may require a health maintenance organization to provide evidence which demonstrates that the health maintenance organization has substantially complied with the requirements set forth in this section, including, without limitation, payment within 30 days of at least 95 percent of approved claims or at least 90 percent of the total dollar amount for approved claims. 8. If the Commissioner determines that a health maintenance organization is not in substantial compliance with the requirements set forth in this section, the Commissioner may require the health maintenance organization to pay an administrative fine in an amount to be determined by the Commissioner. Upon a second or subsequent determination that a health maintenance organization is not in substantial compliance with the requirements set forth in this section, the Commissioner may suspend or revoke the certificate of authority of the health maintenance organization. (Added to NRS by 1991, 1331; A 1999, 1651; 2001, 2735; 2003, 3368) NRS 695C.187 Schedule for payment of claims: Mandatory inclusion in arrangements for provision of health care. 1. A health maintenance organization shall not: (a) Enter into any contract or agreement, or make any other arrangements, with a provider for the provision of health care; or (b) Employ a provider pursuant to a contract, an agreement or any other arrangement to provide health care, unless the contract, agreement or other arrangement specifically provides that the health maintenance organization and provider agree to the schedule for the payment of claims set forth in NRS 695C.185. 2. Any contract, agreement or other arrangement between a health maintenance organization and a provider that is entered into or renewed on or after October 1, 2001, that does not specifically include a provision concerning the schedule for the payment of claims as required by subsection 1 shall be deemed to conform with the requirements of subsection 1 by operation of law. (Added to NRS by 2001, 2734) NRS 695C.190 Commissioner may require submission of information. The Commissioner may require the submission of whatever relevant information he deems necessary in determining whether to approve or disapprove a filing made pursuant to NRS 695C.170 to 695C.200, inclusive. (Added to NRS by 1973, 1252; A 1985, 1448; 1989, 1274) NRS 695C.193 Summary of coverage: Contents of disclosure; approval by Commissioner; regulations. 1. The Commissioner shall adopt regulations which require a health maintenance organization to file with the Commissioner, for his approval, a disclosure summarizing the coverage provided by each health care plan offered by the health maintenance organization. The disclosure must include: (a) Any significant exception, reduction or limitation that applies to the plan; and (b) Any other information, that the Commissioner finds necessary to provide for full and fair disclosure of the provisions of the plan. 2. The disclosure must be written in language which is easily understood and must include a statement that the disclosure is a summary of the plan only, and that the evidence of coverage itself should be read to determine the governing contractual provisions. 3. The Commissioner shall not approve any proposed disclosure submitted to him pursuant to this section which does not comply with the requirements of this section and the applicable regulations. (Added to NRS by 1989, 1253) NRS 695C.195 Summary of coverage: Copy to be provided before policy issued; policy not to be offered unless summary approved by Commissioner. A health maintenance organization shall provide to the group policyholder to whom it offers a health care plan a copy of the disclosure approved for that plan pursuant to NRS 695C.193 before the plan is issued. A health maintenance organization shall not offer a health care plan unless the disclosure for that plan has been approved by the Commissioner. (Added to NRS by 1989, 1253) NRS 695C.200 Approval of forms and schedules. The Commissioner shall within a reasonable period approve any form if the requirements of NRS 695C.170 are met and any schedule of charges if the requirements of NRS 695C.180 are met. It is unlawful to issue such form or to use such schedule of charges until approved. If the Commissioner disapproves such filing, he shall notify the filer. In the notice, the Commissioner shall specify the reasons for his disapproval. A hearing will be granted within 90 days after a request in writing by the person filing. (Added to NRS by 1973, 1251) NRS 695C.201 Offering policy of health insurance for purposes of establishing health savings account. A health maintenance organization may, subject to regulation by the Commissioner, offer a policy of health insurance that has a high deductible and is in compliance with 26 U.S.C. § 223 for the purposes of establishing a health savings account. (Added to NRS by 2005, 2158) NRS 695C.203 Denying coverage solely because person was victim of domestic violence prohibited. A health maintenance organization shall not deny a claim, refuse to issue a policy or cancel a policy solely because the claim involves an act that constitutes domestic violence pursuant to NRS 33.018, or because the person applying for or covered by the policy was the victim of such an act of domestic violence, regardless of whether the insured or applicant contributed to any loss or injury. (Added to NRS by 1997, 1096) NRS 695C.205 Denying coverage solely because insured was intoxicated or under the influence of controlled substance prohibited; exceptions. [Effective July 1, 2006.] 1. Except as otherwise provided in subsection 2, a health maintenance organization shall not: (a) Deny a claim under a health care plan solely because the claim involves an injury sustained by an enrollee as a consequence of being intoxicated or under the influence of a controlled substance. (b) Cancel participation under a health care plan solely because an enrollee has made a claim involving an injury sustained by the enrollee as a consequence of being intoxicated or under the influence of a controlled substance. (c) Refuse participation under a health care plan to an eligible applicant solely because the applicant has made a claim involving an injury sustained by the applicant as a consequence of being intoxicated or under the influence of a controlled substance. 2. The provisions of this section do not prohibit a health maintenance organization from enforcing a provision included in a health care plan to: (a) Deny a claim which involves an injury to which a contributing cause was the insured’s commission of or attempt to commit a felony; (b) Cancel participation under a health care plan solely because of such a claim; or (c) Refuse participation under a health care plan to an eligible applicant solely because of such a claim. (Added to NRS by 2005, 2345, effective July 1, 2006) NRS 695C.207 Requiring or using information concerning genetic testing. 1. A health maintenance organization shall not: (a) Require an enrollee or any member of his family to take a genetic test; (b) Require an enrollee to disclose whether he or any member of his family has taken a genetic test or the genetic information of the enrollee or a member of his family; or (c) Determine the rates or any other aspect of the coverage or benefits for health care provided to an enrollee based on: (1) Whether the enrollee or any member of his family has taken a genetic test; or (2) Any genetic information of the enrollee or any member of his family. 2. As used in this section: (a) “Genetic information” means any information that is obtained from a genetic test. (b) “Genetic test” means a test, including a laboratory test which uses de

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