h is medically necessary because of the development of new techniques and treatment for diabetes. (c) “Diabetes” includes type I, type II and gestational diabetes. (Added to NRS by 1997, 745) NRS 695C.173 Required provision concerning coverage for newly born and adopted children and children placed for adoption. 1. All individual and group health care plans which provide coverage for a family member of the enrollee must as to such coverage provide that the health care services applicable for children are payable with respect to: (a) A newly born child of the enrollee from the moment of birth; (b) An adopted child from the date the adoption becomes effective, if the child was not placed in the home before adoption; and (c) A child placed with the enrollee for the purpose of adoption from the moment of placement as certified by the public or private agency making the placement. The coverage of such a child ceases if the adoption proceedings are terminated as certified by the public or private agency making the placement. The plans must provide the coverage specified in subsection 3, and must not exclude premature births. 2. The evidence of coverage may require that notification of: (a) The birth of a newly born child; (b) The effective date of adoption of a child; or (c) The date of placement of a child for adoption, and payments of the required charge, if any, must be furnished to the health maintenance organization within 31 days after the date of birth, adoption or placement for adoption in order to have the coverage continue beyond the 31-day period. 3. The coverage for newly born and adopted children and children placed for adoption consists of preventive health care services as well as coverage of injury or sickness, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities and, within the limits of the policy, necessary transportation costs from place of birth to the nearest specialized treatment center under major medical policies, and with respect to basic policies to the extent such costs are charged by the treatment center. 4. A health maintenance organization shall not restrict the coverage of a dependent child adopted or placed for adoption solely because of a preexisting condition the child has at the time he would otherwise become eligible for coverage pursuant to that plan. Any provision relating to an exclusion for a preexisting condition must comply with NRS 689B.500 or 689C.190, as appropriate. 5. For covered services provided to the child, the health maintenance organization shall reimburse noncontracted providers of health care to an amount equal to the average amount of payment for which the organization has agreements, contracts or arrangements for those covered services. (Added to NRS by 1975, 1110; A 1989, 741; 1995, 2436; 1997, 2959) NRS 695C.1731 Required provision concerning coverage for screening for colorectal cancer. 1. A health care plan issued by a health maintenance organization that provides coverage for the treatment of colorectal cancer must provide coverage for colorectal cancer screening in accordance with: (a) The guidelines concerning colorectal cancer screening which are published by the American Cancer Society; or (b) Other guidelines or reports concerning colorectal cancer screening which are published by nationally recognized professional organizations and which include current or prevailing supporting scientific data. 2. An evidence of coverage for a health care plan subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2003, has the legal effect of including the coverage required by this section, and any provision of the evidence of coverage that conflicts with the provisions of this section is void. (Added to NRS by 2003, 1335) NRS 695C.1733 Required provision concerning coverage for certain drugs for treatment of cancer. Except as otherwise provided in NRS 695C.1693: 1. No evidence of coverage that provides coverage for a drug approved by the Food and Drug Administration for use in the treatment of an illness, disease or other medical condition may be delivered or issued for delivery in this state unless the evidence of coverage includes coverage for any other use of the drug for the treatment of cancer, if that use is: (a) Specified in the most recent edition of or supplement to: (1) The United States Pharmacopoeia Drug Information; or (2) The American Hospital Formulary Service Drug Information; or (b) Supported by at least two articles reporting the results of scientific studies that are published in scientific or medical journals, as defined in 21 C.F.R. § 99.3. 2. The coverage required pursuant to this section: (a) Includes coverage for any medical services necessary to administer the drug to the enrollee. (b) Does not include coverage for any: (1) Experimental drug used for the treatment of cancer if that drug has not been approved by the Food and Drug Administration; or (2) Use of a drug that is contraindicated by the Food and Drug Administration. 3. Any evidence of coverage subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1999, has the legal effect of including the coverage required by this section, and any provision of the evidence of coverage that conflicts with the provisions of this section is void. (Added to NRS by 1999, 761; A 2003, 3531) NRS 695C.1734 Required provision concerning coverage for prescription drug previously approved for medical condition of enrollee. 1. Except as otherwise provided in this section, evidence of coverage which provides coverage for prescription drugs must not limit or exclude coverage for a drug if the drug: (a) Had previously been approved for coverage by the health maintenance organization or insurer for a medical condition of an enrollee and the enrollee’s provider of health care determines, after conducting a reasonable investigation, that none of the drugs which are otherwise currently approved for coverage are medically appropriate for the enrollee; and (b) Is appropriately prescribed and considered safe and effective for treating the medical condition of the enrollee. 2. The provisions of subsection 1 do not: (a) Apply to coverage for any drug that is prescribed for a use that is different from the use for which that drug has been approved for marketing by the Food and Drug Administration; (b) Prohibit: (1) The health maintenance organization or insurer from charging a deductible, copayment or coinsurance for the provision of benefits for prescription drugs to the enrollee or from establishing, by contract, limitations on the maximum coverage for prescription drugs; (2) A provider of health care from prescribing another drug covered by the evidence of coverage that is medically appropriate for the enrollee; or (3) The substitution of another drug pursuant to NRS 639.23286 or 639.2583 to 639.2597, inclusive; or (c) Require any coverage for a drug after the term of the evidence of coverage. 3. Any provision of an evidence of coverage subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 2001, which is in conflict with this section is void. (Added to NRS by 2001, 863; A 2003, 2300) NRS 695C.1735 Required provision concerning coverage for cytologic screening tests and mammograms for certain women. 1. A health maintenance plan must provide coverage for benefits payable for expenses incurred for: (a) An annual cytologic screening test for women 18 years of age or older; (b) A baseline

Vegas Law