Nevada Revised Statutes 695B.400 – Written notice to insured required to be provided by insurer explaining right to file complaint; written notice to insured required when insurer denies coverage of health care service
1. Following approval by the Commissioner, each insurer that issues a contract for hospital or medical services in this State shall provide written notice to an insured, in clear and comprehensible language that is understandable to an ordinary layperson, explaining the right of the insured to file a written complaint. Such notice must be provided to an insured:
Terms Used In Nevada Revised Statutes 695B.400
- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Contract: A legal written agreement that becomes binding when signed.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Medical services: means the furnishing or providing of any or all of the following:
(a) Medical or surgical services, in or out of a hospital, by a physician licensed to practice under the laws of Nevada. See Nevada Revised Statutes 695B.030
(a) At the time the insured receives a certificate of coverage or evidence of coverage;
(b) Any time that the insurer denies coverage of a health care service or limits coverage of a health care service to an insured; and
(c) Any other time deemed necessary by the Commissioner.
2. Any time that an insurer denies coverage of a health care service to a beneficiary or subscriber, including, without limitation, denying a claim relating to a contract for dental, hospital or medical services pursuant to NRS 695B.2505, it shall notify the beneficiary or subscriber in writing within 10 working days after it denies coverage of the health care service of:
(a) The reason for denying coverage of the service;
(b) The criteria by which the insurer determines whether to authorize or deny coverage of the health care service; and
(c) The right of the beneficiary or subscriber to file a written complaint and the procedure for filing such a complaint.
3. A written notice which is approved by the Commissioner shall be deemed to be in clear and comprehensible language that is understandable to an ordinary layperson.