Nevada · Statutes
Chapter 695G
99 sections
99 sections
- Nev. Rev. Stat. § 695G.010Definitions.
- Nev. Rev. Stat. § 695G.012“Adverse determination” defined.
- Nev. Rev. Stat. § 695G.014“Authorized representative” defined.
- Nev. Rev. Stat. § 695G.015“Benefits” defined.
- Nev. Rev. Stat. § 695G.016“Clinical peer” defined.
- Nev. Rev. Stat. § 695G.017“Covered person” defined.
- Nev. Rev. Stat. § 695G.019“Health benefit plan” defined.
- Nev. Rev. Stat. § 695G.020“Health care plan” defined.
- Nev. Rev. Stat. § 695G.022“Health care services” defined.
- Nev. Rev. Stat. § 695G.024“Health carrier” defined.
- Nev. Rev. Stat. § 695G.026“Independent review organization” defined.
- Nev. Rev. Stat. § 695G.030“Insured” defined.
- Nev. Rev. Stat. § 695G.040“Managed care” defined.
- Nev. Rev. Stat. § 695G.050“Managed care organization” defined.
- Nev. Rev. Stat. § 695G.053“Medical or scientific evidence” defined.
- Nev. Rev. Stat. § 695G.055“Medically necessary” defined.
- Nev. Rev. Stat. § 695G.060“Primary care physician” defined.
- Nev. Rev. Stat. § 695G.070“Provider of health care” defined.
- Nev. Rev. Stat. § 695G.080“Utilization review” defined.
- Nev. Rev. Stat. § 695G.085“Utilization review organization” defined.
- Nev. Rev. Stat. § 695G.090Applicability of chapter and other provisions.
- Nev. Rev. Stat. § 695G.095Offering policy of health insurance for purposes of establishing health savings account.
- Nev. Rev. Stat. § 695G.100Documents filed with Commissioner treated as public record; exception.
- Nev. Rev. Stat. § 695G.110Medical director required to be physician licensed in this State.
- Nev. Rev. Stat. § 695G.120Utilization review: Development and maintenance of written policies and procedures for use by managed care organization and subcontractors.
- Nev. Rev. Stat. § 695G.125Contracts with certain federally qualified health centers.
- Nev. Rev. Stat. § 695G.127Contracts between managed care organization and provider of health care: Managed care organization required to use form to obtain information on provider of health care; modification; submission by managed care organization of schedule of payments to provider.
- Nev. Rev. Stat. § 695G.130Report regarding methods for reviewing quality of health care services: Form of report; availability for public inspection.
- Nev. Rev. Stat. § 695G.140Certain persons in managed care organization in fiduciary relationship to insured.
- Nev. Rev. Stat. § 695G.150Authorization of recommended and covered health care services required.
- Nev. Rev. Stat. § 695G.155Managed care organization required to offer and issue plan regardless of health status of persons; prohibited acts; authority to include wellness program in plan that offers discounts based on health status under certain circumstances.
- Nev. Rev. Stat. § 695G.160Written criteria concerning coverage of health care services and standards for quality of health care services.
- Nev. Rev. Stat. § 695G.162Required provision concerning coverage for services provided through telehealth to same extent as though provided in person or by other means; required provision concerning reimbursement for certain services provided through telehealth in same amount as though provided in person or by other means; prohibited acts; requirements for certain managed care organizations concerning teledentistry.
- Nev. Rev. Stat. § 695G.163Plan covering prescription drugs: Provision of notice and information regarding use of formulary.
- Nev. Rev. Stat. § 695G.164Required provision in certain plans concerning coverage for continued medical treatment; exceptions; regulations.
- Nev. Rev. Stat. § 695G.166Plan covering prescription drugs prohibited from limiting or excluding coverage for prescription drug previously approved for medical condition of insured; exceptions.
- Nev. Rev. Stat. § 695G.167Plan covering treatment of cancer through use of chemotherapy: Prohibited acts related to orally administered chemotherapy.
- Nev. Rev. Stat. § 695G.168Required provision in plan covering treatment of colorectal cancer concerning coverage for colorectal cancer screening.
- Nev. Rev. Stat. § 695G.170Required provision concerning coverage for medically necessary emergency services at any hospital; prohibited acts.
- Nev. Rev. Stat. § 695G.171Required provision concerning coverage for certain tests and vaccines relating to human papillomavirus; prohibited acts.
- Nev. Rev. Stat. § 695G.172Plan covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products.
- Nev. Rev. Stat. § 695G.173Required provision concerning coverage for certain treatment received as part of clinical trial or study for treatment of cancer or chronic fatigue syndrome; authority of managed care organization to require certain information; immunity from liability.
- Nev. Rev. Stat. § 695G.174Required provision concerning coverage for management and treatment of sickle cell disease and its variants; plan covering prescription drugs required to provide coverage for medically necessary prescription drugs to treat sickle cell disease and its variants.
- Nev. Rev. Stat. § 695G.175Contracts for provision of emergency medical services, outpatient services or inpatient services with hospital or other facility that provides acute care in smaller city or county: Prohibited acts.
- Nev. Rev. Stat. § 695G.176Plan covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by managed care organization if insured is person with disability.
- Nev. Rev. Stat. § 695G.177Required provision in plans covering treatment of prostate cancer concerning coverage for prostate cancer screening; prohibited acts.
- Nev. Rev. Stat. § 695G.180Quality assurance program: Requirements; written description; informing providers; necessary staff; review; responsibility for activities.
- Nev. Rev. Stat. § 695G.190Quality improvement committee: Administration; duties.
- Nev. Rev. Stat. § 695G.200Establishment; approval; requirements; assistance for persons filing complaints; examination.
- Nev. Rev. Stat. § 695G.210Review board; appeal; right to expedited review of complaint; notice to insured.
- Nev. Rev. Stat. § 695G.220Annual report; managed care organization required to maintain records of and report complaints concerning something other than health care services.
- Nev. Rev. Stat. § 695G.230Written notice required by carrier to insured explaining rights of insureds regarding decision to deny coverage; written notice to insured when health carrier denies coverage of health care service.
- Nev. Rev. Stat. § 695G.241Circumstances under which adverse determination may be subject to external review; exceptions.
- Nev. Rev. Stat. § 695G.243Applicability.
- Nev. Rev. Stat. § 695G.245Written notice of right to request external review; form; contents.
- Nev. Rev. Stat. § 695G.247Requests for external review to be in writing; exception; form and content.
- Nev. Rev. Stat. § 695G.251Request for review; assignment of independent review organization; provision of documents relating to adverse determination to independent review organization.
- Nev. Rev. Stat. § 695G.261Review of documents by independent review organization; decision of independent review organization.
- Nev. Rev. Stat. § 695G.271Expedited approval or denial of request.
- Nev. Rev. Stat. § 695G.275Experimental or investigational health care service or treatment: Request for external review; request for expedited external review.
- Nev. Rev. Stat. § 695G.280Basis for decision of independent review organization.
- Nev. Rev. Stat. § 695G.290Decision in favor of covered person binding on health carrier; limitation of liability; cost for independent review organization.
- Nev. Rev. Stat. § 695G.300Submission of complaint of covered person to independent review organization.
- Nev. Rev. Stat. § 695G.303Independent review organization and health carrier required to maintain written records; submission of report upon request.
- Nev. Rev. Stat. § 695G.307Health carrier required to provide description of external review procedures; format; contents.
- Nev. Rev. Stat. § 695G.310Annual report; requirements.
- Nev. Rev. Stat. § 695G.320Provision of health care services to recipients of Medicaid or enrollees in Children’s Health Insurance Program: Requirement to contract with hospital with certain endorsement for inclusion in network of providers.
- Nev. Rev. Stat. § 695G.325Provision of health care services to recipients of Medicaid: Notice to recipients if Nevada Health Authority obtains waiver to provide dental care to persons with diabetes; coordination to ensure receipt of such care.
- Nev. Rev. Stat. § 695G.330Provision of health care services to recipients of Medicaid: Coverage for antipsychotic or anticonvulsant medication that is not on list of preferred prescription drugs required upon failure of drug on list to treat condition.
- Nev. Rev. Stat. § 695G.340Approval or denial; payment of claim and interest; request for additional information; award of costs and attorney’s fees; compliance with requirements; imposition of administrative fine or suspension or revocation of certificate of authority for failure to comply; report of compliance by organization.
- Nev. Rev. Stat. § 695G.400Managed care organization prohibited from restricting or interfering with certain communications between provider of health care and patient.
- Nev. Rev. Stat. § 695G.405Managed care organization prohibited from denying coverage solely because applicant or insured was intoxicated or under the influence of controlled substance; exceptions.
- Nev. Rev. Stat. § 695G.410Managed care organization prohibited from taking certain actions against provider solely because provider advocates on behalf of patient, assists patient or reports violation of law.
- Nev. Rev. Stat. § 695G.415Managed care organization prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression.
- Nev. Rev. Stat. § 695G.420Managed care organization prohibited from offering or paying financial incentive to provider to deny, reduce, withhold, limit or delay medically necessary services.
- Nev. Rev. Stat. § 695G.1635Plan covering prescription drugs: Required actions by managed care organization related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared.
- Nev. Rev. Stat. § 695G.1639Plan covering prescription drug for treatment of medical condition that is part of step therapy protocol: Use of certain guidelines required; establishment of process to request exemption from step therapy protocol required; granting of request; applicability of provisions.
- Nev. Rev. Stat. § 695G.1643Required provision concerning coverage for habilitative speech-language pathology or rehabilitative speech-language pathology as treatment for stuttering for certain persons; prohibited acts.
- Nev. Rev. Stat. § 695G.1645Required provision in plan for group coverage concerning coverage for autism spectrum disorders for certain persons; prohibited acts.
- Nev. Rev. Stat. § 695G.1662Limitation on cost-sharing obligation for insulin covered under plan covering prescription insulin drugs.
- Nev. Rev. Stat. § 695G.1665Required provision in plan covering prescription drugs concerning coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications; prohibited acts; exception.
- Nev. Rev. Stat. § 695G.1675Plan covering prescription drug for treatment of cancer or cancer symptom that is part of step therapy protocol: Managed care organization required to allow insured or attending practitioner to apply for exemption from step therapy protocol in certain circumstances; procedure for applying for and granting exemption.
- Nev. Rev. Stat. § 695G.1678Required provision in plan covering treatment of lung cancer concerning coverage for screening for lung cancer.
- Nev. Rev. Stat. § 695G.1702Plan covering prescription drugs: Submission to step therapy protocol for drug to treat psychiatric condition prohibited in certain circumstances.
- Nev. Rev. Stat. § 695G.1703Required provision concerning coverage for biomarker testing for diagnosis, treatment, management and monitoring of cancer in certain circumstances; establishment of process to request exception or appeal denial of coverage; time for responding to request for prior authorization.
- Nev. Rev. Stat. § 695G.1705Required provision concerning coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus and hepatitis C; reimbursement of certain providers of health care for certain services; prohibited acts.
- Nev. Rev. Stat. § 695G.1707Required provision concerning coverage for testing, treatment and prevention of sexually transmitted diseases; required provision concerning coverage for condoms for certain insureds.
- Nev. Rev. Stat. § 695G.1709Required provisions concerning coverage of certain gynecological and obstetrical services without prior authorization or referral from primary care physician; designation of obstetrician or gynecologist as primary care physician.
- Nev. Rev. Stat. § 695G.1712Required provision concerning coverage for screening, genetic counseling and testing related to BRCA gene in certain circumstances.
- Nev. Rev. Stat. § 695G.1713Required provision concerning coverage for certain screenings and tests for breast cancer; prohibited acts.
- Nev. Rev. Stat. § 695G.1714Required provision concerning coverage for examination of person who is pregnant for certain diseases.
- Nev. Rev. Stat. § 695G.1715Required provision concerning coverage for drug or device for contraception and related health services; prohibited acts; exceptions.
- Nev. Rev. Stat. § 695G.1716Health care plan covering maternity care: Prohibited acts by managed care organization if insured is acting as gestational carrier; child deemed child of intended parent for purposes of plan.
- Nev. Rev. Stat. § 695G.1717Required provision concerning coverage for certain services, screenings and tests relating to wellness; prohibited acts.
- Nev. Rev. Stat. § 695G.1718Required provision concerning coverage for medically necessary treatment of conditions relating to gender dysphoria and gender incongruence; restriction on refusal to cover certain treatments; authority of managed care organization to prescribe requirements for covering surgical treatments for minors; determination of medical necessity.
- Nev. Rev. Stat. § 695G.1719Required provision concerning coverage for certain drugs and services related to substance use disorder and opioid use disorder; reimbursement of pharmacists and pharmacies for certain services; prohibited acts.
- Nev. Rev. Stat. § 695G.1765Required provision concerning coverage for dental service provided by qualified dental hygienist in certain circumstances.
- Nev. Rev. Stat. § 695G.17145Required provision concerning coverage for noninvasive prenatal screening in certain plans.
- Nev. Rev. Stat. § 695G.17165Required provision concerning coverage for procedure or service for preservation of fertility in certain circumstances; exemption. [Effective January 1, 2027.]