orate the requirements of subsection 3 in approving or disapproving an evidence of coverage required by subsection 2. (Added to NRS by 1973, 1251; A 1975, 1852; 1979, 1182; 1983, 2041) NRS 695C.1703 Coverage for prescription drugs: Provision of notice and information regarding use of formulary. 1. A health maintenance organization or insurer that offers or issues evidence of coverage which provides coverage for prescription drugs shall include with any evidence of that coverage provided to an enrollee, notice of whether a formulary is used and, if so, of the opportunity to secure information regarding the formulary from the organization or insurer pursuant to subsection 2. The notice required by this subsection must: (a) Be in a language that is easily understood and in a format that is easy to understand; (b) Include an explanation of what a formulary is; and (c) If a formulary is used, include: (1) An explanation of: (I) How often the contents of the formulary are reviewed; and (II) The procedure and criteria for determining which prescription drugs are included in and excluded from the formulary; and (2) The telephone number of the organization or insurer for making a request for information regarding the formulary pursuant to subsection 2. 2. If a health maintenance organization or insurer offers or issues evidence of coverage which provides coverage for prescription drugs and a formulary is used, the organization or insurer shall: (a) Provide to any enrollee or participating provider of health care upon request: (1) Information regarding whether a specific drug is included in the formulary. (2) Access to the most current list of prescription drugs in the formulary, organized by major therapeutic category, with an indication of whether any listed drugs are preferred over other listed drugs. If more than one formulary is maintained, the organization or insurer shall notify the requester that a choice of formulary lists is available. (b) Notify each person who requests information regarding the formulary, that the inclusion of a drug in the formulary does not guarantee that a provider of health care will prescribe that drug for a particular medical condition. (Added to NRS by 2001, 863) NRS 695C.1705 Group health care plan issued to replace discontinued policy or coverage: Requirements; notice of reduction of benefits; statement of benefits; applicability to self-insured employer. Except as otherwise provided in the provisions of NRS 689B.340 to 689B.590, inclusive, and chapter 689C of NRS relating to the portability and accountability of health insurance: 1. A group health care plan issued by a health maintenance organization to replace any discontinued policy or coverage for group health insurance must: (a) Provide coverage for all persons who were covered under the previous policy or coverage on the date it was discontinued; and (b) Except as otherwise provided in subsection 2, provide benefits which are at least as extensive as the benefits provided by the previous policy or coverage, except that benefits may be reduced or excluded to the extent that such a reduction or exclusion was permissible under the terms of the previous policy or coverage, if that plan is issued within 60 days after the date on which the previous policy or coverage was discontinued. 2. If an employer obtains a replacement plan pursuant to subsection 1 to cover his employees, any benefits provided by the previous policy or coverage may be reduced if notice of the reduction is given to his employees pursuant to NRS 608.1577. 3. Any health maintenance organization which issues a replacement plan pursuant to subsection 1 may submit a written request to the insurer which provided the previous policy or coverage for a statement of benefits which were provided under that policy or coverage. Upon receiving such a request, the insurer shall give a written statement to the organization indicating what benefits were provided and what exclusions or reductions were in effect under the previous policy or coverage. 4. If an employee or enrollee was a recipient of benefits under the coverage provided pursuant to NRS 695C.1709, he is not entitled to have issued to him by a health maintenance organization a replacement plan unless he has reported for his normal employment for a period of 90 consecutive days after last being eligible to receive any benefits under the coverage provided pursuant to NRS 695C.1709. 5. The provisions of this section apply to a self-insured employer who provides health benefits to his employees and replaces those benefits with a group health care plan issued by a health maintenance organization. (Added to NRS by 1987, 850; A 1989, 1253; 1997, 2958) NRS 695C.1707 Required provision for continuation of coverage. Any policy of group insurance to which an enrollee is entitled under a health care plan provided by a health maintenance organization must contain a provision which permits the continuation of coverage pursuant to the provisions of NRS 689B.245 to 689B.249, inclusive, 689B.340 to 689B.590, inclusive, and chapter 689C of NRS relating to the portability and accountability of health insurance. (Added to NRS by 1987, 2235; A 1997, 2959) NRS 695C.1709 Required provision concerning coverage for enrollee on leave without pay as result of total disability. 1. As used in this section, “total disability” and “totally disabled” mean the continuing inability of the enrollee, because of an injury or illness, to perform substantially the duties related to his employment for which he is otherwise qualified. 2. No policy of group insurance to which an enrollee is entitled under a health care plan provided by a health maintenance organization may be delivered or issued for delivery in this state unless it provides continuing coverage for an enrollee and his dependents who are otherwise covered by the policy while the enrollee is on leave without pay as a result of a total disability. The coverage must be for any injury or illness suffered by the enrollee which is not related to the total disability or for any injury or illness suffered by his dependent. The coverage must be equal to or greater than the coverage otherwise provided by the policy. 3. The coverage required pursuant to subsection 2 must continue until: (a) The date on which the employment of the enrollee is terminated; (b) The date on which the enrollee obtains another policy of health insurance; (c) The date on which the policy of group insurance is terminated; or (d) After a period of 12 months in which benefits under such coverage are provided to the enrollee, whichever occurs first. (Added to NRS by 1989, 1253) NRS 695C.171 Required provision concerning coverage relating to mastectomy. 1. A health maintenance plan which provides coverage for the surgical procedure known as a mastectomy must also provide commensurate coverage for: (a) Reconstruction of the breast on which the mastectomy has been performed; (b) Surgery and reconstruction of the other breast to produce a symmetrical structure; and (c) Prostheses and physical complications for all stages of mastectomy, including lymphedemas. 2. The provision of services must be determined by the attending physician and the patient. 3. The plan or issuer may require deductibles and coinsurance payments if they are consistent with those established for other benefits. 4. Written notice of the availability of the coverage must be given upon enrollment and annually thereafter. The notice must be sent to all participants: (a) In the next mailing made by the plan or issuer to the participant or beneficiary; or (b) As part of any annual information packet sent to the

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