Offering policy of health insurance for purposes of establishing health savings account. NRS 695C.203 Denying coverage solely because person was victim of domestic violence prohibited. NRS 695C.205 Denying coverage solely because insured was intoxicated or under the influence of controlled substance prohibited; exceptions. [Effective July 1, 2006.] NRS 695C.207 Requiring or using information concerning genetic testing. NRS 695C.210 Annual report and financial statement required; administrative penalty for failure to file report or statement. NRS 695C.220 Applications, filings and reports open to public inspection. NRS 695C.230 Fees. NRS 695C.240 Information required to be available for inspection. NRS 695C.250 Open enrollment. NRS 695C.260 Complaint system. NRS 695C.265 Required procedure for arbitration of disputes concerning independent medical evaluations. NRS 695C.267 Provision requiring binding arbitration authorized; procedures for arbitration; declaratory relief. NRS 695C.270 Bond required; waiver. NRS 695C.275 Commissioner to adopt regulations for licensing of provider-sponsored organizations. NRS 695C.280 Commissioner authorized to adopt regulations for licensing of agents or brokers. NRS 695C.290 Insurance company may establish or contract with health maintenance organization. NRS 695C.300 Prohibited practices. NRS 695C.310 Examinations. NRS 695C.311 Periodic examination by Commissioner to determine financial condition of health maintenance organization. NRS 695C.313 Financial examination: Procedure; appointment of examiner; maintenance and use of records; penalty for obstruction or interference. NRS 695C.315 Financial examination: Payment of expense. NRS 695C.317 Statutory procedures required for examination and hearing. NRS 695C.320 Rehabilitation, liquidation or conservation. NRS 695C.325 Authorization to offer health care plan to small employer for purpose of establishing medical savings accounts. NRS 695C.330 Disciplinary proceedings: Grounds; effect of suspension or revocation. NRS 695C.340 Disciplinary proceedings: Notice; hearing; judicial review. NRS 695C.350 Violations: Remedies; penalties. _________ NRS 695C.010 Short title. This chapter may be cited as the Nevada Health Maintenance Organization Act. (Added to NRS by 1973, 1246) NRS 695C.020 Legislative declaration. The Legislature hereby declares that the rising cost of health services in recent years has led government agencies, private organizations, and legislative bodies to seek alternatives to the traditional medical delivery system which would provide improved health care and would provide such health care at a lower cost. The health maintenance organization is a concept which has received much attention as one means through which an improvement in delivery might be achieved. The Legislature therefore enacts this chapter to carry out this objective. (Added to NRS by 1973, 1246) NRS 695C.030 Definitions. As used in this chapter, unless the context otherwise requires: 1. “Comprehensive health care services” means medical services, dentistry, drugs, psychiatric and optometric and all other care necessary for the delivery of services to the consumer. 2. “Enrollee” means a natural person who has been voluntarily enrolled in a health care plan. 3. “Evidence of coverage” means any certificate, agreement or contract issued to an enrollee setting forth the coverage to which he is entitled. 4. “Health care plan” means any arrangement whereby any person undertakes to provide, arrange for, pay for or reimburse any part of the cost of any health care services and at least part of the arrangement consists of arranging for or the provision of health care services paid for by or on behalf of the enrollee on a periodic prepaid basis. 5. “Health care services” means any services included in the furnishing to any natural person of medical or dental care or hospitalization or incident to the furnishing of such care or hospitalization, as well as the furnishing to any person of any other services for the purpose of preventing, alleviating, curing or healing human illness or injury. 6. “Health maintenance organization” means any person which provides or arranges for provision of a health care service or services and is responsible for the availability and accessibility of such service or services to its enrollees, which services are paid for or on behalf of the enrollees on a periodic prepaid basis without regard to the dates health services are rendered and without regard to the extent of services actually furnished to the enrollees, except that supplementing the fixed prepayments by nominal additional payments for services in accordance with regulations adopted by the Commissioner shall not be deemed to render the arrangement not to be on a prepaid basis. A health maintenance organization, in addition to offering health care services, may offer indemnity or service benefits provided through insurers or otherwise. 7. “Provider” means any physician, hospital or other person who is licensed or otherwise authorized in this state to furnish health care services. (Added to NRS by 1973, 1246; A 1985, 538; 1997, 1629) NRS 695C.050 Applicability of certain provisions. 1. Except as otherwise provided in this chapter or in specific provisions of this title, the provisions of this title are not applicable to any health maintenance organization granted a certificate of authority under this chapter. This provision does not apply to an insurer licensed and regulated pursuant to this title except with respect to its activities as a health maintenance organization authorized and regulated pursuant to this chapter. 2. Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, must not be construed to violate any provision of law relating to solicitation or advertising by practitioners of a healing art. 3. Any health maintenance organization authorized under this chapter shall not be deemed to be practicing medicine and is exempt from the provisions of chapter 630 of NRS. 4. The provisions of NRS 695C.110, 695C.125, 695C.1691, 695C.1693, 695C.170 to 695C.200, inclusive, 695C.250 and 695C.265 do not apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the state plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services. This subsection does not exempt a health maintenance organization from any provision of this chapter for services provided pursuant to any other contract. 5. The provisions of NRS 695C.1694, 695C.1695 and 695C.1731 apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the state plan for Medicaid. (Added to NRS by 1973, 1258; A 1983, 2030; 1995, 2720; 1997, 311, 1528; 1999, 418, 420, 1945, 2004, 2241; 2001, 141, 144, 864, 2734; 2003, 1335, 3366, 3531) NRS 695C.055 Applicability of certain other provisions. 1. The provisions of NRS 449.465, 679A.200, 679B.700, subsections 2, 4, 18, 19 and 32 of NRS 680B.010, NRS 680B.020 to 680B.060, inclusive, and chapters 686A and 695G of NRS apply to a health maintenance organization. 2. For the purposes of subsection 1, unless the context requires that a provision apply only to insurers, any reference in those sections to “insurer” must be replaced by “health maintenance organization.” (Added to NRS by 1987, 469; A 1995, 472, 988; 1997, 299, 311, 2958, 2962; 2001,

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