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- 83rd Session (2025)
EMERGENCY REQUEST of Speaker of the Assembly
Assembly Bill No. 555–Assemblymember Yeager
CHAPTER..........
AN ACT relating to insurance; establishing a maximum cost -
sharing amount that certain health insurers may impose for a
30-day supply of prescription insulin drugs; and providi ng
other matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law requires certain policies of health insurance to include coverage
for the management and treatment of diabetes. Existing law requires that such
coverage be subject to t he same deductible, copayment, coinsurance and other
conditions as are required under the policy for other types of health care. (NRS
689A.0427, 689B.0357, 695B.1927, 695C.1727) Sections 1, 4, 6-9, 11, 15 and 16
of this bill prohibit certain private health insurers from imposing a deductible,
copayment, coinsurance or other cost -sharing obligation greater than $35 for a 30 -
day supply of a prescription insulin drug. Sections 2, 5, 10 and 13 clarify that an
insurer may be required by sections 1, 4, 9 or 11 to impose a different deductible,
copayment or coinsurance for a 30 -day supply of a prescription insulin drug than
would otherwise be required by the relevant policy of health insurance for other
types of health care. Section 3 of this bill authorizes the Commissioner of
Insurance to require certain policies of insurance issued by a domestic insurer to a
person who resides in another state to meet the requirements of section 1 in certain
circumstances. Sections 12 and 17 of this bill indicate that the requirements of
sections 11 and 16, respectively, are inapplicable to coverage provided by a health
maintenance org anization or managed care organization to: (1) recipients of
Medicaid or insurance under the Children’s Health Insurance Program; and (2)
government employees and their dependents. Section 14 of this bill authorizes the
Commissioner to suspend or revoke the certificate of authority issued to a health
maintenance organization that fails to comply with the requirements of section 11.
The Commissioner would also be authorized to take such action against other
insurers that fail to comply with the requirements of sections 1, 4, 6-9, 15 and 16.
(NRS 680A.200)
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 689A of NRS is hereby amended by
adding thereto a new section to read as follows:
1. An insurer that offers or issues a policy of health
insurance which provides coverage for prescription insulin drugs
shall not impose against an insured a deductible, copayment,
coinsurance or other cost -sharing obligation that is greater than
$35 for a 30 -day supply of a prescript ion insulin drug which is
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prescribed to the insured and covered by the insurer, regardless of
the amount or type of prescription insulin drug prescribed.
2. As used in this section:
(a) “Diabetes” includes type I, type II and gestational diabetes.
(b) “Prescription insulin drug” means a prescription drug that
contains insulin and is used to control blood glucose levels for the
purpose of treating diabetes.
Sec. 2. NRS 689A.0427 is hereby amended to read as follows:
689A.0427 1. No policy of health insurance that provides
coverage for hospital, medical or surgical expenses may be
delivered or issued for delivery in this state unless the policy
includes coverage for the management and treatment of diabetes,
including, without limitation, coverage for the self -management of
diabetes.
2. An insurer who delivers or issues for delivery a policy
specified in subsection 1:
(a) Shall include in any disclosure of the coverage provided by
the policy notice to each policyhol der and subscriber under the
policy of the availability of the benefits required by this section.
(b) [Shall] Except as otherwise provided in section 1 of this act,
shall provide the coverage required by this section subject to the
same deductible, copayment, coinsurance and other such conditions
for coverage that are required under the policy.
3. A policy of health insurance subject to the provisions of this
chapter that is delivered, issued for delivery or renewed on or after
January 1, 1998, has the legal effect of including the coverage
required by this section, and any provision of the policy th at
conflicts with this section is void.
4. As used in this section:
(a) “Coverage for the management and treatment of diabetes”
includes coverage for medication, equipment, supplies and
appliances that are medically necessary for the treatment of
diabetes.
(b) “Coverage for the self-management of diabetes” includes:
(1) The training and education provided to an insured person
after the insured person is initially diagnosed with diabetes which is
medically necessary for the care and management of diabe tes,
including, without limitation, counseling in nutrition and the proper
use of equipment and supplies for the treatment of diabetes;
(2) Training and education which is medically necessary as a
result of a subsequent diagnosis that indicates a signifi cant change
in the symptoms or condition of the insured person and which
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requires modification of the insured person’s program of self -
management of diabetes; and
(3) Training and education which is medically necessary
because of the development of new t echniques and treatment for
diabetes.
(c) “Diabetes” includes type I, type II and gestational diabetes.
Sec. 3. NRS 689A.330 is hereby amended to read as follows:
689A.330 If any policy is issued by a domestic insurer for
delivery to a person residing in another state, and if the insurance
commissioner or corresponding public officer of that other state has
informed the Commissioner that the policy is not subject to approval
or disapproval by that officer, the Commissio ner may by ruling
require that the policy meet the standards set forth in NRS 689A.030
to 689A.320, inclusive [.] , and section 1 of this act.
Sec. 4. Chapter 689B of NRS is hereby amended by adding
thereto a new section to read as follows:
1. An insurer that offers or issues a policy of group health
insurance which provides coverage for prescription insulin drugs
shall not impose against an insured a deductible, copayment,
coinsurance or other cost -sharing obligation that is greater than
$35 for a 30 -day supply of a prescription insulin drug which is
prescribed to the insured and covered by the insurer, regardless of
the amount or type of prescription insulin drug prescribed.
2. As used in this section:
(a) “Diabetes” includes type I, type II and gestational diabetes.
(b) “Prescription insulin drug” means a prescription drug that
contains insulin and is used to con trol blood glucose levels for the
purpose of treating diabetes.
Sec. 5. NRS 689B.0357 is hereby amended to read as follows:
689B.0357 1. No group policy of health insurance that
provides coverage for hospital, medical or surgical expenses may be
delivered or issued for delivery in this state unless the policy
includes coverage for the management and treatment of diabetes,
including, without limitation, coverage for the self -management of
diabetes.
2. An insurer who deli vers or issues for delivery a policy
specified in subsection 1:
(a) Shall include in any disclosure of the coverage provided by
the policy notice to each policyholder and subscriber under the
policy of the availability of the benefits required by this section.
(b) [Shall] Except as provided in section 4 of this act, shall
provide the coverage required by this section subject to the same
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deductible, copayment, coinsurance and other such conditions for
coverage that are required under the policy.
3. A policy subject to the provisions of this chapter that is
delivered, issued for delivery or renewed on or after January 1,
1998, has the legal effect of including the coverage required by this
section, and any provision of the policy that conflicts with th is
section is void.
4. As used in this section:
(a) “Coverage for the management and treatment of diabetes”
includes coverage for medication, equipment, supplies and
appliances that are medically necessary for the treatment of
diabetes.
(b) “Coverage for the self-management of diabetes” includes:
(1) The training and education provided to the employee or
member of the insured group after the employee or member is
initially diagnosed with diabetes which is medically necessary for
the care and manageme nt of diabetes, including, without limitation,
counseling in nutrition and the proper use of equipment and supplies
for the treatment of diabetes;
(2) Training and education which is medically necessary as a
result of a subsequent diagnosis that indicate s a significant change
in the symptoms or condition of the employee or member of the
insured group and which requires modification of his or her program
of self-management of diabetes; and
(3) Training and education which is medically necessary
because o f the development of new techniques and treatment for
diabetes.
(c) “Diabetes” includes type I, type II and gestational diabetes.
Sec. 6. Chapter 689C of NRS is hereby amended by adding
thereto a new section to read as follows:
1. A carrier that offers or issues a health benefit plan which
provides coverage for prescription insulin drugs shall not impose
against an insured a deductible, copayment, coinsurance or other
cost-sharing obligation that is greater than $35 fo r a 30 -day
supply of a prescription insulin drug which is prescribed to the
insured and covered by the carrier, regardless of the amount or
type of prescription insulin drug prescribed.
2. As used in this section:
(a) “Diabetes” includes type I, type II and gestational diabetes.
(b) “Prescription insulin drug” means a prescription drug that
contains insulin and is used to control blood glucose levels for the
purpose of treating diabetes.
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Sec. 7. NRS 689C.425 is hereby amended to read as follows:
689C.425 A voluntary purchasing group and any contract
issued to such a group pursuant to NRS 689C.360 to 689C.600,
inclusive, are subject to the provisions of NRS 689C.015 to
689C.355, inclusive, and section 6 of this act, to the extent
applicable and not in conflict with the express provisions of NRS
687B.408 and 689C.360 to 689C.600, inclusive.
Sec. 8. Chapter 695A of NRS is hereby amended by adding
thereto a new section to read as follows:
1. A society that offers or issues a benefit contract which
provides coverage for prescription insulin drugs shall not impose
against an insured a deductible , copayment, coinsurance or other
cost-sharing obligation that is greater than $35 for a 30 -day
supply of a prescription insulin drug which is prescribed to the
insured and covered by the society, regardless of the amount or
type of prescription insulin drug prescribed.
2. As used in this section:
(a) “Diabetes” includes type I, type II and gestational diabetes.
(b) “Prescription insulin drug” means a prescription drug that
contains insulin and is used to control blood glucose levels for the
purpose of treating diabetes.
Sec. 9. Chapter 695B of NRS is hereby amended by adding
thereto a new section to read as follows:
1. A hospital or medical services corporation that offers or
issues a policy of health insurance which provides coverage for
prescription insulin drugs shall not impose against an insured a
deductible, copayment, coinsurance or other cost -sharing
obligation that is greater than $35 for a 30 -day supply of a
prescription insulin drug which is prescribed to th e insured and
covered by the hospital or medical services corporation, regardless
of the amount or type of prescription insulin drug prescribed.
2. As used in this section:
(a) “Diabetes” includes type I, type II and gestational diabetes.
(b) “Prescription insulin drug” means a prescription drug that
contains insulin and is used to control blood glucose levels for the
purpose of treating diabetes.
Sec. 10. NRS 695B.1927 is hereby amended to read as
follows:
695B.1927 1. No contract for hospital or medical service that
provides coverage for hospital, medical or surgical expenses may be
delivered or issued for delivery in this state unless the contract
includes coverage for the management and treatment of diabetes,
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including, without limitation, coverage for the self -management of
diabetes.
2. An insurer who delivers or issues for delivery a contract
specified in subsection 1:
(a) Shall include in any disclosure of the coverage provided by
the contract notice to each policyholder or subscriber covered under
the contract of the availability of the benefits required by this
section.
(b) [Shall] Except as otherwise provided in section 9 of this act,
shall provide the coverage required by this section subject to the
same deductible, copayment, coinsurance and other such conditions
for coverage that are required under the contract.
3. A contract for hospital or medical service subject to the
provisions of this chapter that is delivered, issued for delivery or
renewed on or after January 1, 1998, has the legal effect of
including the coverage required by this section, and any provision of
the contract that conflicts with this section is void.
4. As used in this section:
(a) “Coverage for the management and treatment of diabetes”
includes coverage for medication, equipment, supplies and
appliances that are medically necessary for the t reatment of
diabetes.
(b) “Coverage for the self-management of diabetes” includes:
(1) The training and education provided to a person covered
under the contract after the person is initially diagnosed with
diabetes which is medically necessary for the care and management
of diabetes, including, without limitation, counseling in nutrition
and the proper use of equipment and supplies for the treatment of
diabetes;
(2) Training and education which is medically necessary as a
result of a subsequent diagno sis that indicates a significant change
in the symptoms or condition of the person covered under the
contract and which requires modification of the person’s program of
self-management of diabetes; and
(3) Training and education which is medically necess ary
because of the development of new techniques and treatment for
diabetes.
(c) “Diabetes” includes type I, type II and gestational diabetes.
Sec. 11. Chapter 695C of NRS is hereby amended by adding
thereto a new section to read as follows:
1. A health maintenance organization that offers or issues a
health care plan which provides coverage for prescription insulin
drugs shall not impose against an enrollee a deductible,
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copayment, coinsurance or other cost -sharing oblig ation that is
greater than $35 for a 30-day supply of a prescription insulin drug
which is prescribed to the enrollee and covered by the health
maintenance organization, regardless of the amount or type of
prescription insulin drug prescribed.
2. As used in this section:
(a) “Diabetes” includes type I, type II and gestational diabetes.
(b) “Prescription insulin drug” means a prescription drug that
contains insulin and is used to control blood glucose levels for the
purpose of treating diabetes.
Sec. 12. NRS 695C.050 is hereby amended to read as follows:
695C.050 1. Except as otherwise provided in this chapter or
in specific provisions of this title, the provisions of this title are not
applicable to any health maintena nce organization granted a
certificate of authority under this chapter. This provision does not
apply to an insurer licensed and regulated pursuant to this title
except with respect to its activities as a health maintenance
organization authorized and regulated pursuant to this chapter.
2. Solicitation of enrollees by a health maintenance
organization granted a certificate of authority, or its representatives,
must not be construed to violate any provision of law relating to
solicitation or advertising by practitioners of a healing art.
3. Any health maintenance organization authorized under this
chapter shall not be deemed to be practicing medicine and is exempt
from the provisions of chapter 630 of NRS.
4. The provisions of NRS 695C.110, 695C.125, 69 5C.1691,
695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to
695C.173, inclusive, and section 11 of this act , 695C.1733,
695C.17335, 695C.1734, 695C.1751, 695C.1755, 695C.1759,
695C.176 to 695C.200, inclusive, and 695C.265 do not apply to a
health maintenance organization that provides health care services
through managed care to recipients of Medicaid under the State Plan
for Medicaid or insuranc e pursuant to the Children’s Health
Insurance Program pursuant to a contract with the Division of
Health Care Financing and Policy of the Department of Health and
Human Services. This subsection does not exempt a health
maintenance organization from any pr ovision of this chapter for
services provided pursuant to any other contract.
5. The provisions of NRS 695C.16932 to 695C.1699,
inclusive, 695C.1701, 695C.1708, 695C.1728, 695C.1731,
695C.17333, 695C.17345, 695C.17347, 695C.1736 to 695C.1745,
inclusive, 695C.1757 and 695C.204 apply to a health maintenance
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organization that provides health care services through managed
care to recipients of Medicaid under the State Plan for Medicaid.
6. The provisions of NRS 695C.17095 and section 11 of this
act do not apply to a health maintenance organization that provides
health care services to members of the Public Employees’ Benefits
Program. This subsection does not e xempt a health maintenance
organization from any provision of this chapter for services
provided pursuant to any other contract.
7. The provisions of NRS 695C.1735 and section 11 of this act
do not apply to a health maintenance organization that provides
health care services to:
(a) The officers and employees, and the dependents of officers
and employees, of the governing body of any county, school district,
municipal corporation, political subdivision, public corporation or
other local governmental agency of this State; or
(b) Members of the Public Employees’ Benefits Program.
This subsection does not exempt a health maintenance
organization from any provision of this chapter for services
provided pursuant to any other contract.
Sec. 13. NRS 695C.1727 is hereby amended to read as
follows:
695C.1727 1. No evidence of coverage that provides
coverage for hospital, medical or surgical expenses may be
delivered or issued for delivery in this state unless the evidence of
coverage includes coverage for the management and treatment of
diabetes, i ncluding, without limitation, coverage for the self -
management of diabetes.
2. [An] Except as otherwise provided in section 11 of this act,
an insurer who delivers or issues for delivery an evidence of
coverage specified in subsection 1 shall provide the coverage
required by this section subject to the same deductible, copayment,
coinsurance and other such conditions for the evidence of coverage
that are required under the evidence of coverage.
3. Evidence of coverage subject to the provisions of this
chapter that is delivered, issued for delivery or renewed on or after
January 1, 1998, has the legal effect of including the coverage
required by this sectio n, and any provision of the evidence of
coverage that conflicts with this section is void.
4. As used in this section:
(a) “Coverage for the management and treatment of diabetes”
includes coverage for medication, equipment, supplies and
appliances that are medically necessary for the treatment of
diabetes.
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(b) “Coverage for the self-management of diabetes” includes:
(1) The training and education provided to the enrollee after
the enrollee is initially diagnosed with diabetes which is medically
necessary for the care and management of diabetes, including,
without limitation, counseling in nutrition and the proper use of
equipment and supplies for the treatment of diabetes;
(2) Training and education which is medically necessary as a
result of a subse quent diagnosis that indicates a significant change
in the symptoms or condition of the enrollee and which requires
modification of the enrollee’s program of self -management of
diabetes; and
(3) Training and education which is medically necessary
because of the development of new techniques and treatment for
diabetes.
(c) “Diabetes” includes type I, type II and gestational diabetes.
Sec. 14. NRS 695C.330 is hereby amended to read as follows:
695C.330 1. The Commissioner may suspend or revoke any
certificate of authority issued to a health maintenance organization
pursuant to the provisions of this chapter if the Commissioner finds
that any of the following conditions exist:
(a) The health maintenance organization is op erating
significantly in contravention of its basic organizational document,
its health care plan or in a manner contrary to that described in and
reasonably inferred from any other information submitted pursuant
to NRS 695C.060, 695C.070 and 695C.140, unless any amendments
to those submissions have been filed with and approved by the
Commissioner;
(b) The health maintenance organization issues evidence of
coverage or uses a schedule of charges for health care services
which do not comply with the requirements of NRS 695C.1691 to
695C.200, inclusive, and section 11 of this act or 695C.204 or
695C.207;
(c) The health care plan does not furnish comprehensive health
care services as provided for in NRS 695C.060;
(d) The Commissioner certifies that the health maintenance
organization:
(1) Does not meet the requirements of subsection 1 of NRS
695C.080; or
(2) Is unable to fulfill its obligations to furnish health care
services as required under its health care plan;
(e) The health maintenance organization is no longer financially
responsible and may reasonably be expected to be unable to meet its
obligations to enrollees or prospective enrollees;
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(f) The health maintenance organization has failed to put into
effect a mechanism affording the enrollees an op portunity to
participate in matters relating to the content of programs pursuant to
NRS 695C.110;
(g) The health maintenance organization has failed to put into
effect the system required by NRS 695C.260 for:
(1) Resolving complaints in a manner reasona bly to dispose
of valid complaints; and
(2) Conducting external reviews of adverse determinations
that comply with the provisions of NRS 695G.241 to 695G.310,
inclusive;
(h) The health maintenance organization or any person on its
behalf has advertised or merchandised its services in an untrue,
misrepresentative, misleading, deceptive or unfair manner;
(i) The continued operation of the health maintenance
organization would be hazardous to its enrollees or creditors or to
the general public;
(j) The he alth maintenance organization fails to provide the
coverage required by NRS 695C.1691; or
(k) The health maintenance organization has otherwise failed to
comply substantially with the provisions of this chapter.
2. A certificate of authority must be suspended or revoked only
after compliance with the requirements of NRS 695C.340.
3. If the certificate of authority of a health maintenance
organization is suspended, the health maintenance organization shall
not, during the period of that suspension, enroll any additional
groups or new individual contracts, unless those groups or persons
were contracted for before the date of suspension.
4. If the certificate of authority of a health maintenance
organization is revoked, the organization shall proceed, immediately
following the effective date of the order of revocation, to wind up its
affairs and shall conduct no further business except as may be
essential to the orderly conclusion of the affairs of the organization.
It shall engage in no further adver tising or solicitation of any kind.
The Commissioner may, by written order, permit such further
operation of the organization as the Commissioner may find to be in
the best interest of enrollees to the end that enrollees are afforded
the greatest practical opportunity to obtain continuing coverage for
health care.
Sec. 15. Chapter 695F of NRS is hereby amended by adding
thereto a new section to read as follows:
1. A prepaid limited health service organization that offers or
issues evidence of coverage which provides coverage for
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prescription insulin drugs shall not impose against an enrollee a
deductible, copayment, coinsurance or other cost -sharing
obligation that is greater than $35 for a 30 -day supply of a
prescription insulin drug which is prescribed to the enrollee and
covered by the prepaid limited health service organization,
regardless of the amount or type of prescription insulin drug
prescribed.
2. As used in this section:
(a) “Diabetes” includes type I, type II and gestational diabetes.
(b) “Prescription insulin drug” means a prescription drug that
contains insulin and is used to control blood glucose levels for the
purpose of treating diabetes.
Sec. 16. Chapter 695G of NRS is h ereby amended by adding
thereto a new section to read as follows:
1. A managed care organization that offers or issues a health
care plan which provides coverage for prescription insulin drugs
shall not impose against an insured a deductible, copayment,
coinsurance or other cost -sharing obligation that is greater than
$35 for a 30 -day supply of a prescription insulin drug which is
prescribed to the insured and covered by the managed care
organization, regardless of the amount or type of prescription
insulin drug prescribed.
2. As used in this section:
(a) “Diabetes” includes type I, type II and gestational diabetes.
(b) “Prescription insulin drug” means a prescription drug that
contains insulin and is used to control blood glucose levels for the
purpose of treating diabetes.
Sec. 17. NRS 695G.090 is hereby amended to read as follows:
695G.090 1. Except as otherwise provided in subsection 3,
the provisions of this chapter apply to each organization and insurer
that ope rates as a managed care organization and may include,
without limitation, an insurer that issues a policy of health
insurance, an insurer that issues a policy of individual or group
health insurance, a carrier serving small employers, a fraternal
benefit s ociety, a hospital or medical service corporation and a
health maintenance organization.
2. In addition to the provisions of this chapter, each managed
care organization shall comply with:
(a) The provisions of chapter 686A of NRS, including all
obligations and remedies set forth therein; and
(b) Any other applicable provision of this title.
3. The provisions of NRS 695G.127, 695G.1639, 695G.164,
695G.1645, 695G.167 and 695G.200 to 695G.230, inclusive, and
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section 16 of this act do not apply to a managed care organization
that provides health care services to recipients of Medicaid under
the State Plan for Medicaid or insurance pursuant to the Ch ildren’s
Health Insurance Program pursuant to a contract with the Division
of Health Care Financing and Policy of the Department of Health
and Human Services.
4. The provisions of NRS 695C.1735 and 695G.1639 and
section 16 of this act do not apply to a managed care organization
that provides health care services to members of the Public
Employees’ Benefits Program.
5. The provisions of section 16 of this act do not apply to a
managed care organization that provides health care services to
officers and employees, and the dependents of officers and
employees, of the governing body of any county, school district,
municipal corporation, political subdivision, public corporation or
other local governmental agency of this State.
6. Subsections 3 , [and] 4 and 5 do not exempt a managed care
organization from any provision of this chapter for services
provided pursuant to any other contract.
Sec. 18. The provisions of this act do not apply to any policy
of health insurance, policy of group health insurance, health benefit
plan, benefit contract, health care plan or evidence of coverage
issued before October 1, 2025, but ap ply to any renewal or
extension of such a policy, plan, contract or evidence of coverage.
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