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Vegas Law

t vary because of the health status, claims experience, industry, occupation or geographic area of the individual. 4. An individual carrier shall not terminate, fail to renew, or limit its contract or agreement of representation with a producer for any reason related to the health status, claims experience, industry, occupation or geographic location of an individual at the time that the health benefit plan is issued to or renewed by the individual placed by the producer with the individual carrier. 5. A denial by an individual carrier of an application for coverage from an eligible person must be in writing and must state the reason for the denial. 6. The Commissioner may adopt regulations that set forth additional standards to provide for the fair marketing and broad availability of health benefit plans to eligible persons in this state. 7. A violation of any provision of this section by an individual carrier may constitute an unfair trade practice for the purposes of chapter 686A of NRS. 8. The provisions of this section apply to a third-party administrator if the third-party administrator enters into a contract, agreement or other arrangement with an individual carrier to provide administrative, marketing or other services related to the offering of a health benefit plan to eligible persons in this state. 9. Nothing in this section interferes with the right and responsibility of a broker to advise and represent the best interests of an eligible person who is seeking health insurance coverage from an individual carrier. (Added to NRS by 1997, 2896) Individual Health Insurance Coverage NRS 689A.715 Requirements for employee welfare benefit plan for providing benefits for employees of more than one employer. 1. An employee welfare benefit plan for providing benefits for employees of more than one employer under which individual health insurance coverage is provided must comply with the provisions of NRS 679B.139 and 689A.470 to 689A.740, inclusive, and the regulations adopted by the Commissioner pursuant thereto. 2. As used in this section, the term “employee welfare benefit plan for providing benefits for employees of more than one employer” is intended to be equivalent to the term “employee welfare benefit plan which is a multiple employer welfare arrangement” as used in federal statutes and regulations. (Added to NRS by 1997, 2890) NRS 689A.720 Written certification of coverage required for determining period of creditable coverage accumulated by person; provision of certificate to insured. 1. To determine the period of creditable coverage of a person, a health insurance issuer offering individual health insurance coverage shall provide written certification of coverage on a form prescribed by the Commissioner to the person that certifies: (a) The period of creditable coverage of the person under the individual health insurance coverage; and (b) The date that a substantially completed application was received by the health insurance issuer from the person for individual health insurance coverage. 2. The certification of coverage must be provided to the insured: (a) At the time that the insured ceases to be covered under the individual health insurance coverage or otherwise becomes covered under any provision of the Consolidated Omnibus Budget Reconciliation Act of 1985, as that act existed on July 16, 1997, relating to the continuation of coverage; (b) If the insured becomes covered under such a provision, at the time that the insured ceases to be covered by that provision; and (c) Upon the request of the insured, if the request is made not later than 24 months after the date on which the insured ceased to be covered as described in paragraphs (a) and (b). (Added to NRS by 1997, 2897) Bona Fide Associations NRS 689A.725 Requirements for plan for coverage. For the purposes of NRS 689A.470 to 689A.740, inclusive, a plan for coverage of a bona fide association must: 1. Conform with NRS 689A.680 to 689A.700, inclusive, concerning rates. 2. Provide for the renewability of coverage for members of the bona fide association, and their dependents, if such coverage meets the criteria set forth in NRS 689A.630. 3. Provide for the availability of coverage for members of the bona fide association, and their dependents, if such coverage conforms with NRS 689A.640, except that the bona fide association is not required to offer basic and standard health benefit plan coverage to its members or their dependents. 4. Conform with subsection 1 of NRS 689A.660, relating to preexisting conditions. (Added to NRS by 1997, 2889) NRS 689A.730 Producer may only sign up eligible persons if eligible persons are actively engaged in or related to association. For the purposes of providing coverage under a health benefit plan pursuant to the provisions of NRS 689A.470 to 689A.740, inclusive, a producer may only market association memberships to eligible persons, accept applications for such membership, or sign up such members in a bona fide association if the eligible persons being marketed are actively engaged in, or directly related to, the bona fide association. (Added to NRS by 1997, 2889) Miscellaneous Provisions NRS 689A.735 Report to Commissioner by trustee of medical savings account. On or before July 1 of each year, a trustee of a medical savings account established and maintained in accordance with 26 U.S.C. § 220 shall report to the Commissioner the number of medical savings accounts administered by the trustee during the previous calendar year. (Added to NRS by 1997, 2899) NRS 689A.740 Regulations. The Commissioner shall adopt regulations as necessary to carry out the provisions of NRS 689A.470 to 689A.740, inclusive. (Added to NRS by 1997, 2896) SYSTEM FOR RESOLVING COMPLAINTS OF INSUREDS NRS 689A.745 Approval; requirements; examination. 1. Except as otherwise provided in subsection 4, each insurer that issues a policy of health insurance in this State shall establish a system for resolving any complaints of an insured concerning health care services covered under the policy. The system must be approved by the Commissioner in consultation with the State Board of Health. 2. A system for resolving complaints established pursuant to subsection 1 must include an initial investigation, a review of the complaint by a review board and a procedure for appealing a determination regarding the complaint. The majority of the members on a review board must be insureds who receive health care services pursuant to a policy of health insurance issued by the insurer. 3. The Commissioner or the State Board of Health may examine the system for resolving complaints established pursuant to subsection 1 at such times as either deems necessary or appropriate. 4. Each insurer that issues a policy of health insurance in this State that provides, delivers, arranges for, pays for or reimburses any cost of health care services through managed care shall provide a system for resolving any complaints of an insured concerning those health care services that complies with the provisions of NRS 695G.200 to 695G.310, inclusive. (Added to NRS by 1997, 307; A 2003, 774) NRS 689A.750 Annual report; insurer to maintain records of complaints concerning something other than health care services. 1. Each insurer that issues a policy of health insurance in this State shall submit to the Commissioner and the State Board of Health an annual report regarding its system for resolving complaints established pursuant to subsection 1 of NRS 689A.745 on a form prescribed by the Commissioner in consultation with the State Board of Health which includes, without limitation: (a) A description of the procedures used for resolving any complaints of an insured; (b) The total number of complain

Vegas Law




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