§ 689C.015 Definitions
§ 689C.017 ‘Affiliated’ defined
§ 689C.019 ‘Affiliation period’ defined
§ 689C.023 ‘Bona fide association’ defined
§ 689C.025 ‘Carrier’ defined
§ 689C.045 ‘Class of business’ defined
§ 689C.047 ‘Control’ defined
§ 689C.053 ‘Creditable coverage’ defined
§ 689C.055 ‘Dependent’ defined
§ 689C.065 ‘Eligible employee’ defined
§ 689C.071 ‘Geographic rating area’ defined
§ 689C.072 ‘Geographic service area’ defined
§ 689C.073 ‘Group health plan’ defined
§ 689C.075 ‘Health benefit plan’ defined
§ 689C.077 ‘Network plan’ defined
§ 689C.078 ‘Open enrollment’ defined
§ 689C.079 ‘Plan for coverage of a bona fide association’ defined
§ 689C.081 ‘Plan sponsor’ defined
§ 689C.083 ‘Producer’ defined
§ 689C.0835 ‘Professional employer organization’ defined
§ 689C.085 ‘Rating period’ defined
§ 689C.095 ‘Small employer’ defined
§ 689C.104 ‘Voluntary purchasing group’ defined
§ 689C.106 ‘Waiting period’ defined
§ 689C.1065 Applicability
§ 689C.109 Certain plan, fund or program established or maintained by partnership required to be treated as employee welfare benefit plan which is group health plan; partnership deemed employer of each partner
§ 689C.111 Professional employer organization deemed large employer in certain circumstances
§ 689C.113 Requirements for employee welfare benefit plan for providing benefits for employees of more than one employer
§ 689C.115 Mandatory and optional coverage
§ 689C.125 Rating factors for determining premiums; rating periods
§ 689C.131 Contracts between carrier and providers of health care: Prohibiting carrier from charging provider of health care fee for inclusion on list of providers given to insureds; carrier required to use form to obtain information on provider of health ca
§ 689C.135 Effect of provision in health benefit plan for restricted network on determination of rates
§ 689C.143 Offering of policy of health insurance for purposes of establishing health savings account
§ 689C.155 Regulations
§ 689C.156 Each health benefit plan marketed in this State required to be offered to small employers; issuance; carrier required to provide system for resolving complaints of employees if services provided or paid for through managed care
§ 689C.1565 Coverage to small employers not required under certain circumstances; notice required to Commissioner of and prohibition on writing new business after election not to offer new coverage required
§ 689C.158 Producer authorized only to market to or sign up small employers and eligible employees in bona fide associations if employers and employees are actively engaged in or directly related to bona fide association
§ 689C.159 Certain provisions inapplicable to plan that carrier makes available only through bona fide association
§ 689C.160 Carrier must uniformly apply requirements to determine whether to provide coverage
§ 689C.165 Carrier prohibited from modifying plan to restrict or exclude coverage or benefits for specific diseases, medical conditions or services otherwise covered by plan; exceptions
§ 689C.1652 Coverage for medically necessary treatment of conditions relating to gender dysphoria and gender incongruence required; restriction on refusal to cover certain treatments; authority of carrier to prescribe requirements for covering surgical treatmen
§ 689C.1653 Coverage for testing, treatment and prevention of sexually transmitted diseases required; coverage for condoms for certain insureds required
§ 689C.1655 Coverage for autism spectrum disorders for certain persons required; prohibited acts
§ 689C.166 Coverage for alcohol or substance use disorder: Required in group health insurance policy
§ 689C.1665 Coverage for certain drugs and services related to substance use disorder and opioid use disorder required; reimbursement of pharmacists and pharmacies for certain services; prohibited acts
§ 689C.167 Coverage for alcohol or substance use disorders: Benefits provided by group health insurance policy
§ 689C.1671 Coverage for drugs, laboratory testing and certain services related to human immunodeficiency virus and hepatitis C required; reimbursement of certain providers of health care for certain services; prohibited acts
§ 689C.1672 Coverage for certain tests and vaccines relating to human papillomavirus required; prohibited acts
§ 689C.1673 Coverage for screening, genetic counseling and testing related to BRCA gene required in certain circumstances
§ 689C.1674 Coverage for certain screenings and tests for breast cancer required; prohibited acts
§ 689C.1675 Coverage for examination of person who is pregnant for certain diseases required
§ 689C.1676 Coverage for drug or device for contraception and related health services required; prohibited acts; exceptions
§ 689C.1678 Coverage for certain services, screenings and tests relating to wellness required; prohibited acts
§ 689C.1679 Plan covering prescription drugs: Required actions by carrier related to acquisition of prescription drugs for certain insureds residing in area for which emergency or disaster has been declared
§ 689C.168 Plan covering prescription drugs prohibited from limiting or excluding coverage for prescription drug previously approved for medical condition of insured; exception
§ 689C.1681 Plan 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; app
§ 689C.1682 Plan covering prescription drugs: Submission to step therapy protocol for drug to treat psychiatric condition prohibited in certain circumstances
§ 689C.1683 Coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications required in plan covering prescription drugs; prohibited acts; exception
§ 689C.1684 Plan covering prescription drug for treatment of cancer or cancer symptom that is part of step therapy protocol: Carrier required to allow insured or attending practitioner to apply for exemption from step therapy protocol in certain circumstances;
§ 689C.1685 Plan covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products
§ 689C.1687 Coverage for management and treatment of sickle cell disease and its variants required; coverage for medically necessary prescription drugs to treat sickle cell disease and its variants required in plan covering prescription drugs
§ 689C.1688 Coverage for biomarker testing for diagnosis, treatment, management and monitoring of cancer required in certain circumstances; establishment of process to request exception or appeal denial of coverage; time for responding to request for prior auth
§ 689C.169 Coverage for severe mental illness required under group health insurance policy
§ 689C.170 Authorized variation of minimum participation and contributions; denial of coverage based on industry prohibited
§ 689C.180 Carrier to offer same coverage to all eligible employees; denial of coverage to otherwise eligible employee
§ 689C.183 Plan and carrier required to permit employee or dependent of employee to enroll for coverage under certain circumstances
§ 689C.187 Manner and period for enrolling dependent of covered employee; period of special enrollment
§ 689C.190 Carrier required to offer and issue plan regardless of health status of employees; prohibited acts; authority to include wellness program in plan that offers discounts based on health status under certain circumstances
§ 689C.191 Determination of applicable creditable coverage of person; determining period of creditable coverage of person; required statement for certain election by carrier; applicability
§ 689C.192 Written certification of coverage required for purpose of determining period of creditable coverage accumulated by person
§ 689C.193 Carrier prohibited from imposing restriction on being participant of or beneficiary of plan inconsistent with certain provisions; restrictions on rules of eligibility that may be established
§ 689C.194 Plan covering maternity and pediatric care: Required to allow minimum stay in hospital in connection with childbirth; exceptions; prohibited acts
§ 689C.1945 Plan covering maternity care: Prohibited acts by carrier if insured is acting as gestational carrier; child deemed child of intended parent for purposes of plan
§ 689C.1947 Plan covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by carrier if insured is person with disability
§ 689C.195 Coverage for services provided through telehealth required to same extent as though provided in person or by other means; reimbursement for certain services provided through telehealth required in same amount as though provided in person or by oth
§ 689C.196 Insurer prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence
§ 689C.197 Carrier prohibited from denying coverage because applicant or insured was intoxicated or under influence of controlled substance; exceptions
§ 689C.1975 Carrier prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression
§ 689C.198 Insurer prohibited from requiring or using information concerning genetic testing; exceptions
§ 689C.200 Circumstances in which carrier is not required to offer coverage
§ 689C.203 Requirement for denial of application for coverage from small employer; regulations setting standards for fair marketing and broad availability of plans
§ 689C.207 Regulations concerning reissuance of health benefit plan
§ 689C.220 Adjustment in rates required to be applied uniformly
§ 689C.265 Carrier authorized to modify coverage for insurance product under certain circumstances
§ 689C.281 Plan covering prescription drugs: Provision of notice and information regarding use of formulary
§ 689C.310 Renewal of plan; discontinuance of issuance or renewal of coverage or of plan offered only through bona fide association; discontinuance of product; applicability
§ 689C.320 Required notification when carrier discontinues transacting insurance in this State or particular geographic service area of state; restrictions on carrier that discontinues transacting insurance
§ 689C.325 Coverage offered through network plan not required to be offered to eligible employee who does not reside or work in geographic service area or if carrier lacks capacity to deliver adequate service to additional employers and employees
§ 689C.335 Approval or denial of claims; payment of claims and interest; requests for additional information; award of costs and attorney’s fees; compliance with requirements; imposition of administrative fine or suspension or revocation of certificate of au
§ 689C.350 Health benefit plan which offers difference of payment between preferred providers of health care and providers who are not preferred: Limitations on deductibles and copayments; circumstances in which service is deemed to be provided by preferred
§ 689C.355 Prohibited acts of carrier or producer related to encouraging or directing small employer to take certain actions; exceptions; prohibited acts by carrier related to contract or agreement with producer; violation may constitute unfair trade practic
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Terms Used In Nevada Revised Statutes > Chapter 689C > Health Benefit Plans

  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • 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
  • Contract: A legal written agreement that becomes binding when signed.
  • controlled substance: means a drug, immediate precursor or other substance which is listed in schedule I, II, III, IV or V for control by the State Board of Pharmacy pursuant to Nevada Revised Statutes 0.031
  • Conviction: A judgement of guilt against a criminal defendant.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Dependent: A person dependent for support upon another.
  • 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.
  • Fraud: Intentional deception resulting in injury to another.
  • Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
  • physician: means a person who engages in the practice of medicine, including osteopathy and homeopathy. See Nevada Revised Statutes 0.040
  • Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.