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Nevada Revised Statutes

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Nevada NRS
Ins.
Contracts of Ins.
“Medically necessary” defined.

Nevada Insurance
Sec. § 687B.635
“Medically necessary” defined.

Medically necessary has the meaning ascribed to it in NRS 695G.055.

687B.010
Scope. 687B.015
“Binder” defined. 687B.021
Signatures. 687B.030
Waiver of payment of premium. 687B.040
Insurable interest: Personal insurance. 687B.050
Insurable interest: Exception when certain institutions designated beneficiary. 687B.060
Insurable interest: Property. 687B.070
Power to contract: Purchase of insurance and annuities by minors. 687B.080
Consent of insured to life or health insurance required; exceptions; notice of application for or request to increase coverage of insurance upon life of another required. 687B.090
Alteration of application: Life and health insurance. 687B.100
Application as evidence. 687B.110
Representations in applications. 687B.113
Control of cost of health care: Provisions encouraging use of certain services and facilities. 687B.117
Control of cost of health care: Insurer required to use three or more practices that control cost in administering benefits. 687B.120
Filing and approval of forms. 687B.122
Readability of policies: Applicability of requirements. 687B.124
Readability of policies: Flesch test; style, arrangement and overall appearance; index or table of contents. 687B.126
Readability of policies: Filing policy for Commissioners approval; exceptions to score requirements on Flesch test. 687B.128
Readability of policies: Approval by Commissioner. 687B.130
Grounds for disapproval. 687B.140
Standard provisions. 687B.145
Provisions in policies of casualty insurance: Proration of recovery or benefits; uninsured and underinsured motorist coverage; coverage for medical expenses; insurer not entitled to subrogation upon payment made because of underinsured vehicle coverage. 687B.147
Exclusion, reduction or limitation of certain coverage in motor vehicle insurance policies allowed; conditions; form and contents of disclosure. 687B.150
Inclusion of portion of charter or bylaws. 687B.160
Execution of policies. 687B.170
Underwriters and combination policies. 687B.180
Validity and construction of noncomplying forms. 687B.182
Binders: Issuance; effective dates. 687B.183
Binders: Forms; required statement; delivery. 687B.184
Binders: Form and premium for policy issued as replacement. 687B.185
Binders: Prohibition of use to lower premiums. 687B.186
Binders: Proof of insurance coverage. 687B.187
Binders: Disapproval of insurer. 687B.190
Delivery of policy. 687B.200
Assignability. 687B.210
Payment discharges insurer. 687B.220
Forms for proof of loss to be furnished. 687B.225
Requirements for contracts for payment of cost of medical or dental care which require prior authorization of care. 687B.240
Administration of claims not waiver. 687B.250
Payment not to constitute admission of liability or waiver of defenses. 687B.255
Insurer to pay claim with negotiable instrument. 687B.260
Exemption of proceeds of certain policies. 687B.270
Exemption of proceeds: Health insurance. 687B.280
Exemption of proceeds: Group insurance. 687B.290
Exemption of proceeds: Annuities; assignability of rights. 687B.300
Retention of proceeds of policy by insurer. 687B.310
Cancellations and nonrenewals; scope of application. 687B.320
Midterm cancellation; exception. 687B.325
Industrial insurance policies: Midterm cancellation; notice to policyholder. 687B.330
Anniversary cancellation. 687B.340
Nonrenewals. 687B.345
Annual review of coverage and benefits provided in policy. 687B.350
Renewal with altered terms. 687B.355
Information about claims paid on behalf of policyholder; regulations. 687B.360
Information about grounds. 687B.370
Information about applying for insurance through certain plans; exception. 687B.380
Immunity. 687B.385
Refusal to issue, cancellation, nonrenewal or increase in premium due to claims for which insured was not at fault, claims for which insurer made no payment or recovered entirety of payment or inquiries relating to a claim prohibited. 687B.390
Cancellation or nonrenewal on sole basis of age, residence, race, color, creed, national origin, ancestry, sexual orientation, gender identity or expression or occupation prohibited. 687B.400
Discrimination on sole basis of age prohibited; burden of proof; exception. 687B.402
Compliance with certain federal laws regarding genetic information. 687B.404
Compliance with certain federal laws regarding mental health and addiction. 687B.406
Compliance with certain federal laws regarding dependent students. 687B.408
Notifications required concerning changes related to prescription drugs used for transplanted organs. 687B.409
Payments to out-of-network providers for treatment of mental health or abuse of alcohol or drugs. 687B.410
Withdrawal of insurance for particular class of insureds: Notice; administrative review. 687B.420
Notice of proposed cancellation, nonrenewal or alteration of terms of certain policies, contracts or plans of insurance. 687B.430
Regulations: Policies which provide for payment of expenses not covered by Medicare; sale of more than one policy of health insurance to same person. 687B.440
Umbrella policies: Disclosure statement indicating whether policy includes uninsured or underinsured motorist coverage; form. 687B.450
Required medical examination; potentially serious medical condition; notification. 687B.460
Certificates of insurance for property or casualty insurance. 687B.470
“Health benefit plan” defined. 687B.480
Availability; waiting period; effective date. 687B.490
Carrier required to demonstrate capacity to adequately deliver services; Commissioner to determine capacity; annual summary. 687B.500
Basis for premium rate; exceptions. 687B.600
Definitions. 687B.605
“Covered person” defined. 687B.610
“Evidence of coverage” defined. 687B.615
“Health benefit plan” defined. 687B.620
“Health care services” defined. 687B.625
“Health carrier” defined. 687B.630
“Intermediary” defined. 687B.635
“Medically necessary” defined. 687B.640
“Network” defined. 687B.645
“Network plan” defined. 687B.650
“Participating provider of health care” defined. 687B.655
“Primary care physician” defined. 687B.660
“Provider of health care” defined. 687B.665
“Utilization review” defined. 687B.670
Requirements to offer or issue network plan. 687B.680
Health carrier to notify participating providers of health care of services covered by network plan. 687B.690
Required provisions in contract between participating provider of health care and health carrier. 687B.700
Participating provider of health care to continue delivery of services if health carrier or intermediary insolvent or ceases operations; billing of covered person; termination of services. 687B.710
Provisions to be construed in favor of covered person, survive termination of contract and supersede certain contrary agreements. 687B.720
Notice of insolvency or cessation of operations of health carrier or intermediary. 687B.730
Health carrier to provide notice of administrative policies and programs. 687B.740
Inducement to provide less than medically necessary health care services prohibited. 687B.750
Health carrier not to prohibit certain actions by participating provider of health care. 687B.760
Health records; confidentiality. 687B.770
Assignment or delegation of rights and responsibilities without prior written consent prohibited. 687B.780
Participating provider of health care to furnish covered services to all covered persons; exception. 687B.790
Health carrier to notify participating provider of health care of obligation to collect coinsurance, copayment or deductible or notify covered person of obligation for services not covered. 687B.800
Retaliation for good faith reporting to state or federal authority prohibited. 687B.810
Health carrier to allow participating provider of health care to determine whether a person is a covered person. 687B.820
Procedures for resolution of disputes. 687B.830
Contract for purposes of network plan prohibited from conflicting with network plan or law; notice of provisions and incorporated documents; notice of changes. 687B.840
Health carrier to notify participating provider of health care of status and inclusion on certain lists maintained by health carrier. 687B.850
Regulations. 687B.4095
Policies of health insurance including prescription drug coverage: Restrictions on moving prescription drug from lower-cost tier to higher-cost tier.

Source

Nev. Legislature

Last accessed

Aug. 23, 2019

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Location:https://nevada.public.law/statutes/nrs_687b.635.

Original Source: § 687B.635 — “Medically necessary” defined., https://www.leg.state.nv.us/NRS/NRS-687B.html#NRS687BSec635 (last accessed Aug. 23, 2019).