverage provided pursuant to this paragraph

23-6 [.] , except that the provisions of section 4 of this act do not apply to such

23-7 coverage.

23-8 (d) Defray part or all of the cost of maintenance of a self-insurance fund

23-9 or of the premiums upon insurance. The money for contributions must be

23-10 budgeted for in accordance with the laws governing the county, school

23-11 district, municipal corporation, political subdivision, public corporation or

23-12 other public agency of the State of Nevada.

23-13 2. If a school district offers group insurance to its officers and

23-14 employees pursuant to this section, members of the board of trustees of the

23-15 school district must not be excluded from participating in the group

23-16 insurance. If the amount of the deductions from compensation required to

23-17 pay for the group insurance exceeds the compensation to which a trustee is

23-18 entitled, the difference must be paid by the trustee.

23-19 Sec. 33. NRS 287.045 is hereby amended to read as follows:

23-20 287.045 1. Except as otherwise provided in this section, every officer

23-21 or employee of the state is eligible to participate in the program on the first

23-22 day of the month following the completion of 90 days of full-time

23-23 employment.

23-24 2. Professional employees of the University and Community College

23-25 System of Nevada who have annual employment contracts are eligible to

23-26 participate in the program on:

23-27 (a) The effective dates of their respective employment contracts, if those

23-28 dates are on the first day of a month; or

23-29 (b) The first day of the month following the effective dates of their

23-30 respective employment contracts, if those dates are not on the first day of a

23-31 month.

23-32 3. Every officer or employee who is employed by a participating public

23-33 agency on a permanent and full-time basis on the date the agency enters

23-34 into an agreement to participate in the state’s group insurance program, and

23-35 every officer or employee who commences his employment after that date

23-36 is eligible to participate in the program on the first day of the month

23-37 following the completion of 90 days of full-time employment.

23-38 4. Every senator and assemblyman is eligible to participate in the

23-39 program on the first day of the month following the 90th day after his initial

23-40 term of office begins.

23-41 5. An officer or employee of the governing body of any county, school

23-42 district, municipal corporation, political subdivision, public corporation or

23-43 other public agency of the State of Nevada who retires under the conditions

24-1 set forth in NRS 286.510 or 286.620 and was not participating in the state’s

24-2 group insurance program at the time of his retirement is eligible to

24-3 participate in the program 30 days after notice of the selection to participate

24-4 is given pursuant to NRS 287.023 or 287.0235. The committee on benefits

24-5 shall make a separate accounting for these retired persons. For the first year

24-6 following enrollment, the rates charged must be the full actuarial costs

24-7 determined by the actuary based upon the expected claims experience with

24-8 these retired persons. The claims experience of these retired persons must

24-9 not be commingled with the retired persons who were members of the

24-10 state’s program before their retirement, nor with active employees of the

24-11 state. After the first year following enrollment, the rates charged must be

24-12 the full actuarial costs determined by the actuary based upon the past

24-13 claims experience of these retired persons since enrolling.

24-14 6. Notwithstanding the provisions of subsections 1, 3 and 4, if the

24-15 committee on benefits does not, pursuant to NRS 689B.580, elect to

24-16 exclude the program from compliance with NRS 689B.340 to [689B.600,]

24-17 689B.590, inclusive, and if the coverage under the program is provided by

24-18 a health maintenance organization authorized to transact insurance in this

24-19 state pursuant to chapter 695C of NRS, any affiliation period imposed by

24-20 the program may not exceed the statutory limit for an affiliation period set

24-21 forth in NRS 689B.500.

24-22 Sec. 34. NRS 689B.600 is hereby repealed.

24-23 Sec. 35. 1. This section and sections 1, 2, 4, 6 to 22, inclusive, 24 to

24-24 29, inclusive, 32, 33 and 34 of this act become effective on July 1, 1999.

24-25 2. Sections 3, 5, 23, 30 and 31 of this act become effective on October

24-26 1, 1999.

 

24-27 TEXT OF REPEALED SECTION

 

24-28 689B.600 Insurance for groups of 51 persons or more which offers

24-29 medical and surgical benefits and mental health benefits: Aggregate

24-30 lifetime and annual limits on benefits.

24-31 1. Except as otherwise provided in this section, if group health

24-32 insurance for groups of 51 persons or more which is issued or delivered for

24-33 issuance in this state and which offers both medical and surgical benefits

24-34 and mental health benefits:

24-35 (a) Does not include an aggregate lifetime limit on substantially all

24-36 medical and surgical benefits, the group health insurance may not impose

24-37 an aggregate lifetime limit on the mental health benefits.

24-38 (b) Includes an aggregate lifetime limit on substantially all medical and

24-39 surgical benefits, the aggregate lifetime limit on the mental health benefits

25-1 offered by the group health insurance must not be less than the aggregate

25-2 lifetime limit set for the medical and surgical benefits.

25-3 (c) Includes no aggregate lifetime limits, or different aggregate lifetime

25-4 limits, on different categories of medical and surgical benefits, the

25-5 applicable aggregate lifetime limit that must be applied in accordance with

25-6 paragraph (b) to the mental health benefits of the group health insurance

25-7 must be computed by taking into account the weighted average of the

25-8 aggregate lifetime limits applicable to such categories of medical and

25-9 surgical benefits offered by the group health insurance. The computation of

25-10 the aggregate lifetime limit must be consistent with the rules adopted by the

25-11 Secretary of the United States Department of Labor pursuant to 29 U.S.C. §

25-12 1185a.

25-13 2. Except as otherwise provided in this section, if group health

25-14 insurance for groups of 51 persons or more which is issued or delivered for

25-15 issuance in this state and which offers both medical and surgical benefits

25-16 and mental health benefits:

25-17 (a) Does not include an annual limit on substantially all medical and

25-18 surgical benefits, the group health insurance may not impose an annual

25-19 limit on the mental health benefits.

25-20 (b) Includes an annual limit on substantially all medical and surgical

25-21 benefits, the annual limit on the mental health benefits offered by the group

25-22 health insurance must not be less than the annual limit set for the medical

25-23 and surgical benefits.

25-24 (c) Includes no annual limit, or different annual limits, on different

25-25 categories of medical and surgical benefits, the applicable annual limit that

25-26 must be applied in accordance with paragraph (b) to the mental health

25-27 benefits of the group health insurance must be computed by taking into

25-28 account the weighted average of the annual limits applicable to such

25-29 categories of medical and surgical benefits offered by the group health

25-30 insurance. The computation of the annual limit must be consistent with the

25-31 rules adopted by the Secretary of the United States Department of Labor

25-32 pursuant to 29 U.S.C. § 1185a.

25-33 3. Nothing in this section:

25-34 (a) Requires group health insurance to provide mental health benefits.

25-35 (b) Except as specifically provided in subsection 1, affects the terms or

25-36 conditions of group health insurance that provides mental health benefits,

25-37 relating to the amount, duration or scope of those benefits, including, but

25-38 not limited to, cost sharing, limits on numbers of visits or days of coverage

25-39 and requirements relating to medical necessity.

25-40 4. Group health insurance is not required to comply with the provisions

25-41 of this section if the application of this section would result in an increase

25-42 in the cost under the group health insurance of 1 percent or more.

26-1 5. If the group health insurance offers a participant or beneficiary more

26-2 than one benefit package option, the provisions of this section must be

26-3 applied separately to each such option offered.

26-4 6. As used in this section:

26-5 (a) "Aggregate lifetime limit" means a limitation on the total amount of

26-6 benefits that may be paid with respect to those benefits under group health

26-7 insurance with respect to a policyholder or other coverage unit.

26-8 (b) "Annual limit" means a limitation on the total amount of benefits

26-9 that may be paid with respect to those benefits in a 12-month period under

26-10 group health insurance with respect to an individual or other coverage unit.

26-11 (c) "Medical and surgical benefits" means benefits, as defined under the

26-12 group health insurance, provided by such insurance for medical or surgical

26-13 services. The term does not include benefits for services relating to mental

26-14 health.

26-15 (d) "Mental health benefits" means benefits, as defined under the group

26-16 health insurance, provided by such insurance for services relating to mental

26-17 health. The term does not include benefits provided for the treatment of

26-18 substance abuse or chemical dependency.

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