Senate Bill No. 212–Committee on Commerce and Labor

 

February 20, 2001

____________

 

Referred to Committee on Commerce and Labor

 

SUMMARY—Repeals provisions that require policy of individual health insurance to include certain coverage and benefits. (BDR 57‑127)

 

FISCAL NOTE:            Effect on Local Government: No.

                                    Effect on the State: No.

 

~

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

AN ACT relating to health insurance; repealing provisions that require a policy of individual health insurance to include certain coverage and benefits; 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. NRS 687B.225 is hereby amended to read as follows:

1-2    687B.225  1.  Except as otherwise provided in NRS [689A.0405,

1-3  689A.0413,] 689B.031, 689B.0374, 695B.1912, 695B.1914, 695C.1713,

1-4  695C.1735 and 695G.170, any contract for group, blanket or individual

1-5  health insurance or any contract by a nonprofit hospital, medical or dental

1-6  service corporation or organization for dental care which provides for

1-7  payment of a certain part of medical or dental care may require the insured

1-8  or member to obtain prior authorization for that care from the insurer or

1-9  organization. The insurer or organization shall:

1-10    (a) File its procedure for obtaining approval of care pursuant to this

1-11  section for approval by the commissioner; and

1-12    (b) Respond to any request for approval by the insured or member

1-13  pursuant to this section within 20 days after it receives the request.

1-14    2.  The procedure for prior authorization [may] must not discriminate

1-15  among persons licensed to provide the covered care.

1-16    Sec. 2.  NRS 689A.030 is hereby amended to read as follows:

1-17    689A.030  A policy of health insurance must not be delivered or issued

1-18  for delivery to any person in this state unless it otherwise complies with

1-19  this code, and complies with the following:

1-20    1.  The entire money and other considerations for the policy must be

1-21  expressed therein.

1-22    2.  The time when the insurance takes effect and terminates must be

1-23  expressed therein.

2-1    3.  It must purport to insure only one person, except that a policy may

2-2  insure, originally or by subsequent amendment, upon the application of an

2-3  adult member of a family[,] who shall be deemed the policyholder, any

2-4  two or more eligible members of that family, including the husband, wife,

2-5  dependent children, [from the time of birth, adoption or placement for the

2-6  purpose of adoption as provided in NRS 689A.043, or] any children under

2-7  a specified age which must not exceed 19 years [except as provided in

2-8  NRS 689A.045,] and any other person dependent upon the policyholder.

2-9    4.  The style, arrangement and overall appearance of the policy must

2-10  not give undue prominence to any portion of the text, and every printed

2-11  portion of the text of the policy and of any endorsements or attached papers

2-12  must be plainly printed in light-faced type of a style in general use, the size

2-13  of which must be uniform and not less than 10 points with a lower case

2-14  unspaced alphabet length not less than 120 points. “Text” includes all

2-15  printed matter except the name and address of the insurer, the name or the

2-16  title of the policy, the brief description, if any, and captions and

2-17  subcaptions.

2-18    5.  The exceptions and reductions of indemnity must be set forth in the

2-19  policy and, other than those contained in NRS 689A.050 to 689A.290,

2-20  inclusive, must be printed, at the insurer’s option, with the benefit

2-21  provision to which they apply or under an appropriate caption such as

2-22  “Exceptions” or “Exceptions and Reductions,” except that if an exception

2-23  or reduction specifically applies only to a particular benefit of the policy, a

2-24  statement of that exception or reduction must be included with the benefit

2-25  provision to which it applies.

2-26    6.  Each such form, including riders and endorsements, must be

2-27  identified by a number in the lower left-hand corner of the first page

2-28  thereof.

2-29    7.  The policy must not contain any provision purporting to make any

2-30  portion of the charter, rules, constitution or bylaws of the insurer a part of

2-31  the policy unless that portion is set forth in full in the policy, except in the

2-32  case of the incorporation of or reference to a statement of rates or

2-33  classification of risks, or short-rate table filed with the commissioner.

2-34    [8.  The policy must provide benefits for expense arising from care at

2-35  home or health supportive services if that care or service was prescribed by

2-36  a physician and would have been covered by the policy if performed in a

2-37  medical facility or facility for the dependent as defined in chapter 449 of

2-38  NRS.

2-39    9.  The policy must provide, at the option of the applicant, benefits for

2-40  expenses incurred for the treatment of abuse of alcohol or drugs, unless the

2-41  policy provides coverage only for a specified disease or provides for the

2-42  payment of a specific amount of money if the insured is hospitalized or

2-43  receiving health care in his home.

2-44    10.  The policy must provide benefits for expense arising from hospice

2-45  care.]

2-46    Sec. 3.  NRS 689A.040 is hereby amended to read as follows:

2-47    689A.040  1.  Except as otherwise provided in [subsections 2 and 3,

2-48  each such] subsection 2, each policy of health insurance delivered or

2-49  issued for delivery to any person in this state must contain the provisions

3-1  specified in NRS 689A.050 to 689A.170, inclusive, in the words in which

3-2  the provisions appear, except that the insurer may, at its option, substitute

3-3  for one or more of the provisions corresponding provisions of different

3-4  wording approved by the commissioner which are in each instance not less

3-5  favorable in any respect to the insured or the beneficiary. Each such

3-6  provision must be preceded individually by the applicable caption shown

3-7  [,] or, at the option of the insurer, by such appropriate individual or group

3-8  captions or subcaptions as the commissioner may approve.

3-9    2.  [Each policy delivered or issued for delivery in this state after

3-10  November 1, 1973, must contain a provision, if applicable, setting forth the

3-11  provisions of NRS 689A.045.

3-12    3.] If any such provision is in whole or in part inapplicable to or

3-13  inconsistent with the coverage provided by a particular form of policy, the

3-14  insurer, with the approval of the commissioner, may omit from the policy

3-15  any inapplicable provision or part of a provision, and shall modify any

3-16  inconsistent provision or part of a provision in such a manner as to make

3-17  the provision as contained in the policy consistent with the coverage

3-18  provided by the policy.

3-19    Sec. 4.  NRS 689A.280 is hereby amended to read as follows:

3-20    689A.280  [1.] There may be a provision as follows:

3-21    Intoxicants and Narcotics: The insurer is not liable for any loss sustained

3-22  or contracted in consequence of the insured’s being intoxicated or under

3-23  the influence of any narcotic unless administered on the advice of a

3-24  physician.

3-25    [2.  If the insurer includes the provision set forth in subsection 1, he

3-26  shall also provide that such provision in no way affects benefits payable for

3-27  the treatment of alcohol or drug abuse, as required by subsection 9 of NRS

3-28  689A.030.]

3-29    Sec. 5.  NRS 689A.0404, 689A.0405, 689A.041, 689A.0413,

3-30  689A.0415, 689A.0417, 689A.0423, 689A.0425, 689A.0427, 689A.043,

3-31  689A.045, 689A.0455 and 689A.046 are hereby repealed.

 

3-32  LEADLINES OF REPEALED SECTIONS

 

3-33    689A.0404  Coverage for use of certain drugs for treatment of

3-34   cancer.

3-35    689A.0405  Coverage for cytologic screening test and

3-36   mammograms for certain women.

3-37    689A.041  Coverage for mastectomy and reconstructive surgery.

3-38    689A.0413  Coverage for certain gynecological or obstetrical

3-39   services without authorization or referral from primary care

3-40   physician.

3-41    689A.0415  Coverage for drug or device for contraception and for

3-42   hormone replacement therapy in certain circumstances; prohibited

3-43   actions by insurer; exceptions.

4-1    689A.0417  Coverage for health care services related to

4-2  contraceptives and hormone replacement therapy in certain

4-3   circumstances; prohibited actions by insurer; exceptions.

4-4    689A.0423  Coverage for treatment of certain inherited metabolic

4-5   diseases.

4-6    689A.0425  Individual health benefit plan that includes coverage

4-7   for maternity care and pediatric care: Requirement to allow

4-8   minimum stay in hospital in connection with childbirth; prohibited

4-9   acts.

4-10    689A.0427  Coverage for management and treatment of diabetes.

4-11    689A.043  Coverage of newly born and adopted children and

4-12   children placed for adoption.

4-13    689A.045  Termination of coverage on dependent child.

4-14    689A.0455  Coverage for treatment of conditions relating to severe

4-15   mental illness.

4-16    689A.046  Benefits for treatment of abuse of alcohol or drugs.

 

4-17  H