Revises provisions relating to insurance. (BDR 57-256)

REQUIRES TWO-THIRDS MAJORITY VOTE
(§ 199 & NRS 683A.08524)
A.B. 74

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ASSEMBLY BILL NO. 74–COMMITTEE
ON COMMERCE AND LABOR

(ON BEHALF OF THE DIVISION OF INSURANCE OF THE
DEPARTMENT OF BUSINESS AND INDUSTRY)

PREFILED NOVEMBER 20, 2024
____________

Referred to Committee on Commerce and Labor

SUMMARY—Revises provisions relating to insurance.
(BDR 57-256)

FISCAL NOTE: Effect on Local Government: Increases or Newly
Provides for Term of Imprisonment in County or City
Jail or Detention Facility.
Effect on the State: Yes.

~

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

AN ACT relating to insurance; making various changes to the Nevada
Insurance Code; revising provisions governing examinations
of insurers and other persons subject to regulation under the
Code; revising certain powers and duties of the Commissioner
of Insurance; revising various requirements and restrictions
imposed on insurers and other persons subject to regulation
under the Code; revising provisions relating to service
contracts, providers of service contracts and administrators of
service contracts; repealing provisions governing insurance
for home protection; revising provisions relating to
administrators; standardizing the definitions of certain words
and terms; revising provisions relating to adjustors; revising
provisions relating to certain trade practices and frauds;
removing certain obsolete and duplicative provisions;
transferring certain duties from the Commissioner of Financial
Institutions to the Commissioner of Mortgage Lending;
revising provisions relating to certain accounts and funds
relevant to the regulation of certain insurers and insurance
administration; designating certain employees of the Division
of Insurance of the Department of Business and Industry as
category II peace officers; providing penalties; and providing
other matters properly relating thereto.

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Legislative Counsel’s Digest:
Existing law requires the Commissioner of Insurance to reg ulate insurance in 1
this State and enforce the provisions of the Nevada Insurance Code. (NRS 2
679B.120) Existing law sets forth various requirements relating to examinations of 3
insurers, which are conducted by the Commissioner. (NRS 679B.230 -679B.300) 4
Section 354 of this bill repeals those provisions of existing law relating to 5
examinations of insurers. Sections 1-41 of this bill reenact, reorganize and revise 6
those provisions into a new chapter of the Nevada Re vised Statutes governing 7
examinations of insurers and other persons subject to regulation under the Nevada 8
Insurance Code. Sections 3-12 and 27-41 additionally enact provisions that are 9
modeled, in general, after the Market Conduct Surveillance Model Law adopted by 10
the National Association of Insurance Commissioners and which: (1) require the 11
Commissioner to coll ect and analyze information concerning the market practices 12
of insurers; and (2) authorize the Commissioner to take certain actions, including, 13
without limitation, the conducting of certain examinations, based on the results of 14
that analysis. Sections 43, 54, 65, 111, 113, 114, 124-127, 197, 203, 210, 213, 216-15
218, 221, 223, 229, 251, 253, 269, 289-291, 293, 294, 297, 318, 319, 336, 340 and 16
342 of this bill make conforming changes to replace references in existing law to 17
the sections which were repealed and reenacted in sections 2-41. 18
Section 42 of this bill authorizes the Com missioner, during a state of 19
emergency or declaration of disaster, to issue a temporary order to address certain 20
matters relating to policies issued in this State. Section 42 requires each such order 21
to be approved by the Governor and meet certain other requirements. Section 333 22
of this bill exempts any order issued by the Commissioner pursuant to section 42 23
from the requirements of the Nevada Administrative Procedure Act. 24
(NRS 233B.039) 25
Section 44 of this bill expands the applicability of a provision of existing law 26
requiring the Secretary of State to nullify the charter or cer tificate of certain 27
insurers who are prohibited from transacting insurance in this State to include any 28
person who is prohibited from transacting insurance in this State. Section 45 of this 29
bill revises requirements imposed on the Commissioner concerning the publication 30
of a guide to rates for policies of insurance for motor vehicles. Section 46 of this 31
bill revises provisions governing oversight by the Commissioner of certain usual 32
and customary fees or reimbursement methodologies. Section 47 of this bill 33
authorizes an attorney employed by the Division of Insurance of the Department of 34
Business and Industry to act as legal counsel to the Division and the Commissioner 35
in certain matters, instead of the Attorne y General. Section 48 of this bill: (1) 36
authorizes the Commissioner to enter into contracts with the National Association 37
of Insurance Commissioners for g oods and services related to the regulation of 38
insurance; and (2) exempts such a contract from the provisions of existing law 39
governing purchasing for the State. Section 116 of this bill makes a conforming 40
change to update an internal reference changed by section 48. Section 51 of this 41
bill authorizes the Commissioner to limit, in addition to suspending, the certificate 42
of authority of an insurer under certain circumstances. 43
Existing law provides for the registration and regulation of administrators by 44
the Commissioner. (NRS 683A.0805-683A.0893) Section 55 of this bill requires an 45
administrator to report to the Commissioner certain information concerning 46
administrative actions and criminal prosecutions against the administrator. Section 47
57 of this bill applies certain definitions in existing law relating to administrators to 48
section 55. Sections 58-60 of this bill revise provisions relating to certain: (1) 49
documents which are required as part of an application for registration as an 50
administrator; (2) bonds which are required to be filed by an admi nistrator; and (3) 51
recordkeeping requirements for administrators. Section 61 of this bill authorizes an 52
administrator to use accounts in a financial instit ution not located in this State to 53
hold certain money in a fiduciary capacity. Section 62 of this bill authorizes the 54

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Commissioner to revoke the registrat ion of an administrator without further notice 55
if the registration has already been suspended and the administrator becomes 56
nonresponsive. 57
Existing law provides for the registration and regulation of providers of service 58
contracts by the Commissioner. (Ch apter 690C of NRS) Sections 52 and 205 of 59
this bill: (1) reduce from 2 years to 1 year the length of time that a certificate of 60
registration for a service contract provider is valid; and (2) proportionally reduce 61
the fees for registration and renewal to reflect annual instead of biennial 62
registration. Sections 202, 207 and 209 of this bill revise provisions relating to 63
certain duties and requirements for the registration of a service contract provider. 64
Section 206 of this bill revises provisions relating to the financial security which is 65
required of a service contract provider. Section 208 of this bill requires a service 66
contract to include the name of the holder of the service contract. Sections 56, 199, 67
201 and 204 of this bill: (1) require a person who administers a service contract to 68
obtain a certificate of registration as an administrator issued by the Commissioner; 69
(2) subject such an administr ator to the provisions of existing law governing 70
administrators; and (3) set forth certain requirements for the operation of such an 71
administrator. Sections 200 and 211 of this bill authorize the Commissioner to: (1) 72
issue a cease and desist order under certain circumstances; and (2) suspend, without 73
advance notice or a hearing, the registration of a service contrac t provider if the 74
provider violates a cease and desist order from the Commissioner. Section 212 of 75
this bill increases the maximum fines the Commissioner may assess for certain 76
violations of existing law relating to service contracts. 77
Section 64 of this bill: (1) removes a provision requiring certain hear ings to be 78
held within 30 days of a written application under certain circumstances, thus 79
making existing law applicable which provides a 60 -day timeline for such hearings 80
under those circumstances; and (2) authorizes the Commissioner, after notice and 81
the opportunity for a hearing, to take certain actions against the license of a 82
business organization. (NRS 679B.310) 83
Existing law provides for the licensure and regulation of independent adjusters, 84
public adjusters, company adjusters and staff adjusters by the Commissioner. 85
(Chapter 684A of NRS) Section 67 of this bill eliminates the staff adjuster and 86
company adjuster license types and instead consolidates those license types into the 87
independent adjuster license type. Sections 66, 68-70, 73-76, 343 and 344 of this 88
bill make conforming changes to reflect that consolidation. 89
Existing law generally exempts a person who is licensed as an adjuster in 90
another state from the requirement to take and p ass an examination to obtain a 91
nonresident license as an adjuster under certain circumstances. Sections 71 and 72 92
of this bill require a person to take and pass such an examination if the home state 93
of the person requires a nonresident applicant for a license as an adjuster to take 94
and pass an examination for licensure. 95
Section 77 of this bill revises requirements for licensing as a surplus lines 96
broker. Section 78 of this bill revises provisions relating to the Commissioner 97
accepting service of process on behalf of unauthorized insurers in certain 98
circumstances. 99
Existing law governs trade practices and frauds relating to the insurance 100
business and gives the Commissioner exclusive jurisdiction to regulate trade 101
practices in the insurance business. (Chapter 686A of NRS) Sections 80-83, 97, 99, 102
101, 102 and 110 of this bill revise and add to the provisions of exis ting law 103
governing trade practices and frauds for the purpose of conforming more closely to 104
the Unfair Trade Practices Act adopted by the National Association of Insurance 105
Commissioners. Section 80 prohibits an insurer from taking certain discriminatory 106
actions. Section 81 imposes certain requirements on an insurer relating to 107
recordkeeping. Section 82 prohibits a person from making certain false or 108
fraudulent statements or representations. Section 83 requires a property and 109

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casualty insurer to provide to a primary insured certain loss information upon 110
request. Section 97 prohibits an insurer from providing certain inducements to 111
purchase insurance. Section 99 sets forth certain restrictions upon a person, bank or 112
affiliate relating to insurance. Section 101 sets forth certain actions relating to 113
value-added products or services that do not constitute prohibited discrimination or 114
rebates. Section 102 sets forth certain actions that constitute prohibited unfair 115
discrimination. Section 110 sets forth certain recordkeeping requirements for a 116
person who generates leads for an insurer or producer of insurance relating to 117
health insurance products and services. 118
Existing law prohibits cer tain health insurers from denying a claim, refusing to 119
issue or cancelling a policy of health insurance solely because the claim involves an 120
act of domestic violence or the person applying for or covered by the policy was the 121
victim of such an act of domes tic violence. (NRS 689A.413, 689B.068, 689C.196, 122
695A.195, 695B.316, 695C.203, 695D.217) Section 354 repeals those provisions. 123
Sections 84-93 of this bill instead set forth restrictions concerning discr imination 124
based on domestic violence which are modeled, in general, after several model acts 125
adopted by the National Association of Insurance Commissioners relating to unfair 126
discrimination against subjects of abuse. Sections 83-92 prohibit insurers, 127
insurance professionals and other persons from engaging in various discriminatory 128
actions relating to domestic violence, including, among other actions: (1) denying, 129
refusing to issue or renew, cancelling or otherwise terminating a policy of insurance 130
on the basis of the domestic violence status of a person; an d (2) with certain 131
exceptions, denying benefits on a policy of insurance on the basis of domestic 132
violence status, including, without limitation, denying a claim under a policy of 133
health insurance solely because the claim involves an act that constitutes d omestic 134
violence. Section 93 requires an insurer or insurance professional to explain to an 135
applicant or insured, and demonstrate to the Commissioner, cert ain matters relating 136
to certain actions involving medical conditions relating to domestic violence. 137
Section 109 of this bill sets forth certain unfair trade practices relating to the 138
handling of claims that are modeled, in general, after provisions set forth in the 139
Unfair Claims Settlement Practices Act adopte d by the National Association of 140
Insurance Commissioners. 141
Section 115 of this bill limits deductions for depreciation in the settlement of 142
certain prope rty insurance claims to the cost of physical goods being repaired or 143
replaced. 144
Section 117 of this bill reduces the time within which an insurer is required to 145
respond to a request for prior authorization, from within 20 days after the insurer 146
received the request to: (1) within 2 business days after the date of submission of 147
the request, if the request involves urgent health care services; and (2) within 5 148
business days after the date of submission of the request, if the request does not 149
involve urgent health care services. 150
Existing law prohibits an insurer from taking certain adverse actions against a 151
policy of motor vehicle insurance as a result of the filing of certain claims or the 152
making of certain inquiries. (NRS 687B.385) Section 118 of this bill expands that 153
prohibition to prohibit an insurer from taking certain adverse actions against a 154
policy of property or casualty insurance as a result of the filing of certain claims or 155
the making of certain inquiries. 156
Section 119 of this bill revises the dates on which the Commissioner is required 157
to request and an insurer is required to pro vide certain annual information relating 158
to compliance with certain federal laws. 159
Sections 128-134, 153-159, 175-181, 197, 232-237, 252, 270, 298-302, 304 160
and 305 of this bill reorganize and revise, for consistency throughout various 161
provisions of the Nevada Insurance Code, certain definit ions in existing law of the 162
terms “medical management technique,” “network plan,” “provider network 163
contract,” “provider of health care” and “therapeutic equivalent” as those terms 164

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relate to: (1) individual health insurance; (2) group and blanket health in surance; 165
(3) health insurance for small employers; (4) fraternal benefit societies; (5) 166
nonprofit corporations for hospital, medical and dental service; (6) health 167
maintenance organizations; and (7) managed care organizations. Sections 63, 120-168
123, 136-149, 151, 152, 160-174, 183-194, 238-250, 255-268, 274-287, 296, 303, 169
306-317, 328, 337, 338 and 349 of this bill make conforming changes to eliminate 170
duplicative references in provisions of existing law to which those reorganiz ed 171
definitions apply. 172
Section 135 of this bill removes certain obsolete references to a program for 173
reinsurance. Section 150 of this bill exempts certain health benefit plans from a 174
requirement to include certain provisions relating to reinstatement. 175
Sections 214 and 215 of this bill transfer certain duties of the Commissioner of 176
Financial Instituti ons to the Commissioner of Mortgage Lending. Sections 219, 177
321, 322 and 345 of this bill revise the conditions under which certain insurers are 178
considered impaired or insolvent for the purpose of conforming more closely to the 179
Insurer Receivership Model Act adopted by the National Association of Insurance 180
Commissioners. 181
Sections 220 and 334 of this bill provide for the confidentiality of certain 182
information relating to captive insurers. Section 222 of this bill authorizes the 183
Commissioner to exempt a pure captive insurer that only insures risks of its parent 184
and affiliated companies or controlled unaffiliated businesses from certain 185
provisions of existing la w applicable to captive insurers generally. For a captive 186
insurer who is not currently transacting the business of insurance and has been 187
issued a certificate of dormancy by the Commissioner, section 224 of this bill: (1) 188
revises the amount of capital and surplus required of a dormant captive insurer; and 189
(2) requires a dormant captive insurer to comply with any applicable 190
responsibilities of the insurer which accrued before the date on which the certificate 191
of dormancy was issued. Section 230 of this bill specifies the minimum amount of 192
the annual premium tax that is required to be paid by a captive insu rer in any year 193
in which the captive insurer was not a dormant captive insurer and wrote no direct 194
premiums or assumed no reinsurance premiums. Section 225 of this bill eliminates 195
a requirement for the Commissioner to adopt administrative regulations relating to 196
the competence of an attorney with whom a captive insurer enters into a contract. 197
Section 226 of this bill authorizes the calculation of what constitutes an 198
extraordinary dividend or extraordinary distribution based on the fiscal year of a 199
captive insurer rather than a calendar year. Sections 227 and 228 of this bill revise 200
provisions relating t o certain reporting requirements applicable to certain captive 201
insurers for consistency in existing law among different types of captive insurers. 202
Sections 230 and 231 of this bill: (1) eliminate the Account for the Regulation 203
and Supervision of Captive Insurers; and (2) redirect all fees, assessments, taxes 204
and other sources of funds which are credited to the Account into the Fund for 205
Insurance Administration and Enforcement. 206
Section 254 of this bill revises provisions relating to certain deductibles and 207
coinsurance payments which are applicable to group contracts fo r hospital, medical 208
or dental services. 209
Section 271 of this bill clarifies the applicability to health maintenance 210
organizations of certain existing la ws relating to network plans. Sections 272 and 211
273 of this bill revise certain terminology relating to the capital and surplus of a 212
health maintenance organization. 213
Sections 323-327 of this bill authorize the Commissioner to appoint a person 214
who is not an employee of the Division of Insurance to serve as the administrative 215
supervisor of an insurer which has been placed under administrative supervision by 216
the Commissioner. 217
Section 335 of this bill designates investigators and administrators of the 218
Division who perform certain duties relating to insurance fraud as category II peace 219

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officers, thus requiring them to meet certain training and educational requirements 220
applicable to those officers. 221
Sections 339 and 341 of this bill authorize the Commissioner to adopt 222
administrative regulations relating to cemeteries and crematories for pets. 223
Sections 347 and 348 of this bill: (1) require an association of self -insured 224
public or private employers to file a corrective action plan with the Commissioner 225
relating to certain deficiencies; and (2) authorize the Commissioner to withdraw the 226
certificate of an association if the association fails to notify the Commissioner of 227
such a deficiency. 228
Section 354 repeals provisions of existing law relating to insurance for home 229
protection. (NRS 645.645, 690B.100 -690B.180) Section 354 also repeals a 230
provision applicable to health insurance for small employers which is duplicative of 231
existing law applicable to all group and blanket health insurance. (NRS 689C.320) 232
Sections 53, 182, 195 and 330-332 of this bill make conforming changes by 233
removing and replacing references in existing law to provisions repealed by 234
section 354. 235

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

Section 1. Title 57 of NRS is hereby amended by adding 1
thereto a new chapter to consist of the provisions set forth as 2
sections 2 to 41, inclusive, of this act. 3
Sec. 2. As used in this chapter, unless the context otherwise 4
requires, the words and terms defined in sections 3 to 12, 5
inclusive, of this act have the meanings ascribed to them in those 6
sections. 7
Sec. 3. “Desk examination” means a targeted examination 8
that is conducted at a location o ther than the office of the insurer 9
or the location at which the records under review are stored. 10
Sec. 4. “Market analysis” means the process required by 11
sections 27 and 28 of this act whereby the Commissioner and 12
market conduct surveillance personnel collect and analyze 13
information to develop a baseline understanding of the 14
marketplace and to identify patterns or pract ices of insurers that 15
deviate significantly from the norm or that may pos e a potential 16
risk to a consumer of insurance. 17
Sec. 5. 1. “Market conduct action” means any action that 18
the Commissioner may initiate to assess and address the market 19
practices of an insurer, including, without limitation, market 20
analysis, a targeted examination and any other action described in 21
section 30 of this act. 22
2. The term does not include any action by the Commissioner 23
to resolve any individual complaint of a consumer or other report 24
or a specific instance of misconduct. 25
Sec. 6. “Market conduct surveillance personnel” means any 26
person employed by or contracted with by the Commissioner to 27

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collect, analyze, review or act on information in the insurance 1
marketplace that identifies patterns or practices of insurers. 2
Sec. 7. “Market conduct uniform examination procedures” 3
means the most recent set of guidelines, developed and adopted by 4
the National Association of Insurance Commissioners, to be used 5
by market conduct surveillance personnel in conducting an 6
examination. 7
Sec. 8. “Market Regulation Handbook” means the most 8
recent handbook, developed and adopted by the National 9
Association of Insurance Commissioners, which: 10
1. Outlines the elements and objectives of market analysis 11
and the process by which states can establish and implement 12
programs of market analysis; and 13
2. Sets forth guidelines which document established practices 14
to be used by market conduct surveillance personnel in developing 15
and executing an examination. 16
Sec. 9. “On-site examination” means a targeted examination 17
that is conducted at the office of the insurer or the location at 18
which the records under review are stored. 19
Sec. 10. “Standardized Data Request” means the most recent 20
set of field names and descriptions, developed and adopted by the 21
National Association of Insurance Commissioners, for use by 22
market conduct surveillance personnel during an examination. 23
Sec. 11. “Targeted examination” means a focused 24
examination based on the results of market analysis to review 25
specific line s of business or specific business practices of an 26
insurer as described in section 13 of this act. 27
Sec. 12. “Third-party model or product” means a model or 28
product used by an insurer that was provided to the insurer by a 29
person not under direct or indir ect corporate control of the 30
insurer. 31
Sec. 13. The specific lines of business or specific business 32
practices of an insurer that may be the subject of a targeted 33
examination include, without limitation: 34
1. Underwriting and rating; 35
2. Marketing and sales; 36
3. Complaint handling operations or management; 37
4. Advertising materials; 38
5. Licensing; 39
6. Policyholder services; 40
7. Nonforfeitures; 41
8. Claims handling; or 42
9. Policy forms and filings. 43
Sec. 14. If a change is made to any procedures, guidelines, 44
handbook or other work product of the National Association of 45

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Insurance Commissioners referenced in this chapter that would 1
materially change the manner in which a market conduct action is 2
conducted, the Commissioner shall give notice and provide 3
interested parties with the opportunity for a hearing to be held 4
pursuant to NRS 679B.310 on the matter if: 5
1. The change cannot be implemented without an amendment 6
to an existing statute or regulation; or 7
2. The Commissioner chooses not to follow the change or 8
otherwise deviate from the most recent version of the procedures , 9
guidelines, handbook or other work product. 10
Sec. 15. 1. For the purpose of determining financial 11
condition, fulfillment of contractual obligations and compliance 12
with the law, the Commissioner shall, as often as he or she deems 13
advisable, examine the affairs, transactions, accounts, records and 14
assets of each person subject to regulation under this Code and of 15
any person as to any matter relevant to the financial affairs of the 16
person subject to regulation under this Code or to the 17
examination. Except as otherwise expressly provided in this Code, 18
the Commiss ioner shall so examine each authorized insurer not 19
less frequently than every 5 years. In scheduling and determining 20
the nature, scope and frequency of examinations, the 21
Commissioner shall consider: 22
(a) The results of any analysis or any applicable financ ial 23
statement; 24
(b) Any change in management or ownership of the person 25
subject to regulation under this Code; 26
(c) Any applicable actuarial opinion or summary; 27
(d) Any applicable report of an independent certified public 28
accountant; and 29
(e) Any other applicable criteria set forth in the Market 30
Regulation Handbook and most recent edition of the Financial 31
Condition Examiners Handbook , published by the National 32
Association of Insurance Commissioners that is in effect when the 33
Commissioner ex ercises his or her discretion pursuant to this 34
section. 35
2. In performing an examination pursuant to this section of a 36
person subject to regulation under this Code , the Commissioner 37
may examine or investigate any person, or the business of any 38
person, if the examination or investigation is, in the sole discretion 39
of the Commissioner, necessary or material to the examination of 40
the person subject to regulation under this Code. 41
3. The examination of an alien insurer must be limited to its 42
insurance transac tions, assets, trust deposits and affairs in the 43
United States, except as otherwise required by the Commissioner. 44

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4. The Commissioner shall in like manner examine each 1
insurer applying for an initial certificate of authority to transact 2
insurance in this State. 3
5. In lieu of an examination under this chapter, the 4
Commissioner may accept a report of the examination of a foreign 5
or alien insurer prepared by the Division for a foreign insurer’s 6
state of domicile or an alien insurer’s state of entry into the United 7
States. 8
6. As far as practicable, the examination of a foreign or alien 9
insurer must be made in cooperation with the supervisory officers 10
of insurance of other states in which the insurer transacts 11
business. 12
Sec. 16. To ascertain compliance with law, or relationships 13
and transactions between any person and any person subject to 14
regulation under this Code, the Commissioner may, as often as he 15
or she deems advisable, examine the accounts, records, documents 16
and transactions relating to such compliance or relationships of: 17
1. Any producer of insurance, solicitor, surplus lines broker, 18
general agent, adjuster, insurer representative, bail agent, motor 19
club agent or any other licensee or any other person the 20
Commissioner has reason to believe may be holding himself or 21
herself out as any of the foregoing. 22
2. Any person having a contract under which the person 23
enjoys in fact the exclusive or dominant right to manage or 24
control an insurer. 25
3. Any insurance holding com pany or other person holding 26
the shares of voting stock or the proxies of policyholders of a 27
domestic insurer, to control the management thereof, as voting 28
trustee or otherwise. 29
4. Any subsidiary of the person subject to regulation under 30
this Code. 31
5. Any person engaged in this State in, or proposing to 32
engage in this State in, or holding himself or herself out in this 33
State as so engaging or proposing, or in this State assisting in, the 34
promotion, formation or financing of an insurer or insurance 35
holding corporation, or corporation or other group to finance an 36
insurer or the production of its business. 37
6. Any independent review organization, as defined in 38
NRS 695G.026. 39
Sec. 17. 1. When the Commissioner determines to examine 40
the affairs of any person, the Commissioner shall designate one or 41
more examiners and instruct the examiner or examiners as to the 42
scope of the examination. 43
2. The Commissioner shall conduct each examinatio n in an 44
expeditious, fair and impartial manner. 45

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3. Upon any such examination the Commissioner, or the 1
examiner if specifically so authorized in writing by the 2
Commissioner, may administer oaths and examine under oath any 3
person as to any matter relevant to the affairs under examination 4
or relevant to the examination. 5
4. Every person being examined and the officers, attorneys, 6
employees, agents and representatives of the person shall make 7
freely available to the Commissioner or the examiners of the 8
Commissioner the accounts, records, documents, files, 9
information, assets and matters of the person which are in his or 10
her possession or control and relating to the subject of the 11
examination and shall facilitate the examination. 12
5. If t he Commissioner or ex aminer finds any accounts or 13
records to be inadequate, or inadequately kept or posted, the 14
Commissioner may employ experts to reconstruct, rewrite, post or 15
balance the accounts or records at the expense of the person being 16
examined if that person has failed to maintain, complete or correct 17
the accounts or records after the Commissioner or examiner has 18
given the person written notice and a reasonable opportunity to do 19
so. 20
6. Neither the Commissioner nor any examiner may remove 21
any account, record, document, file or other property of the person 22
being examined from the offices or place of the person being 23
examined except with the written consent of the person before 24
removal or pursuant to an order of a court duly obtained. This 25
provision does not affect the m aking and removal of copies or 26
abstracts of any such account, record, document , file or other 27
property. 28
7. Any person who refuses without just cause to be examined 29
under oath or who willfully obstructs or interferes with an 30
examiner in the exercise of his or her authority pursuant to this 31
section is guilty of a misdemeanor. 32
8. This chapter does not limit the Commissioner’s authority: 33
(a) To terminate or suspend an examination in order to pursue 34
other legal or regulatory action. 35
(b) During any hearing or any legal action, to use and, if so 36
ordered by a court, to make public a final or preliminary report of 37
an examination, working papers or other documents of an 38
examiner or insurer, or any other information discovered or 39
developed during the course of an examination. Such documents 40
must be given their appropriate evidentiary weight and must not be 41
accepted as prima facie evidence of the facts contained therein. 42
Sec. 18. 1. No cause of action arises, nor may any liability 43
be imposed against any person for the act of communicating or 44
delivering information or data to the Commissioner or any 45

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authorized representative or examiner of the Commissioner 1
pursuant to an examination made under this chapter, if the act of 2
communication or delivery was performed in good faith and 3
without fraudulent intent, the intent to deceive or gross 4
negligence. 5
2. The Commissioner, his or her authorized representative or 6
any examiner appointed by the Commissioner is entitled to an 7
award of attorne y’s fees and costs if he or she is the prevailing 8
party in a civil cause of action for libel, slander or any other 9
relevant tort arising out of activities in carrying out the provisions 10
of this chapter and the party bringing the action was not 11
substantially justified in doing so. For the purposes of this 12
subsection, an action is substantially justified if the action had a 13
reasonable basis in law or fact at the time it was brought. 14
Sec. 19. 1. Except as otherwise provided in subsection 2: 15
(a) The cost of an examination of an insurer, or of any person 16
described in subsection 1, 2, 5 or 6 of section 16 of this act, must 17
be bor ne by the person examined. Such costs include only the 18
reasonable compensation and per diem allowance of the 19
examiners of the Commissioner, including expert assistance, and 20
incidental expenses as necessarily incurred in the examination. As 21
to the costs inc urred in any such examination, the Commissioner 22
shall give due consideration to scales and limitations 23
recommended by the National Association of Insurance 24
Commissioners and outlined in the examination manual 25
sponsored by the Association. 26
(b) The person examined shall promptly pay the costs of the 27
examination upon presentation by the Commissioner of a 28
reasonably detailed written statement thereof. 29
2. The Commissioner may bill a person subject to regulation 30
under this Code for the examination of any person referred to in 31
subsection 1 of section 16 of this act and shall adopt regulations 32
governing such billings. 33
Sec. 20. 1. All money received by the Commissioner 34
pursuant to section 19 of this act must be deposited in the Fund 35
for Insu rance Administration and Enforcement created by 36
NRS 680C.100. 37
2. Money for travel, per diem, compensation and other 38
necessary and authorized expenses incurred by an examiner or 39
other representative of the Division in the examination of any 40
person requir ed to pay, and making payment of, the expense of 41
examination pursuant to section 19 of this act must be paid out of 42
the Fund for Insurance Administration and Enforcement as other 43
claims against the State are paid. 44

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- *AB74*
Sec. 21. The provisions of sections 22 to 26, inclusive, of this 1
act apply to an examination conducted by the Commissioner other 2
than a targeted examination. 3
Sec. 22. 1. If the Commissioner deems it necessary to value 4
any asset involved in an examination, the Commissioner may 5
submit a written request to the person being examined to appoint 6
one or more appraisers who by reason of education, experience or 7
special training, and disinterest, are competent to appraise the 8
asset. Selection of any such appraiser must be subject to the 9
written approval of the Com missioner. If no such appointment is 10
made within 10 days after the request was delivered to the person, 11
the Commissioner may appoint the appraiser or appraisers. 12
2. Any such appraisal must be expeditiously made, and a copy 13
of the appraisal furnished to the Commissioner and to the person 14
being examined. 15
3. The reasonable costs of the appraisal must be borne by the 16
person being examined. 17
Sec. 23. 1. Not later than 60 days after the completion of 18
an examination, the examin er designated by the Commissioner 19
shall file a verified report of examination, in writing, which must 20
be comprised only of facts appearing upon the books, records or 21
other documents of the person subject to regulation under this 22
Code, the agents of the per son or other persons examined 23
concerning the affairs of the person , or as ascertained from the 24
testimony of the officers or agents of the person or other persons 25
examined concerning the affairs of the person , and such 26
conclusions and recommendations as the examiner finds 27
reasonably warranted from the facts. The report of examination 28
must be verified by the oath of the examiner making the report. 29
2. The report of examination of a person subject to regulation 30
under this Code verified pursuant to subsection 1 is prima facie 31
evidence in any action or proceeding for the receivership, 32
conservation or liquidation of the person brought in the name of 33
the State against the person , or the officers or agents of the 34
person, upon the facts stated therein. 35
Sec. 24. 1. Upon receipt of the verified report of 36
examination pursuant to section 23 of this act , the Commiss ioner 37
shall deliver a copy of the report to the person examined with a 38
notice affording the person 10 days or such additional reasonable 39
period as the Commissioner for good cause may allow within 40
which to review the report and make a written submission or 41
rebuttal with respect to recommended changes or any matters 42
contained in the report. 43
2. Within 30 days after the end of the period allowed for the 44
receipt of written submissions or rebuttals, the Commissioner shall 45

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fully consider and review the report, t ogether with any written 1
submissions or rebuttals and any relevant portions of the 2
examiner’s working papers and enter an order: 3
(a) Adopting the report as filed or with modification or 4
corrections; 5
(b) Rejecting the report with directions to the examine r to 6
reopen the examination for purposes of obtaining additional data, 7
documentation or information, and requiring the refiling of the 8
report pursuant to subsection 1 of section 23 of this act; or 9
(c) For an investigatory hearing for purposes of obtaining 10
additional documentation, data, information and testimony. 11
3. If the report reveals that a person subject to regulation 12
under this Code is operating in violation of any law, regulation or 13
previous order of the Commissioner, the Commissioner may order 14
the person to take any action the Commissioner considers 15
necessary or appropriate to cure the violation. 16
Sec. 25. 1. If requested by the person examined, within the 17
period allowed under subsection 1 of section 24 of this act, or if 18
ordered pursuant to subsection 2 of that sect ion, the 19
Commissioner shall hold a hearing relative to the report and shall 20
not file the report in the Division for public inspection until after 21
the hearing and the order of the Commissioner thereon. 22
2. If no hearing has been requested or ordered, the report of 23
examination, with modifications, if any, as the Commissioner 24
deems proper, must be filed in the Division for public inspection 25
within 30 days after the expiration of the period allowed for review 26
by the person examined. Otherwise the report must b e so filed 27
within 30 days after final hearing thereon, except that the 28
Commissioner may withhold from public inspection any report for 29
so long as the Commissioner deems such withholding to be 30
necessary for the protection of the person examined against 31
unwarranted injury or to be in the public interest. 32
3. The Commissioner shall forward to the person examined a 33
copy of the report of examination as filed, together with any 34
recommendations or statements relating thereto which the 35
Commissioner deems proper. 36
4. If the report concerns the examination of a domestic 37
insurer, a copy of the report, or a summary thereof approved by 38
the Commissioner must be presented by the insurer ’s chief 39
executive officer to the insurer ’s board of directors or similar 40
governing bo dy at its next regular board meeting. A copy of the 41
report must also be furnished by the secretary of the insurer, if 42
incorporated, or by the attorney -in-fact if a reciprocal insurer, 43
within 30 days after receipt of the report in final form by the 44
insurer, to each member of the insurer ’s board of directors or 45

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- *AB74*
similar governing body, and the certificate of the secretary or 1
attorney-in-fact that a copy of the report of examination has been 2
so furnished shall be deemed to constitute knowledge of the 3
contents of the report by each such member. 4
Sec. 26. 1. The Commissioner may disclose the content of a 5
report of examination , preliminary report, or the results of an 6
examination, or any matter relating thereto, to the Division or a ny 7
agency of any other state or country that regulates insurance, or to 8
law enforcement officers of this or any other state, or to an agency 9
of the Federal Government at any time, if the agency or office 10
receiving the report or matter relating thereto agre es in writing to 11
hold it confidential in a manner consistent with this chapter. 12
Access may also be granted to the National Association of 13
Insurance Commissioners. 14
2. All working papers, recorded information, documents and 15
copies thereof produced by, obta ined by or disclosed to the 16
Commissioner or any other person in the course of an 17
examination are confidential, are not subject to subpoena, and 18
may not be made public by the Commissioner or any other person, 19
except as necessary for a hearing or as provided in this section, 20
NRS 239.0115 and subsection 4 of section 25 of this act. A person 21
to whom information is given must agree in writing before 22
receiving th e information to provide to it the same confidential 23
treatment as required by this section, unless the prior written 24
consent of the person to which it pertains has been obtained. 25
Sec. 27. For the purpose of conducting the analysis required 26
by section 28 of this act, the Commissioner and market conduct 27
surveillance personnel shall collect information from: 28
1. Data currently available to the Division; 29
2. Surveys and required reporting requirements; 30
3. Information collected by the National Association of 31
Insurance Commissioners; 32
4. Other sources in public and private sectors; and 33
5. Other sources from within and outside the insurance 34
industry. 35
Sec. 28. 1. The Commissioner and market conduct 36
surveillance personnel shall analyze the information collected 37
pursuant to section 27 of this act to develop a baseline 38
understanding of the marketplace and to identify for further 39
review any insurer or pattern or practice of an insurer t hat 40
deviates significantly from the norm or that may pose a potential 41
risk to a consumer of insurance. 42
2. The Commissioner and market conduct surveillance 43
personnel shall use the Market Regulation Handbook as one 44
resource in performing the analysis required by subsection 1. 45

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Sec. 29. Except as otherwise provided by law, every insurer 1
or other person from whom information is sought in connection 2
with a market conduct action, including the officers, directors and 3
agents of the insurer or other person , shall provide the 4
Commissioner or market conduct surveillance personnel 5
convenient and free access to all books, records, accounts, papers, 6
documents and any or all computer or other recordings relating to 7
the property, assets, business and affairs of the insurer. The 8
officers, directors, employees, producers of insurance and agents 9
of the insurer or other person shall facilitate market conduct 10
actions and aid in market conduct a ctions so far as it is in their 11
power to do so. 12
Sec. 30. 1. If the Commissioner determines, as the result of 13
market analysis, that further inquiry into an insurer or a pattern 14
or practice of an insurer is needed, the Commissioner may, subject 15
to section 32 of this act, initiate an on -site examination or, before 16
initiating an on -site examination, initiate one or more other 17
market conduct actions, including, without limitation: 18
(a) Correspondence with the insurer. 19
(b) An interview with the insurer. 20
(c) Information gathering. 21
(d) Policy and procedure reviews. 22
(e) Interrogatories. 23
(f) A review of any self -evaluation or compliance program of 24
the insurer, including, without limitation, membership in a best 25
practices organization. 26
(g) A desk examination. 27
(h) Any other investigation, review or other action the 28
Commissioner deems appropriate to assess the market practices of 29
the insurer. 30
2. Any market conduct action initiated by the Commissioner 31
must: 32
(a) Be cost effective for the Division and the insurer; 33
(b) Provide for the protection of consumers of insurance; and 34
(c) Focus on the general business practices and compliance 35
activities of the insurer rather than on identifying infrequent or 36
unintentional errors that do not cause significant harm to 37
consumers of insurance. 38
3. Before initiating a market conduct action, the 39
Commissioner may provide the insurer an opportunity to resolve 40
any concerns of the Commissioner raised by market analysis to the 41
satisfaction of the Commissioner. 42
4. The Commissioner shall notify an insurer in writing if the 43
Commissioner initiates a market conduct action which requires a 44
response or other participation from the insurer. 45

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- *AB74*
5. The Commissioner shall take reasonable steps to eliminate 1
duplicative inquiries and coordinate market conduct actions and 2
findings with other states. 3
Sec. 31. 1. The Commissioner may determine the 4
frequency and timing of market conduct actions . In determining 5
the frequency and t iming of market conduct actions, the 6
Commissioner shall consider: 7
(a) The specific market conduct action to be initiated; and 8
(b) Whether extraordinary circumstances indicating a risk to 9
consumers warrant immediate action. 10
2. If the Commissioner has r eason to believe that more than 11
one insurer is engaged in common practices that constitute 12
grounds for initiating a market conduct action , the Commissioner 13
may schedule and coordinate more than one market conduct 14
action simultaneously. 15
3. The Commissioner shall conduct any targeted examination 16
in accordance with the Market Regulation Handbook and the 17
market conduct uniform examination procedures. 18
4. To the greatest extent possible, the Division shall use the 19
Standardized Data Request during a targeted e xamination. The 20
Division may adopt by regulation a successor product to the 21
Standardized Data Request if the Commissioner determines the 22
successor product is substantially similar. 23
5. In lieu of a targeted examination of a foreign or alien 24
insurer licens ed in this State, the Commissioner may accept an 25
examination report of another state if the Commissioner 26
determines that the state has a market surveillance system that is 27
comparable to the provisions of this chapter. 28
Sec. 32. 1. To the greatest extent possible, the 29
Commissioner shall consider initiating a desk examination or 30
other market conduct action described in section 30 of this act 31
before initiating an on-site examination. 32
2. If the Commissioner determines that other market conduct 33
actions identified in section 30 of this act are not appropriate or if 34
the Commissioner has already conducted another market conduct 35
action but determines that further inquiry into an insurer or the 36
pattern or practices of an insurer is wa rranted, the Commissioner 37
may initiate and conduct an on-site examination. 38
3. If the Commissioner schedules an on-site examination, the 39
Commissioner shall post notice of that fact, in accordance with the 40
requirements set forth in section 34 of this act, on the system for 41
tracking examinations maintained by the National Association of 42
Insurance Commissioners or its successor product or 43
organization, as determined by the Commissioner. 44

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- *AB74*
Sec. 33. Before conducting an on -site examination, market 1
conduct surveillance personnel shall prepare a work plan for the 2
examination that must include, without limitation: 3
1. The name and address of the insurer to be examined; 4
2. The name and contact information of a lead examiner who 5
will oversee the examination; 6
3. Notice of any personnel from outside the Division who will 7
assist in the examination; 8
4. The justification for the on-site examination; 9
5. The scope of the on-site examination; 10
6. The date on which the on -site examination is scheduled to 11
begin; 12
7. An estimate of the length of time that the on -site 13
examination will take; 14
8. A budget for the on-site examination; and 15
9. The factors which will be included in the billing for the on-16
site examination. 17
Sec. 34. 1. Except as otherwise provided in subsection 3, 18
not later than 60 days before the date on which an on -site 19
examination is scheduled to begin, the Commissioner shall: 20
(a) Send to the insurer: 21
(1) Notice in writing of that fact; 22
(2) The work plan prepared pursuant to section 33 of this 23
act; and 24
(3) A request for the insurer to name an examination 25
coordinator and to provide the name and contact information of 26
that person to the Commissioner. 27
(b) Post notice of that fact on the system for tracking 28
examinations maintained by the National Association of 29
Insurance Commissioners or its successor product or 30
organization, as determined by the Commissioner. 31
2. Except as otherwise provided in subsection 3, not later 32
than 30 days before the date on which an on -site examination is 33
scheduled to begin, the Commissioner shall conduct a pre -34
examination conference with the examination coordinator named 35
by the insurer pursuant to paragraph (a) of subsection 1 and any 36
other key personnel , as determined by the Commissioner or 37
examination coordinator, as applicable. 38
3. If the on -site examination is initiated in response to 39
extraordinary circumstances pursuant to paragraph (b) of 40
subsection 1 of section 31 of this act, the Commissioner shall 41
comply with the provisions of this section as soon as is practicable. 42
4. Before completing an on -site examination, the lead 43
examiner named in the work plan prepared pursuant to section 33 44
of this act shall conduct an exit conference with the insurer. 45

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- *AB74*
5. As soon as is practicable after completing the examination, 1
the Commissioner shall s end notice in writing to the insurer 2
confirming the date on which the on -site examination was 3
completed. 4
Sec. 35. 1. Except by mutual agreement in writing between 5
the Commissioner and the insurer to modify the following 6
timeline: 7
(a) Not later than 60 days after the date on which an on-site 8
examination is confirmed as complete pursuant to subsection 5 of 9
section 34 of this act, the Commissioner shall send a draft report 10
of examination results to the insurer. 11
(b) Not later than 30 days after the date on which the insurer 12
receives the draft report of examination results described in 13
paragraph (a), the insurer may send any wri tten comments related 14
to the draft report to the Commissioner. The insurer is not 15
required by this paragraph to submit written comments. If the 16
insurer submits written comments pursuant to this paragraph, the 17
comments must not include the name of any perso n involved in 18
any aspect of the examination, except that the name of a person 19
may be included to acknowledge the involvement of the person in 20
the examination. 21
(c) Not later than 30 days after the date on which the 22
Commissioner receives any written comment s from the insurer 23
pursuant to paragraph (b), or not later than 60 days after the date 24
on which the Commissioner sent the draft report pursuant to 25
paragraph (a) if the insurer does not submit any written 26
comments, the Commissioner shall send a final report of 27
examination results to the insurer in compliance with the 28
requirements of subsections 2 and 3. 29
(d) Not later than 30 days after the date on which the insurer 30
receives the final report of examination results, the insurer shall 31
be deemed to accept the f inal report and the findings of the final 32
report unless the insurer: 33
(1) Makes a written application for a hearing pursuant to 34
NRS 679B.310; or 35
(2) Makes a written request for a one -time extension from 36
the Commissioner of 30 additional days. The Commis sioner may 37
grant a request for extension submitted pursuant to this 38
subparagraph if the Commissioner determines it is appropriate. 39
2. The Commissioner may make revisions or corrections to 40
the report of examination results at any time after sending a draf t 41
report to the insurer pursuant to paragraph (a) of subsection 1 42
and before sending a final report to the insurer pursuant to 43
paragraph (c) of subsection 1. If the insurer submits any written 44

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- *AB74*
comments related to the draft report pursuant to paragraph (b) of 1
subsection 1, the Commissioner: 2
(a) Shall make a good faith effort to informally resolve any 3
issues raised in the written comments; and 4
(b) Except as otherwise provided in subsection 3, shall include 5
the written comments in the final report of examina tion results, 6
either in the body of the report or as an appendix. 7
3. The final report of examination results must not include 8
the name of any person involved in any aspect of the examination, 9
except that the name of a person may be included to acknowledge 10
the involvement of the person in the examination . If the insurer 11
submits written comments pursuant to paragraph (b) of subsection 12
1 in violation of the requirements of that paragraph, the 13
Commissioner shall redact the written comments in compli ance 14
with the requirements of this subsection before including the 15
written comments in the final report. 16
Sec. 36. 1. Except as otherwise provided in this section, the 17
Commissioner shall keep confidential the final report of 18
examination results created pursuant to section 35 of this act for 19
not less than 30 days after: 20
(a) The date on which the insurer acce pts the report or is 21
deemed to accept the report; or 22
(b) The date on which any proceedings related to a hearing 23
requested by the insurer pursuant to NRS 679B.310 have 24
concluded. 25
2. So long as a court of competent jurisdiction has not stayed 26
the publication of the final report of examination results created 27
pursuant to section 35 of this act, the Commissioner shall make 28
the final report open for public in spection after the period of 29
confidentiality described in subsection 1 has expired. 30
3. Nothing in this chapter shall be construed to prevent the 31
Commissioner from disclosing to the insurance regulatory body of 32
any other state or agency of the Federal Gov ernment, at any time, 33
any information discovered in the course of or the results of 34
targeted examination or any matter relating thereto, including, 35
without limitation, any draft report or final report of examination 36
results, if the state, agency or office receiving the information, 37
results or report agrees to hold the information, results or report 38
confidential in accordance with the provisions of this chapter. 39
Sec. 37. 1. Except as otherwise provided by law, in the 40
course of any market conduct action, market conduct surveillance 41
personnel shall have free and full access to all books and records, 42
employees, officers and directors, as practicable, of an insurer 43
during regular business hours. 44

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- *AB74*
2. An insurer utilizing a third -party model or product for any 1
of the activities which are the subject of a market conduct action 2
shall, upon the request of market conduct surveillance personnel, 3
make the details of the third-party model or product available. 4
3. All documents created, produced, disclosed to or obtained 5
by the Commissioner, the National Association of Insurance 6
Commissioners or any other person in the course of market 7
analysis or any other market conduct action shall be confidential 8
and privileged, shall not be subject to subpoena, and shall not be 9
subject to discovery or admissible in evidence in any private civil 10
action. For the purposes of this subsection, the term “documents” 11
includes, without limitation, working papers, third-party models or 12
products, complaint logs and any copies of the foregoing. 13
4. Disclosure from an insurer to the Commissioner of any 14
documents, materials or other information subject to the 15
provisions of this section shall not be construed as a waiver of any 16
applicable privilege or claim of confidentiality. 17
Sec. 38. Notwithstanding the provisions of section 37 of this 18
act, the Commissioner may, in order to assist in the performance 19
of his or her duties: 20
1. Share documents, materials and other information, 21
including confidential and privileged documents, m aterials and 22
other information, with an agency of any other state or country 23
that regulates insurance, law enforcement officers of this or any 24
other state, an agency of the Federal Government or the National 25
Association of Insurance Commissioners and its a ffiliates and 26
subsidiaries, if the recipient of the information has the legal 27
authority to and agrees to maintain the confidential and privileged 28
status of the information; 29
2. Receive documents, materials and other information, 30
including confidential and privileged documents, materials and 31
other information, from an agency of any other state or country 32
that regulates insurance, law enforcement officers of this or any 33
other state, an agency of the Federal Government or the National 34
Association of Insurance Commissioners and its affiliates and 35
subsidiaries, if the Commissioner maintains the confidential and 36
privileged status of any information received with notice of or the 37
understanding that it is confidential or privileged under the laws 38
of the jurisdictio n where the document, material or other 39
information originated; and 40
3. Enter into agreements governing the sharing and use of 41
documents, materials and other information consistent with this 42
chapter. 43
Sec. 39. 1. Market conduct surveillance personnel must be 44
qualified by education, experience and, where applicable, 45

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- *AB74*
professional designations. The Commissioner may contract with 1
qualified outside market conduct surveillance personnel to 2
supplement existing market conduct surve illance personnel if the 3
Commissioner determines assistance is necessary. 4
2. Except as otherwise provided in subsection 3, market 5
conduct surveillance personnel have a conflict of interest in a 6
market conduct action pursuant to the provisions of this cha pter if 7
the market conduct surveillance personnel directly or indirectly: 8
(a) Are affiliated with the management of the insurer subject 9
to the market conduct action; 10
(b) Have been employed by the insurer subject to the market 11
conduct action; or 12
(c) Own a pecuniary interest in the insurer subject to the 13
market conduct action. 14
3. Nothing in the provisions of subsection 2 shall be 15
construed to automatically preclude a person from being: 16
(a) A policyholder or claimant under a policy of insurance; 17
(b) A grantee of a mortgage or similar instrument on the 18
residence of the person from a regulated entity, if under 19
customary terms and in the ordinary course of business; 20
(c) An owner of an investment in shares of regulated 21
diversified investment companies; or 22
(d) A settlor or beneficiary of a blind trust into which any 23
otherwise permissible holding has been placed. 24
Sec. 40. 1. Any fine or other penalty levied as the result of 25
a market conduct action must be consistent, reasona ble and 26
justified. 27
2. In determining whether a fine or penalty is consistent, 28
reasonable and justified, the Commissioner shall consider: 29
(a) Any actions taken by the insurer to maintain membership 30
in and comply with the standards of any best practices 31
organizations that promote high ethical standards of conduct in 32
the marketplace; and 33
(b) The extent to which the insurer maintains any program of 34
regulatory compliance to assess, report and remediate any 35
problems detected by the insurer. 36
Sec. 41. 1. The Commissioner shall report data which is 37
collected during market analysis to the market information 38
systems which are used by the National Association of Insurance 39
Commissioners, or successor products as determined by the 40
Commissioner, including, without limitation, the Complaint s 41
Database System, the Examination Tracking System and the 42
Regulatory Information Retrieval System. 43

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- *AB74*
2. The Division shall compile and maintain data and other 1
information in a manner that meets the requirements of the 2
National Association of Insurance Commissioners. 3
3. The Commissioner shall share information and coordinate 4
the market analysis and examination efforts of the Division with 5
other states through the National Association of Insurance 6
Commissioners. 7
Sec. 42. Chapter 679B of NRS is hereby amended by adding 8
thereto a new section to read as follows: 9
1. If the Governor or the Legislature proclaims the existence 10
of a state of emergency or issues a declaration of disaster pursuant 11
to NRS 414.070, the Commissioner may issue an order that 12
addresses any or all of the following matters related to policies 13
issued in this State: 14
(a) Reporting requirements for claims; 15
(b) Grace periods for payment of insurance premi ums and 16
performance of other duties by an insured; or 17
(c) Temporary postponement of cancellations and 18
nonrenewals. 19
2. An order issued pursuant to subsection 1: 20
(a) Must be approved by the Governor; 21
(b) Is effective for not more than 30 days unless the 22
Commissioner, with the approval of the Governor, extends the 23
order for an additional period of not more than 30 days or any 24
subsequent additional period of not more than 30 days. 25
(c) Must specify, by line of insurance: 26
(1) The geographic areas in which the order applies, which 27
must be: 28
(I) Within, but may be less extensive than , the 29
geographic area specified in the proclamation of the existence of a 30
state of emergency or declaration of disaster; and 31
(II) Specified by an appropriate means of deline ation 32
which may include, without limitation, delineation by zip code; 33
and 34
(2) The date on which the order becomes effective and the 35
date on which the order terminates. 36
3. The Commissioner shall adopt regulations that establish 37
general criteria for an order issued pursuant to subsection 1. 38
4. Nothing in this section prohibits the Commissioner from 39
adopting an emergency regulation in accordance with chapter 40
233B of NRS relating to a specific proclamation of a state of 41
emergency or declaration of disaste r or otherwise limits or affects 42
the regulatory authority of the Commissioner as provided by law. 43

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- *AB74*
Sec. 43. NRS 679B.139 is hereby amended to read as follows: 1
679B.139 1. The Commissioner may adopt regulations 2
governing plans for providing welfare benefits to employees of 3
more than one employer. The regulations must provide standards 4
requiring the maintenance of specified levels of reserves and 5
specified levels of contributions which any such plan, or any trust 6
established under such a plan, must meet. If a plan does not meet the 7
standards, no benefits may be paid under the plan. 8
2. The Commissioner may conduct an examination of any 9
insurer which administers a plan for providing welfare benefits to 10
employees of more than one employer to determine whether the 11
insurer is complying with the Commissioner’s regulations. The cost 12
of the examination must be borne by the insurer in the manner 13
provided in [NRS 679B.290. ] section 19 of this act. If the 14
Commissioner determines that the insurer is not complying with 15
the Commissioner’s regulations, the Commissioner shall require the 16
insurer not to pay benefits under the plan. 17
3. As used in this section, the term “plan for providing welfare 18
benefits for employees of more than one employer” is intended to be 19
equivalent to the term “employee welfare benefit plan which is a 20
multiple employer welfare arrangement” as used in federal statute s 21
and regulations. 22
Sec. 44. NRS 679B.142 is hereby amended to read as follows: 23
679B.142 1. The Commissioner shall deliver to the Secretary 24
of State a copy of an order of the Commissioner or of the district 25
court prohibiting [an insurer] a person from transacting insurance in 26
this state as a corporation, limited -liability company, limited 27
partnership or limited-liability partnership. 28
2. Upon receiving the order, the Secretary of State shall nullify 29
the charter of the corporation or limited -liability company or the 30
certificate of the limited partnership or limited-liability partnership. 31
3. The Secretary of State shall not accept for filing a document 32
with the same name as a corporation, limited -liability company, 33
limited partnership or limited -liability partnership whose charter or 34
certificate has been nullified. 35
Sec. 45. NRS 679B.145 is hereby amended to read as follows: 36
679B.145 The Commissioner shall: 37
1. Publish a guide to rates for policies of insurance for motor 38
vehicles which contains: 39
(a) An explanation of the various types of coverage available. 40
(b) A list of all insurers which offer insurance for motor vehicles 41
in Nevada. 42
(c) [Comparisons of the cost for each type of insurance when 43
purchased from the five insurers who offer it at the highest price and 44

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- *AB74*
the five insurers who offer it at the lowest price, using one or more 1
hypothetical examples developed by the Commissioner. 2
(d)] Any other information which the Commissioner deems 3
appropriate and useful to the public. 4
2. Maintain the guide by republishing it with revised 5
information [at least once each year. ] if the Commissioner 6
determines market conditions have changed enough to warrant an 7
update. 8
3. Distribute the guide and the information contained in the 9
guide in any manner the Commissioner deems appropriate. 10
Sec. 46. NRS 679B.152 is hereby amended to read as follows: 11
679B.152 1. Every insurer or organization for dental care 12
which pays claims on the basis of usual and customary fees [for 13
medical] or [dental care which are “usual and customary” ] other 14
reimbursement methodology shall submit to the Commissioner a 15
complete description of the method it uses to determine those fees 16
[.] or of the other methodology, as applicable. Except as otherwise 17
provided in NRS 239.0115, this information must be kep t 18
confidential by the Commissioner. The fees [determined] or 19
methodology submitted by the insurer or organization [to be the 20
usual and customary fees ] for [that] dental care are subject to the 21
approval of the Commissioner as being the usual and customary fees 22
or an appropriate reimbursement methodology in that locality. 23
[The] Except as otherwise provided in subsection 3, the provisions 24
of this subsection apply to medical or dental care provided to a 25
claimant under any contract of insurance. 26
2. Any contrac t for group, blanket or individual health 27
insurance and any contract issued by a nonprofit hospital, medical or 28
dental service corporation or organization for dental care, which 29
provides a plan for dental care to its insureds or members which 30
limits their choice of a dentist, under the plan to those in a 31
preselected group, must offer its insureds or members the option of 32
selecting a plan of benefits which does not restrict the choice of a 33
dentist. The selection of that option does not entitle the insured or 34
member to any increase in contributions by his or her employer or 35
other organization toward the premium or cost of the optional plan 36
over that contributed under the restricted plan. 37
3. The provisions of subsection 1 do not apply to fees or 38
reimbursement methodologies used to reimburse a participating 39
provider of health care under a network plan issued pursuant to 40
NRS 687B.600 to 687B.850, inclusive. 41
Sec. 47. NRS 679B.180 is hereby amended to read as follows: 42
679B.180 1. The Commissioner may invoke the aid of the 43
courts through injunction or other proper process, mandatory or 44
otherwise, to enjoin any existing or threatened violation of any 45

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- *AB74*
provision of this Code, or to enforce any proper order made by or 1
action taken by the Commissioner. 2
2. If the Commissioner has reason to believe that any person 3
has violated any provision of this Code, or other law applicable to 4
insurance operations, for which criminal prosecution in the opinion 5
of the Commissioner would be in order, the Commissioner shall 6
give the information relative thereto to the appropriate district 7
attorney or to the Attorney General. The district attorney or 8
Attorney General shall promptly institute such action or proceedings 9
against such person as in the opinio n of the district attorney or 10
Attorney General the information may require or justify. 11
3. Except as otherwise provided in this Code, an attorney 12
employed by the Division or the Attorney General shall act as legal 13
counsel to the Division and the Commissio ner in all matters 14
pertaining to the administration and enforcement of this Code. 15
Sec. 48. NRS 679B.220 is hereby amended to read as follows: 16
679B.220 1. The Commissioner shall communicate on 17
request of the regulatory of ficer for insurance in any state, province 18
or country any information which it is the duty of the Commissioner 19
by law to ascertain respecting authorized insurers. 20
2. The Commissioner may: 21
(a) Be a member of the National Association of Insurance 22
Commissioners or any successor organization . [;] 23
(b) Exchange with the [association] Association or any 24
successor organization any information, not otherwise confidential, 25
relating to applicants and licensees under this title . [;] 26
(c) Communicate with the [association] Association or any 27
successor organization concerning the business of insurance 28
generally . [;] 29
(d) Enter into contracts with or through the Association or any 30
successor organization for goods and services related to the 31
regulation of insurance. Any contract entered into pursuant to this 32
paragraph is not subject to the provisions of chapter 333 of NRS. 33
(e) Enter into compacts with the regulatory officers in other 34
states to: 35
(1) Further the uniform treatment of insurers throughout the 36
United States; 37
(2) Ensure market stability; or 38
(3) Ensure essential insurance is made available to Nevada 39
residents . [; and 40
(e)] (f) Participate in and support other cooperative activities of 41
public officers having supervision of the business of insurance. 42
Sec. 49. NRS 679B.630 is hereby amended to read as follows: 43
679B.630 The Commissioner shall establish a program within 44
the Division to investigate any act or practice which: 45

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- *AB74*
1. Violates the provisions of NRS 686A.010 to [686A.310,] 1
686A.325, inclusive [;] , and sections 80 to 93, inclusive, of this 2
act; or 3
2. Defrauds or is an attempt to defraud an insurer. 4
Sec. 50. NRS 680A.120 is hereby amended to read as follows: 5
680A.120 1. Except as otherwise provided in [subsections 2 6
and 5, ] subsection 4, to qualify for authority to transact any one 7
kind of insurance as defined in NRS 681A.010 to 681A.080, 8
inclusive, or combinations of kinds of insurance as shown below, an 9
insurer shall possess and thereafter maintain unimpaired paid -in 10
capital stock, if a stock insurer, or unimpaired basic surplus, if a 11
mutual or a reciprocal insurer, and free surplus not less than 100 12
percent of the minimum required capital stock or minimum required 13
basic surplus, and when first so authorized shall possess initial free 14
surplus, all in amounts not less than as determined from the 15
following table: 16
17
FOREIGN MUTUAL RECIPROCAL 18
STOCK INSURERS INSURERS INSURERS 19
Minimum Minimum Minimum 20
Kind or Required Initial Required Initial Required Initial 21
Kinds of Capital Free Basic Free Basic Free 22
Insurance Stock Surplus Surplus Surplus Surplus Surplus 23
24
Life ................... 500,000 [1,000,000] 500,000 [1,000,000] N/A N/A 25
2,000,000 2,000,000 26
Health, Property, 27
Casualty, Surety, 28
Marine & 29
Transportation 30
Multiple 31
line ................ 500,000 [1,000,000] 500,000 [1,000,000] 500,000 [1,000,000] 32
2,000,000 2,000,000 2,000,000 33
Title .................. 500,000 [750,000] N/A N/A N/A N/A 34
1,500,000 35
Financial 36
[Guarantee] 37
Guaranty ...... 10,000,000 40,000,000 N/A N/A N/A N/A 38
39
2. [At the discretion of the Commissioner, a domestic insurer 40
holding a valid certificate of authority to transact insurance in this 41
state immediately prior to January 1, 1992, may, if otherwise 42
qualified therefor, continue to be so authorized while possessing t he 43
amount of paid -in capital stock, if a stock insurer, or surplus, if a 44
mutual insurer, required by the laws of this state for such authority 45

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immediately before January 1, 1992, for a period not to exceed 2 1
years. On or before January 1, 1994, the insurer shall meet the 2
requirements of subsection 1. The Commissioner shall not grant 3
such an insurer authority to transact any other or additional kinds of 4
insurance unless it then fully complies with the requirements as to 5
capital and surplus, as applied to all kinds of insurance which it then 6
proposes to transact, as provided by this section for like foreign 7
insurers applying for original certificates of authority pursuant to 8
this Code. 9
3.] Capital and surplus requirements are based upon all the 10
kinds of insu rance transacted by the insurer in any and all areas in 11
which it operates or proposes to operate, whether or not only a 12
portion of such kinds are to be transacted in this state. 13
[4.] 3. As to surplus required for qualification to transact one or 14
more kinds of insurance and thereafter to be maintained, domestic 15
mutual insurers are governed by chapter 693A of NRS and domestic 16
reciprocal insurers are governed by chapter 694B of NRS. 17
[5.] 4. An insurer who transacts financial guaranty insurance in 18
this state must transact only one kind of insurance and possess and 19
maintain the minimum capital and surplus requirements pursuant to 20
subsection 1. 21
Sec. 51. NRS 680A.200 is hereby amended to read as follows: 22
680A.200 1. Except as otherwise provided in NRS 616B.472, 23
the Commissioner may refuse to continue or may suspend, limit or 24
revoke an insurer’s certificate of authority if the Commissioner finds 25
after a hearing thereon, or upon waiver of hearing by the insurer, 26
that the insurer has: 27
(a) Violated or failed to comply with any lawful order of the 28
Commissioner; 29
(b) Conducted business in an unsuitable manner; 30
(c) Willfully violated or willfully failed to comply with any 31
lawful regulation of the Commissioner; or 32
(d) Violated any provision of this Code other than one for 33
violation of which suspension or revocation is mandatory. 34
 In lieu of such a suspension or revocation, the Commissioner 35
may levy upon the insurer, and the insurer shall pay forthwith, an 36
administrative fine of not more than $2,000 for each act or violation. 37
2. Except as otherwise provided in chapter 696B of NRS, the 38
Commissioner shall suspend or revoke an insurer’s certificate of 39
authority on any of the following grounds if the Commissioner finds 40
after a hearing thereon that the insurer: 41
(a) Is in unsound condition, is being fraudulently conducted, or 42
is in such a condition or is using such methods and practices in the 43
conduct of its business as to render its further transaction of 44

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- *AB74*
insurance in this State current ly or prospectively hazardous or 1
injurious to policyholders or to the public. 2
(b) With such frequency as to indicate its general business 3
practice in this State: 4
(1) Has without just cause failed to pay, or delayed payment 5
of, claims arising under its p olicies, whether the claims are in 6
favor of an insured or in favor of a third person with respect to the 7
liability of an insured to the third person; or 8
(2) Without just cause compels insureds or claimants to 9
accept less than the amount due them or to e mploy attorneys or to 10
bring suit against the insurer or such an insured to secure full 11
payment or settlement of such claims. 12
(c) Refuses to be examined, or its directors, officers, employees 13
or representatives refuse to submit to examination relative to i ts 14
affairs, or to produce its books, papers, records, contracts, 15
correspondence or other documents for examination by the 16
Commissioner when required, or refuse to perform any legal 17
obligation relative to the examination. 18
(d) Except as otherwise provided i n NRS 681A.110, has 19
reinsured all its risks in their entirety in another insurer. 20
(e) Has failed to pay any final judgment rendered against it in 21
this State upon any policy, bond, recognizance or undertaking as 22
issued or guaranteed by it, within 30 days a fter the judgment 23
became final or within 30 days after dismissal of an appeal before 24
final determination, whichever date is the later. 25
3. In addition to the grounds specified in subsections 1 and 2, 26
the Commissioner may refuse to continue or may suspend, limit or 27
revoke an insurer’s certificate of authority if the Commissioner finds 28
after a hearing thereon, or upon waiver of hearing by the insurer, 29
that the insurer has failed to comply with any provision of NRS 30
439B.800 to 439B.875, inclusive, if applicab le, or any applicable 31
regulation adopted pursuant thereto. 32
4. The Commissioner may, without advance notice or a hearing 33
thereon, immediately limit or suspend the certificate of authority of 34
any insurer as to which proceedings for receivership, 35
conservatorship, rehabilitation or other delinquency proceedings 36
have been commenced in any state by the public officer who 37
supervises insurance for that state. 38
5. No proceeding to suspend, limit or revoke a certificate of 39
authority pursuant to this section may be maintained unless it is 40
commenced by the giving of notice to the insurer within 5 years 41
after the occurrence of the charged act or omission. This limitation 42
does not apply if the Commissioner finds fraudulent or willful 43
evasion of taxes. 44

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- *AB74*
Sec. 52. NRS 680B.010 is hereby amended to read as follows: 1
680B.010 The Commissioner shall collect in advance and 2
receipt for, and persons so served must pay to the Commissioner, 3
fees and miscellaneous charges as follows: 4
1. Insurer’s certificate of authority: 5
(a) Filing initial application ............................................... $2,450 6
(b) Issuance of certificate: 7
(1) For any one kind of insurance as defined in 8
NRS 681A.010 to 681A.080, inclusive ........................................ 283 9
(2) For two or more kinds of insurance as so 10
defined .......................................................................................... 578 11
(3) For a reinsurer ........................................................... 2,450 12
(c) Each annual continuation of a certificate ....................... 2,450 13
(d) Reinstatement pursuant to NRS 680A.180, 50 14
percent of the annual continuation fee otherwise 15
required. 16
(e) Registration of additional title pursuant to 17
NRS 680A.240 ................................................................................ 50 18
(f) Annual re newal of the registration of 19
additional title pursuant to NRS 680A.240 ..................................... 25 20
2. Charter documents, other than those filed 21
with an application for a certificate of authority. 22
Filing amendments to articles of incorporation, 23
charter, bylaws, power of attorney and other 24
constituent documents of the insurer, each document .................. $10 25
3. Annual statement or report. For filing annual 26
statement or report ........................................................................ $25 27
4. Service of process: 28
(a) Filing of power of attorney .................................................. $5 29
(b) Acceptance of service of process ........................................ 30 30
5. Licenses, appointments and renewals for 31
producers of insurance: 32
(a) Application and license ................................................... $125 33
(b) Appointment fee for each insurer ........................................ 15 34
(c) Triennial renewal of each license ...................................... 125 35
(d) Temporary license ............................................................... 10 36
(e) Modification of an existing license ..................................... 50 37
6. Surplus lines brokers: 38
(a) Application and license ................................................... $125 39
(b) Triennial renewal of each license ...................................... 125 40
7. Managing general agents’ licenses, 41
appointments and renewals: 42
(a) Application and license ................................................... $125 43
(b) Appointment fee for each insurer ........................................ 15 44
(c) Triennial renewal of each license ...................................... 125 45

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- *AB74*
8. Adjusters’, as defined in NRS 684A.030, 1
licenses and renewals: 2
(a) Application and license ................................................... $125 3
(b) Triennial renewal of each license ...................................... 125 4
9. Licenses and renewals for appraisers of 5
physical damage to motor vehicles: 6
(a) Application and license ................................................... $125 7
(b) Triennial renewal of each license ...................................... 125 8
10. Insurance vending machines: 9
(a) Application and license, for each machine ...................... $125 10
(b) Triennial renewal of each license ...................................... 125 11
11. Permit for solicitation for securities: 12
(a) Application for permit ..................................................... $100 13
(b) Extension of permit ............................................................. 50 14
12. Securities salespersons for domestic 15
insurers: 16
(a) Application and license ..................................................... $25 17
(b) Annual renewal of license ................................................... 15 18
13. Rating organizations: 19
(a) Application and license ................................................... $500 20
(b) Annual renewal ................................................................. 500 21
14. Certificates and renewals for administrators 22
licensed pursuant to chapter 683A of NRS: 23
(a) Application and certificate of registration ....................... $125 24
(b) Triennial renewal .............................................................. 125 25
15. For copies of the insurance laws of Nevada, 26
a fee which is not less than the cost of producing the 27
copies. 28
16. Certified copies of certificates of authority 29
and licenses issued pursuant to the Code ...................................... $10 30
17. For copies and amendments of documents 31
on file in the Division, a reasonable charge fixed by 32
the Commissioner, includi ng charges for duplicating 33
or amending the forms and for certifying the copies 34
and affixing the official seal. 35
18. Letter of clearance for a producer of 36
insurance or other licensee if requested by someone 37
other than the licensee ................................................................... $10 38
19. Certificate of status as a producer of 39
insurance or other licensee if requested by someone 40
other than the licensee ................................................................... $10 41
20. Licenses, appointments and renewals for bail 42
agents: 43
(a) Application and license ................................................... $125 44
(b) Appointment for each surety insurer ................................... 15 45

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- *AB74*
(c) Triennial renewal of each license .................................... $125 1
21. Licenses and renewals for bail enforcement 2
agents: 3
(a) Application and license ................................................... $125 4
(b) Triennial renewal of each license ...................................... 125 5
22. Licenses, appointments and renewals for 6
general agents for bail: 7
(a) Application and license ................................................... $125 8
(b) Initial appointment by each insurer ..................................... 15 9
(c) Triennial renewal of each license ...................................... 125 10
23. Licenses and renewals for bail solicitors: 11
(a) Application and license ................................................... $125 12
(b) Triennial renewal of each license ...................................... 125 13
24. Licenses and renewals for title agents and 14
escrow officers: 15
(a) Application and license ................................................... $125 16
(b) Triennial renewal of each license ...................................... 125 17
(c) Appointment fee for each title insurer ................................. 15 18
25. Certificate of authority and renewal for a 19
seller of prepaid funeral contracts ............................................... $125 20
26. Licenses and renewals for agents for prepaid 21
funeral contracts: 22
(a) Application and license ................................................... $125 23
(b) Triennial renewal of each license ...................................... 125 24
27. Reinsurance intermediary broker or 25
manager: 26
(a) Application and license ................................................... $125 27
(b) Triennial renewal of each license ...................................... 125 28
28. Agents for and sellers of prepaid burial 29
contracts: 30
(a) Application and certificate or license .............................. $125 31
(b) Triennial renewal .............................................................. 125 32
29. Risk retention groups: 33
(a) Initial registration ............................................................ $250 34
(b) Each annual continuation of a certificate of 35
registration .................................................................................... 250 36
30. Required filing of forms: 37
(a) For rates and policies......................................................... $25 38
(b) For riders and endorsements ............................................... 10 39
31. Viatical settlements: 40
(a) Provider of viatical settlements: 41
(1) Application and license ........................................... $1,000 42
(2) Annual renewal ......................................................... 1,000 43
(b) Broker of viatical settlements: 44
(1) Application and license ................................................ 500 45

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- *AB74*
(2) Annual renewal .......................................................... $500 1
(c) Registration of producer of insurance acting 2
as a viatical settlement broker ....................................................... 250 3
32. Insurance consultants: 4
(a) Application and license ................................................... $125 5
(b) Triennial renewal .............................................................. 125 6
33. Licensee’s association with or designation, 7
appointment or sponsorship by an organization: 8
(a) Initial association, designation or sponsorship 9
and renewal of association, designation or 10
sponsorship, for each organization ............................................... $50 11
(b) Initial appointment and annual renewal of 12
appointment .................................................................................... 15 13
34. Purchasing groups: 14
(a) Initial registration and review of an 15
application ................................................................................... $100 16
(b) Each annual continuation of registration........................... 100 17
35. Exchange enrollment facilitators: 18
(a) Application and certificate .............................................. $125 19
(b) Triennial renewal of each certificate ................................. 125 20
(c) Temporary certificate .......................................................... 10 21
36. Agent who performs utilization reviews: 22
(a) Application and registration ............................................ $250 23
(b) Renewal of registration ..................................................... 250 24
37. Motor club: 25
(a) Filing of application ........................................................ $500 26
(b) Issuance of certificate........................................................ 283 27
38. Motor club agent: 28
(a) Application and license ..................................................... $78 29
(b) Appointment by each motor club .......................................... 5 30
(c) Triennial renewal of each license ........................................ 78 31
39. Title plant company: 32
(a) Application and license ..................................................... $10 33
(b) Renewal of license .............................................................. 10 34
40. Service contract provider: 35
(a) Application and registration ........................... [$2,000] $1,000 36
(b) Renewal of registration ...................................... [2,000] 1,000 37
41. In addition to any other fee or charge, all applicable fees 38
required of any person, including, without limitation, pe rsons listed 39
in this section, pursuant to NRS 680C.110. 40
Sec. 53. NRS 681A.020 is hereby amended to read as follows: 41
681A.020 1. “Casualty insurance” includes: 42
(a) Vehicle insurance. Insurance against loss of or damage to 43
any land vehicle or aircraft or any draft or riding animal or to 44
property while contained therein or thereon or being loaded or 45

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- *AB74*
unloaded therein or therefrom, from any hazard or cause, and 1
against any loss, liability or expense resulting from or inciden tal to 2
ownership, maintenance or use of any such vehicle, aircraft or 3
animal, together with insurance against accidental injury to natural 4
persons, irrespective of legal liability of the insured, including the 5
named insured, while in, entering, alighting f rom, adjusting, 6
repairing, cranking, or caused by being struck by a vehicle, aircraft 7
or draft or riding animal, if such insurance is issued as an incidental 8
part of insurance on the vehicle, aircraft or draft or riding animal. 9
(b) Liability insurance. Insurance against legal liability for the 10
death, injury or disability of any human being, or for damage to 11
property, including liability resulting from negligence in rendering 12
expert, fiduciary or professional services, and provisions of medical, 13
hospital, surgical, disability benefits to injured persons and funeral 14
and death benefits to dependents, beneficiaries or personal 15
representatives of persons killed, irrespective of legal liability of the 16
insured, when issued as an incidental coverage with or supplemental 17
to liability insurance. 18
(c) Workers’ compensation and employer’s liability. Insurance 19
of the obligations accepted by, imposed upon or assumed by 20
employers under law for death, disablement or injury of employees. 21
(d) Burglary and theft. Insurance against loss or damage by 22
burglary, theft, larceny, robbery, forgery, fraud, vandalism, 23
malicious mischief, confiscation, or wrongful conversion, disposal 24
or concealment, or from any attempt at any of the foregoing, 25
including supplemental coverage for medi cal, hospital, surgical and 26
funeral expense incurred by the named insured or any other person 27
as a result of bodily injury during the commission of a burglary, 28
robbery or theft by another, and, also, insurance against loss of or 29
damage to moneys, coins, bu llion, securities, notes, drafts, 30
acceptances or any other valuable papers and documents, resulting 31
from any cause. 32
(e) Personal property floater. Insurance upon personal effects 33
against loss or damage from any cause. 34
(f) Glass. Insurance against loss or damage to glass, including its 35
lettering, ornamentation and fittings. 36
(g) Boiler and machinery. Insurance against any liability and 37
loss or damage to property or interest resulting from accidents to or 38
explosions of boilers, pipes, pressure containers, m achinery or 39
apparatus, and to make inspection of and issue certificates of 40
inspection upon boilers, machinery and apparatus of any kind, 41
whether or not insured. 42
(h) Leakage and fire extinguishing equipment. Insurance against 43
loss or damage to any property or interest caused by the breakage or 44
leakage of sprinklers, hoses, pumps and other fire -extinguishing 45

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- *AB74*
equipment or apparatus, water pipes or containers, or by water 1
entering through leaks or openings in buildings, and insurance 2
against loss or damage to such sprinklers, hoses, pumps and other 3
fire-extinguishing equipment or apparatus. 4
(i) Credit and mortgage guaranty. Insurance against loss or 5
damage resulting from failure of debtors to pay their obligations to 6
the insured, and insurance of real property mortgage lenders against 7
loss by reason of nonpayment of the mortgage indebtedness. 8
(j) Elevator. Insurance against loss of or damage to any property 9
of the insured, resulting from the ownership, maintenance or use of 10
elevators, except loss or damage by fire, and to make inspection of 11
and issue certificates of inspection upon, elevators. 12
(k) Congenital defects. Insurance against congenital defects in 13
human beings. 14
(l) Livestock. Insurance against loss or damage to livestock, and 15
services of a veterinary for such animals. 16
(m) Entertainments. Insurance indemnifying the producer of any 17
motion picture, television, radio, theatrical, sport, spectacle, 18
entertainment, or similar production, event or exhibition against loss 19
from interruption, postponement or ca ncellation thereof due to 20
death, accidental injury or sickness of performers, participants, 21
directors or other principals. 22
(n) Miscellaneous. Insurance against any other kind of loss, 23
damage or liability properly a subject of insurance and not within 24
any other kind of insurance as defined in this chapter, if such 25
insurance is not disapproved by the Commissioner as being contrary 26
to law or public policy . [, including insurance for home protection 27
issued pursuant to NRS 690B.100 to 690B.180, inclusive.] 28
2. Provision of medical, hospital, surgical and funeral benefits, 29
and of coverage against accidental death or injury, as incidental to 30
and part of other insurance as stated under paragraphs (a) (vehicle), 31
(b) (liability), (d) (burglary), (g) (boiler and mac hinery) and (j) 32
(elevator) of subsection 1 shall for all purposes be deemed to be the 33
same kind of insurance to which it is so incidental, and is not subject 34
to provisions of this Code applicable to life and health insurances. 35
Sec. 54. NRS 681B.400 is hereby amended to read as follows: 36
681B.400 1. The following types of information shall qualify 37
as confidential information: 38
(a) A memorandum in support of an opinion submitted pursuant 39
to NRS 681B.200 to 681B.260, inclusiv e, or 681B.350 and any 40
other documents, materials and other information, including, 41
without limitation, all working papers, and copies thereof, created, 42
produced or obtained by or disclosed to the Commissioner or any 43
other person in connection with such memorandum; 44

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- *AB74*
(b) All documents, materials and other information, including, 1
without limitation, all working papers, and copies thereof, created, 2
produced or obtained by or disclosed to the Commissioner or any 3
other person in the course of an examination auth orized by 4
subsection 4 of [NRS 679B.230] section 15 of this act or subsection 5
7 of NRS 681B.300, provided that if an examination report or other 6
material prepared in connection with an examination authorized by 7
[NRS 679B.230 to 679B.300, ] sections 2 to 41, inclusive, of this 8
act, is not held as private and confidential information in accordance 9
with the provisions of [NRS 679B.230 to 679B.300, ] sections 2 to 10
41, inclusive, of this act, an adopted examination report created in 11
accordance with the provisions of subsection 4 of [NRS 679B.230] 12
section 15 of this act or subsection 7 of NRS 681B.300 shall not be 13
deemed confidential information; 14
(c) Any reports, documents, materials and other information 15
developed by an applicable company in support of, or in connection 16
with, an annual certification by the applicable company in 17
accordance with the provisions of paragraph (b) of subsection 1 of 18
NRS 681B.360 evaluating the effectiveness of the company’s 19
internal controls with respect to a principle-based valuation, and any 20
other documents, materials and other information, including, 21
without limitation, all working papers, and copies thereof, created, 22
produced or obtained by or disclosed to the Commissioner or any 23
other person in connection with such reports, documents, materials 24
and other information; 25
(d) Any principle -based valuation rep ort developed in 26
accordance with paragraph (c) of subsection 1 of NRS 681B.360, 27
and any other documents, materials and other information, 28
including, without limitation, all working papers, and copies thereof, 29
created, produced or obtained by or disclosed t o the Commissioner 30
or any other person in connection with such report; and 31
(e) Any experience data and experience materials, and any other 32
documents, materials, data and other information, including, without 33
limitation, all working papers, and copies ther eof, created, produced 34
or obtained by or disclosed to the Commissioner or any other person 35
in connection with such data and materials. 36
2. As used in this section: 37
(a) “Experience data” means all documents, materials, data and 38
other information submitted by an applicable company to the 39
Commissioner, a designated experience reporting agent or other 40
such person authorized to act on behalf of the Commissioner 41
pursuant to NRS 681B.500 and 681B.510. 42
(b) “Experience materials” means all documents, materials, d ata 43
and other information, including, without limitation, all working 44
papers, and copies thereof, created or produced in connection with 45

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- *AB74*
experience data including, without limitation, any potentially 1
company-identifying or personally identifiable informati on, that is 2
provided to or obtained by the Commissioner, a designated 3
experience reporting agent or other such person authorized to act on 4
behalf of the Commissioner pursuant to NRS 681B.500 and 5
681B.510. 6
Sec. 55. Chapter 683A of NRS is hereby amended by adding 7
thereto a new section to read as follows: 8
An administrator shall report to the Commissioner: 9
1. Any administrative action taken against the administrator 10
in another jurisdiction or by another governmental agency i n this 11
State, not later than 30 days after the date of the final disposition 12
of the matter. The report must include, without limitation, a copy 13
of the complaint filed, the order issued and any other relevant 14
legal documents. 15
2. Any criminal prosecution against the administrator in any 16
jurisdiction, not later than 30 days after the date of the initial 17
pretrial hearing. The report must include, without limitation, a 18
copy of the complaint filed, any order issued after the pretrial 19
hearing and any other relevant legal documents. 20
Sec. 56. NRS 683A.025 is hereby amended to read as follows: 21
683A.025 1. Except as limited by this section, 22
“administrator” means a person who: 23
(a) Directly or indirectly underwrites or collects cha rges or 24
premiums from or adjusts or settles claims of residents of this State 25
or any other state from within this State in connection with workers’ 26
compensation insurance, life or health insurance coverage or 27
annuities, including coverage or annuities prov ided by an employer 28
for his or her employees; 29
(b) Administers an internal service fund pursuant to 30
NRS 287.010; 31
(c) Administers a trust established pursuant to NRS 287.015, 32
under a contract with the trust; 33
(d) Administers a program of self-insurance for an employer; 34
(e) Administers a program which is funded by an employer and 35
which provides pensions, annuities, health benefits, death benefits or 36
other similar benefits for his or her employees; 37
(f) Administers a program of pharmacy benefits for an 38
employer, insurer, internal service fund or trust; [or] 39
(g) Administers a service contract, as defined in NRS 40
690C.080; or 41
(h) Is an insurance company that is licensed to do business in 42
this State or is acting as an insurer with respect to a policy lawfully 43
issued and delivered in a state where the insurer is authorized to do 44
business, if the insurance company performs any act des cribed in 45

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paragraphs (a) to [(f),] (g), inclusive, for or on behalf of another 1
insurer unless the insurers are affiliated and each insurer is licensed 2
to do business in this State. 3
2. “Administrator” does not include: 4
(a) An employee authorized to act o n behalf of an administrator 5
who holds a certificate of registration from the Commissioner. 6
(b) An employer acting on behalf of his or her employees or the 7
employees of a subsidiary or affiliated concern. 8
(c) A labor union acting on behalf of its members. 9
(d) Except as otherwise provided in paragraph [(g)] (h) of 10
subsection 1, an insurance company licensed to do business in this 11
State or acting as an insurer with respect to a policy lawfully issued 12
and delivered in a state in which the insurer was author ized to do 13
business. 14
(e) A producer of life or health insurance licensed in this State, 15
when his or her activities are limited to the sale of insurance. 16
(f) A creditor acting on behalf of his or her debtors with respect 17
to insurance covering a debt between the creditor and debtor. 18
(g) A trust and its trustees, agents and employees acting for it, if 19
the trust was established under the provisions of 29 U.S.C. § 186. 20
(h) Except as otherwise provided in paragraph (c) of subsection 21
1, a trust and its trustee s, agents and employees acting for it, if the 22
trust was established pursuant to NRS 287.015. 23
(i) A trust which is exempt from taxation under section 501(a) 24
of the Internal Revenue Code, 26 U.S.C. § 501(a), its trustees and 25
employees, and a custodian, his or her agents and employees acting 26
under a custodial account which meets the requirements of section 27
401(f) of the Internal Revenue Code, 26 U.S.C. § 401(f). 28
(j) A bank, credit union or other financial institution which is 29
subject to supervision by federal or state banking authorities. 30
(k) A company which issues credit cards, and which advances 31
for and collects premiums or charges from credit card holders who 32
have authorized it to do so, if the company does not adjust or settle 33
claims. 34
(l) An attorney at law who adjusts or settles claims in the normal 35
course of his or her practice or employment, but who does not 36
collect charges or premiums in connection with life or health 37
insurance coverage or with annuities. 38
3. As used in this section, “affiliat ed” means any insurer or 39
other person that directly, or indirectly through one or more 40
intermediaries, controls or is controlled by, or is under common 41
control with, another insurer or other person. 42

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Sec. 57. NRS 683A.0805 i s hereby amended to read as 1
follows: 2
683A.0805 As used in NRS 683A.0805 to 683A.0893, 3
inclusive, and section 55 of this act, unless the context otherwis e 4
requires, the words and terms defined in NRS 683A.081 to 5
683A.084, inclusive, have the meanings ascribed to them in those 6
sections. 7
Sec. 58. NRS 683A.08522 is hereby amended to read as 8
follows: 9
683A.08522 Each application for a certificate of registration as 10
an administrator must include or be accompanied by: 11
1. A financial statement of the applicant that has been reviewed 12
by an independent certified public accountant and which includes: 13
(a) A statement regar ding the amount of money that the 14
applicant expects to collect from or disburse to residents of this state 15
during the next calendar year. 16
(b) Financial information for the 90 days immediately preceding 17
the date the application was filed with the Commissioner. 18
(c) An income statement and balance sheet for the 2 years 19
immediately preceding the application that are: 20
(1) Prepared in accordance with generally accepted 21
accounting principles [;] , statutory accounting principles or other 22
recognized financial s tandards as the Commissioner may allow; 23
and 24
(2) Reviewed by an independent certified public accountant. 25
(d) A certification of the financial statement by an officer of the 26
applicant. 27
2. The documents used to create the business association of the 28
administrator, including articles of incorporation, articles of 29
association, a partnership agreement, a trust agreement and a 30
shareholders’ agreement. 31
3. The documents used to regulate the internal affairs of the 32
administrator, including the bylaws, rules or regulations of the 33
administrator. 34
4. A certificate of registration issued pursuant to NRS 600.350 35
for a trade name or trademark used by the administrator, if 36
applicable. 37
5. An organizational chart that identifies each person who 38
directly or indirectly controls the administrator and each affiliate of 39
the administrator. 40
6. A notarized affidavit from each person who manages or 41
controls the administrator, including each member of the board of 42
directors or board of trustees, each officer, partner and member of 43
the business association of the administrator, and each shareholder 44

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- *AB74*
of the administrator who holds not less than 10 percent of the voting 1
stock of the administrator. The affidavit must include: 2
(a) The personal history, business record and insur ance 3
experience of the affiant; 4
(b) Whether the affiant has been investigated by any regulatory 5
authority or has had any license or certificate denied, suspended or 6
revoked in any state; and 7
(c) Any other information that the Commissioner may require. 8
7. The complete name and address of each office of the 9
administrator, including offices located outside this state. 10
8. A statement that sets forth whether the administrator has: 11
(a) Held a license or certificate to transact any kind of insurance 12
in this state or any other state and whether that license or certificate 13
has been refused, suspended or revoked; 14
(b) Been indebted to any person and, if so, the circumstances of 15
that debt; and 16
(c) Had an administrative agreement cancelled and, if so, the 17
circumstances of that cancellation. 18
9. A statement that describes the business plan of the 19
administrator. The statement must include information: 20
(a) Concerning the number of persons on the staff of the 21
administrator and the activities proposed in this state or in any other 22
state. 23
(b) That demonstrates the capability of the administrator to 24
provide a sufficient number of experienced and qualified persons for 25
the processing of claims, the keeping of records and, if applicable, 26
underwriting. 27
10. If the applic ant intends to solicit new or renewal business, 28
proof that the applicant employs or has contracted with a producer 29
of insurance licensed in this state to solicit and take applications. An 30
applicant who intends to solicit insurance contracts directly or to act 31
as a producer must provide proof that the applicant is licensed as a 32
producer in this state. 33
11. If the applicant is not an insurer and is not [domiciled] 34
resident in this State, a copy of the license, certificate or other 35
authorization issued by the state in which the applicant is 36
[domiciled] resident which authorizes the applicant to act as an 37
administrator in that state, if any. 38
12. Any other information required by the Commissioner. 39
Sec. 59. NRS 683A.0857 is hereby amended to read as 40
follows: 41
683A.0857 1. Each administrator shall file with the 42
Commissioner a bond which complies with NRS 679B.175, 43
continuous in form and in an amount determined by the 44
Commissioner of not less than $100,000. 45

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- *AB74*
2. The Commissioner shall establish schedules for the amount 1
of the bond required, based on the amount of money received and 2
distributed by an administrator. 3
3. The bond must inure to the benefit of any person damaged 4
by any fraudulent act or conduct of the administrato r [and must be 5
conditioned upon faithful accounting and application of all money 6
coming into the administrator’s possession ] in connection with his 7
or her activities as an administrator. 8
4. A replacement bond must meet all requirements for the 9
initial bond. 10
Sec. 60. NRS 683A.0873 is hereby amended to read as 11
follows: 12
683A.0873 1. Each administrator shall maintain at his or her 13
principal office adequate books and records of all transactions 14
between the administrator, the insurer and the insured. The books 15
and records must be maintained in accordance with prudent 16
standards of recordkeeping for insurance and with regulations of the 17
Commissioner for a period of 5 years after the transaction to which 18
they respectively relate. After the 5 -year period, the administrator 19
may [remove] return the books and records [from the State, store 20
their contents on microfilm or return them ] to the appropriate 21
insurer. 22
2. The Commissioner may examine, audit and inspect books 23
and records maintained by an administrator under the provisions of 24
this section to carry out the provisions of [NRS 679B.230 to 25
679B.300,] sections 2 to 41, inclusive [.] , of this act. 26
3. The names and addresses of insured persons and any other 27
material which is in the books and records of an administrator are 28
confidential except as otherwise provided in NRS 239.0115 and 29
except when used in proceedings against the administrator. 30
4. The insurer may inspect and examine all books and records 31
to the extent necessary to fulfill all contractual obligations to insured 32
persons, subject to restrictions in the written agreement between the 33
insurer and administrator. 34
Sec. 61. NRS 683A.0877 is hereby amended to read as 35
follows: 36
683A.0877 1. All insurance charges and premiums collected 37
by an administrator on behalf of an insurer and return premiums 38
received from an insurer are held by the administrator in a fiduciary 39
capacity. 40
2. Money must be remitted within 15 days to the pe rson or 41
persons entitled to it, or be deposited within 15 days in one or more 42
fiduciary accounts established and maintained by the administrator 43
in a bank, credit union or other financial institution . [in this state. ] 44

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- *AB74*
The fiduciary accounts must be separa te from the personal or 1
business accounts of the administrator. 2
3. If charges or premiums deposited in an account have been 3
collected for or on behalf of more than one insurer, the administrator 4
shall cause the bank, credit union or other financial institution where 5
the fiduciary account is maintained to record clearly the deposits 6
and withdrawals from the account on behalf of each insurer. 7
4. The administrator shall promptly obtain and keep copies of 8
the records of each fiduciary account and shall furn ish any insurer 9
with copies of the records which pertain to him or her upon demand 10
of the insurer. 11
5. The administrator shall not pay any claim by withdrawing 12
money from his or her fiduciary account in which premiums or 13
charges are deposited. 14
6. Withdrawals must be made as provided in the agreement 15
between the insurer and the administrator for: 16
(a) Remittance to the insurer. 17
(b) Deposit in an account maintained in the name of the insurer. 18
(c) Transfer to and deposit in an account for the payment of 19
claims. 20
(d) Payment to a group policyholder for remittance to the insurer 21
entitled to the money. 22
(e) Payment to the administrator of the commission, fees or 23
charges of the administrator. 24
(f) Remittance of return premiums to persons entitled to them. 25
7. The administrator shall maintain copies of all records 26
relating to deposits or withdrawals and, upon the request of an 27
insurer, provide the insurer with copies of those records. 28
Sec. 62. NRS 683A.0892 is hereby amended to read as 29
follows: 30
683A.0892 1. The Commissioner: 31
(a) Shall suspend or revoke the certificate of registration of an 32
administrator if the Commissioner has determined, after notice and a 33
hearing, that the administrator: 34
(1) Is in an unsound financial condition; 35
(2) Uses methods or practices in the conduct of business that 36
are hazardous or injurious to insured persons or members of the 37
general public; or 38
(3) Has failed to pay any judgment against the administrator 39
in this State within 60 days after the judgment became final. 40
(b) May suspend or revoke the certificate of registration of an 41
administrator if the Commissioner determines, after notice and a 42
hearing, that the administrator: 43

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- *AB74*
(1) Has knowingly violated or failed to comply with any 1
provision of this Code, any regulation adopted pursuant to this Code 2
or any order of the Commissioner; 3
(2) Has refused to be examined by the Commissioner or has 4
refused to produce accounts, records or files for examination upon 5
the request of the Commissioner; 6
(3) Has, without just cause, refused to pay claims or perform 7
services pursuant to the administrator’s contracts or has, without just 8
cause, caused persons to accept less than the amount of money owed 9
to them pursuant to the contracts, or has caused persons to employ 10
an attorney or bring a civil action against the administrator to 11
receive full payment or settlement of claims; 12
(4) Is affiliated with, managed by or owned by another 13
administrator or an insurer who transacts insurance in this State 14
without a certificate of authority or certificate of registration; 15
(5) Fails to comply with any of the requirements for a 16
certificate of registration; 17
(6) Has been convicted of, or has entered a plea of guilty, 18
guilty but mentally ill or nolo contendere to, a felony, whether or 19
not adjudication was withheld; 20
(7) Has had his or her authority to act as an administrator in 21
another state limited, suspended or revoked; or 22
(8) Has failed to file an annual report in accordance with 23
NRS 683A.08528. 24
(c) May suspend or revoke the certificate of registration of an 25
administrator if the Commissioner determines, after notice and a 26
hearing, that a responsible person: 27
(1) Has refused to provide any information relating to the 28
administrator’s affairs or refused to perform any other legal 29
obligation relating to an examination upon request by the 30
Commissioner; or 31
(2) Has been convicted of, or has entered a plea of guilty, 32
guilty but mentally ill or nolo contendere to, a felony committed on 33
or after October 1, 2003, whether or not adjudication was withheld. 34
(d) May, upon notice to the administrator, suspend the 35
certificate of registration of the administrator pending a hearing if: 36
(1) The administrator is impaired or insolvent; 37
(2) A proceeding for receivership, conserv atorship or 38
rehabilitation has been commenced against the administrator in any 39
state; or 40
(3) The financial condition or the business practices of the 41
administrator represent an imminent threat to the public health, 42
safety or welfare of the residents of this State. 43
(e) May revoke the certificate of registration of an 44
administrator if: 45

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- *AB74*
(1) The Commissioner suspends the certificate of 1
registration of the administrator pursuant to paragraph (d); and 2
(2) The administrator or a responsible person has not 3
responded to the notice required by paragraph (d) within 10 days 4
after the date on which the Commissioner transmitted the notice. 5
(f) May, in addition to or in lieu of the suspension or revocation 6
of the certificate of registration of the administrator, im pose a fine 7
of $2,000 for each act or violation. 8
2. As used in this section, “responsible person” means any 9
person who is responsible for or controls or is authorized to control 10
or advise the affairs of an administrator, including, without 11
limitation: 12
(a) A member of the board of directors, board of trustees, 13
executive committee or other governing board or committee of the 14
administrator; 15
(b) The president, vice president, chief executive officer, chief 16
operating officer or any other principal officer of an administrator, if 17
the administrator is a corporation; 18
(c) A partner or member of the administrator, if the 19
administrator is a partnership, association or limited -liability 20
company; and 21
(d) Any shareholder or member of the administrator who 22
directly or indirectly holds 10 percent or more of the voting stock, 23
voting securities or voting interest of the administrator. 24
Sec. 63. NRS 683A.179 is hereby amended to read as follows: 25
683A.179 1. A pharmacy benefit manager shall not: 26
(a) Prohibit a pharmacist or pharmacy from providing 27
information to a covered person concerning: 28
(1) The amount of any copayment or coinsurance for a 29
prescription drug; or 30
(2) The availability of a less expensive alternative or generic 31
drug including, without limitation, information concerning clinical 32
efficacy of such a drug; 33
(b) Penalize a pharmacist or pharmacy for providing the 34
information described in paragraph (a) or selling a less expensive 35
alternative or generic drug to a covered person; 36
(c) Prohibit a pharmacy from offering or providing delivery 37
services directly to a covered person as an ancillary service of the 38
pharmacy; or 39
(d) If the pharmacy benefit manager manages a pharmacy 40
benefits plan that provides coverage through a net work plan, charge 41
a copayment or coinsurance for a prescription drug in an amount 42
that is greater than the total amount paid to a pharmacy that is in the 43
network of providers under contract with the third party. 44
2. The provisions of this section: 45

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- *AB74*
(a) Must not be construed to authorize a pharmacist to dispense 1
a drug that has not been prescribed by a practitioner, as defined in 2
NRS 639.0125, except to the extent authorized by a specific 3
provision of law, including, without limitation, NRS 453C.120, 4
639.28078 and 639.28085. 5
(b) Do not apply to an institutional pharmacy, as defined in NRS 6
639.0085, or a pharmacist working in such a pharmacy as an 7
employee or independent contractor. 8
3. As used in this section, “network plan” [means a health 9
benefit plan of fered by a health carrier under which ] has the 10
[financing and delivery of medical care is provided, in whole or ] 11
meaning ascribed to it in [part, through a defined set of providers 12
under contract with the carrier. The term does not include an 13
arrangement for the financing of premiums.] NRS 687B.645. 14
Sec. 64. NRS 683A.461 is hereby amended to read as follows: 15
683A.461 1. If the Commissioner denies an application for, 16
or refuses to renew, a license, the Commissioner shall notify the 17
applicant or licensee and state in writing the reason for the denial or 18
refusal. The applicant or licensee may apply in writing, pursuant to 19
NRS 679B.310, for a hearing before the Commissioner to determine 20
the reasonableness of the denial or ref usal. [The hearing must be 21
held within 30 days and conducted pursuant to NRS 679B.330. The 22
applicant or licensee may waive the requirement to hold the hearing 23
within 30 days, in writing, before a hearing is held.] 24
2. The Commissioner may suspend, revoke or refuse to renew 25
the license of a business organization if the Commissioner finds, 26
after notice and the opportunity for a hearing, that a violation by a 27
natural person was known or should have been known by one or 28
more of the partners, officers or manage rs acting on behalf of the 29
organization, the violation was not reported to the Commissioner 30
and no corrective action was taken. 31
3. In addition to or in lieu of a denial, suspension or revocation 32
of, or refusal to renew, a license, an administrative fine of not less 33
than $25 nor more than $500 may be imposed for each violation or 34
act. An order imposing a fine must specify the date, not less than 15 35
days nor more than 30 days after the date of the order, before which 36
the fine must be paid. If the fine is no t paid when due, the 37
Commissioner shall immediately revoke the license of a licensee 38
and the fine must be recovered in a civil action brought on behalf of 39
the Commissioner by the Attorney General. The Commissioner 40
shall immediately deposit all such fines c ollected with the State 41
Treasurer for credit to the State General Fund. 42
4. The Commissioner retains the authority to enforce the 43
provisions of, and impose any penalty or pursue any remedy 44
authorized by, this title against any person who is under 45

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- *AB74*
investigation for or charged with a violation of a provision of this 1
title even if the license or registration of the person has been 2
surrendered or has lapsed by operation of law. 3
5. A licensee must pay all applicable fees, including renewal 4
fees, and maintain any required education during a period of 5
suspension of his or her license. 6
Sec. 65. NRS 683C.018 is hereby amended to read as follows: 7
683C.018 The provisions of chapters 679A and 679B of NRS , 8
sections 2 to 41, inclusive, of this act, and NRS 683A.301, 9
683A.341 and 683A.351 apply to an insurance consultant. 10
Sec. 66. NRS 684A.027 is hereby amended to read as follows: 11
684A.027 “Home state” means: 12
1. The District of Columbia or any state or territory of the 13
United States in which an independent [, company, staff ] or public 14
adjuster maintains his, her or its principal place of residence or 15
principal place of business and is licensed to act as a resident 16
independent [, company, staff] or public adjuster; or 17
2. If neither the state in which the adjuster maintains his or her 18
principal place of residence nor the state in which the adjuster 19
maintains his, her or its principal place of business licenses 20
independent [, company, staff ] or public adjusters for the line of 21
authority sought by the adjuster, a state: 22
(a) Which has an examination requirement; 23
(b) In which the adjuster is licensed; and 24
(c) Which the adjuster declares to be the home state. 25
Sec. 67. NRS 684A.030 is hereby amended to read as follows: 26
684A.030 1. “Independent adjuster” means [an] : 27
(a) An adjuster who is representing the interests of an insurer or 28
a self-insurer and who: 29
[(a)] (1) Contracts for compensation with the insurer or self -30
insurer as an independent contractor or an employee of an 31
independent contractor; 32
[(b)] (2) Is treated for tax purposes by the insurer or self -insurer 33
in a manner consistent with an independent contractor rather than an 34
employee; and 35
[(c)] (3) Investigates, negotiates or settles property, casu alty or 36
surety claims, including, without limitation, workers’ compensation 37
claims, for the insurer or self-insurer. 38
(b) A salaried employee of an insurer who: 39
(1) Investigates, negotiates or settles property, casualty or 40
surety claims, including, witho ut limitation, workers’ 41
compensation claims; and 42
(2) Obtains a license pursuant to this chapter. 43
(c) A person who investigates, negotiates or settles workers’ 44
compensation claims under the authority of a third -party 45

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- *AB74*
administrator who holds a certificate of registration issued by the 1
Commissioner pursuant to NRS 683A.08524. 2
2. “Public adjuster” means an adjuster employed by and 3
representing solely the financial interests of the insured named in 4
the policy. The term does not include an adjuster who inves tigates, 5
negotiates or settles workers’ compensation claims. 6
[3. “Company adjuster” means a salaried employee of an 7
insurer who: 8
(a) Investigates, negotiates or settles property, casualty or surety 9
claims, including, without limitation, workers’ compensation 10
claims; and 11
(b) Obtains a license pursuant to this chapter. 12
4. “Staff adjuster” means a person who investigates, negotiates 13
or settles workers’ compensation claims under the authority of a 14
third-party administrator who holds a certificate o f registration 15
issued by the Commissioner pursuant to NRS 683A.08524.] 16
Sec. 68. NRS 684A.040 is hereby amended to read as follows: 17
684A.040 1. Except as otherwise provided in NRS 18
684A.060, no person may act as, or hold himself or herself out to be, 19
an adjuster in this State unless then licensed as such under the 20
applicable adjuster’s license issued under the provisions of this 21
chapter. 22
2. Any person violating the provisions of this section is guilty 23
of a gross misdemeanor. 24
3. Except as otherwise provided in NRS 684A.060, a person 25
who acts as an adjuster in this State without a license is subject to an 26
administrative fine of not more than $1,000 for each violation. 27
4. A salaried employee of an insurer who investigates , 28
negotiates or settles workers’ compensation claims may, but is not 29
required to, obtain a license as [a company] an independent adjuster 30
pursuant to this chapter. The provisions of subsections 1, 2 and 3 do 31
not apply to a salaried employee of an insurer. A salaried employee 32
of an insurer is subject to the requirements of NRS 616B.0275. 33
Sec. 69. NRS 684A.050 is hereby amended to read as follows: 34
684A.050 [1.] The Commissioner may license an individual 35
as an independent a djuster [,] or a public [adjuster, a company 36
adjuster or a staff ] adjuster. No individual shall be licensed 37
concurrently under the same license or separate licenses as more 38
than one such type of adjuster. 39
[2. A company adjuster and a staff adjuster shall pay the same 40
fees as provided for an independent adjuster in NRS 680B.010 and 41
680C.110.] 42
Sec. 70. NRS 684A.090 is hereby amended to read as follows: 43
684A.090 1. The applicant for a license as an adjuster shall 44
file a written application therefor with the Commissioner on forms 45

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- *AB74*
prescribed and furnished by the Commissioner. As part of, or in 1
connection with, the application, the applicant shall furnish 2
information as to his or her identity, personal history, experience, 3
financial responsibility, business record and other pertinent matters 4
as reasonably required by the Commissioner to determine the 5
applicant’s eligibility and qualifications for the license. 6
2. If the applicant is a natural person, the application must 7
include the social security number of the applicant and include a 8
completed copy of the Uniform Individual Application. 9
3. If the applicant is a business entity, the application must 10
identify the natural person designated pursuant to paragraph (b) of 11
subsection 1 of NRS 684A.080 and must include: 12
(a) A completed copy of the Uniform Business Entity 13
Application; 14
(b) The name of each member, officer and director of the 15
business entity, as applicable; 16
(c) The name of each executive officer and director who ow ns 17
more than 10 percent of the outstanding voting securities of the 18
applicant; and 19
(d) The name of any other individual who owns more than 10 20
percent of the outstanding voting securities of the applicant. 21
 Each such member, officer, director and individual shall furnish 22
information to the Commissioner as though applying for an 23
individual license. 24
4. If the applicant is a nonresident of this state, the application 25
must be accompanied by an appointment of t he Commissioner as 26
process agent and agreement to appear pursuant to NRS 684A.200. 27
5. The application must be accompanied by the applicable 28
license fee as specified in NRS 680B.010 [and subsection 2 of NRS 29
684A.050] and, in addition to any other fee or c harge, all applicable 30
fees required pursuant to NRS 680C.110 . [and subsection 2 of 31
NRS 684A.050.] 32
6. No applicant for such a license may willfully misrepresent 33
or withhold any fact or information called for in the application 34
form or in connection therewith. A violation of this subsection is a 35
gross misdemeanor. 36
7. If the Commissioner determines that the information 37
contained in a Uniform Individual Application or Uniform Business 38
Entity Application submitted with an application pursuant to this 39
section is not true, correct and complete to the best of the applicant’s 40
knowledge and belief, the Commissioner may refuse to issue a 41
license to the applicant or suspend or revoke the applicant’s license. 42
Sec. 71. NRS 684A.100 is hereby amended to read as follows: 43
684A.100 Each person who intends to apply for a license as an 44
adjuster must, before applying for the license, personally take and 45

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- *AB74*
pass to the Commissioner’s satisfaction a written examination 1
testing the applicant ’s qualifications and competence to act as an 2
adjuster and his or her knowledge of pertinent provisions of this 3
Code unless: 4
1. [The] Except as otherwise provided in paragraph (d) of 5
subsection 1 of NRS 684A.115, the person: 6
(a) Is not a resident of this State; 7
(b) Has passed an examination to become licensed as an adjuster 8
in the person’s home state; and 9
(c) Is currently licensed and in good standing in the person’s 10
home state as an adjuster; or 11
2. The person was licensed in this State as the same t ype of 12
adjuster within the 24-month period immediately preceding the date 13
of the application, unless the previous license was revoked or 14
suspended or its continuation was refused by the Commissioner. 15
Sec. 72. NRS 684A.115 is hereby amended to read as follows: 16
684A.115 1. The Commissioner shall issue a nonresident 17
license as an adjuster to a nonresident person if: 18
(a) The person is currently licensed in good standing as an 19
adjuster in the resident or home state of the person; 20
(b) The person has submitted the proper request for licensure 21
and has paid the fees required pursuant to NRS 680B.010 and, in 22
addition to any other fee or charge, all applicable fees required 23
pursuant to NRS 680C.110; 24
(c) The person has submitted o r transmitted to the 25
Commissioner the appropriate completed application for licensure; 26
and 27
(d) [The] Except as otherwise provided in this paragraph, the 28
home state of the person awards nonresident licenses as an adjuster 29
to persons of this State on the sa me basis. If the home state of the 30
person requires a nonresident applicant for a license as an 31
adjuster to take and pass an examination in that state which tests 32
the applicant’s qualifications and competence to act as an 33
adjuster, the person must also take and pass the examination 34
required by NRS 684A.100. 35
2. The Commissioner may verify the licensing status of the 36
nonresident person through any appropriate database, including, 37
without limitation, the Producer Database maintained by the 38
National Insurance Producer Registry, its affiliates or subsidiaries, 39
or may request that the nonresident person submit proof that the 40
nonresident person is licensed and in good standing in the person’s 41
home state as an adjuster. 42
3. As a condition to the continuation of a nonresident license as 43
an adjuster, the nonresident adjuster shall maintain a resident license 44
as an adjuster in the home state of the adjuster. A nonresident 45

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license as an adjuster issued under this section shall be terminated 1
and must be surrendered imme diately to the Commissioner if the 2
resident license as an adjuster in the home state is terminated for any 3
reason, unless: 4
(a) The termination is due to the nonresident adjuster being 5
issued a new resident license as an adjuster in a new home state; and 6
(b) The new resident license as an adjuster is from a state that 7
has reciprocity with this State. 8
4. The Commissioner shall give notice of the termination of a 9
resident license as an adjuster within 30 days after the date of the 10
termination to any states that issued a nonresident license as an 11
adjuster to the holder of the resident license. If the resident license 12
as an adjuster was terminated due to a change in the home state of 13
the adjuster, the notice must include both the previous and current 14
address of the adjuster. 15
5. The Commissioner shall terminate a nonresident license as 16
an adjuster issued pursuant to this section if the adjuster establishes 17
legal residency in this State and fails to apply for a resident license 18
as an adjuster within 90 days after establishing legal residency. 19
Sec. 73. NRS 684A.120 is hereby amended to read as follows: 20
684A.120 1. The Commissioner shall prescribe the form of 21
the adjuster license, which shall state: 22
(a) The licensee’s name, bu siness address and a personal 23
identification number; 24
(b) The classification of the license, whether as an independent 25
adjuster [,] or a public [adjuster, a company adjuster or a staff ] 26
adjuster; 27
(c) Date of issuance and general conditions as to expiration and 28
termination; and 29
(d) Such other conditions as the Commissioner deems proper. 30
2. The Commissioner may not issue a license in a trade name 31
unless the name has been registered as provided by law. 32
3. In order to assist in the performance of the Commissioner’s 33
duties, the Commissioner may contract with any nongovernmental 34
entity, including, without limitation, the National Association of 35
Insurance Commissioners or its affiliates or subsidiaries, to perform 36
any ministerial function, including, without limitation, the collection 37
of fees and data, relating to licensing, that the Commissioner deems 38
appropriate. 39
Sec. 74. NRS 684A.130 is hereby amended to read as follows: 40
684A.130 1. Each license issued or renewed under this 41
chapter continues in force for 3 years unless it is suspended, revoked 42
or otherwise terminated. A license may be renewed upon payment 43
of all applicable fees for renewal to the Commissioner, completion 44
of any other requirement for renewal of the license specified in this 45

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chapter and submission of the statement required pursuant to NRS 1
684A.143 if the licensee is a natural person. The statement, if 2
required, must be submitted, all requirements must be completed 3
and all applicable fees must be paid on or before the renewal date 4
for the license. 5
2. Any license not so renewed expires on the renewal date. The 6
Commissioner may accept a request for renewal received by the 7
Commissioner within 30 days after the expiration of the license if 8
the request is accompanied by: 9
(a) A fee for renewal of 150 percent of all applicable fees 10
otherwise required, except for any fee required pursuant to NRS 11
680C.110 ; [and subsection 2 of NRS 684A.050;] 12
(b) If the person requesting renewal is a natural person, the 13
statement required pursuant to NRS 684A.143; 14
(c) Proof of successful completion of any requirement for an 15
examination unless exempt pursuant to NRS 684A.105; and 16
(d) If applicable, a request for a waiver of the time limit for 17
renewal and of any fine or sanct ion otherwise required or imposed 18
because of the failure of the licensee to renew his or her license 19
because of military service, extended medical disability or other 20
extenuating circumstance. 21
3. An adjuster who is unable to comply with the procedures 22
and requirements to renew a license due to military service, long -23
term medical disability or some other extenuating circumstance may 24
request waiver of same and a waiver of any requirement relating to 25
an examination, fine or other sanction imposed for failure to comply 26
with such procedures or requirements. 27
4. An adjuster shall inform the Commissioner by any means 28
acceptable to the Commissioner of any change in the residence 29
address or business address for the home state or in the legal name 30
of the adjuster within 30 days of the change. 31
5. In order to assist in the performance of the duties of the 32
Commissioner, the Commissioner may contract with 33
nongovernmental entities, including, without limitation, the 34
National Association of Insurance Commissioners or its affiliates or 35
subsidiaries, to perform any ministerial function, including, without 36
limitation, the collection of fees and data, related to licensing that 37
the Commissioner may deem appropriate. 38
6. This section does not apply to temporary licenses iss ued 39
under NRS 684A.150. 40
7. As used in this section, “renewal date” means: 41
(a) For the first renewal of the license, the last day of the month 42
which is 3 years after the month in which the Commissioner 43
originally issued the license. 44

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(b) For each renewal after the first renewal of the license, the 1
last day of the month which is 3 years after the month in which the 2
license was last due to be renewed. 3
Sec. 75. NRS 684A.150 is hereby amended to read as follows: 4
684A.150 1. In the event of death or inability to act as a 5
licensed independent adjuster [,] of the type described in paragraph 6
(a) of subsection 1 of NRS 684A.030, the Commissioner may issue 7
a temporary license as an independent adjuster of the type described 8
in par agraph (a) of subsection 1 of NRS 684A.030 to another 9
individual qualified therefor except as to the taking and passing of 10
the required examination, to enable such individual to continue the 11
business of the deceased licensee or the licensee who has a 12
disability. 13
2. The temporary license shall be valid for 6 months, or until 14
the temporary licensee earlier qualifies for a regular license as an 15
independent adjuster [.] of the type described in paragraph (a) of 16
subsection 1 of NRS 684A.030. 17
3. A temporary license issued pursuant to this section may be 18
renewed for one additional period of 180 days if: 19
(a) The temporary licensee, on or before a date specified by the 20
Commissioner as the last day on which the temporary license is 21
renewable, submits to the Comm issioner a written request which 22
includes, without limitation, sufficient justification for the renewal; 23
and 24
(b) The Commissioner approves the request. 25
Sec. 76. NRS 684A.180 is hereby amended to read as follows: 26
684A.180 1. Each adjuster shall keep at his or her business 27
address shown on the adjuster’s license a record of all transactions 28
under the license. 29
2. The record shall include: 30
(a) A copy of each contract between an independent adjuster of 31
the type described in paragraph (a) of subsection 1 of NRS 32
684A.030 and an insurer or self-insurer. 33
(b) A copy of all investigations or adjustments undertaken. 34
(c) A statement of any fee, commission or other compensation 35
received or to be received by the adjuster on account of such 36
investigation or adjustment. 37
3. The adjuster shall make such records available for 38
examination by the Commissioner at all times, and shall retain the 39
records for at least 3 years after the closure of the claim to which the 40
records apply. 41
4. An independent adjuster of the type described in paragraph 42
(a) of subsection 1 of NRS 684A.030 shall comply with any record 43
retention policy agreed to in a contract between the independent 44
adjuster and an insurer or self-insurer to the extent that such a policy 45

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imposes a requirement to retain records for a longer period than the 1
period required by this section. 2
Sec. 77. NRS 685A.120 is hereby amended to read as follows: 3
685A.120 1. No person may act a s, hold himself or herself 4
out as or be a surplus lines broker with respect to subjects of 5
insurance for which this State is the insured’s home state unless the 6
person is licensed as such by the Commissioner pursuant to this 7
chapter. 8
2. Any person who ha s been licensed by this State as a 9
producer of insurance for [general lines for at least 6 months, ] 10
property and casualty insurance , or has been licensed in another 11
state as a surplus lines broker and continues to be licensed in that 12
state, and who is deemed by the Commissioner to be competent and 13
trustworthy with respect to the handling of surplus lines may be 14
licensed as a surplus lines broker upon: 15
(a) Application for a license and payment of all applicable fees 16
for a license; 17
(b) Submitting the statement required pursuant to NRS 18
685A.127; and 19
(c) Passing any examination prescribed by the Commissioner on 20
the subject of surplus lines. 21
3. An application for a license must be submitted to the 22
Commissioner on a form designated and furnished by the 23
Commissioner. The application must include the social security 24
number of the applicant. 25
4. A license issued or renewed pursuant to this chapter 26
continues in force for 3 years unless it is suspended, revoked or 27
otherwise terminated. The license may be renewed upon submission 28
of the statement required pursuant to NRS 685A.127 and payment 29
of all applicable fees for renewal to the Commissioner on or before 30
the renewal date for the license. 31
5. A license which is not renewed expires on the renewal date. 32
The Commissioner may accept a request for renewal received by the 33
Commissioner within 30 days after the expiration of the license if 34
the request is accompanied by: 35
(a) The statement required pursuant to NRS 685A.127; 36
(b) All applicable fees for renewal; and 37
(c) A penalty in an amount that is equal to 50 percent of all 38
applicable fees for renewal, except for any fee required pursuant to 39
NRS 680C.110. 40
6. As used in this section, “renewal date” means: 41
(a) For the first renewal of the license, the last day of the month 42
which is 3 years after the month in which the Commissioner 43
originally issued the license. 44

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(b) For each renewal after the first renewal of the license, the 1
last day of the month which is 3 years after the month in which the 2
license was last due to be renewed. 3
Sec. 78. NRS 685B.050 is hereby amended to read as follows: 4
685B.050 1. Any act of transacting an insurance business as 5
set forth in NRS 685B.030 by any unauthorized insurer is equivalent 6
to and constitutes an irrevocable appointment by such an insurer, 7
binding upon the insurer, the insurer’s executor or administrator, or 8
successor in interest if a corporation, of the Commissioner or the 9
successor in office of the Commissioner, to be the true and lawful 10
attorney of such an insurer upon whom may be served all lawful 11
process in any action, suit or proceeding in any court by the 12
Commissioner or by the State and upon whom may be served any 13
notice, order, pleading or process in any proceeding before the 14
Commissioner and which arises out of transacting an insurance 15
business in this state by such an insurer. Any act of transacting an 16
insurance business in this state by any unauthorized insurer is 17
signification of its agreement that any such lawful process in such a 18
court action, suit or proceeding and any such notice, order, pleading 19
or process in such an administrative proceeding before the 20
Commissioner so served is of the same legal force and validity as 21
personal service or process in this state upon such an insurer. 22
2. Service of process in such an action must be made by 23
delivering to and leaving with the Commissioner, or some person in 24
apparent charge of the office of the Commissioner, [two copies] one 25
copy thereof and by payment to the Commissioner of the fee 26
prescribed by law. Service upon the Commissioner as attorney is 27
service upon the principal. 28
3. The Commissioner shall forthwith forward [by certified mail 29
one of the copies of ] such process or such notice, order, pleading or 30
process in proceedings before the Commissioner to the defendant in 31
such a court proceeding or to whom the notice, order, pleading or 32
process in such an administrative proceeding is addressed or 33
directed at its last known principal place of business . [and shall 34
keep a record of all pr ocess so served on him or her which must 35
show the day and hour of service.] Such service is sufficient if: 36
(a) Notice of such service and a copy of the court process or the 37
notice, order, pleading or process in such an administrative 38
proceeding are sent w ithin 10 days thereafter by certified mail by 39
the plaintiff or the plaintiff’s attorney in the court proceeding or by 40
the Commissioner in the administrative proceeding to the defendant 41
in the court proceeding or to whom the notice, order, pleading or 42
process in such an administrative proceeding is addressed or 43
directed at the last known principal place of business of the 44
defendant in the court or administrative proceeding. 45

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(b) The defendant’s receipt or receipts issued by the post office 1
with which the letter is certified, showing the name of the sender of 2
the letter and the name and address of the person or insurer to whom 3
the letter is addressed, and an affidavit of the plaintiff or the 4
plaintiff’s attorney in a court proceeding or of the Commissioner in 5
an administrative proceeding, showing compliance therewith are 6
filed with the clerk of the court in which such an action, suit or 7
proceeding is pending or with the Commissioner in administrative 8
proceedings, on or before the date the defendant in the court or 9
administrative proceedings is required to appear or respond thereto, 10
or within such further time as the court or Commissioner may allow. 11
4. No plaintiff is entitled to a judgment or determination by 12
default in any court or administrative proceeding i n which court 13
process or notice, order, pleading or process in proceedings before 14
the Commissioner is served under this section until 45 days after the 15
date of filing of the affidavit of compliance. 16
5. For the purposes of this section, “process” in an ac tion in a 17
court includes only a summons or the initial documents served in 18
such an action. The Commissioner is not required to serve any 19
documents in such an action after the initial service of process. 20
6. Nothing in this section limits or affects the right to serve any 21
process, notice, order or demand upon any person or insurer in any 22
other manner permitted by law. 23
Sec. 79. Chapter 686A of NRS is hereby amended by adding 24
thereto the provisions set forth as sections 80 to 93, inclusive, of this 25
act. 26
Sec. 80. 1. Except as otherwise provided in subsection 2 or 27
3, an insurer shall not refuse to insure, refuse to continue to 28
insure or limit the amount of coverage available to a person on the 29
basis of race, religion, sex, marital status or national origin. 30
2. The provisions of this section do not prohibit an insurer 31
from taking marital status into account for the purpose of defining 32
persons eligible for dependent benefits. 33
3. The provisions of this section do not prohibit or limit the 34
operation of fraternal benefit societies authorized to do business in 35
this State pursuant to chapter 695A of NRS. 36
Sec. 81. 1. An insurer shall maintain its books, documents 37
and other business records, including, without limitation, 38
recordings: 39
(a) In such an order that data regarding complaints, claims, 40
rating, underwriting and marketing are accessible and retrievable 41
for examination by the Commissioner; and 42
(b) For a period of not less than 5 years after the date on 43
which the book, document or other business record was created. 44

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2. An insurer shall maintain a complete record of all 1
complaints received since the date of the mo st recent examination 2
conducted pursuant to sections 2 to 41, inclusive, of this act, which 3
must include, without limitation: 4
(a) The total number of complaints; 5
(b) The classification of each complaint by line of insurance; 6
(c) The nature of each complaint; 7
(d) The disposition of each complaint; and 8
(e) The time it took for the insurer to process each complaint. 9
3. As used in this section, “complaint” means any 10
communication made in writing, by telephone or by electronic 11
mail which primarily expresses a grievance. 12
Sec. 82. A person shall not make false or fraudulent 13
statements or representations on or relating to an application for a 14
policy for the purpose of obtaining a fee, commission, money or 15
other benefit. 16
Sec. 83. 1. Except as otherwise provided in subsection 3 or 17
4, an insurer that issues policies of property and casualty 18
insurance shall provide to a primary insured, within 30 days after 19
the date on which the primary insured makes a written request for 20
such information, the following loss information for the 3 policy 21
years immediately preceding the date of the request: 22
(a) For all claims, the date and description of the claim and 23
the total amount of payments; and 24
(b) For any other o ccurrence not described in paragraph (a), 25
the date and description of the occurrence. 26
2. If a prospective insurer requests that a primary insured 27
provide detailed loss information which is beyond the scope of the 28
information described in subsection 1, th e primary insured may 29
submit to the insurer, by mail, electronic mail or other means, a 30
written request for the additional information. A prospective 31
insurer shall not request more detailed loss information than is 32
reasonably required to underwrite the sam e line or class of 33
insurance. 34
3. Except as otherwise provided in subsection 4, an insurer 35
that receives a written request from a primary insured pursuant to 36
subsection 2 shall provide the information to the insured as soon 37
as practicable, but in no even t later than 20 days after the date on 38
which the insurer receives the written request. 39
4. The provisions of this section do not require an insurer to 40
provide loss reserve information. A prospective insurer shall not 41
refuse to insure an applicant solely b ecause the prospective 42
insurer is unable to obtain loss reserve information. 43
Sec. 84. As used in sections 84 to 93, inclusive, of this act, 44
unless the context otherwise requires, the words and terms defined 45

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in sections 85 to 88, inclusive, of this act have the meanings 1
ascribed to them in those sections. 2
Sec. 85. “Domestic violence” has the meaning ascribed to it 3
in NRS 33.018. 4
Sec. 86. “Domestic violence related medical condition” 5
means a medical condition sustained by a subject of domestic 6
violence which arises in whole or in part from an act or pattern of 7
domestic violence. 8
Sec. 87. “Domestic violence status” means the fact or 9
perception that a person is, has been or may be a subject of 10
domestic violence, without regard to whether the person has 11
sustained a domestic violence related medical condition. 12
Sec. 88. “Insurance professional” means a producer of 13
insurance, adjuster or administrator licensed pursuant to the 14
provisions of this title. 15
Sec. 89. “Subject of domestic violence” means a person: 16
1. Against whom an act of domestic violence has been 17
directed; 18
2. Who has a past or current injury, illness or disorder that 19
resulted from domestic violence or other domestic violence related 20
medical condition; or 21
3. Who seeks, may have sought or had reason to seek: 22
(1) Medical or psychological treatment for domestic 23
violence; or 24
(2) Protection or shelter from domestic violence, including, 25
without limitation, a temporary or extended order for protection 26
issued by a court. 27
Sec. 90. 1. Except as otherwise provided in subsection 2, a 28
person shall not: 29
(a) Deny, refuse to issue, refuse to renew or reissue, cancel o r 30
otherwise terminate, restrict or exclude insurance coverage on or 31
add a premium differential to a policy of insurance for an 32
applicant or insured on the basis of the domestic violence status of 33
the applicant or insured; or 34
(b) Except as otherwise permit ted or required by the laws of 35
this State relating to acts of domestic violence committed by an 36
insurance beneficiary, exclude, limit or deny benefits on a policy 37
of insurance on the basis of the domestic violence status of an 38
insured, including, without l imitation, denying a claim solely 39
because the claim involves an act that constitutes domestic 40
violence. 41
2. The provisions of this section do not prohibit an insurer or 42
insurance professional from declining to issue a life insurance 43
policy if the applican t or prospective owner of the policy is or 44
would be designated as a beneficiary of the policy, and: 45

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(a) The applicant or prospective owner of the policy lacks an 1
insurable interest in the insured; 2
(b) The applicant or prospective owner of the policy is k nown, 3
on the basis of medical, law enforcement or court records , to have 4
committed an act of domestic violence against the proposed 5
insured; or 6
(c) The insured or prospective insured: 7
(1) Is a subject of domestic violence; and 8
(2) Has objected to, or a person who has assumed the care 9
of the insured or prospective insured if a minor or incapacitated 10
person has objected to, the policy on the grounds that the policy 11
would be issued to or for the direct or indirect benefit of the 12
perpetrator of domestic violence. 13
Sec. 91. 1. A person shall not engage in any conduct that is 14
unfairly discriminatory pursuant to this section. 15
2. If an insurer or insurance professional has information in 16
its possession that clearly indicates t hat an insured or applicant is 17
a subject of domestic violence, it is unfairly discriminatory for a 18
person employed by or contracting with the insurer or insurance 19
professional to disclose or transfer confidential domestic violence 20
information for any purpo se or to any person, except where the 21
disclosure or transfer is made: 22
(a) To the insured or applicant who is a subject of domestic 23
violence or a person who is designated in writing by the insured or 24
applicant. Nothing in this section shall be construed to preclude a 25
subject of domestic violence from obtaining his or her insurance 26
records. 27
(b) To a provider of health care: 28
(1) For the direct provision of health care services; or 29
(2) Who is designated in writing by the insured or applicant 30
who is a subject of domestic violence. 31
(c) Pursuant to an order of the Commissioner or a court of 32
competent jurisdiction or otherwise required by law. 33
(d) When necessary for a valid business purpose to transfer 34
information that contains confidential domestic violence 35
information which cannot reasonably be segregated, without 36
undue hardship. Confidential domestic violence information may 37
be disclosed pursuant to this paragraph only: 38
(1) If the recipient of the information executes a written 39
agreement to be bound by t he prohibitions of this section in all 40
respects and to be subject to the jurisdiction of the courts of this 41
State for enforcement of this section for the benefit of the 42
applicant or insured; and 43
(2) To the following persons: 44

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(I) A reinsurer that indemnifies or seeks to indemnify all 1
or any part of a policy covering a subject of domestic violence and 2
that cannot underwrite or satisfy its obligations under the 3
reinsurance agreement without the disclosure of the information; 4
(II) A party to a proposed or consummated sale, 5
transfer, merger or consolidation of all or part of the business of 6
the insurer or insurance professional; 7
(III) Medical or claims personnel contracting with the 8
insurer or insurance professional, only if necessary to process an 9
application, to perform the duties of the insurer or insurance 10
professional under the policy or to protect the safety or privacy of 11
a subject of domestic violence; or 12
(IV) If the confidential domestic violence information is 13
an address or telephone number, to persons or entities with whom 14
the insurer or insurance professional transacts business only 15
where the business cannot be transacted without the address or 16
telephone number. 17
(e) To an attorney who needs the information to represent the 18
insurer or insurance professional effectively, if the insurer or 19
insurance professional: 20
(1) Notifies the attorney of obligations of the insurer or 21
insurance professional under this section; and 22
(2) Requests that the attorney exercise due diligence to 23
protect the confidential domestic violence information consistent 24
with the obligation of the attorney to represent the insurer or 25
insurance professional. 26
(f) To the owner of the policy or assignee, in the course of 27
delivering the policy, if the policy contains infor mation about 28
domestic violence status. 29
(g) To any other person or entity deemed appropriate by the 30
Commissioner. 31
3. Except as otherwise provided in subsection 4, it is unfairly 32
discriminatory to: 33
(a) Request information about acts of domestic violence or 34
domestic violence status or make use of that information, however 35
obtained, except where the request for or use of information is for 36
the purpose of complying with a legal obligation or to verify a 37
claim that a person is a subject of domestic violence. 38
(b) Except as otherwise provided in this paragraph, terminate 39
coverage under a policy of group health insurance for a subject of 40
domestic violence because coverage was originally issued in the 41
name of the perpetrator of domestic violence, and the perpetra tor 42
has divorced, separated from or lost custody of the subject of 43
domestic violence or the coverage of the perpetrator has been 44
terminated voluntarily or involuntarily. The provisions of this 45

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paragraph do not prohibit an insurer or insurance professional 1
from requiring the subject of domestic violence to pay the full 2
premium for coverage under the policy of group health insurance 3
or from requiring , as a condition of coverage , that the subject of 4
domestic violence reside or work within the geographic servic e 5
area of the insurer or insurance professional . If the insurer or 6
insurance professional offers conversion to an equivalent 7
individual plan, the insurer or insurance professional may 8
terminate the coverage under a policy of group health insurance 9
after th e continuation coverage required by this paragraph has 10
been in force for 18 months. The continuation coverage required 11
by this paragraph: 12
(1) Shall be satisfied by coverage required under the 13
Consolidated Omnibus Budget Reconciliation Act of 1985 which is 14
provided to a subject of domestic violence; and 15
(2) Is not intended to be in addition to coverage provided 16
under the Consolidated Omnibus Budget Reconciliation Act of 17
1985. 18
4. For a policy of life insurance, to the extent otherwise 19
permitted by sections 84 to 93, inclusive, of this act and any other 20
applicable law, the provisions of subsection 3 do not prohibit an 21
insurer or insurance professional from asking about a medical 22
condition or from using medical information to underwrite a 23
policy or to carry out its duties under the policy, even if the 24
medical information is related to a medical condition that the 25
insurer or insurance professional knows or has reason to know is 26
related to domestic violence. 27
5. As used in this section “confidential domestic violence 28
information” means information concerning: 29
(a) An act of domestic violence; 30
(b) The domestic violence status of a subject of domestic 31
violence; or 32
(c) The status of an applicant or insured as a family member, 33
employer or associate of, or a person in a relationship with, a 34
subject of domestic violence. 35
Sec. 92. 1. A person shall not engage in any conduct that is 36
unfairly discriminatory pursuant to this section. 37
2. Except as otherwise provided in subsection 3, for a policy 38
of property or casualty insurance it is unfairly discriminatory to: 39
(a) Exclude or limit payment for a covered loss or deny a 40
covered claim incurred as a result of domestic violence by a 41
person other than a co-insured; 42
(b) Fail to pay losses arising out of domestic violence to an 43
innocent i nsured who makes a first -party claim, to the extent of 44
the legal interest of the first -party claimant in the covered 45

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property, if the loss is caused by the intentional act of an insured; 1
or 2
(c) Use exclusions or limitations on coverage which the 3
Commissioner has determined unreasonably restrict the ability of 4
a subject of domestic violence to be indemnified for losses. 5
3. The provisions of subsection 2: 6
(a) Do not require payment in excess of the loss or policy 7
limits; and 8
(b) Do not prohibit an insurer or insurance professional from 9
applying reasonable standards to proof of claims. 10
Sec. 93. An insurer or insurance professional that takes an 11
action that adversely affects an applicant or insured on the basis 12
of a me dical condition that the insurer or insurance professional 13
knows or has reason to know is related to domestic violence: 14
1. Shall explain the reason for its action to the applicant or 15
insured in writing; and 16
2. At the request of the Commissioner, must b e able to 17
demonstrate that the action and any applicable policy provisions: 18
(a) Do not have the purpose or effect of treating domestic 19
violence status as a medical condition or underwriting criteria; 20
(b) Are not based on any actual or perceived correlati on 21
between a medical condition and domestic violence; 22
(c) Are otherwise permitted by law and applied in the same 23
manner and to the same extent to all applicants and insureds with 24
a similar medical condition, without regard to whether the 25
condition or claim is related to domestic violence; and 26
(d) Except for claims actions, are based on a determination, 27
made in conformance with sound actuarial principles and 28
otherwise supported by actual or reasonably anticipated 29
experience, that there is a correlation between the medical 30
condition and a material increase in insurance risk. 31
Sec. 94. NRS 686A.010 is hereby amended to read as follows: 32
686A.010 The purpose of NRS 686A.010 to [686A.310,] 33
686A.325, inclusive, and sections 80 to 93, inclusive, of this act is 34
to regulate trade practices in the business of insurance in accordance 35
with the intent of Congress as expressed in the Act of Congress 36
approved March 9, 1945, being c. 20, 59 Stat. 33, also designated as 37
15 U.S.C. §§ 1011 to 1015, inclusive, and Title V of Public Law 38
106-102, 15 U.S.C. §§ 6801 et seq. 39
Sec. 95. NRS 686A.015 is hereby amended to read as follows: 40
686A.015 1. Notwithstanding any other provision of law, the 41
Commissioner has exclusive jurisdiction in regulating the subject of 42
trade practices in the business of insurance in this state. 43
2. The Commissioner shall establish a program within the 44
Division to investigate any act or pra ctice which constitutes an 45

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unfair or deceptive trade practice in violation of the provisions of 1
NRS 686A.010 to [686A.310,] 686A.325, inclusive [.] , and 2
sections 80 to 93, inclusive, of this act. 3
3. The powers conferred upon the Commissioner by NRS 4
686A.010 to 686A.325, inclusive, and sections 80 to 93, inclusive, 5
of this act, are in addition to and supplemental to any other 6
powers conferred upon the Commissioner to enforce any 7
penalties, fines or forfeitures authorized by law with respect to any 8
unfair method of competition or any unfair or deceptive a ct or 9
practice in the business of insurance. 10
Sec. 96. NRS 686A.020 is hereby amended to read as follows: 11
686A.020 A person shall not engage in this state in any 12
practice which is defined in NRS 686A.010 to [686A.310,] 13
686A.325, inclusive, and sections 80 to 93, inclusive, of this act as, 14
or determined pursuant to NRS 686A.170 to be, an unfair method of 15
competition or an unfair or deceptive act or practice in the business 16
of insurance. 17
Sec. 97. NRS 686A.030 is hereby amended to read as follows: 18
686A.030 A person shall not [make,] : 19
1. Make, issue, circulate or cause to be made, issued or 20
circulated, any estimate, illustration, circular, statement, sales 21
presentation or comparison which: 22
[1.] (a) Misrepresents the benefits, advantages, conditions or 23
terms of any insurance policy; 24
[2.] (b) Misrepresents the dividends or share of the surplus to be 25
received on any insurance policy; 26
[3.] (c) Makes any false or misleading s tatement as to the 27
dividends or share of surplus previously paid on any insurance 28
policy; 29
[4.] (d) Is misleading or is a misrepresentation as to the 30
financial condition of any person, or as to the legal reserve system 31
upon which any life insurer operates; 32
[5.] (e) Uses any name or title of any policy or class of 33
insurance policies misrepresenting the true nature thereof; 34
[6.] (f) Is a misrepresentation , including, without limitation, 35
any intentional or unintentional misrepresentation of a premium 36
rate, for the purpose of inducing or tending to induce the purchase, 37
lapse, forfeiture, exchange, conversion or surrender of any insurance 38
policy; 39
[7.] (g) Is a misrepresentation for the purpose of effecting a 40
pledge or assignment of or effecting a loan against any insurance 41
policy; [or 42
8.] (h) Misrepresents any insurance policy as being shares of 43
stock [.] ; or 44

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(i) Offers or provides an insurance policy as an inducement to 1
the purchase of another policy or contract or otherwise uses the 2
terms “free,” “no cost” or other terms of similar meaning. 3
2. As an inducement to purchase an insurance policy, issue 4
or deliver or permit any producer, officer or employee to issue or 5
deliver: 6
(a) Agency company stock or other capital stock; 7
(b) Benefit certificates or shares in any common law 8
corporation; 9
(c) Securities of any special or advisory board contracts; or 10
(d) Any other contracts promising returns and profits. 11
Sec. 98. NRS 686A.040 is hereby amended to read as follows: 12
686A.040 No person shall make, publish, disseminate, 13
circulate or place before the public, or cause, directly or indirectly, 14
to be made, published, disseminated, circulated or placed before the 15
public, through electronic mail or other electronic means, on an 16
internet website, in a newspaper, magazine or other publication, or 17
in the form of a notice, circular, pamphlet, letter , [or] poster [,] or 18
in any electronic form, or over any radio or television station, or in 19
any other way, any advertisement, announ cement or statement 20
containing any assertion, representation or statement with respect to 21
the business of insurance or with respect to any person in the 22
conduct of his or her insurance business, which is untrue, deceptive 23
or misleading. 24
Sec. 99. NRS 686A.085 is hereby amended to read as follows: 25
686A.085 1. A person, bank or affiliate shall not [in any 26
manner extend] require as a condition precedent to the lending of 27
money or extension of credit, [lease] or [sell property of] any [kind, 28
or furnish any services, or fix or vary ] renewal thereof , that the 29
[consideration for any of them, on the condition ] person to whom 30
such money is lent or credit is extended, or [requirement that the 31
customer purchase insurance from] whose obligation a creditor is to 32
acquire or finance, negotiate any policy or renewal thereof 33
through a [parent, subsidiary ] particular insurer or [affiliate] 34
producer of insurance or group of [the bank. For the purposes of ] 35
producers. 36
2. A person, bank or affi liate shall not reject a policy of 37
insurance solely because the policy has been issued or 38
underwritten by a person who is not associated with the original 39
person, bank or affiliate when insurance is required in connection 40
with a loan or extension of credit. 41
3. A person, bank or affiliate that lends money or extends 42
credit shall not: 43
(a) As a condition for extending credit or offering any product 44
or service that is equivalent to an extension of credit, require that 45

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a customer obtain insurance from a bank or an affiliate or a 1
particular insurer or producer of insurance. The provisions of this 2
paragraph do not prohibit a person, bank or affiliate from 3
informing a customer or prospective customer that: 4
(1) Insurance is required in order to obtain a loan or credit; 5
(2) Loan or credit approval is contingent upon the 6
procurement of acceptable insurance by the customer; or 7
(3) Insurance is available from the person, bank or 8
affiliate. 9
(b) Unreasonably reject a policy furnished by the customer or 10
borrower for the protection of the property securing the credit or 11
lien. A rejection shall not be deemed unreasonable if the rejection 12
is based on reasonable standards, uniformly applied, relating to 13
the extent of coverage required and the financial soundness of the 14
services of an insurer. The standards must not: 15
(1) Discriminate against any particular type of insurer; or 16
(2) Call for the rejection of a policy simply because the 17
policy contains coverage in addition to that required in the credit 18
transaction. 19
(c) Require that any customer, borrower, mortgagor, 20
purchaser, insurer or producer of insurance pay a separate charge 21
in connection with the handling of any policy required as security 22
for a loan on real estate or to substitute the policy of one insurer 23
for that of another. The provisions of this paragraph do not apply 24
to: 25
(1) The interest that may be charged on premium loans or 26
premium advancements in accordance with the terms of the loan 27
or credit document; or 28
(2) Charges that would be required when the p erson, bank 29
or affiliate is the licensed producer of insurance providing the 30
insurance. 31
(d) Require any procedure or condition of a duly licensed 32
producer of insurance or insurer which is not customarily 33
required of those producers or insurers affiliated or in any way 34
connected with the person who lends money or extends credit. 35
(e) Use an advertisement or other promotional material 36
relating to insurance that would cause a reasonable person to 37
mistakenly believe that the Federal Government or the State: 38
(1) Is responsible for the insurance sales activity of, or 39
stands behind the credit of, the person, bank or affiliate; or 40
(2) Guarantees any returns on insurance products or is a 41
source of payment on any insurance obligation of or sold by the 42
person, bank or affiliate. 43
(f) Act as a producer of insurance unless properly licensed in 44
accordance with chapter 683A of NRS. 45

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(g) Pay or receive any commission, brokerage fee or other 1
compensation as a producer of insurance, unless the person holds 2
a valid license as a producer for the applicable class of insurance. 3
This paragraph does not prohibit a person who is not licensed as a 4
producer from making a referral to a licensed producer if the 5
person does not discuss any specific terms and conditions of a 6
policy of insurance. This paragraph does not prohibit a person 7
who is not licensed as a producer from being compensated for a 8
referral. In the case of a referral of a customer, the compensation 9
must be a fixed dollar amount for each referral that does not 10
depend on whether the customer purchases an insurance produc t 11
from the licensed producer. Any person who accepts deposits from 12
the public in an area where such transactions are routinely 13
conducted in the bank may not receive more than a one -time, 14
nominal fee of a fi xed dollar amount for each referral of a 15
customer that does not depend on whether the referral results in a 16
transaction. 17
(h) Solicit or sell insurance unless: 18
(1) Other than credit insurance or flood insurance, the 19
solicitation or sale is completed thro ugh documents which are 20
separate from any transaction involving credit; 21
(2) The insurance sales activities are, to the extent 22
practicable, physically separated from the areas where retail 23
deposits are routinely accepted by banks; and 24
(3) The person, ba nk or affiliate maintains separate and 25
distinct books and records relating to the transactions involving 26
insurance, including , without limitation, all files relating to and 27
reflecting any complaint of a consumer. 28
(i) Include the expense of insurance premi ums, other than 29
credit insurance premiums or flood insurance premiums, in the 30
primary transaction involving credit without the express written 31
consent of the customer. 32
4. A person, bank or affiliate that lends money or extends 33
credit and that solicits in surance primarily for personal, family or 34
household purposes shall disclose to the customer in writing that 35
the insurance related to an extension of credit may be purchased 36
from an insurer or producer of insurance that the customer 37
chooses, subject to the right of the lender to reject a given insurer 38
or agent as provided in paragraph (b) of subsection 3. The 39
disclosure must inform the customer that the insurer or producer 40
the customer chooses will not affect the decision to extend credit 41
or terms of credit in any way, except that the person, bank or 42
affiliate may impose reasonable requirements concerning the 43
creditworthiness of the insurer and the scope of coverage chosen 44
as provided in paragraph (b) of subsection 3. 45

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5. Except as otherwise provided in subs ection 6, a bank or 1
any person who solicits, sells, advertises or offers insurance on the 2
premises of a bank or on behalf of a bank shall: 3
(a) Disclose to the customer in writing, where practicable and 4
in a clear and conspicuous manner, before a sale takes place, that 5
the insurance: 6
(1) Is not a deposit; 7
(2) Is not insured by the Federal Deposit Insurance 8
Corporation or any other agency of the Federal Government; 9
(3) Is not guaranteed by the bank, any affiliate of the bank 10
or any person that is s oliciting, selling, advertising or offering 11
insurance; and 12
(4) If applicable, involves investment risk , including, 13
without limitation, possible loss of value. 14
(b) Except as otherwise provided in this paragraph, obtain 15
written acknowledgment from the cus tomer of receipt of the 16
disclosure described in paragraph (a), either at the time of receipt 17
or at the time of the initial purchase of the policy of insurance. If 18
the solicitation is conducted by telephone, the person or bank shall 19
obtain oral acknowledgme nt from the customer of receipt of the 20
disclosure, maintain sufficient documentation of the oral 21
acknowledgment and make reasonable efforts to obtain a written 22
acknowledgment from the customer. If a customer affirmatively 23
consents to receiving the disclosu re by electronic means and the 24
disclosure is provided in a format that the customer may retain or 25
obtain later, the person or bank may provide the disclosure by 26
electronic means and obtain acknowledgment from the customer 27
of receipt of the disclosure by electronic means. 28
6. The provisions of paragraph (a) of subsection 5 apply: 29
(a) Only: 30
(1) When a person purchases, applies to purchase or is 31
solicited to purchase insurance products or annuities primarily for 32
personal, family or household purposes; and 33
(2) To the extent that the disclosure is accurate. 34
(b) To an affiliate of a bank only to the extent that it sells, 35
solicits, advertises or offers insurance products or annuities at an 36
office of a bank or on behalf of a bank. 37
7. For the purposes of sub section 5, a person solicits, sells, 38
advertises or offers insurance on behalf of a bank, whether at an 39
office of the bank or another location, if: 40
(a) The person represents to the customer that the solicitation, 41
sale, advertisement or offer of the insuran ce is by or on behalf of 42
the bank; 43
(b) Documents evidencing the solicitation, sale, advertisement 44
or offer of the insurance identify or refer to the bank; or 45

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(c) The bank: 1
(1) Refers a customer to the person who sells insurance; 2
and 3
(2) Has a contractual agreement to receive commissions or 4
fees derived from the sale of insurance resulting from the referral. 5
8. The Commissioner may examine and investigate the 6
insurance activities of any person, insurer, bank or affiliate that 7
the Commissioner believes may be in violation of this section. The 8
person, insurer, bank or affiliate shall make its books and records 9
available to the Commissioner for inspection upon reasonable 10
notice. A person who is affected by a violation or potential 11
violation of this secti on may submit a complaint or other material 12
pertinent to the enforcement of this section to the Commissioner. 13
Any examination undertaken pursuant to this subsection must be 14
conducted in accordance with sections 2 to 41, inclusive, of this 15
act. 16
9. Nothing in this section: 17
(a) Prevents a person, bank or affil iate that lends money or 18
extends credit from placing insurance on real or personal property 19
in the event that a mortgagor, borrower or purchaser has failed to 20
provide required insurance in accordance with the terms of a loan 21
or credit document. 22
(b) Applies to credit related insurance. 23
10. As used in this section, the terms [“affiliate,” “parent” ] 24
“affiliate” and [“subsidiary”] “bank” have the meanings ascribed to 25
them in NRS 683A.231. 26
Sec. 100. NRS 686A.095 is he reby amended to read as 27
follows: 28
686A.095 1. An insurer shall not, without the written consent 29
of the [agent,] producer of insurance, cancel a written agreement 30
with [an agent ] a producer or reduce or restrict the [agent’s] 31
authority of the producer to transact property or casualty insurance 32
based solely on the loss ratio experience on insurance transacted by 33
that [agent,] producer, if the [agent] producer was required to 34
submit the applications for that insurance for underwriting approval, 35
all material information on those applications was fully completed 36
and the [agent] producer did not omit or alter any information 37
provided by the applicants for that insurance. 38
2. As used in this section, “loss ratio experience” means the 39
amount of money received by the insurer in payment of premiums 40
divided by the amount of money expended by the insurer in 41
payment of claims for a specified period. 42

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Sec. 101. NRS 686A.120 is hereby amended to read as 1
follows: 2
686A.120 1. Nothing in NRS 686A.100, 686A.105 and 3
686A.110 shall be construed as including within the definition of 4
discrimination or rebates any of the following practices: 5
(a) In the case of any contract of life insurance or life annuity, 6
paying bonuses to policyholders or otherwise abating their 7
premiums in whole or in part out of surplus accumulated from 8
nonparticipating insurance, provided that any such bonuses or 9
abatement of premiums shall be fair and equitable to policyholders 10
and for the best interests of the insurer and its policyholders. 11
(b) In the case of life insurance policies issued on the debit plan, 12
making allowance to policyholders who have continuously for a 13
specified period made premium payments directly to an office of the 14
insurer in an amount which fairly represents the saving in collection 15
expense. 16
(c) Readjusting the rate of premium for a group insurance policy 17
based on the loss or expense experience thereunder, at the end of the 18
first or any subsequent policy year of insurance thereunder, which 19
may be made retroactive only for such policy year. 20
(d) Reducing the premium rate for policies of large amounts, but 21
not exceeding savings in issuance and adminis tration expenses 22
reasonably attributable to such policies as compared with policies of 23
similar plan issued in smaller amounts. 24
(e) Reducing the premium rates for life or health insurance 25
policies or annuity contracts on salary savings, payroll deduction, 26
preauthorized check, bank draft or similar plans in amounts 27
reasonably commensurate with the savings made by the use of such 28
plans. 29
(f) Extending credit for the payment of any premium, and for 30
which credit a reasonable rate of interest is charged and collected. 31
(g) The offering or provision by an insurer or producer of 32
insurance, or by or through an employee, affiliate or third -party 33
representative, of a value-added product or service at no or 34
reduced cost when the product or service is not specified in the 35
policy of insurance if: 36
(1) The product or service relates to the insurance 37
coverage; 38
(2) The product or service is primarily designed to: 39
(I) Provide loss mitigation or control; 40
(II) Reduce the cost to administer claims or settle 41
claims; 42
(III) Provide education about risk of liability or risk of 43
loss to persons or property; 44

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(IV) Monitor or assess risk, identify sources of risk or 1
develop strategies to eliminate or reduce risk; 2
(V) Enhance health; 3
(VI) Enhance financial wellness , including, without 4
limitation, through education or financial planning services; 5
(VII) Provide services after a loss; 6
(VIII) Incentivize changes in behavior to improve the 7
health or reduce the risk of death or disability of a policyholder, 8
potential policyholder, certificate holder, potential certificate 9
holder, insured, potential insured or applicant; or 10
(IX) Assist in the administration of employee or retiree 11
benefit insurance coverage; 12
(3) The cost to the insurer or producer of insurance 13
offering the product or service to a customer is reasonable in 14
comparison to the customer’s premiums or insurance coverage for 15
the policy class; 16
(4) If the insurer or producer of insurance is providing the 17
product or service offered, the insurer or producer ensures that 18
the customer is provided with contact information to assist the 19
customer with any question relating to the product or service; and 20
(5) The availability of the product or service is: 21
(I) Based on documented objective criteria which must 22
be maintained by the insurer or producer of insurance and made 23
available upon request of the Commissioner; and 24
(II) Offered in a manner that is not unfairly 25
discriminatory. 26
2. If an insurer or producer of insurance does not have 27
sufficient evidence but has a good faith belief that a product or 28
service described in paragraph (g) of subsection 1 meets the 29
criteria set forth in subparagraph (2) of paragraph (g) of 30
subsection 1, the insurer or producer may provide the product or 31
service as part of a pilot o r testing program for not more than 1 32
year if: 33
(a) Not less than 21 days before beginning the pilot or testing 34
program, the insurer or producer notifies the Commissioner of the 35
intent to begin the program; 36
(b) The Commissioner does not object to the prop osed pilot or 37
testing program within 21 days after the date on which notice was 38
given pursuant to paragraph (a); and 39
(c) The insurer or producer provides the product or service in 40
the pilot or testing program in a manner that is not unfairly 41
discriminatory. 42
3. Nothing in NRS 686A.010 to [686A.310,] 686A.325, 43
inclusive, and sections 80 to 93, inclusive, of this act shall be 44
construed as including within the definition of securities as 45

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- *AB74*
inducements to purchase insurance the selling or offering for sale, 1
contemporaneously with life insurance, of mutual fund shares or 2
face amount certificates of regulated investment companies under 3
offerings registered with the Securities and Exchange Co mmission 4
where such shares or such face amount certificates or such insurance 5
may be purchased independently of and not contingent upon 6
purchase of the other, at the same price and upon similar terms and 7
conditions as where purchased independently. 8
Sec. 102. NRS 686A.130 is hereby amended to read as 9
follows: 10
686A.130 1. Except as otherwise provided in subsection 2, 11
no property, casualty, surety or title insurer or underwritten title 12
company or any employee or representative thereof, and no [broker, 13
agent or solicitor] producer of insurance may pay, allow or give, or 14
offer to pay, allow or give, directly or indirectly, as an inducement 15
to insurance, or after insurance has been effected, any rebate, 16
discount, abatement, credit or reduction of the premium named in a 17
policy of insurance, or any special favor or advantage in th e 18
dividends or other benefits to accrue thereon, or any valuable 19
consideration or inducement whatever, not specified or provided for 20
in the policy, except to the extent provided for in an applicable filing 21
with the Commissioner. 22
2. The provisions of subs ections 1 and 4 do not prohibit any 23
property, casualty or surety insurer or any employee or 24
representative thereof, or any [broker, agent or solicitor] producer 25
of insurance from providing to an insured or prospective insured 26
prizes and gifts, goods, wares , merchandise, gift certificates, 27
donations made to charitable organizations, raffle entries, meals, 28
event tickets and other items not to exceed $100 in aggregate value 29
per insured or prospective insured in any 1 calendar year. 30
3. No title insurer or underwritten title company may: 31
(a) Pay, directly or indirectly, to the insured or any person acting 32
as agent, representative, attorney or employee of the owner, lessee, 33
mortgagee, existing or prospective, of the real property or interest 34
therein which is the subject matter of title insurance or as to which a 35
service is to be performed, any commission, rebate or part of its fee 36
or charges or other consideration as inducement or compensation for 37
the placing of any order for a title insurance policy or for 38
performance of any escrow or other service by the insurer or 39
underwritten title company with respect thereto; or 40
(b) Issue any policy or perform any service in connection with 41
which it or any [agent] producer of insurance or other person has 42
paid or contemplates paying any commission, rebate or inducement 43
in violation of this section. 44

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4. Except as otherwise provided in subsection 2, no insured 1
named in a policy or any employee of that insured may knowingly 2
receive or accept, directly or indirectly, any such rebate, discount, 3
abatement, credit or reduction of premium, or any such special favor 4
or advantage or valuable consideration or inducement. 5
5. No such insurer may make or permit any unfair 6
discrimination between insured or property having like insuring or 7
risk characteristics [, in] : 8
(a) In the premium or rates charged for insurance, or in the 9
dividends or other benefits payable thereon, or in any other of the 10
terms and conditions of insurance. 11
(b) By refusing to insure, refusing to renew, cance lling or 12
limiting the amount of insurance coverage on a property or 13
casualty risk solely because of the geographic location of the risk, 14
unless such action is the result of the application of sound 15
underwriting and actuarial principles related to actual or 16
reasonably anticipated loss experience. 17
(c) By refusing to insure, refusing to renew, cance lling or 18
limiting the amount of insurance coverage on the residential 19
property risk, or the personal property contained therein, solely 20
because of the age of the residential property. 21
(d) Except as otherwise provided in this paragraph, by 22
terminating, modifying coverage, refusing to issue or refusing to 23
renew any property or casualty policy solely because the applicant 24
or insured or any employee of either is mentally or physically 25
impaired. The provisions of this paragraph do not apply to a policy 26
of accident or health insurance which is sold by a casualty insurer 27
if the termination, modification, refusal to issue or refusal to 28
renew a policy is otherwise permitted by this title. 29
(e) Except as otherwise provided in this paragraph, by refusing 30
to insure a person solely because another insurer has refused to 31
write a policy, cance lled an existing policy or refused to renew an 32
existing policy in which that person was the name d insured. The 33
provisions of this paragraph do not prohibit an insurer from 34
terminating an excess policy of insurance due to the failure of the 35
insured to maintain any required underlying insurance. 36
6. No casualty insurer may make or permit any unfair 37
discrimination between persons legally qualified to provide a 38
particular service, in the amount of the fee or charge for that service 39
payable as a benefit under any policy or contract of casualty 40
insurance. 41
7. The provisions of this section do not prohibit: 42
(a) The payment of commissions or other compensation to 43
licensed [agents, brokers or solicitors.] producers of insurance. 44

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(b) The extension of credit to an insured for the payment of any 1
premium and for which credit a reasonable rate of interest is charged 2
and collected. 3
(c) Any insurer from allowing or returning to its participating 4
policyholders, members or subscribers, dividends, savings or 5
unabsorbed premium deposits. 6
(d) With respect to title insurance, bulk rates or special rates for 7
customers o f prescribed classes if the bulk or special rates are 8
provided for in the effective schedule of fees and charges of the title 9
insurer or underwritten title company. 10
8. The provisions of this section do not apply to wet marine 11
and transportation insurance. 12
Sec. 103. NRS 686A.150 is hereby amended to read as 13
follows: 14
686A.150 Except as provided in subsection [2] 3 of NRS 15
686A.120 (contemporaneous sales of life insurance and mutual fund 16
shares), no person shall sell, agree or offer to sell, or give or offer to 17
give, directly or indirectly in any manner whatsoever, as an 18
inducement to insurance or in connection therewith, any stock, 19
shares, bonds or other securities of any kind, or any advisory board 20
contract or other contrac t or agreement of any kind offering or 21
promising returns and profits. 22
Sec. 104. NRS 686A.160 is hereby amended to read as 23
follows: 24
686A.160 If the Commissioner has cause to believe that any 25
person has been engaged or is e ngaging, in this state, in any unfair 26
method of competition or any unfair or deceptive act or practice 27
prohibited by NRS 686A.010 to [686A.310,] 686A.325, inclusive, 28
and sections 80 to 93, inclusive, of this act, and that a proceeding 29
by the Commissioner in respect thereto would be in the interest of 30
the public, the Commissioner may issue and serve upon such person 31
a statement of the c harges and a notice of the hearing to be held 32
thereon. The statement of charges and notice of hearing shall 33
comply with the requirements of NRS 679B.320 and shall be served 34
upon such person directly or by certified or registered mail, return 35
receipt requested. 36
Sec. 105. NRS 686A.170 is hereby amended to read as 37
follows: 38
686A.170 1. If the Commissioner believes that any person 39
engaged in the insurance business is in the conduct of such business 40
engaging in this state in an y method of competition or in any act or 41
practice not defined in NRS 686A.010 to [686A.310,] 686A.325, 42
inclusive, and sections 80 to 93, inclusive, of this act which is 43
unfair or deceptive and that a proceeding by the Commission er in 44
respect thereto would be in the public interest, the Commissioner 45

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shall, after a hearing of which notice and of the charges against such 1
person are given to the person, make a written report of the findings 2
of fact relative to such charges and serve a copy thereof upon such 3
person and any intervener at the hearing. 4
2. If such report charges a violation of NRS 686A.010 to 5
[686A.310,] 686A.325, inclusive, and sections 80 to 93, inclusive, 6
of this act, and if such method of competition, act or practice has 7
not been discontinued, the Commissioner may, through the Attorney 8
General, at any time after 20 days after the service of such report 9
cause an action to be instituted in the district court of the coun ty 10
wherein the person resides or has his or her principal place of 11
business to enjoin and restrain such person from engaging in such 12
method, act or practice. The court shall have jurisdiction of the 13
proceeding and shall have power to make and enter appropr iate 14
orders in connection therewith and to issue such writs or orders as 15
are ancillary to its jurisdiction or necessary in its judgment to 16
prevent injury to the public pendente lite; but the State of Nevada 17
shall not be required to give security before the issuance of any such 18
order or injunction under this section. If a stenographic record of the 19
proceedings in the hearing before the Commissioner was made, a 20
certified transcript thereof including all evidence taken and the 21
report and findings shall be received in evidence in such action. 22
3. If the court finds that: 23
(a) The method of competition complained of is unfair or 24
deceptive; 25
(b) The proceedings by the Commissioner with respect thereto 26
are to the interest of the public; and 27
(c) The findings of the Commissioner are supported by the 28
weight of the evidence, 29
 it shall issue its order enjoining and restraining the continuance 30
of such method of competition, act or practice. 31
4. Either party may appeal from such final judgment or order 32
or decree of c ourt in a like manner as provided for appeals in civil 33
cases. 34
5. If the Commissioner’s report made under subsection 1 or 35
order on hearing made under NRS 679B.360 does not charge a 36
violation of NRS 686A.010 to [686A.310,] 686A.325, inclusive, 37
and sections 80 to 93, inclusive, of this act, then any intervener in 38
the proceedings may appeal therefrom within the time and in the 39
manner provided in this Code for appeals from the Commissioner 40
generally. 41
6. Upon violation of any injunction issued under this section, 42
the Commissioner, after a hearing thereon, may impose the 43
appropriate penalties provided for in NRS 686A.187. 44

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Sec. 106. NRS 686A.180 is hereby amended to read as 1
follows: 2
686A.180 1. Service of all process, statements of charges and 3
notices under NRS 686A.010 to [686A.310,] 686A.325, inclusive, 4
and sections 80 to 93, inclusive, of this act upon unauthorized 5
insurers shall be made by delivering to and leavin g with the 6
Commissioner or some person in apparent charge of the office of the 7
Commissioner [two copies ] one copy thereof, or in the manner 8
provided for by subsection 2 of NRS 685B.050 (service of process). 9
2. The Commissioner shall forward all such proc ess, 10
statements of charges and notices to the insurer in the manner 11
provided in subsection 3 of NRS 685B.050. 12
3. No default shall be taken against any such unauthorized 13
insurer until expiration of 30 days after the date of forwarding by 14
the Commissioner under subsection 2, or date of service of process 15
if under subsection 2 of NRS 685B.050. 16
4. NRS 685B.050 applies to all process, statements of charges 17
and notices under this section. 18
Sec. 107. NRS 686A.183 is hereby amended to read as 19
follows: 20
686A.183 1. After the hearing provided for in NRS 21
686A.160, the Commissioner shall issue an order on hearing 22
pursuant to NRS 679B.360. If the Commissioner determines that the 23
person charged has engaged in an unfair method of competition or 24
an unfair or deceptive act or practice in violation of NRS 686A.010 25
to [686A.310,] 686A.325, inclusive, and sections 80 to 93, 26
inclusive, of this act, the Commissioner shall order the person to 27
cease and desist from engaging in that method of competition, act or 28
practice, and may order one or both of the following: 29
(a) If the person knew or reasonably should have known that he 30
or she was in violation o f NRS 686A.010 to [686A.310,] 686A.325, 31
inclusive, and sections 80 to 93, inclusive, of this act, payment of 32
an administrative fine of not more than $5,000 for each act or 33
violation, except that as to licensed agents, brokers, solicitors and 34
adjusters, the administrative fine must not exceed $500 for each ac t 35
or violation. 36
(b) Suspension or revocation of the person’s license if the 37
person knew or reasonably should have known that he or she was in 38
violation of NRS 686A.010 to [686A.310,] 686A.325, inclusive [.] , 39
and sections 80 to 93, inclusive, of this act. 40
2. Until the expiration of the time allowed for taking an appeal, 41
pursuant to NRS 679B.370, if no petition for review has been filed 42
within that time, or, if a petition for review has been filed within that 43
time, until the official record in the proceeding has been filed with 44
the court, the Commissioner may, at any time, upon such notice and 45

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in such manner as the Commissioner deems proper, modify or set 1
aside, in whole or in part, any order issued by him or her under this 2
section. 3
3. After the expiration of the time allowed for taking an appeal, 4
if no petition for review has been filed, the Commissioner may at 5
any time, after notice and opportunity for hearing, reopen and alter, 6
modify or set aside, in whole or in part, any order issued by him or 7
her under this section whenever in the opinion of th e Commissioner 8
conditions of fact or of law have so changed as to require such 9
action or if the public interest so requires. 10
Sec. 108. NRS 686A.270 is hereby amended to read as 11
follows: 12
686A.270 No insurer shall be held guilty of having committed 13
any of the acts prohibited by NRS 686A.010 to [686A.310,] 14
686A.325, inclusive, and sections 80 to 93, inclusive, of this act by 15
reason of the act of any agent, solicitor or employee not an officer, 16
director or department head thereof, unless an of ficer, director or 17
department head of the insurer has knowingly permitted such act or 18
has had prior knowledge thereof. 19
Sec. 109. NRS 686A.310 is hereby amended to read as 20
follows: 21
686A.310 1. Engaging in any of the following activities is 22
considered to be an unfair practice: 23
(a) Misrepresenting to insureds or claimants pertinent facts or 24
insurance policy provisions relating to any coverage at issue. 25
(b) Failing to acknowledge and act reasonably promptly upon 26
communications with respect to claims arising under insurance 27
policies. 28
(c) Failing to adopt and implement reasonable standards for the 29
prompt investigation and processing of claims arising under 30
insurance policies. 31
(d) Failing to affirm or deny coverage of cl aims within a 32
reasonable time after proof of loss requirements have been 33
completed and submitted by the insured. 34
(e) Failing to effectuate prompt, fair and equitable settlements of 35
claims in which liability of the insurer has become reasonably clear. 36
(f) Compelling insureds to institute litigation to recover amounts 37
due under an insurance policy by offering substantially less than the 38
amounts ultimately recovered in actions brought by such insureds, 39
when the insureds have made claims for amounts reasonabl y similar 40
to the amounts ultimately recovered. 41
(g) Attempting to settle a claim by an insured for less than the 42
amount to which a reasonable person would have believed he or she 43
was entitled by reference to written or printed advertising material 44
accompanying or made part of an application. 45

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(h) Attempting to settle claims on the basis of an application 1
which was altered without notice to, or knowledge or consent of, the 2
insured, or the representative, agent or broker of the insured. 3
(i) Failing, upon payment of a claim, to inform insureds or 4
beneficiaries of the coverage under which payment is made. 5
(j) Making known to insureds or claimants a practice of the 6
insurer of appealing from arbitration awards in favor of insureds or 7
claimants for the purpose of compelling them to accept settlements 8
or compromises less than the amount awarded in arbitration. 9
(k) Delaying the investigation or payment of claims by requiring 10
an insured or a claimant, or the physician of either, to submit a 11
preliminary claim repo rt, and then requiring the subsequent 12
submission of formal proof of loss forms, both of which 13
submissions contain substantially the same information. 14
(l) Failing to settle claims promptly, where liability has become 15
reasonably clear, under one portion of the insurance policy coverage 16
in order to influence settlements under other portions of the 17
insurance policy coverage. 18
(m) Failing to comply with the provisions of NRS 687B.310 to 19
687B.390, inclusive, or 687B.410. 20
(n) Failing to provide promptly to an in sured a reasonable 21
explanation of the basis in the insurance policy, with respect to the 22
facts of the insured’s claim and the applicable law, for the denial of 23
the claim or for an offer to settle or compromise the claim. 24
(o) Advising an insured or claimant not to seek legal counsel. 25
(p) Misleading an insured or claimant concerning any applicable 26
statute of limitations. 27
(q) Refusing to pay a claim without conducting a reasonable 28
investigation. 29
(r) Failing to provide forms necessary to present a claim and a 30
reasonable explanation concerning the use of the form s within 15 31
days after the date on which a request for the forms is made. 32
2. In addition to any rights or remedies available to the 33
Commissioner, an insurer is liable to its insured for any d amages 34
sustained by the insured as a result of the commission of any act set 35
forth in subsection 1 as an unfair practice. 36
Sec. 110. NRS 686A.400 is hereby amended to read as 37
follows: 38
686A.400 1. A company shall maintain records of each 39
transaction for 3 years after making the final entry with respect to 40
the transaction. The records may be preserved in photographic form, 41
electronic form, on microfilm or microfiche or in a form approved 42
by the Commissioner. 43
2. A person who generates leads or other information relating 44
to potential customers of health insurance products and services 45

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for any insurer or producer of insurance shall maintain any 1
books, documents and other business records: 2
(a) In such an order that data regard ing complaints and 3
marketing are accessible and retrievable for examination by the 4
Commissioner; and 5
(b) For 3 years after the date on which the book, document or 6
other record was created. 7
3. The records , books, documents and other business records 8
maintained pursuant to this section must be open to the 9
Commissioner at all times. The Commissioner may require a 10
company to furnish to the Commissioner in any form the 11
Commissioner requires any information ma intained in the 12
company’s records. 13
Sec. 111. NRS 686A.410 is hereby amended to read as 14
follows: 15
686A.410 The Commissioner may conduct an examination of a 16
company at any time in accordance with [NRS 679B.250 to 17
679B.287,] sections 2 to 41, inclusive [.] , of this act. The expense 18
of the examination must be borne by the company in accordance 19
with [NRS 679B.290] section 19 of this act as if the company were 20
an insurer. 21
Sec. 112. NRS 686A.520 is hereby amended to read as 22
follows: 23
686A.520 1. The provisions of NRS 683A.341, 683A.451, 24
683A.461 and 686A.010 to [686A.310,] 686A.325, inclusive, and 25
sections 80 to 93, inclusive, of this act apply to companies. 26
2. For the purposes of s ubsection 1, unless the context requires 27
that a section apply only to insurers, any reference in those sections 28
to “insurer” must be replaced by a reference to “company.” 29
Sec. 113. NRS 686B.125 is hereby amended to read as 30
follows: 31
686B.125 1. Except as otherwise provided in this section, no 32
insurer, organization or person licensed pursuant to this title may 33
sell or offer to sell any contract providing coverage for dental care at 34
a rate which is excessive for the benefits offered to the insured or 35
member. For the purpose of this section, a ratio of losses to 36
premiums collected which is less than 75 percent is presumed to 37
show an excessive rate. 38
2. The provisions of subsection 1 do not apply to a contract 39
providing coverage for dental care that is sold to a small employer 40
pursuant to the provisions of chapter 689C of NRS. As used in this 41
subsection, “small employer” has the meaning ascribed to it in 42
NRS 689C.095. 43
3. Each year, every insurer, organization or person licen sed 44
pursuant to this title who provides coverage for dental care in this 45

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State shall, in accordance with requirements established by 1
regulation of the Commissioner, file with the Commissioner a report 2
of the losses and premiums collected for that insurer, organization or 3
person, as applicable, for the calendar year. 4
4. For the purposes of subsection 3, the values of losses and 5
premiums collected must be determined at the end of each calendar 6
year for the entire calendar year. 7
5. The Commissioner may, pursuant to [NRS 679B.240, ] 8
section 16 of this act, examine the accounts, records, documents and 9
transactions of any insurer, organization or person licensed pursuant 10
to this title who sells or offers to sell any contract providing 11
coverage for dental care in this State to ascertain compliance with 12
the provisions of this section. 13
Sec. 114. NRS 686B.1784 is hereby amended to read as 14
follows: 15
686B.1784 1. The Commissioner may examine any insurer, 16
advisory organization or plan for apportioned risks whenever the 17
Commissioner determines that such an examination is necessary. 18
2. The reasonable co st of an examination must be paid by the 19
insurer or other person examined upon presentation by the 20
Commissioner of an accounting of those costs pursuant to [NRS 21
679B.290.] section 19 of this act. 22
3. In lieu of an examination, the Commissioner may accept the 23
report of an examination made by the agency of another state that 24
regulates insurance. 25
Sec. 115. Chapter 687B of NRS is hereby amended by adding 26
thereto a new section to read as follows: 27
1. In any settlement for the payment of a claim pertaining to 28
a policy or coverage of property insurance, if the contract of 29
insurance provides for a settlement on the basis of actual cash 30
value or another term which is similarly defined, only the cost of 31
the physical goods being repaired or replaced may be subject to a 32
deduction for depreciation. 33
2. The following types of payments, if separately itemized by 34
the provider of repairs or replacement or by any governmental 35
entity, must be paid or reimbursed by the insurer in full and may 36
not be subject to a deduction for depreciation: 37
(a) The cost of services provided, including, without limitation, 38
labor; 39
(b) Any expenses incurred by th e provider of repairs or 40
replacement, including, without limitation, overhead expenses 41
which do not pertain to the repair or replacement of physical 42
goods; 43
(c) Any profits earned by the provider of repairs or 44
replacement; 45

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(d) Any taxes paid by the governmental entity in connection 1
with the repair or replacement; 2
(e) Any fees or charges, by any name called, required to be 3
paid by the governmental entity which are not part of the price of 4
the physical goods being repaired or replaced. 5
3. Any cost not separately itemized shall be deemed to be part 6
of the cost of physical goods being repaired or replaced, unless 7
otherwise stated by the provider of repairs or replacement or the 8
governmental entity. 9
4. As used in this section, “actual cash value” means 10
replacement cost minus a deduction for depreciation. 11
Sec. 116. NRS 687B.120 is hereby amended to read as 12
follows: 13
687B.120 1. Except as otherwise provided in subsection 2: 14
(a) No life or health insurance policy or contract, annuity 15
contract form, policy form, health care plan or plan for dental care, 16
whether individual, group or blanket, including those to be issued by 17
a health maintenance organization, organization for dental care or 18
prepaid limited health service organizat ion, or application form 19
where a written application is required and is to be made a part of 20
the policy or contract, or printed rider or endorsement form or form 21
of renewal certificate, or form of individual certificate or statement 22
of coverage to be issue d under group or blanket contracts, or by a 23
health maintenance organization, organization for dental care or 24
prepaid limited health service organization, may be delivered or 25
issued for delivery in this state, unless the form has been filed with 26
and approved by the Commissioner. 27
(b) As to individual policies pursuant to paragraph [(d)] (e) of 28
subsection 2 of NRS 679B.220 or group insurance policies 29
effectuated and delivered outside this state but covering persons 30
resident in this state, the certificates to be delivered or issued for 31
delivery in this state must be filed, for informational purposes only, 32
with the Commissioner at the request of the Commissioner. 33
2. As to group insurance policies to be issued to a group 34
approved pursuant to NRS 688B.030 or 689 B.026, no policies of 35
group insurance may be marketed to a resident or employer of this 36
State unless the policy and any form or certificate to be issued 37
pursuant to the policy has been filed with and approved by the 38
Commissioner. 39
3. Every filing made pursuant to the provisions of subsection 1 40
or 2 must be made not less than 45 days in advance of any delivery 41
pursuant to subsection 1 or marketing pursuant to subsection 2. At 42
the expiration of 45 days the form so filed shall be deemed approved 43
unless prior thereto it has been affirmatively approved or 44
disapproved by order of the Commissioner. Approval of any such 45

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form by the Commissioner constitutes a waiver of any unexpired 1
portion of such waiting period. The Commissioner may extend by 2
not more than an addi tional 30 days the period within which the 3
Commissioner may so affirmatively approve or disapprove any such 4
form, by giving notice to the insurer of the extension before 5
expiration of the initial 45-day period. At the expiration of any such 6
period as so ex tended, and in the absence of prior affirmative 7
approval or disapproval, any such form shall be deemed approved. 8
The Commissioner may at any time, after notice and for cause 9
shown, withdraw any such approval. 10
4. Any order of the Commissioner disapproving any such form 11
or withdrawing a previous approval must state the grounds therefor 12
and the particulars thereof in such detail as reasonably to inform the 13
insurer thereof. Any such withdrawal of a previously approved form 14
is effective at the expiration of su ch a period, not less than 30 days 15
after the giving of notice of withdrawal, as the Commissioner in 16
such notice prescribes. 17
5. The Commissioner may, by order, exempt from the 18
requirements of this section for so long as the Commissioner deems 19
proper any i nsurance document or form or type thereof specified in 20
the order, to which, in the opinion of the Commissioner, this section 21
may not practicably be applied, or the filing and approval of which 22
are, in the opinion of the Commissioner, not desirable or neces sary 23
for the protection of the public. 24
6. Appeals from orders of the Commissioner disapproving any 25
such form or withdrawing a previous approval may be taken as 26
provided in NRS 679B.310 to 679B.370, inclusive. 27
Sec. 117. NRS 687B.225 is hereby amended to read as 28
follows: 29
687B.225 1. Except as otherwise provided in NRS 30
689A.0405, 689A.0412, 689A.0413, 689A.0418, 689A.0437, 31
689A.044, 689A.0445, 689A.0459, 689B.031, 689B.0312, 32
689B.0313, 689B.0315, 689B.0317, 689B.0319, 689B .0374, 33
689B.0378, 689C.1665, 689C.1671, 689C.1675, 689C.1676, 34
695A.1843, 695A.1856, 695A.1865, 695A.1874, 695B.1912, 35
695B.1913, 695B.1914, 695B.1919, 695B.19197, 695B.1924, 36
695B.1925, 695B.1942, 695C.1696, 695C.1699, 695C.1713, 37
695C.1735, 695C.1737, 695C.1 743, 695C.1745, 695C.1751, 38
695G.170, 695G.1705, 695G.171, 695G.1714, 695G.1715, 39
695G.1719 and 695G.177, any contract for group, blanket or 40
individual health insurance or any contract by a nonprofit hospital, 41
medical or dental service corporation or organiz ation for dental care 42
which provides for payment of a certain part of medical or dental 43
care may require the insured or member to obtain prior authorization 44

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for that care from the insurer or organization. The insurer or 1
organization shall: 2
(a) File its procedure for obtaining approval of care pursuant to 3
this section for approval by the Commissioner; and 4
(b) Unless a shorter time period is prescribed by a specific 5
statute, including, without limitation, NRS 689A.0446, 689B.0361, 6
689C.1688, 695A.1859, 695B.19087, 695C.16932 and 695G.1703, 7
[respond to any ] approve a request for [approval by ] prior 8
authorization or respond to the insured , [or] member or provider 9
of health care [pursuant to this section ] with a request for 10
additional information: 11
(1) If the request for prior authorization involves urgent 12
health care services, within [20] 2 business days after [it receives] 13
the date on which the request [.] for prior authorization was 14
submitted; or 15
(2) If the request for prior authorization does not involve 16
urgent health care services, within 5 business days after the date 17
on which the request for prior authorization was submitted. 18
2. The procedure for prior authorization may not discriminate 19
among persons licensed to provide the covered care. 20
Sec. 118. NRS 687B.385 is hereby amended to read as 21
follows: 22
687B.385 1. An insurer shall not refuse to issue, cancel, 23
refuse to renew or increase the premium for renewal of a policy of 24
motor vehicle insurance covering private passenger cars or 25
commercial vehicles as a result of any [: 26
1. Claims] claims made under any policy of insuran ce with 27
respect to which the insured was not at fault . [;] 28
2. An insurer shall not refuse to issue, set a higher premium 29
when issuing, cancel, refuse to renew or increase the premium for 30
renewal of a policy of property or casualty insurance as a result of 31
any: 32
(a) Claims made under any policy of insurance for which the 33
insurer has not made any payment or for which the insurer 34
recovered the entirety of the insurer’s payment on the claim by 35
means of salvage, subrogation or another mechanism; or 36
[3.] (b) Inquiries made regarding an actual or potential claim 37
under any policy of insurance regarding: 38
[(a)] (1) The existence of insurance coverage for any matter; or 39
[(b)] (2) Any hypothetical or informational matter pertaining to 40
insurance. 41
Sec. 119. NRS 687B.404 is hereby amended to read as 42
follows: 43
687B.404 1. An insurer or other organization providing 44
health coverage pursuant to chapter 689A, 689B, 689C, 695A, 45

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695B, 695C, 695F or 695G of NRS, including, without limitatio n, a 1
health maintenance organization or managed care organization that 2
provides health care services through managed care to recipients of 3
Medicaid under the State Plan for Medicaid, shall adhere to the 4
applicable provisions of the Paul Wellstone and Pete Domenici 5
Mental Health Parity and Addiction Equity Act of 2008, Public Law 6
110-343, Division C, Title V, Subtitle B, and any federal regulations 7
issued pursuant thereto. 8
2. On or before [July] April 1 of each year, the Commissioner 9
shall prescribe and pr ovide to each insurer or other organization 10
providing health coverage subject to the provisions of subsection 1 a 11
data request that solicits information necessary to evaluate the 12
compliance of an insurer or other organization with the Paul 13
Wellstone and Pe te Domenici Mental Health Parity and Addiction 14
Equity Act of 2008, Public Law 110 -343, Division C, Title V, 15
Subtitle B, including, without limitation, the comparative analyses 16
specified in 42 U.S.C. § 300gg-26(a)(8). 17
3. On or before [October] June 1 of each year, each insurer or 18
other organization providing health coverage subject to the 19
provisions of subsection 1 shall: 20
(a) Complete and submit to the Commissioner the data request 21
prescribed pursuant to subsection 2; or 22
(b) Submit to the Commissioner a copy of a report submitted by 23
the insurer or other organization to the Federal Government 24
demonstrating compliance with the Paul Wellstone and Pete 25
Domenici Mental Health Parity and Addiction Equity Act of 2008, 26
Public Law 110 -343, Division C, Title V, Sub title B, including, 27
without limitation, the comparative analyses specified in 42 U.S.C. 28
§ 300gg-26(a)(8). The Commissioner may request from an insurer 29
or other organization who submits a copy of such a report any 30
supplemental information necessary to deter mine whether the 31
insurer or other organization is in compliance with that federal law. 32
4. Any information provided by an insurer or other 33
organization to the Commissioner pursuant to subsection 3 is 34
confidential. 35
5. On or before December 31 of each year, the Commissioner 36
shall compile a report summarizing the information submitted to the 37
Commissioner pursuant to this section and submit the report to: 38
(a) The Patient Protection Commission created by 39
NRS 439.908; 40
(b) The Governor; and 41
(c) The Direc tor of the Legislative Counsel Bureau for 42
transmittal to: 43
(1) In even-numbered years, the next regular session of the 44
Legislature; and 45

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(2) In odd -numbered years, the Joint Interim Standing 1
Committee on Health and Human Services. 2
6. The Commissioner m ay adopt any regulations necessary to 3
carry out the provisions of this section. 4
Sec. 120. NRS 687B.409 is hereby amended to read as 5
follows: 6
687B.409 1. Every payment made pursuant to a policy of 7
health insurance to pay for treatment relating solely to mental health 8
or an alcohol or substance use disorder must be made directly to the 9
provider of health care that provides the treatment if the provider: 10
(a) Is an out-of-network provider; and 11
(b) Has obtained and delivered to the insurer or an authorized 12
representative of the insurer, including, without limitation, a third -13
party administrator, a written assignment of benefits pursuant to 14
which the insured has assigned to the provider the insured’s benefits 15
under the policy of health insurance with regard to the treatment. 16
2. An out-of-network provider that receives payment pursuant 17
to subsection 1: 18
(a) Shall, if a person paid the provider directly for the treatment 19
described in subsection 1, refund to the person the amoun t that the 20
person paid directly to the provider for the treatment, less any 21
applicable deductible, copayment or coinsurance, not later than 45 22
days after the provider receives payment pursuant to subsection 1; 23
and 24
(b) Must indemnify and hold harmless the insurer against any 25
claim made against the insurer by the person who receives the 26
treatment described in subsection 1 for any amount paid by the 27
insurer to the provider in compliance with this section. 28
3. An assignment of benefits described in paragraph (b) of 29
subsection 1 is irrevocable for the period: 30
(a) Beginning on the date the insured gives to the out -of-31
network provider the assignment of benefits; and 32
(b) Ending on the later of: 33
(1) The date on which the out -of-network provider receives 34
from the insurer the final payment for the treatment; or 35
(2) The date of the final resolution, including, without 36
limitation, by settlement or trial, of all claims relating to all 37
payments which relate to the treatment. 38
4. Nothing in this section shall be construed to require an 39
insurer to make a payment to an out-of-network provider: 40
(a) Who is not authorized by law to provide the treatment; 41
(b) Who provides the treatment in violation of any law; or 42
(c) In an amount which exceeds the amount required by the 43
policy of health insurance to be paid for out-of-network treatment. 44
5. As used in this section: 45

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(a) “Health care services” means services for the diagnosis, 1
prevention, treatment, care or relief of a health condition, illness, 2
injury or disease. 3
(b) “Insured” means a person who receives benefits pursuant to 4
a policy of health insurance. 5
(c) “Insurer” means a person, including, without limitation, a 6
governmental entity, who issues or otherwise provides a policy of 7
health insurance. 8
(d) “Network pl an” has the meaning ascribed to it in NRS 9
[689B.570.] 687B.645. 10
(e) “Out-of-network provider” means a provider of health care 11
who: 12
(1) Provides health care services; 13
(2) Is paid, pursuant to a policy of health insurance, for 14
providing the health care services; and 15
(3) Is not under contract to provide the health care services as 16
part of any network plan associated with the policy of health 17
insurance. 18
(f) “Policy of health insurance” includes, without limitation, a 19
policy, contract, certificate, plan or agreement, as applicable, issued 20
pursuant to or otherwise governed by NRS 287.0402 to 287.049, 21
inclusive, or chapter 608, 689A, 689B, 689C, 695A, 695B, 695C, 22
695F or 695G of NRS for the provision of, delivery of, arrangement 23
for, payment for or reimbursement for any of the costs of health care 24
services. 25
(g) “Provider of health care” has the meaning ascribed to it in 26
NRS [695G.070.] 629.031. 27
Sec. 121. NRS 687B.490 is hereby amended to read as 28
follows: 29
687B.490 1. A carrier that offers coverage in the small 30
employer group or individual market must, before making any 31
network plan available for sale in this State, demonstrate the 32
capacity to deliver services adequately by applying to the 33
Commissioner for the issuance of a network plan and submitting a 34
description of the procedures and programs to be implemented to 35
meet the requirements described in subsection 2. 36
2. The Commissioner shall determine, within 90 days after 37
receipt of the application required pursuant to su bsection 1, if the 38
carrier, with respect to the network plan: 39
(a) Has demonstrated the willingness and ability to ensure that 40
health care services will be provided in a manner to ensure both 41
availability and accessibility of adequate personnel and facilities in a 42
manner that enhances availability, accessibility and continuity of 43
service; 44

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(b) Has organizational arrangements established in accordance 1
with regulations promulgated by the Commissioner; and 2
(c) Has a procedure established in accordance with regulations 3
promulgated by the Commissioner to develop, compile, evaluate 4
and report statistics relating to the cost of its operations, the pattern 5
of utilization of its services, the availability and accessibility of its 6
services and such other matte rs as may be reasonably required by 7
the Commissioner. 8
3. The Commissioner may certify that the carrier and the 9
network plan meet the requirements of subsection 2, or may 10
determine that the carrier and the network plan do not meet such 11
requirements. Upon a determination that the carrier and the network 12
plan do not meet the requirements of subsection 2, the 13
Commissioner shall specify in what respects the carrier and the 14
network plan are deficient. 15
4. A carrier approved to issue a network plan pursuant to this 16
section must file annually with the Commissioner a summary of 17
information compiled pursuant to subsection 2 in a manner 18
determined by the Commissioner. 19
5. The Commissioner shall, not less than once each year, or 20
more often if deemed necessary by the Commissioner for the 21
protection of the interests of the people of this State, make a 22
determination concerning the availability and accessibility of the 23
health care services of any network plan approved pursuant to this 24
section. 25
6. The expense of any det ermination made by the 26
Commissioner pursuant to this section must be assessed against the 27
carrier and remitted to the Commissioner. 28
7. When making any determination concerning the availability 29
and accessibility of the services of any network plan or prop osed 30
network plan pursuant to this section, the Commissioner shall 31
consider services that may be provided through telehealth, as 32
defined in NRS 629.515, pursuant to the network plan or proposed 33
network plan to be available services. 34
8. As used in this section: 35
(a) “Network plan” has the meaning ascribed to it in NRS 36
[689B.570.] 687B.645. 37
(b) “Small employer” has the meaning ascribed to it in 38
NRS 689C.095. 39
Sec. 122. NRS 687B.615 is hereby amended to read as 40
follows: 41
687B.615 “Health benefit plan” has the meaning ascribed to it 42
in NRS [695G.019.] 687B.470. 43

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Sec. 123. NRS 687B.660 is hereby amended to read as 1
follows: 2
687B.660 “Provider of health care” has the meaning ascribed 3
to it in NRS [695G.070.] 629.031. 4
Sec. 124. NRS 688C.175 is hereby amended to read as 5
follows: 6
688C.175 1. Persons engaged in the business of viatical 7
settlements are subject to the provisions of this chapter and to the 8
following provisions, to the extent reasonably applicable: 9
(a) [NRS 679B.230 to 679B.300,] Sections 2 to 41, inclusive, of 10
this act concerning examinations of insurers. 11
(b) NRS 679B.310 to 679B.370, in clusive, concerning hearings 12
regarding insurers and employees of insurers. 13
(c) Chapter 680A of NRS. 14
(d) Chapter 683A of NRS. 15
(e) NRS 686A.010 to [686A.310,] 686A.325, inclusive, and 16
sections 80 to 93, inclusive, of this act concerning trade practices 17
and frauds. 18
2. Nothing in this chapter or elsewhere in this title preempts or 19
otherwise limits the provisions of chapter 90 of NRS, or of any 20
rules, regulations or orders issued by or through the Administrator 21
of the Securities Division of the Office of the Secretary of State or 22
the Administrator’s designee acting pursuant to the authority 23
granted by chapter 90 of NRS. 24
3. Compliance with the provisions of this chapter does not 25
constitute compliance with any applicable provisions of chapter 90 26
of NRS or with any rule, regulation or order adopted or issued 27
thereunder. 28
Sec. 125. NRS 688C.180 is hereby amended to read as 29
follows: 30
688C.180 The Commissioner may examine or investigate a 31
licensee under this chapter as often as the Commissioner considers 32
appropriate. An examination will be conducted in the manner 33
provided in [NRS 679B.230 to 679B.300, ] sections 2 to 41, 34
inclusive [.] , of this act. The Commissioner may also examine or 35
investigate any other person or business insofar as the 36
Commissioner considers necessary or material to the examination or 37
investigation of the licensee. Instead of an examination or 38
investigation under this chapter of a foreign or alien person licensed 39
under this chapter, the Commissioner may accept a report on 40
examination or investigation of the licensee by the equivalent 41
authority of the licensee’s state of domicile or port of entry. 42

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Sec. 126. NRS 689.160 is hereby amended to read as follows: 1
689.160 1. The provisions of NRS 683A.341, 683A.451, 2
683A.461 and 686A.010 to [686A.310,] 686A.325, inclusive, and 3
sections 80 to 93, inclusive, of this act apply to agents and sellers. 4
2. For the purposes of subsection 1, unless the context requires 5
that a section apply only to insurers, any reference in those sections 6
to “insurer” must be replaced by a reference to “agent” and “seller.” 7
3. The provisions of [NRS 679B.230 to 679B.300, ] sections 2 8
to 41, inclusive, of this act apply to sellers. Unless the context 9
requires that a provision apply only to insurers, any reference in 10
those sections to “insurer” must be replaced by a reference to 11
“seller.” 12
4. The provisions of NRS 683A.301 apply to applicants for and 13
holders of a seller’s certificate of authority. Unless the context 14
requires that a provision apply only to an applicant for or holder of a 15
license as a producer of insurance, any reference in that section to: 16
(a) An “applicant for a license as a producer of insurance” must 17
be replaced by a reference to an “applicant for a seller’s certificate 18
of authority”; and 19
(b) A “licensee” must be replaced by a reference to a “holder of 20
a seller’s certificate of authority.” 21
Sec. 127. NRS 689.595 is hereby amended to read as follows: 22
689.595 1. The provisions of NRS 683A.341, 683A.451, 23
683A.461 and 686A.010 to [686A.310,] 686A.325, inclusive, and 24
sections 80 to 93, inclusive, of this act apply to agents and sellers. 25
2. For the purposes of subsection 1, unless the context requires 26
that a section apply only to insurers, any reference in those sections 27
to “insurer” must be replaced by a reference to “agent” and “seller.” 28
3. The provisions of [NRS 679B.230 to 679B.300,] sections 2 29
to 41, inclusive, of this act apply to sellers. Unless the context 30
requires that a provision apply only to insurers, any reference in 31
those sections to “insurer” must be replaced by a reference to 32
“seller.” 33
4. The provisions of NRS 683A.301 apply to applicants for and 34
holders of a seller’s permit. Unless the context requires that a 35
provision apply only to an applicant for or a holder of a license as a 36
producer of insurance, any reference in that section to: 37
(a) An “applicant for a license as a producer of insurance” must 38
be replaced by a reference to an “applicant for a seller’s permit”; 39
and 40
(b) A “licensee” must be replaced by a reference to a “holder of 41
a seller’s permit.” 42

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Sec. 128. Chapter 689A of NRS is hereby amended by adding 1
thereto the provisions set forth as sections 129 to 134, inclusive, of 2
this act. 3
Sec. 129. As used in this chapter, unless the context 4
otherwise requires, the words and terms defined in sections 130 to 5
134, inclusive, of this act have the meanings ascribed to them in 6
those sections. 7
Sec. 130. “Medical management technique” has the 8
meaning ascribed to it in section 299 of this act. 9
Sec. 131. “Network plan” has the meaning ascribed to it in 10
NRS 687B.645. 11
Sec. 132. “Provider network contract” has the meaning 12
ascribed to it in NRS 687B.658. 13
Sec. 133. “Provider of health care” has the meaning 14
ascribed to it in NRS 629.031. 15
Sec. 134. “Therapeutic equivalent” has the meaning 16
ascribed to it in section 302 of this act. 17
Sec. 135. NRS 689A.020 is hereby amended to read as 18
follows: 19
689A.020 Nothing in this chapter applies to or affects: 20
1. Any policy of liability or workers’ compensation insurance 21
with or without supplementary expense coverage therein. 22
2. Any group or blanket policy. 23
3. Life insurance, endowment or annuity contracts, or contracts 24
supplemental thereto which contain only such provisions relating to 25
health insurance as to: 26
(a) Provide additional benefits in case of death or 27
dismemberment or loss of sight by accident or accidental means; or 28
(b) Operate to safeguard such contracts against lapse, or to give 29
a special surrender value or special benefit or an ann uity if the 30
insured or annuitant becomes totally and permanently disabled, as 31
defined by the contract or supplemental contract. 32
4. Reinsurance . [, except as otherwise provided in NRS 33
689A.470 to 689A.740, inclusive, and 689C.610 to 689C.940, 34
inclusive, relating to the program of reinsurance.] 35
5. Any policy of insurance offered on the Silver State Health 36
Insurance Exchange in accordance with NRS 695I.505. 37
Sec. 136. NRS 689A.04048 is hereby amended to read as 38
follows: 39
689A.04048 1. A policy of health insurance which provides 40
coverage for prescription drugs must not require an insured to 41
submit to a step therapy protocol before covering a drug approved 42
by the Food and Drug Administration that is prescribed to treat a 43
psychiatric condition of the insured, if: 44

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(a) The drug has been approved by the Food and Drug 1
Administration with indications for the psychiatric condition of the 2
insured or the use of the drug to treat that psychiatric condition is 3
otherwise supported by medical or scientific evidence; 4
(b) The drug is prescribed by: 5
(1) A psychiatrist; 6
(2) A physician assistant under the supervision of a 7
psychiatrist; 8
(3) An advanced practice registered nurse who has the 9
psychiatric training and experience prescribed by the State Board of 10
Nursing pursuant to NRS 632.120; or 11
(4) A primary care provider that is providing care to an 12
insured in consultation with a practitioner listed in subparagraph (1), 13
(2) or (3), if the closest practitioner listed in subparagraph (1), (2) or 14
(3) who participates in the network plan of the insurer is located 60 15
miles or more from the residence of the insured; and 16
(c) The practitioner listed in paragraph (b) who prescribed the 17
drug knows, based on the medical history of the insured , or 18
reasonably expects each alternative drug that is required to be used 19
earlier in the step therapy protocol to be ineffective at treating the 20
psychiatric condition. 21
2. Any provision of a policy of health insurance subject to the 22
provisions of this ch apter that is delivered, issued for delivery or 23
renewed on or after July 1, 2023, which is in conflict with this 24
section is void. 25
3. As used in this section: 26
(a) “Medical or scientific evidence” has the meaning ascribed to 27
it in NRS 695G.053. 28
(b) [“Network plan” means a policy of health insurance offered 29
by an insurer under which the financing and delivery of medical 30
care is provided, in whole or in part, through a defined set of 31
providers under contract with the insurer. The term does not include 32
an arrangement for the financing of premiums. 33
(c)] “Step therapy protocol” means a procedure that requires an 34
insured to use a prescription drug or sequence of prescription drugs 35
other than a drug that a practitioner recommends for treatment of a 36
psychiatric condition of the insured before his or her policy of health 37
insurance provides coverage for the recommended drug. 38
Sec. 137. NRS 689A.04049 is hereby amended to read as 39
follows: 40
689A.04049 1. An insurer that issues a policy of health 41
insurance shall provide coverage for screening, genetic counseling 42
and testing for harmful mutations in the BRCA gene for women 43
under circumstances where such screening, genetic counseling or 44
testing, as applicable, is required by NRS 457.301. 45

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2. An insurer shall ensure that the benefits required by 1
subsection 1 are made available to an insured through a provider of 2
health care who participates in the network plan of the insurer. 3
3. A policy of health insurance subject to the provisions of this 4
chapter that is delivered, issued for delivery or renewed on or after 5
January 1, 2022, has the legal effect of including the coverage 6
required by subsection 1, and any provision of the policy that 7
conflicts with the provisions of this section is void. 8
[4. As used in this section: 9
(a) “Network plan” means a policy of health insurance offered 10
by an insurer under which the financing and delivery of medical 11
care, including items and services paid for as medical care, are 12
provided, in whole or in part, through a defined set of providers 13
under contract with the insurer. The term does not include an 14
arrangement for the financing of premiums. 15
(b) “Provider of health care” has the meaning ascribed to it in 16
NRS 629.031.] 17
Sec. 138. NRS 689A.0405 is hereby amended to read as 18
follows: 19
689A.0405 1. A policy of health insurance must provide 20
coverage for benefits payable for expenses incurred for: 21
(a) A mammogram to screen for breast cancer annually for 22
insureds who are 40 years of age or older. 23
(b) An imaging test to screen for breast cancer on an interval 24
and at the age deemed most appropriate, when medically necessary, 25
as recommended by the insured’s provider of health care based on 26
personal or family medical history or additional factors that may 27
increase the risk of breast cancer for the insured. 28
(c) A diagnostic imaging test for breast cancer at the age deemed 29
most appropriate, when medically necessary, as recommended by 30
the insured’s provider of health care to evaluate an abnormality 31
which is: 32
(1) Seen or suspected from a mammogram described in 33
paragraph (a) or an imaging test described in paragraph (b); or 34
(2) Detected by other means of examination. 35
2. An insurer must ensure that the benefits required by 36
subsection 1 are made available to an insured through a provider of 37
health care who participates in the network plan of the insurer. 38
3. Except as otherwise provided in subsection 5, an insurer that 39
offers or issues a policy of health insurance shall not: 40
(a) Except as otherwise provided in subsection 6, require an 41
insured to pay a deductible, copayment, coinsurance or any other 42
form of cost -sharing or require a longer waiting period or other 43
condition to obtain any benefit p rovided in the policy of health 44
insurance pursuant to subsection 1; 45

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(b) Refuse to issue a policy of health insurance or cancel a 1
policy of health insurance solely because the person applying for or 2
covered by the policy uses or may use any such benefit; 3
(c) Offer or pay any type of material inducement or financial 4
incentive to an insured to discourage the insured from obtaining any 5
such benefit; 6
(d) Penalize a provider of health care who provides any such 7
benefit to an insured, including, without limitat ion, reducing the 8
reimbursement of the provider of health care; 9
(e) Offer or pay any type of material inducement, bonus or other 10
financial incentive to a provider of health care to deny, reduce, 11
withhold, limit or delay access to any such benefit to an insured; or 12
(f) Impose any other restrictions or delays on the access of an 13
insured to any such benefit. 14
4. A policy subject to the provisions of this chapter which is 15
delivered, issued for delivery or renewed on or after January 1, 16
2024, has the legal e ffect of including the coverage required by 17
subsection 1, and any provision of the policy or the renewal which is 18
in conflict with this section is void. 19
5. Except as otherwise provided in this section and federal law, 20
an insurer may use medical managemen t techniques, including, 21
without limitation, any available clinical evidence, to determine the 22
frequency of or treatment relating to any benefit required by this 23
section or the type of provider of health care to use for such 24
treatment. 25
6. If the applicat ion of paragraph (a) of subsection 3 would 26
result in the ineligibility of a health savings account of an insured 27
pursuant to 26 U.S.C. § 223, the prohibitions of paragraph (a) of 28
subsection 3 shall apply only for a qualified policy of health 29
insurance with respect to the deductible of such a policy of health 30
insurance after the insured has satisfied the minimum deductible 31
pursuant to 26 U.S.C. § 223, except with respect to items or services 32
that constitute preventive care pursuant to 26 U.S.C. § 223(c)(2)(C ), 33
in which case the prohibitions of paragraph (a) of subsection 3 shall 34
apply regardless of whether the minimum deductible under 26 35
U.S.C. § 223 has been satisfied. 36
7. As used in this section [: 37
(a) “Medical management technique” means a practice which is 38
used to control the cost or utilization of health care services or 39
prescription drug use. The term includes, without limitation, the use 40
of step therapy, prior authorization or categorizing drugs and 41
devices based on cost, type or method of administration. 42
(b) “Network plan” means a policy of health insurance offered 43
by an insurer under which the financing and delivery of medical 44
care, including items and services paid for as medical care, are 45

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provided, in whole or in part, through a defined set of pro viders 1
under contract with the insurer. The term does not include an 2
arrangement for the financing of premiums. 3
(c) “Provider of health care” has the meaning ascribed to it in 4
NRS 629.031. 5
(d) “Qualified] , “qualified policy of health insurance” means a 6
policy of health insurance that has a high deductible and is in 7
compliance with 26 U.S.C. § 223 for the purposes of establishing a 8
health savings account. 9
Sec. 139. NRS 689A.0412 is hereby amended to read as 10
follows: 11
689A.0412 1. An insurer that issues a policy of health 12
insurance shall provide coverage for the examination of a person 13
who is pregnant for the discovery of: 14
(a) Chlamydia trachomatis, gonorrhea, hepatitis B and hepatitis 15
C in accordance with NRS 442.013. 16
(b) Syphilis in accordance with NRS 442.010. 17
2. The coverage required by this section must be provided: 18
(a) Regardless of whether the benefits are provided to the 19
insured by a provider of health care, facility or medical laboratory 20
that participates in the network plan of the insurer; and 21
(b) Without prior authorization. 22
3. A policy of health insurance subject to the provisions of this 23
chapter that is delivered, issued for delivery or renewed on or after 24
July 1, 2021, has the legal effect of inclu ding the coverage required 25
by subsection 1, and any provision of the policy that conflicts with 26
the provisions of this section is void. 27
4. As used in this section [: 28
(a) “Medical] , “medical laboratory” has the meaning ascribed 29
to it in NRS 652.060. 30
[(b) “Network plan” means a policy of health insurance offered 31
by an insurer under which the financing and delivery of medical 32
care, including items and services paid for as medical care, are 33
provided, in whole or in part, through a defined set of provider s 34
under contract with the insurer. The term does not include an 35
arrangement for the financing of premiums. 36
(c) “Provider of health care” has the meaning ascribed to it in 37
NRS 629.031.] 38
Sec. 140. NRS 689A.0415 is hereby amended to read as 39
follows: 40
689A.0415 1. An insurer that offers or issues a policy of 41
health insurance which provides coverage for prescription drugs or 42
devices shall include in the policy coverage for any type of hormone 43
replacement therapy which is la wfully prescribed or ordered and 44
which has been approved by the Food and Drug Administration. 45

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2. An insurer that offers or issues a policy of health insurance 1
that provides coverage for prescription drugs shall not: 2
(a) Require an insured to pay a highe r deductible, any 3
copayment or coinsurance or require a longer waiting period or 4
other condition for coverage for a prescription for hormone 5
replacement therapy; 6
(b) Refuse to issue a policy of health insurance or cancel a 7
policy of health insurance solel y because the person applying for or 8
covered by the policy uses or may use in the future hormone 9
replacement therapy; 10
(c) Offer or pay any type of material inducement or financial 11
incentive to an insured to discourage the insured from accessing 12
hormone replacement therapy; 13
(d) Penalize a provider of health care who provides hormone 14
replacement therapy to an insured, including, without limitation, 15
reducing the reimbursement of the provider of health care; or 16
(e) Offer or pay any type of material inducement, bonus or other 17
financial incentive to a provider of health care to deny, reduce, 18
withhold, limit or delay hormone replacement therapy to an insured. 19
3. A policy subject to the provisions of this chapter that is 20
delivered, issued for delivery or renewe d on or after October 1, 21
1999, has the legal effect of including the coverage required by 22
subsection 1, and any provision of the policy or the renewal which is 23
in conflict with this section is void. 24
4. The provisions of this section do not require an ins urer to 25
provide coverage for fertility drugs. 26
[5. As used in this section, “provider of health care” has the 27
meaning ascribed to it in NRS 629.031.] 28
Sec. 141. NRS 689A.0417 is hereby amended to read as 29
follows: 30
689A.0417 1. An insurer that offers or issues a policy of 31
health insurance which provides coverage for outpatient care shall 32
include in the policy coverage for any health care service related to 33
hormone replacement therapy. 34
2. An insurer that offers or issues a policy of health insurance 35
that provides coverage for outpatient care shall not: 36
(a) Require an insured to pay a higher deductible, any 37
copayment or coinsurance or require a longer waiting period or 38
other condition for coverage for outpatient ca re related to hormone 39
replacement therapy; 40
(b) Refuse to issue a policy of health insurance or cancel a 41
policy of health insurance solely because the person applying for or 42
covered by the policy uses or may use in the future hormone 43
replacement therapy; 44

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(c) Offer or pay any type of material inducement or financial 1
incentive to an insured to discourage the insured from accessing 2
hormone replacement therapy; 3
(d) Penalize a provider of health care who provides hormone 4
replacement therapy to an insured, incl uding, without limitation, 5
reducing the reimbursement of the provider of health care; or 6
(e) Offer or pay any type of material inducement, bonus or other 7
financial incentive to a provider of health care to deny, reduce, 8
withhold, limit or delay hormone replacement therapy to an insured. 9
3. A policy subject to the provisions of this chapter that is 10
delivered, issued for delivery or renewed on or after October 1, 11
1999, has the legal effect of including the coverage required by 12
subsection 1, and any provision of the policy or the renewal which is 13
in conflict with this section is void. 14
[4. As used in this section, “provider of health care” has the 15
meaning ascribed to it in NRS 629.031.] 16
Sec. 142. NRS 689A.0418 is hereby amended to read as 17
follows: 18
689A.0418 1. Except as otherwise provided in subsection 8, 19
an insurer that offers or issues a policy of health insurance shall 20
include in the policy coverage for: 21
(a) Up to a 12 -month supply, per prescription, of any type of 22
drug for contraception or its therapeutic equivalent which is: 23
(1) Lawfully prescribed or ordered; 24
(2) Approved by the Food and Drug Administration; 25
(3) Listed in subsection 11; and 26
(4) Dispensed in accordance with NRS 639.28075; 27
(b) Any type of device for contraception which is: 28
(1) Lawfully prescribed or ordered; 29
(2) Approved by the Food and Drug Administration; and 30
(3) Listed in subsection 11; 31
(c) Self-administered hormonal contraceptives dispensed by a 32
pharmacist pursuant to NRS 639.28078; 33
(d) Insertion of a device for contraception or removal of such a 34
device if the device was inserted while the insured was covered by 35
the same policy of health insurance; 36
(e) Education and counseling relating to the initiation of the use 37
of contracept ion and any necessary follow -up after initiating such 38
use; 39
(f) Management of side effects relating to contraception; and 40
(g) Voluntary sterilization for women. 41
2. An insurer shall provide coverage for any services listed in 42
subsection 1 which are within the authorized scope of practice of a 43
pharmacist when such services are provided by a pharmacist who is 44
employed by or serves as an independent contractor of an 45

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in-network pharmacy and in accordance with the applicable 1
provider network contract. Such coverage must be provided to the 2
same extent as if the services were provided by another provider of 3
health care, as applicable to the services being provided. The terms 4
of the policy must not limit: 5
(a) Coverage for services listed in subsection 1 and provided by 6
such a pharmacist to a number of occasions less than the coverage 7
for such services when provided by another provider of health care. 8
(b) Reimbursement for se rvices listed in subsection 1 and 9
provided by such a pharmacist to an amount less than the amount 10
reimbursed for similar services provided by a physician, physician 11
assistant or advanced practice registered nurse. 12
3. An insurer must ensure that the benef its required by 13
subsection 1 are made available to an insured through a provider of 14
health care who participates in the network plan of the insurer. 15
4. If a covered therapeutic equivalent listed in subsection 1 is 16
not available or a provider of health ca re deems a covered 17
therapeutic equivalent to be medically inappropriate, an alternate 18
therapeutic equivalent prescribed by a provider of health care must 19
be covered by the insurer. 20
5. Except as otherwise provided in subsections 9, 10 and 12, an 21
insurer that offers or issues a policy of health insurance shall not: 22
(a) Require an insured to pay a higher deductible, any 23
copayment or coinsurance or require a longer waiting period or 24
other condition for coverage to obtain any benefit included in the 25
policy pursuant to subsection 1; 26
(b) Refuse to issue a policy of health insurance or cancel a 27
policy of health insurance solely because the person applying for or 28
covered by the policy uses or may use any such benefit; 29
(c) Offer or pay any type of material induce ment or financial 30
incentive to an insured to discourage the insured from obtaining any 31
such benefit; 32
(d) Penalize a provider of health care who provides any such 33
benefit to an insured, including, without limitation, reducing the 34
reimbursement of the provider of health care; 35
(e) Offer or pay any type of material inducement, bonus or other 36
financial incentive to a provider of health care to deny, reduce, 37
withhold, limit or delay access to any such benefit to an insured; or 38
(f) Impose any other restrictions or delays on the access of an 39
insured any such benefit. 40
6. Coverage pursuant to this section for the covered dependent 41
of an insured must be the same as for the insured. 42
7. Except as otherwise provided in subsection 8, a policy 43
subject to the provisio ns of this chapter that is delivered, issued for 44
delivery or renewed on or after January 1, 2024, has the legal effect 45

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of including the coverage required by this section, and any provision 1
of the policy or the renewal which is in conflict with this section is 2
void. 3
8. An insurer that offers or issues a policy of health insurance 4
and which is affiliated with a religious organization is not required 5
to provide the coverage required by subsection 1 if the insurer 6
objects on religious grounds. Such an insurer shall, before the 7
issuance of a policy of health insurance and before the renewal of 8
such a policy, provide to the prospective insured written notice of 9
the coverage that the insurer refuses to provide pursuant to this 10
subsection. 11
9. An insurer may requ ire an insured to pay a higher 12
deductible, copayment or coinsurance for a drug for contraception if 13
the insured refuses to accept a therapeutic equivalent of the drug. 14
10. For each of the 18 methods of contraception listed in 15
subsection 11 that have been approved by the Food and Drug 16
Administration, a policy of health insurance must include at least 17
one drug or device for contraception within each method for which 18
no deductible, copayment or coinsurance may be charged to the 19
insured, but the insurer may c harge a deductible, copayment or 20
coinsurance for any other drug or device that provides the same 21
method of contraception. If the insurer charges a copayment or 22
coinsurance for a drug for contraception, the insurer may only 23
require an insured to pay the copayment or coinsurance: 24
(a) Once for the entire amount of the drug dispensed for the plan 25
year; or 26
(b) Once for each 1-month supply of the drug dispensed. 27
11. The following 18 methods of contraception must be 28
covered pursuant to this section: 29
(a) Voluntary sterilization for women; 30
(b) Surgical sterilization implants for women; 31
(c) Implantable rods; 32
(d) Copper-based intrauterine devices; 33
(e) Progesterone-based intrauterine devices; 34
(f) Injections; 35
(g) Combined estrogen- and progestin-based drugs; 36
(h) Progestin-based drugs; 37
(i) Extended- or continuous-regimen drugs; 38
(j) Estrogen- and progestin-based patches; 39
(k) Vaginal contraceptive rings; 40
(l) Diaphragms with spermicide; 41
(m) Sponges with spermicide; 42
(n) Cervical caps with spermicide; 43
(o) Female condoms; 44
(p) Spermicide; 45

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(q) Combined estrogen - and progestin -based drugs for 1
emergency contraception or progestin -based drugs for emergency 2
contraception; and 3
(r) Ulipristal acetate for emergency contraception. 4
12. Except as otherwise pr ovided in this section and federal 5
law, an insurer may use medical management techniques, including, 6
without limitation, any available clinical evidence, to determine the 7
frequency of or treatment relating to any benefit required by this 8
section or the typ e of provider of health care to use for such 9
treatment. 10
13. An insurer shall not: 11
(a) Use medical management techniques to require an insured to 12
use a method of contraception other than the method prescribed or 13
ordered by a provider of health care; 14
(b) Require an insured to obtain prior authorization for the 15
benefits described in paragraphs (a) and (c) of subsection 1; or 16
(c) Refuse to cover a contraceptive injection or the insertion of a 17
device described in paragraph (c), (d) or (e) of subsection 11 a t a 18
hospital immediately after an insured gives birth. 19
14. An insurer must provide an accessible, transparent and 20
expedited process which is not unduly burdensome by which an 21
insured, or the authorized representative of the insured, may request 22
an exception relating to any medical management technique used by 23
the insurer to obtain any benefit required by this section without a 24
higher deductible, copayment or coinsurance. 25
15. As used in this section: 26
(a) “In-network pharmacy” means a pharmacy that has e ntered 27
into a contract with an insurer to provide services to insureds 28
through a network plan offered or issued by the insurer. 29
(b) [“Medical management technique” means a practice which is 30
used to control the cost or utilization of health care services or 31
prescription drug use. The term includes, without limitation, the use 32
of step therapy, prior authorization or categorizing drugs and 33
devices based on cost, type or method of administration. 34
(c) “Network plan” means a policy of health insurance offered 35
by an insurer under which the financing and delivery of medical 36
care, including items and services paid for as medical care, are 37
provided, in whole or in part, through a defined set of providers 38
under contract with the insurer. The term does not include an 39
arrangement for the financing of premiums. 40
(d)] “Provider network contract” [means] includes a contract 41
between an insurer and a [provider of health care or ] pharmacy 42
specifying the rights and responsibilities of the insurer and the 43
[provider of health care or] pharmacy [, as applicable,] for delivery 44
of health care services pursuant to a network plan. 45

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[(e) “Provider of health care” has the meaning ascribed to it in 1
NRS 629.031. 2
(f) “Therapeutic equivalent” means a drug which: 3
(1) Contains an identic al amount of the same active 4
ingredients in the same dosage and method of administration as 5
another drug; 6
(2) Is expected to have the same clinical effect when 7
administered to a patient pursuant to a prescription or order as 8
another drug; and 9
(3) Meets any other criteria required by the Food and Drug 10
Administration for classification as a therapeutic equivalent.] 11
Sec. 143. NRS 689A.0419 is hereby amended to read as 12
follows: 13
689A.0419 1. An insurer that offers or issues a policy of 14
health insurance shall include in the policy coverage for: 15
(a) Counseling, support and supplies for breastfeeding, 16
including breastfeeding equipment, counseling and education during 17
the antenatal, perinatal and postpartum period for not more than 1 18
year; 19
(b) Screening and counseling for interpersonal and domestic 20
violence for women at least annually with intervention services 21
consisting of education, strategies to reduce harm, supportive 22
services or a referral for any other appropriate services; 23
(c) Behavioral counseling concerning sexually transmitted 24
diseases from a provider of health care for sexually active women 25
who are at increased risk for such diseases; 26
(d) Such prenatal screenings and tests as recommended by the 27
American Colle ge of Obstetricians and Gynecologists or its 28
successor organization; 29
(e) Screening for blood pressure abnormalities and diabetes, 30
including gestational diabetes, after at least 24 weeks of gestation or 31
as ordered by a provider of health care; 32
(f) Screening for cervical cancer at such intervals as are 33
recommended by the American College of Obstetricians and 34
Gynecologists or its successor organization; 35
(g) Screening for depression; 36
(h) Screening and counseling for the human immunodeficiency 37
virus consisti ng of a risk assessment, annual education relating to 38
prevention and at least one screening for the virus during the 39
lifetime of the insured or as ordered by a provider of health care; 40
(i) Smoking cessation programs for an insured who is 18 years 41
of age o r older consisting of not more than two cessation attempts 42
per year and four counseling sessions per year; 43
(j) All vaccinations recommended by the Advisory Committee 44
on Immunization Practices of the Centers for Disease Control and 45

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Prevention of the United States Department of Health and Human 1
Services or its successor organization; and 2
(k) Such well-woman preventative visits as recommended by the 3
Health Resources and Services Administration, which must include 4
at least one such visit per year beginning at 14 years of age. 5
2. An insurer must ensure that the benefits required by 6
subsection 1 are made available to an insured through a provider of 7
health care who participates in the network plan of the insurer. 8
3. Except as otherwise provided in subsection 5, an insurer that 9
offers or issues a policy of health insurance shall not: 10
(a) Require an insured to pay a higher deductible, any 11
copayment or coinsurance or require a longer waiting period or 12
other condition to obtain any benefit provided in the policy of health 13
insurance pursuant to subsection 1; 14
(b) Refuse to issue a policy of health insurance or cancel a 15
policy of health insurance solely because the person applying for or 16
covered by the policy uses or may use any such benefit; 17
(c) Offer or pay any type of material inducement or financial 18
incentive to an insured to discourage the insured from obtaining any 19
such benefit; 20
(d) Penalize a provider of health care who provides any such 21
benefit to an insured, including, without limitation, reducing the 22
reimbursement of the provider of health care; 23
(e) Offer or pay any type of material inducement, bonus or other 24
financial incentive to a provider of health care to deny, reduce, 25
withhold, limit or delay access to any such benefit to an insured; or 26
(f) Impose any other restrictions or delays on the access of an 27
insured to any such benefit. 28
4. A policy of health insurance subject to the provisions of this 29
chapter that is delivered, issued for delivery or renewed on or after 30
January 1, 2018, has the legal ef fect of including the coverage 31
required by subsection 1, and any provision of the policy or the 32
renewal which is in conflict with this section is void. 33
5. Except as otherwise provided in this section and federal law, 34
an insurer may use medical management techniques, including, 35
without limitation, any available clinical evidence, to determine the 36
frequency of or treatment relating to any benefit required by this 37
section or the type of provider of health care to use for such 38
treatment. 39
[6. As used in this section: 40
(a) “Medical management technique” means a practice which is 41
used to control the cost or utilization of health care services or 42
prescription drug use. The term includes, without limitation, the use 43
of step therapy, prior authorization or categor izing drugs and 44
devices based on cost, type or method of administration. 45

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(b) “Network plan” means a policy of health insurance offered 1
by an insurer under which the financing and delivery of medical 2
care, including items and services paid for as medical c are, are 3
provided, in whole or in part, through a defined set of providers 4
under contract with the insurer. The term does not include an 5
arrangement for the financing of premiums. 6
(c) “Provider of health care” has the meaning ascribed to it in 7
NRS 629.031.] 8
Sec. 144. NRS 689A.0428 is hereby amended to read as 9
follows: 10
689A.0428 1. An insurer that issues a policy of health 11
insurance shall include in the policy coverage for: 12
(a) Necessary case management services for an i nsured 13
diagnosed with sickle cell disease and its variants; and 14
(b) Medically necessary care for an insured who has been 15
diagnosed with sickle cell disease and its variants. 16
2. An insurer that issues a policy of health insurance which 17
provides coverage for prescription drugs shall include in the policy 18
coverage for medically necessary prescription drugs to treat sickle 19
cell disease and its variants. 20
3. An insurer may use medical management techniques, 21
including, without limitation, any available clinic al evidence, to 22
determine the frequency of or treatment relating to any benefit 23
required by this section or the type of provider of health care to use 24
for such treatment. 25
4. As used in this section: 26
(a) “Case management services” means medical or other health 27
care management services to assist patients and providers of health 28
care, including, without limitation, identifying and facilitating 29
additional resources and treatments, providing information about 30
treatment options and facilitating communication between providers 31
of services to a patient. 32
(b) [“Medical management technique” means a practice which is 33
used to control the cost or utilization of health care services. The 34
term includes, without limitation, the use of step therapy, prior 35
authorization or categorizing drugs and devices based on cost, type 36
or method of administration. 37
(c)] “Medically necessary” has the meaning ascribed to it in 38
NRS 695G.055. 39
[(d)] (c) “Sickle cell disease and its variants” has the meaning 40
ascribed to it in NRS 439.4927. 41
Sec. 145. NRS 689A.0432 is hereby amended to read as 42
follows: 43
689A.0432 1. Except as otherwise provided in this section, 44
an insurer that issues a policy of health insurance shall include in the 45

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policy coverage for the me dically necessary treatment of conditions 1
relating to gender dysphoria and gender incongruence. Such 2
coverage must include coverage of medically necessary 3
psychosocial and surgical intervention and any other medically 4
necessary treatment for such disorders provided by: 5
(a) Endocrinologists; 6
(b) Pediatric endocrinologists; 7
(c) Social workers; 8
(d) Psychiatrists; 9
(e) Psychologists; 10
(f) Gynecologists; 11
(g) Speech-language pathologists; 12
(h) Primary care physicians; 13
(i) Advanced practice registered nurses; 14
(j) Physician assistants; and 15
(k) Any other providers of medically necessary services for the 16
treatment of gender dysphoria or gender incongruence. 17
2. This section does not require a policy of health insurance to 18
include coverage for cosmetic surgery performed by a plastic 19
surgeon or reconstructive surgeon that is not medically necessary. 20
3. An insurer that issues a policy of health insurance shall not 21
categorically refuse to cover medically necessary gender -affirming 22
treatments or procedures or revisions to prior treatments if the 23
policy provides coverage for any such services, procedures or 24
revisions for purposes other than gender transition or affirmation. 25
4. An insurer that issues a policy of health insurance may 26
prescribe requirements t hat must be satisfied before the insurer 27
covers surgical treatment o f conditions relating to gender dysphoria 28
or gender incongruence for an insured who is less than 18 years of 29
age. Such requirements may include, without limitation, 30
requirements that: 31
(a) The treatment must be recommended by a psychologist, 32
psychiatrist or other mental health professional; 33
(b) The treatment must be recommended by a physician; 34
(c) The insured must provide a written expression of the desire 35
of the insured to undergo the treatment; 36
(d) A written plan for treatment that covers at least 1 year must 37
be developed and approved by at least two providers of health care; 38
and 39
(e) Parental consent is provided for the insured unless the 40
insured is expressly authorized by law to con sent on his or her own 41
behalf. 42
5. When determining whether treatment is medically necessary 43
for the purposes of this section, an insurer must consider the most 44

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recent Standards of Care published by the World Professional 1
Association for Transgender Health, or its successor organization. 2
6. An insurer shall make a reasonable effort to ensure that the 3
benefits required by subsection 1 are made available to an insured 4
through a provider of health care who participates in the network 5
plan of the insurer. If, after a reasonable effort, the insurer is unable 6
to make such benefits available through such a provider of health 7
care, the insurer may treat the treatment that the insurer is unable to 8
make available through such a provider of health care in the same 9
manner as other services provided by a provider of health care who 10
does not participate in the network plan of the insurer. 11
7. If an insured appeals the denial of a claim or coverage under 12
this section on the grounds that the treatment requested by the 13
insured is not medically necessary, the insurer must consult with a 14
provider of health care who has experience in prescribing or 15
delivering gender -affirming treatment concerning the medical 16
necessity of the treatment requested by the insured when 17
considering the appeal. 18
8. A policy of health insurance subject to the provisions of this 19
chapter that is delivered, issued for delivery or renewed on or after 20
July 1, 2023, has the legal effect of including the coverage required 21
by subsection 1, and any provision of the policy or the renewal 22
which is in conflict with this section is void. 23
9. As used in this section: 24
(a) “Cosmetic surgery”: 25
(1) Means a surgical procedure that: 26
(I) Does not meaningfully promote the proper function of 27
the body; 28
(II) Does not prevent or treat illness or disease; and 29
(III) Is primarily directed at improving the appearance of 30
a person. 31
(2) Includes, without limitation, cosmetic surgery directed at 32
preserving beauty. 33
(b) “Gender dysphoria” means distress or impairment i n social, 34
occupational or other areas of functioning caused by a marked 35
difference between the gender identity or expression of a person and 36
the sex assigned to the person at birth which lasts at least 6 months 37
and is shown by at least two of the following: 38
(1) A marked difference between gender identity or 39
expression and primary or secondary sex characteristics or 40
anticipated secondary sex characteristics in young adolescents. 41
(2) A strong desire to be rid of primary or secondary sex 42
characteristics because of a marked difference between such sex 43
characteristics and gender identity or expression or a desire to 44

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prevent the development of anticipated secondary sex characteristics 1
in young adolescents. 2
(3) A strong desire for the primary or secondary sex 3
characteristics of the gender opposite from the sex assigned at birth. 4
(4) A strong desire to be of the opposite gender or a gender 5
different from the sex assigned at birth. 6
(5) A strong desire to be treated as the opposite gender or a 7
gender different from the sex assigned at birth. 8
(6) A strong conviction of experiencing typical feelings and 9
reactions of the opposite gender or a gender different from the sex 10
assigned at birth. 11
(c) “Medically necessary” means health care services or 12
products that a prudent provider of health care would provide to a 13
patient to prevent, diagnose or treat an illness, injury or disease, or 14
any symptoms thereof, that are necessary and: 15
(1) Provided in accordance with generally accepted standards 16
of medical practice; 17
(2) Clinically appropriate with regard to type, frequency, 18
extent, location and duration; 19
(3) Not provided primarily for the convenience of the patient 20
or provider of health care; 21
(4) Required to improve a specific health condition of a 22
patient or to preserve the existing state of health of the patient; and 23
(5) The most clinically appropriate level of health care that 24
may be safely provided to the patient. 25
 A provider of health care prescribing, ordering, recommending or 26
approving a health care s ervice or product does not, by itself, make 27
that health care service or product medically necessary. 28
[(d) “Network plan” means a policy of health insurance offered 29
by an insurer under which the financing and delivery of medical 30
care, including items and services paid for as medical care, are 31
provided, in whole or in part, through a defined set of providers 32
under contract with the insurer. The term does not include an 33
arrangement for the financing of premiums. 34
(e) “Provider of health care” has the meaning ascribed to it in 35
NRS 629.031.] 36
Sec. 146. NRS 689A.0437 is hereby amended to read as 37
follows: 38
689A.0437 1. An insurer that offers or issues a policy of 39
health insurance shall include in the policy coverage for: 40
(a) All drugs approved by the United States Food and Drug 41
Administration for preventing the acquisition of human 42
immunodeficiency virus or treating human immunodeficiency virus 43
or hepatitis C in the form recommended by the prescribing 44

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practitioner, regardless of whether the drug is included in the 1
formulary of the insurer; 2
(b) Laboratory testing that is necessary fo r therapy that uses a 3
drug to prevent the acquisition of human immunodeficiency virus; 4
(c) Any service to test for, prevent or treat human 5
immunodeficiency virus or hepatitis C provided by a provider of 6
primary care if the service is covered when provide d by a specialist 7
and: 8
(1) The service is within the scope of practice of the provider 9
of primary care; or 10
(2) The provider of primary care is capable of providing the 11
service safely and effectively in consultation with a specialist and 12
the provider engages in such consultation; and 13
(d) The services described in NRS 639.28085, when provided 14
by a pharmacist who participates in the network plan of the insurer. 15
2. An insurer that offers or issues a policy of health insurance 16
shall reimburse: 17
(a) A pharmacist who participates in the network plan of the 18
insurer for the services described in NRS 639.28085 at a rate equal 19
to the rate of reimbursement provided to a physician, physician 20
assistant or advanced practice registered nurse for similar services. 21
(b) An advanced practice registered nurse or a physician 22
assistant who participates in the network plan of the insurer for any 23
service to test for, prevent or treat human immunodeficiency virus 24
or hepatitis C at a rate equal to the rate of reimbursement provided 25
to a physician for similar services. 26
3. An insurer shall not: 27
(a) Subject the benefits required by subsection 1 to medical 28
management techniques, other than step therapy; 29
(b) Limit the covered amount of a drug described in paragraph 30
(a) of subsection 1; 31
(c) Refuse to cover a drug described in paragraph (a) of 32
subsection 1 because the drug is dispensed by a pharmacy through 33
mail order service; or 34
(d) Prohibit or restrict access to any service or drug to treat 35
human immunodeficiency virus or h epatitis C on the same day on 36
which the insured is diagnosed. 37
4. An insurer shall ensure that the benefits required by 38
subsection 1 are made available to an insured through a provider of 39
health care who participates in the network plan of the insurer. 40
5. A policy of health insurance subject to the provisions of this 41
chapter that is delivered, issued for delivery or renewed on or after 42
January 1, 2024, has the legal effect of including the coverage 43
required by subsection 1, and any provision of the poli cy that 44
conflicts with the provisions of this section is void. 45

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6. As used in this section [: 1
(a) “Medical management technique” means a practice which is 2
used to control the cost or use of health care services or prescription 3
drugs. The term includes, without limitation, the use of step therapy, 4
prior authorization and categorizing drugs and devices based on 5
cost, type or method of administration. 6
(b) “Network plan” means a policy of health insurance offered 7
by an insurer under which the financing and delivery of medical 8
care, including items and services paid for as medical care, are 9
provided, in whole or in part, through a defined set of providers 10
under contract with the insurer. The term does not include an 11
arrangement for the financing of premiums. 12
(c) “Primary] , “primary care” means the practice of family 13
medicine, pediatrics, internal medicine, obstetrics and gynecology 14
and midwifery. 15
[(d) “Provider of health care” has the meaning ascribed to it in 16
NRS 629.031.] 17
Sec. 147. NRS 689A.044 is hereby amended to read as 18
follows: 19
689A.044 1. A policy of health insurance must provide 20
coverage for benefits payable for expenses incurred for: 21
(a) Deoxyribonucleic acid testing for high -risk strains of human 22
papillomavirus every 3 years for women 30 years of age or older; 23
and 24
(b) Administering the human papillomavirus vaccine as 25
recommended for vaccination by a competent authority, including, 26
without limitation, the Centers for Disease Control and Prevention 27
of the United States Department of Health and Human Services, the 28
Food and Drug Administration or the manufacturer of the vaccine. 29
2. An insurer must ensure that the benefits required by 30
subsection 1 are made available to an insured through a provider of 31
health care who participates in the network plan of the insurer. 32
3. Except as otherwise provided in subsection 5, an insurer that 33
offers or issues a policy of health insurance shall not: 34
(a) Require an insured to pay a higher deductible, any 35
copayment or coinsurance or require a longer waiting period or 36
other condition to obtain any benefit provided in the policy of health 37
insurance pursuant to subsection 1; 38
(b) Refuse to issue a policy of health insurance or cancel a 39
policy of health insurance solely because the person applying for or 40
covered by the policy uses or may use any such benefit; 41
(c) Offer or pay any type of material inducement or financial 42
incentive to an insured to discourage the insured from obtaining any 43
such benefit; 44

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(d) Penalize a provider of health care who provides any such 1
benefit to an insured, including, without limitation, reducing the 2
reimbursement of the provider of health care; 3
(e) Offer or pay any type of material inducement, bonus or other 4
financial incentive to a provider of health care to deny, reduce, 5
withhold, limit or delay access to any such benefit to an insured; or 6
(f) Impose any other restrictions or delays on the access of an 7
insured to any such benefit. 8
4. A policy subject to the provisions of th is chapter which is 9
delivered, issued for delivery or renewed on or after January 1, 10
2018, has the legal effect of including the coverage required by 11
subsection 1, and any provision of the policy or the renewal which is 12
in conflict with this section is void. 13
5. Except as otherwise provided in this section and federal law, 14
an insurer may use medical management techniques, including, 15
without limitation, any available clinical evidence, to determine the 16
frequency of or treatment relating to any benefit requi red by this 17
section or the type of provider of health care to use for such 18
treatment. 19
6. As used in this section [: 20
(a) “Human] , “human papillomavirus vaccine” means the 21
Quadrivalent Human Papillomavirus Recombinant Vaccine or its 22
successor which is ap proved by the Food and Drug Administration 23
for the prevention of human papillomavirus infection and cervical 24
cancer. 25
[(b) “Medical management technique” means a practice which is 26
used to control the cost or utilization of health care services or 27
prescription drug use. The term includes, without limitation, the use 28
of step therapy, prior authorization or categorizing drugs and 29
devices based on cost, type or method of administration. 30
(c) “Network plan” means a policy of health insurance offered 31
by an insurer under which the financing and delivery of medical 32
care, including items and services paid for as medical care, are 33
provided, in whole or in part, through a defined set of providers 34
under contract with the insurer. The term does not include an 35
arrangement for the financing of premiums. 36
(d) “Provider of health care” has the meaning ascribed to it in 37
NRS 629.031.] 38
Sec. 148. NRS 689A.0446 is hereby amended to read as 39
follows: 40
689A.0446 1. Subject to the limitation s prescribed by 41
subsection 4, an insurer that issues a policy of health insurance shall 42
include in the policy coverage for medically necessary biomarker 43
testing for the diagnosis, treatment, appropriate management and 44
ongoing monitoring of cancer when such biomarker testing is 45

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supported by medical and scientific evidence. Such evidence 1
includes, without limitation: 2
(a) The labeled indications for a biomarker test or medication 3
that has been approved or cleared by the United States Food and 4
Drug Administration; 5
(b) The indicated tests for a drug that has been approved by the 6
United States Food and Drug Administration or the warnings and 7
precautions included on the label of such a drug; 8
(c) A national coverage determination or local coverage 9
determination, as those terms are defined in 42 C.F.R. § 400.202; or 10
(d) Nationally recognized clinical practice guidelines or 11
consensus statements. 12
2. An insurer shall: 13
(a) Provide the coverage required by subsection 1 in a manner 14
that limits disruptions in care and the need for multiple specimens. 15
(b) Establish a clear and readily accessible process for an 16
insured or provider of health care to: 17
(1) Request an exception to a policy excluding coverage for 18
biomarker testing for the diagnosis, treatment, management o r 19
ongoing monitoring of cancer; or 20
(2) Appeal a denial of coverage for such biomarker testing; 21
and 22
(c) Make the process described in paragraph (b) available on an 23
Internet website maintained by the insurer. 24
3. If an insurer requires an insured to obtain prior authorization 25
for a biomarker test described in subsection 1, the insurer shall 26
respond to a request for such prior authorization: 27
(a) Within 24 hours after receiving an urgent request; or 28
(b) Within 72 hours after receiving any other request. 29
4. The provisions of this section do not require an insurer to 30
provide coverage of biomarker testing: 31
(a) For screening purposes; 32
(b) Conducted by a provider of health care for whom the 33
biomarker testing is not within his or her scope of practice, train ing 34
and experience; 35
(c) Conducted by a provider of health care or a facility that does 36
not participate in the network plan of the insurer; or 37
(d) That has not been determined to be medically necessary by a 38
provider of health care for whom such a determi nation is within his 39
or her scope of practice, training and experience. 40
5. A policy of health insurance subject to the provisions of this 41
chapter that is delivered, issued for delivery or renewed on or after 42
October 1, 2023, has the legal effect of incl uding the coverage 43
required by this section, and any provision of the policy or renewal 44
which is in conflict with the provisions of this section is void. 45

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6. As used in this section: 1
(a) “Biomarker” means a characteristic that is objectively 2
measured and evaluated as an indicator of a normal biological 3
process, a pathogenic process or a pharmacological response to a 4
specific therapeutic intervention and includes, without limitation: 5
(1) An interaction between a gene and a drug that is being 6
used by or considered for use by the patient; 7
(2) A mutation or characteristic of a gene; and 8
(3) The expression of a protein. 9
(b) “Biomarker testing” means the analysis of the tissue, blood 10
or other biospecimen of a patient for the presentation of a biomarker 11
and includes, without limitation, single -analyte tests, multiplex 12
panel tests and whole genome, whole exome and whole 13
transcriptome sequencing. 14
(c) “Consensus statement” means a statement aimed at a specific 15
clinical circumstance that is: 16
(1) Made for th e purpose of optimizing the outcomes of 17
clinical care; 18
(2) Made by an independent, multidisciplinary panel of 19
experts that has established a policy to avoid conflicts of interest; 20
(3) Based on scientific evidence; and 21
(4) Made using a transparent met hodology and reporting 22
procedure. 23
(d) “Medically necessary” means health care services or 24
products that a prudent provider of health care would provide to a 25
patient to prevent, diagnose or treat an illness, injury or disease, or 26
any symptoms thereof, that are necessary and: 27
(1) Provided in accordance with generally accepted standards 28
of medical practice; 29
(2) Not primarily provided for the convenience of the patient 30
or provider of health care; and 31
(3) Significant in guiding and informing the provider of 32
health care in providing the most appropriate course of treatment for 33
the patient in order to prevent, delay or lessen the magnitude of an 34
adverse health outcome. 35
(e) “Nationally recognized clinical practice guidelines” means 36
evidence-based guidelines establishing standards of care that 37
include, without limitation, recommendations intended to optimize 38
care of patients and are: 39
(1) Informed by a systemic review of evidence and an 40
assessment of the risks and benefits of alternative options for care; 41
and 42
(2) Developed using a transparent methodology and 43
reporting procedure by an independent organization or society of 44

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medical professionals that has established a policy to avoid conflicts 1
of interest. 2
[(f) “Network plan” means a policy of health insuranc e offered 3
by an insurer under which the financing and delivery of medical 4
care, including items and services paid for as medical care, are 5
provided, in whole or in part, through a defined set of providers 6
under contract with the insurer. The term does not include an 7
arrangement for the financing of premiums. 8
(g) “Provider of health care” has the meaning ascribed to it in 9
NRS 629.031.] 10
Sec. 149. NRS 689A.0459 is hereby amended to read as 11
follows: 12
689A.0459 1. An insurer that offers or issues a policy of 13
health insurance shall include in the policy coverage for: 14
(a) All drugs approved by the United States Food and Drug 15
Administration to support safe withdrawal from substance use 16
disorder, including, without limitation, lofexidine. 17
(b) All drugs approved by the United States Food and Drug 18
Administration to provide medication -assisted treatment for opioid 19
use disorder, including, without limitation, buprenorphine, 20
methadone and naltrexone. 21
(c) The services described in NRS 639.28079 when provided by 22
a pharmacist or pharmacy that participates in the network plan of the 23
insurer. The Commissioner shall adopt regulations governing the 24
provision of reimbursement for such services. 25
(d) Any service for the treatment of substance use disorder 26
provided by a provider of primary care if the service is covered 27
when provided by a specialist and: 28
(1) The service is within the scope of practice of the provider 29
of primary care; or 30
(2) The provider of primary care is capable of providi ng the 31
service safely and effectively in consultation with a specialist and 32
the provider engages in such consultation. 33
2. An insurer that offers or issues a policy of health insurance 34
shall reimburse a pharmacist or pharmacy that participates in the 35
network plan of the insurer for the services described in NRS 36
639.28079 at a rate equal to the rate of reimbursement provided to a 37
physician, physician assistant or advanced practice registered nurse 38
for similar services. 39
3. An insurer shall provide the cove rage required by 40
paragraphs (a) and (b) of subsection 1 regardless of whether the 41
drug is included in the formulary of the insurer. 42
4. Except as otherwise provided in this subsection, an insurer 43
shall not subject the benefits required by paragraphs (a), (b) and (c) 44
of subsection 1 to medical management techniques, other than step 45

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therapy. An insurer may subject the benefits required by paragraphs 1
(b) and (c) of subsection 1 to other reasonable medical management 2
techniques when the benefits are provided b y a pharmacist in 3
accordance with NRS 639.28079. 4
5. An insurer shall not: 5
(a) Limit the covered amount of a drug described in paragraph 6
(a) or (b) of subsection 1; or 7
(b) Refuse to cover a drug described in paragraph (a) or (b) of 8
subsection 1 because the drug is dispensed by a pharmacy through 9
mail order service. 10
6. An insurer shall ensure that the benefits required by 11
subsection 1 are made available to an insured through a provider of 12
health care who participates in the network plan of the insurer. 13
7. A policy of health insurance subject to the provisions of this 14
chapter that is delivered, issued for delivery or renewed on or after 15
January 1, 2024, has the legal effect of including the coverage 16
required by subsection 1, and any provision of the po licy that 17
conflicts with the provisions of this section is void. 18
8. As used in this section [: 19
(a) “Medical management technique” means a practice which is 20
used to control the cost or use of health care services or prescription 21
drugs. The term includes, without limitation, the use of step therapy, 22
prior authorization and categorizing drugs and devices based on 23
cost, type or method of administration. 24
(b) “Network plan” means a policy of health insurance offered 25
by an insurer under which the financing an d delivery of medical 26
care, including items and services paid for as medical care, are 27
provided, in whole or in part, through a defined set of providers 28
under contract with the insurer. The term does not include an 29
arrangement for the financing of premiums. 30
(c) “Primary] , “primary care” means the practice of family 31
medicine, pediatrics, internal medicine, obstetrics and gynecology 32
and midwifery. 33
[(d) “Provider of health care” has the meaning ascribed to it in 34
NRS 629.031.] 35
Sec. 150. NRS 689A.080 is hereby amended to read as 36
follows: 37
689A.080 1. [There] Except as otherwise provided in 38
subsection 4, there shall be a provision as follows: 39
40
Reinstatement: If any renewal premium be not paid within 41
the time granted the insured for payment, a subsequent 42
acceptance of premium by the insurer or by any agent duly 43
authorized by the insurer to accept such premium, without 44
requiring in connection therewith an application for 45

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reinstatement, shall reinstate t he policy; provided, however, 1
that if the insurer or such agent requires an application for 2
reinstatement and issues a conditional receipt for the premium 3
tendered, the policy will be reinstated upon approval of such 4
application by the insurer or, lacking such approval, upon the 5
45th day following the date of such conditional receipt unless 6
the insurer has previously notified the insured in writing of its 7
disapproval of such application. The reinstated policy shall 8
cover only loss resulting from such accide ntal injury as may 9
be sustained after the date of reinstatement and loss due to 10
such sickness as may begin more than 10 days after such date. 11
In all other respects the insured and insurer shall have the 12
same rights thereunder as they had under the policy 13
immediately before the due date of the defaulted premium, 14
subject to any provisions endorsed herein or attached hereto 15
in connection with the reinstatement. Any premium accepted 16
in connection with a reinstatement shall be applied to a period 17
for which premi um has not been previously paid, but not to 18
any period more than 60 days prior to the date of 19
reinstatement. 20
21
2. The last sentence of subsection 1 may be omitted from any 22
policy which the insured has the right to continue in force subject to 23
its terms by the timely payment of premiums: 24
(a) Until at least age 50; or 25
(b) In the case of a policy issued after age 44, for at least 5 years 26
from its date of issue. 27
3. Pursuant to the last sentence in subsection 1, the insurer 28
shall apply the premium accepted in such manner as to place the 29
policy currently in force, exclusive of any applicable grace period, 30
but not in any event to any period more than 60 days prior to the 31
date of reinstatement. 32
4. The provisions of this section do not apply to a health 33
benefit plan, as defined in NRS 689A.540. 34
Sec. 151. NRS 689A.135 is hereby amended to read as 35
follows: 36
689A.135 1. A person insured under a policy of health 37
insurance may assign his or her right to benefits to the provider of 38
health care who provided the services covered by the policy. The 39
insurer shall pay all or the part of the benefits assigned by the 40
insured to the person designated by the insured. A payment made 41
pursuant to this subsection discharges the insurer’s obligation to pay 42
those benefits. 43
2. If the insured makes an assignment under this section, but 44
the insurer after receiving a copy of the assignment pays the benefits 45

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to the insured, the insurer shall also pay those benefits to the 1
provider of health care who re ceived the assignment as soon as the 2
insurer receives notice of the incorrect payment. 3
[3. For the purpose of this section, “provider of health care” 4
has the meaning ascribed to it in NRS 629.031.] 5
Sec. 152. NRS 689A.635 is hereby amended to read as 6
follows: 7
689A.635 [1.] An individual carrier that offers coverage 8
through a network plan is not required pursuant to NRS 689A.630 to 9
offer coverage to or accept an application from a person if the 10
person does not reside or work in the geographic service area or in a 11
geographic rating area, provided that the coverage is refused or 12
terminated uniformly without regard to any health status -related 13
factor of any eligible person. 14
[2. As used in this section, “network plan” means a health 15
benefit plan offered by a health carrier under which the financing 16
and delivery of medical care is provided, in whole or in part, 17
through a defined set of providers under contract with the carrier. 18
The term does not include an arrangement for the financing of 19
premiums.] 20
Sec. 153. Chapter 689B of NRS is hereby amended by adding 21
thereto the provisions set forth as sections 154 to 159, inclusive, of 22
this act. 23
Sec. 154. As used in this chapter, unless the context 24
otherwise requires, the words and terms defined in sections 155 to 25
159, inclusive, of this act, have the meanings ascribed to them in 26
those sections. 27
Sec. 155. “Medical management technique” has the 28
meaning ascribed to it in section 299 of this act. 29
Sec. 156. “Network plan” has the meaning ascribed to it in 30
NRS 687B.645. 31
Sec. 157. “Provider network contract” has the meaning 32
ascribed to it in NRS 687B.658. 33
Sec. 158. “Provider of health care” has the meaning 34
ascribed to it in NRS 629.031. 35
Sec. 159. “Therapeutic equivalent” has the meaning 36
ascribed to it in section 302 of this act. 37
Sec. 160. NRS 689B.0312 is hereby a mended to read as 38
follows: 39
689B.0312 1. An insurer that offers or issues a policy of 40
group health insurance shall include in the policy coverage for: 41
(a) All drugs approved by the United States Food and Drug 42
Administration for preventing the acquisition of human 43
immunodeficiency virus or treating human immunodeficiency virus 44
or hepatitis C in the form recommended by the prescribing 45

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practitioner, regardless of whether the drug is included in the 1
formulary of the insurer; 2
(b) Laboratory testing that is necessary for therapy that uses a 3
drug to prevent the acquisition of human immunodeficiency virus; 4
(c) Any service to test for, prevent or treat human 5
immunodeficiency virus or hepatitis C provided by a provider of 6
primary care if the service is covered when provided by a specialist 7
and: 8
(1) The service is within the scope of practice of the provider 9
of primary care; or 10
(2) The provider of primary care is capable of providing the 11
service safely and effectively in consultation with a speciali st and 12
the provider engages in such consultation; and 13
(d) The services described in NRS 639.28085, when provided 14
by a pharmacist who participates in the network plan of the insurer. 15
2. An insurer that offers or issues a policy of group health 16
insurance shall reimburse: 17
(a) A pharmacist who participates in the network plan of the 18
insurer for the services described in NRS 639.28085 at a rate equal 19
to the rate of reimbursement provided to a physician, physician 20
assistant or advanced practice registered nurse for similar services. 21
(b) An advanced practice registered nurse or a physician 22
assistant who participates in the network plan of the insurer for any 23
service to test for, prevent or treat human immunodeficiency virus 24
or hepatitis C at a rate equal to the rate of reimbursement provided 25
to a physician for similar services. 26
3. An insurer shall not: 27
(a) Subject the benefits required by subsection 1 to medical 28
management techniques, other than step therapy; 29
(b) Limit the covered amount of a drug descr ibed in paragraph 30
(a) of subsection 1; 31
(c) Refuse to cover a drug described in paragraph (a) of 32
subsection 1 because the drug is dispensed by a pharmacy through 33
mail order service; or 34
(d) Prohibit or restrict access to any service or drug to treat 35
human immunodeficiency virus or hepatitis C on the same day on 36
which the insured is diagnosed. 37
4. An insurer shall ensure that the benefits required by 38
subsection 1 are made available to an insured through a provider of 39
health care who participates in the network plan of the insurer. 40
5. A policy of group health insurance subject to the provisions 41
of this chapter that is delivered, issued for delivery or renewed on or 42
after January 1, 2024, has the legal effect of including the coverage 43
required by subsection 1, and any provision of the policy that 44
conflicts with the provisions of this section is void. 45

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6. As used in this section [: 1
(a) “Medical management technique” means a practice which is 2
used to control the cost or use of health care services or presc ription 3
drugs. The term includes, without limitation, the use of step therapy, 4
prior authorization and categorizing drugs and devices based on 5
cost, type or method of administration. 6
(b) “Network plan” means a policy of group health insurance 7
offered by a n insurer under which the financing and delivery of 8
medical care, including items and services paid for as medical care, 9
are provided, in whole or in part, through a defined set of providers 10
under contract with the insurer. The term does not include an 11
arrangement for the financing of premiums. 12
(c) “Primary] , “primary care” means the practice of family 13
medicine, pediatrics, internal medicine, obstetrics and gynecology 14
and midwifery. 15
[(d) “Provider of health care” has the meaning ascribed to it in 16
NRS 629.031.] 17
Sec. 161. NRS 689B.0313 is hereby amended to read as 18
follows: 19
689B.0313 1. A policy of group health insurance must 20
provide coverage for benefits payable for expenses incurred for: 21
(a) Deoxyribonucleic acid testing for high-risk strains of human 22
papillomavirus every 3 years for women 30 years of age or older; 23
and 24
(b) Administering the human papillomavirus vaccine as 25
recommended for vaccination by a competent authority, including, 26
without limitation, the Centers for Disease Control and Prevention 27
of the United States Department of Health and Human Services, the 28
Food and Drug Administration or the manufacturer of the vaccine. 29
2. An insurer must ensure that the benefits required by 30
subsection 1 are made available to an insured through a provider of 31
health care who participates in the network plan of the insurer. 32
3. Except as otherwise provided in subsection 5, an insurer that 33
offers or issues a policy of group health insurance shall not: 34
(a) Require an insured to pay a higher deductible, any 35
copayment or coinsurance or require a longer waiting period or 36
other condition to obtain any benefit provided in the policy of group 37
health insurance pursuant to subsection 1; 38
(b) Refuse to issue a policy of group health insurance or cancel a 39
policy of group health insurance solely because the person applying 40
for or covered by the policy uses or may use any such benefit; 41
(c) Offer or pay any type of material inducement or financial 42
incentive to an insured to discourage the insured from obtaining any 43
such benefit; 44

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(d) Penalize a provider of health care who provides any such 1
benefit to an insured, including, without limitation, reducing the 2
reimbursement of the provider of health care; 3
(e) Offer or pay any type of material inducement, bonus or other 4
financial incentive to a provider of health care to deny, reduce, 5
withhold, limit or delay access to any such benefit to an insured; or 6
(f) Impose any other restrictions or delays on the access of an 7
insured to any such benefit. 8
4. A policy subject to the provisions of this chapter which is 9
delivered, issued for delivery or renewed on or after January 1, 10
2018, has the legal effect of including the coverage required by 11
subsection 1, and any provision of the policy or the renewal which is 12
in conflict with this section is void. 13
5. Except as otherwise provided in this section and federal law, 14
an insurer may use medical management techniques, including, 15
without limitation, any available clinical evidence, to determine the 16
frequency of or treatment relating to any benefit required by this 17
section or the type of provider of health care to use for such 18
treatment. 19
6. As used in this section [: 20
(a) “Human] “human papillomavirus vaccine” means the 21
Quadrivalent Human Papillomavirus Reco mbinant Vaccine or its 22
successor which is approved by the Food and Drug Administration 23
for the prevention of human papillomavirus infection and cervical 24
cancer. 25
[(b) “Medical management technique” means a practice which is 26
used to control the cost or util ization of health care services or 27
prescription drug use. The term includes, without limitation, the use 28
of step therapy, prior authorization or categorizing drugs and 29
devices based on cost, type or method of administration. 30
(c) “Network plan” means a policy of group health insurance 31
offered by an insurer under which the financing and delivery of 32
medical care, including items and services paid for as medical care, 33
are provided, in whole or in part, through a defined set of providers 34
under contract with the insurer. The term does not include an 35
arrangement for the financing of premiums. 36
(d) “Provider of health care” has the meaning ascribed to it in 37
NRS 629.031.] 38
Sec. 162. NRS 689B.0314 is hereby amended to read as 39
follows: 40
689B.0314 1. An insurer that issues a policy of group health 41
insurance shall provide coverage for screening, genetic counseling 42
and testing for harmful mutations in the BRCA gene for women 43
under circumstances where such screening, genetic counseling or 44
testing, as applicable, is required by NRS 457.301. 45

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2. An insurer shall ensure that the benefits required by 1
subsection 1 are made available to an insured through a provider of 2
health care who participates in the network plan of the insurer. 3
3. A policy of group health insurance subject to the provisions 4
of this chapter that is delivered, issued for delivery or renewed on or 5
after January 1, 2022, has the legal effect of including the coverage 6
required by subsection 1, and any provision of the polic y that 7
conflicts with the provisions of this section is void. 8
[4. As used in this section: 9
(a) “Network plan” means a policy of group health insurance 10
offered by an insurer under which the financing and delivery of 11
medical care, including items and services paid for as medical care, 12
are provided, in whole or in part, through a defined set of pro viders 13
under contract with the insurer. The term does not include an 14
arrangement for the financing of premiums. 15
(b) “Provider of health care” has the meaning ascribed to it in 16
NRS 629.031.] 17
Sec. 163. NRS 689B.0315 is here by amended to read as 18
follows: 19
689B.0315 1. An insurer that issues a policy of group health 20
insurance shall provide coverage for the examination of a person 21
who is pregnant for the discovery of: 22
(a) Chlamydia trachomatis, gonorrhea, hepatitis B and hep atitis 23
C in accordance with NRS 442.013. 24
(b) Syphilis in accordance with NRS 442.010. 25
2. The coverage required by this section must be provided: 26
(a) Regardless of whether the benefits are provided to the 27
insured by a provider of health care, facility o r medical laboratory 28
that participates in the network plan of the insurer; and 29
(b) Without prior authorization. 30
3. A policy of health insurance subject to the provisions of this 31
chapter that is delivered, issued for delivery or renewed on or after 32
July 1, 2021, has the legal effect of including the coverage required 33
by subsection 1, and any provision of the policy that conflicts with 34
the provisions of this section is void. 35
4. As used in this section [: 36
(a) “Medical] , “medical laboratory” has the meaning ascribed 37
to it in NRS 652.060. 38
[(b) “Network plan” means a policy of group health insurance 39
offered by an insurer under which the financing and delivery of 40
medical care, including items and services paid for as medical care, 41
are provided, in whole or in part, through a defined set of providers 42
under contract with the insurer. The term does not include an 43
arrangement for the financing of premiums. 44

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(c) “Provider of health care” has the meaning ascribed to it in 1
NRS 629.031.] 2
Sec. 164. NRS 689B.0319 is hereby amended to read as 3
follows: 4
689B.0319 1. An insurer that offers or issues a policy of 5
group health insurance shall include in the policy coverage for: 6
(a) All drugs approved by the United Sta tes Food and Drug 7
Administration to support safe withdrawal from substance use 8
disorder, including, without limitation, lofexidine. 9
(b) All drugs approved by the United States Food and Drug 10
Administration to provide medication -assisted treatment for opioi d 11
use disorder, including, without limitation, buprenorphine, 12
methadone and naltrexone. 13
(c) The services described in NRS 639.28079 when provided by 14
a pharmacist or pharmacy that participates in the network plan of the 15
insurer. The Commissioner shall adop t regulations governing the 16
provision of reimbursement for such services. 17
(d) Any service for the treatment of substance use disorder 18
provided by a provider of primary care if the service is covered 19
when provided by a specialist and: 20
(1) The service is within the scope of practice of the provider 21
of primary care; or 22
(2) The provider of primary care is capable of providing the 23
service safely and effectively in consultation with a specialist and 24
the provider engages in such consultation. 25
2. An insurer that offers or issues a policy of group health 26
insurance shall reimburse a pharmacist or pharmacy that participates 27
in the network plan of the insurer for the services described in NRS 28
639.28079 at a rate equal to the rate of reimbursement provided to a 29
physician, physician assistant or advanced practice registered nurse 30
for similar services. 31
3. An insurer shall provide the coverage required by 32
paragraphs (a) and (b) of subsection 1 regardless of whether the 33
drug is included in the formulary of the insurer. 34
4. Except as otherwise provided in this subsection, an insurer 35
shall not subject the benefits required by paragraphs (a), (b) and (c) 36
of subsection 1 to medical management techniques, other than step 37
therapy. An insurer may subject the benefits required by paragraphs 38
(b) and (c) of subsection 1 to other reasonable medical management 39
techniques when the benefits are provided by a pharmacist in 40
accordance with NRS 639.28079. 41
5. An insurer shall not: 42
(a) Limit the covered amount of a dr ug described in paragraph 43
(a) or (b) of subsection 1; or 44

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(b) Refuse to cover a drug described in paragraph (a) or (b) of 1
subsection 1 because the drug is dispensed by a pharmacy through 2
mail order service. 3
6. An insurer shall ensure that the benefits re quired by 4
subsection 1 are made available to an insured through a provider of 5
health care who participates in the network plan of the insurer. 6
7. A policy of group health insurance subject to the provisions 7
of this chapter that is delivered, issued for delivery or renewed on or 8
after January 1, 2024, has the legal effect of including the coverage 9
required by subsection 1, and any provision of the policy that 10
conflicts with the provisions of this section is void. 11
8. As used in this section [: 12
(a) “Medical management technique” means a practice which is 13
used to control the cost or use of health care services or prescription 14
drugs. The term includes, without limitation, the use of step therapy, 15
prior authorization and categorizing drugs and devices based on 16
cost, type or method of administration. 17
(b) “Network plan” means a policy of group health insurance 18
offered by an insurer under which the financing and delivery of 19
medical care, including items and services paid for as medical care, 20
are provided, in w hole or in part, through a defined set of providers 21
under contract with the insurer. The term does not include an 22
arrangement for the financing of premiums. 23
(c) “Primary] , “primary care” means the practice of family 24
medicine, pediatrics, internal medicin e, obstetrics and gynecology 25
and midwifery. 26
[(d) “Provider of health care” has the meaning ascribed to it in 27
NRS 629.031.] 28
Sec. 165. NRS 689B.0334 is hereby amended to read as 29
follows: 30
689B.0334 1. Except as otherwise provided in this section, 31
an insurer that issues a policy of group health insurance shall 32
include in the policy coverage for the medically necessary treatment 33
of conditions relating to gender dysphoria and gender incongruence. 34
Such cove rage must include coverage of medically necessary 35
psychosocial and surgical intervention and any other medically 36
necessary treatment for such disorders provided by: 37
(a) Endocrinologists; 38
(b) Pediatric endocrinologists; 39
(c) Social workers; 40
(d) Psychiatrists; 41
(e) Psychologists; 42
(f) Gynecologists; 43
(g) Speech-language pathologists; 44
(h) Primary care physicians; 45

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(i) Advanced practice registered nurses; 1
(j) Physician assistants; and 2
(k) Any other providers of medically necessary services for the 3
treatment of gender dysphoria or gender incongruence. 4
2. This section does not require a policy of group health 5
insurance to include coverage for cosmetic surgery performed by a 6
plastic surgeon or reconstructive surgeon that is not medically 7
necessary. 8
3. An insurer that issues a policy of group health insurance 9
shall not categorically refuse to cover medically necessary gender -10
affirming treatments or procedures or revisions to prior treatments if 11
the policy provides coverage for any such services, procedures or 12
revisions for purposes other than gender transition or affirmation. 13
4. An insurer that issues a policy of group health insurance 14
may prescribe requirements that must be satisfied befo re the insurer 15
covers surgical treatment of conditions relating to gender dysphoria 16
or gender incongruence for an insured who is less than 18 years of 17
age. Such requirements may include, without limitation, 18
requirements that: 19
(a) The treatment must be re commended by a psychologist, 20
psychiatrist or other mental health professional; 21
(b) The treatment must be recommended by a physician; 22
(c) The insured must provide a written expression of the desire 23
of the insured to undergo the treatment; 24
(d) A written plan for treatment that covers at least 1 year must 25
be developed and approved by at least two providers of health care; 26
and 27
(e) Parental consent is provided for the insured unless the 28
insured is expressly authorized by law to consent on his or her own 29
behalf. 30
5. When determining whether treatment is medically necessary 31
for the purposes of this section, an insurer must consider the most 32
recent Standards of Care published by the World Professional 33
Association for Transgender Health, or its successor organization. 34
6. An insurer shall make a reasonable effort to ensure that the 35
benefits required by subsection 1 are made available to an insured 36
through a provider of health care who participates in the network 37
plan of the insurer. If, after a reasonable effort, the insurer is unable 38
to make such benefits available through such a provider of health 39
care, the insurer may treat the treatment that the insurer is unable to 40
make available through such a provider of health care in the same 41
manner as other services provided by a provider of health care who 42
does not participate in the network plan of the insurer. 43
7. If an insured appeals the denial of a claim or coverage under 44
this section on the grounds that the treatment requested by the 45

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insured is not medically necessary, the insurer must consult with a 1
provider of health care who has experience in prescribing or 2
delivering gender -affirming treatment concerning the medical 3
necessity of the treatment requested by the insured when 4
considering the appeal. 5
8. A policy of group health insurance subject to the provisions 6
of this chapter that is delivered, issued for delivery or renewed on or 7
after July 1, 2023, has the legal effect of including the coverage 8
required by subsection 1, and any provision of the policy or renewal 9
which is in conflict with the provisions of this section is void. 10
9. As used in this section: 11
(a) “Cosmetic surgery”: 12
(1) Means a surgical procedure that: 13
(I) Does not meaningfully promote the proper function of 14
the body; 15
(II) Does not prevent or treat illness or disease; and 16
(III) Is primarily directed at improving the appearance of 17
a person. 18
(2) Includes, without limitation, cosmetic surgery directed at 19
preserving beauty. 20
(b) “Gender dysphoria” means distress or impairment in so cial, 21
occupational or other areas of functioning caused by a marked 22
difference between the gender identity or expression of a person and 23
the sex assigned to the person at birth which lasts at least 6 months 24
and is shown by at least two of the following: 25
(1) A marked difference between gender identity or 26
expression and primary or secondary sex characteristics or 27
anticipated secondary sex characteristics in young adolescents. 28
(2) A strong desire to be rid of primary or secondary sex 29
characteristics beca use of a marked difference between such sex 30
characteristics and gender identity or expression or a desire to 31
prevent the development of anticipated secondary sex characteristics 32
in young adolescents. 33
(3) A strong desire for the primary or secondary sex 34
characteristics of the gender opposite from the sex assigned at birth. 35
(4) A strong desire to be of the opposite gender or a gender 36
different from the sex assigned at birth. 37
(5) A strong desire to be treated as the opposite gender or a 38
gender different from the sex assigned at birth. 39
(6) A strong conviction of experiencing typical feelings and 40
reactions of the opposite gender or a gender different from the sex 41
assigned at birth. 42
(c) “Medically necessary” means health care services or 43
products that a prudent provider of health care would provide to a 44

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patient to prevent, diagnose or treat an illness, injury or disease, or 1
any symptoms thereof, that are necessary and: 2
(1) Provided in accordance with generally accepted standards 3
of medical practice; 4
(2) Clinically appropriate with regard to type, frequency, 5
extent, location and duration; 6
(3) Not provided primarily for the convenience of the patient 7
or provider of health care; 8
(4) Required to improve a specific health condition of a 9
patient or to preserve the existing state of health of the patient; and 10
(5) The most clinically appropriate level of health care that 11
may be safely provided to the patient. 12
 A provider of health care prescribing, ordering, recommending or 13
approving a health care servic e or product does not, by itself, make 14
that health care service or product medically necessary. 15
[(d) “Network plan” means a policy of group health insurance 16
offered by an insurer under which the financing and delivery of 17
medical care, including items and services paid for as medical care, 18
are provided, in whole or in part, through a defined set of provide rs 19
under contract with the insurer. The term does not include an 20
arrangement for the financing of premiums. 21
(e) “Provider of health care” has the meaning ascribed to it in 22
NRS 629.031.] 23
Sec. 166. NRS 689B.0358 is hereby a mended to read as 24
follows: 25
689B.0358 1. An insurer that issues a policy of group health 26
insurance shall include in the policy coverage for: 27
(a) Necessary case management services for an insured who has 28
been diagnosed with sickle cell disease and its variants; and 29
(b) Medically necessary care for an insured who has been 30
diagnosed with sickle cell disease and its variants. 31
2. An insurer that issues a policy of group health insurance 32
which provides coverage for prescription drugs shall include in the 33
policy coverage for medically necessary prescription drugs to treat 34
sickle cell disease and its variants. 35
3. An insurer may use medical management techniques, 36
including, without limitation, any available clinical evidence, to 37
determine the frequency of or treatment relating to any benefit 38
required by this section or the type of provider of health care to use 39
for such treatment. 40
4. As used in this section: 41
(a) “Case management services” means medical or other health 42
care management services to assist pati ents and providers of health 43
care, including, without limitation, identifying and facilitating 44
additional resources and treatments, providing information about 45

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treatment options and facilitating communication between providers 1
of services to a patient. 2
(b) [“Medical management technique” means a practice which is 3
used to control the cost or utilization of health care services. The 4
term includes, without limitation, the use of step therapy, prior 5
authorization or categorizing drugs and devices based on co st, type 6
or method of administration. 7
(c)] “Medically necessary” has the meaning ascribed to it in 8
NRS 695G.055. 9
[(d)] (c) “Sickle cell disease and its variants” has the meaning 10
ascribed to it in NRS 439.4927. 11
Sec. 167. NRS 689B.0361 is hereby amended to read as 12
follows: 13
689B.0361 1. Subject to the limitations prescribed by 14
subsection 4, an insurer that issues a policy of group health 15
insurance shall include in the policy coverage for medically 16
necessary biomarker testing for the diagnosis, treatment, appropriate 17
management and ongoing monitoring of cancer when such 18
biomarker testing is supported by medical and scientific evidence. 19
Such evidence includes, without limitation: 20
(a) The labeled indications for a biomarker t est or medication 21
that has been approved or cleared by the United States Food and 22
Drug Administration; 23
(b) The indicated tests for a drug that has been approved by the 24
United States Food and Drug Administration or the warnings and 25
precautions included on the label of such a drug; 26
(c) A national coverage determination or local coverage 27
determination, as those terms are defined in 42 C.F.R. § 400.202; or 28
(d) Nationally recognized clinical practice guidelines or 29
consensus statements. 30
2. An insurer shall: 31
(a) Provide the coverage required by subsection 1 in a manner 32
that limits disruptions in care and the need for multiple specimens. 33
(b) Establish a clear and readily accessible process for an 34
insured or provider of health care to: 35
(1) Request an excepti on to a policy excluding coverage for 36
biomarker testing for the diagnosis, treatment, management or 37
ongoing monitoring of cancer; or 38
(2) Appeal a denial of coverage for such biomarker testing; 39
and 40
(c) Make the process described in paragraph (b) availabl e on an 41
Internet website maintained by the insurer. 42
3. If an insurer requires an insured to obtain prior authorization 43
for a biomarker test described in subsection 1, the insurer shall 44
respond to a request for such prior authorization: 45

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(a) Within 24 hours after receiving an urgent request; or 1
(b) Within 72 hours after receiving any other request. 2
4. The provisions of this section do not require an insurer to 3
provide coverage of biomarker testing: 4
(a) For screening purposes; 5
(b) Conducted by a provid er of health care for whom the 6
biomarker testing is not within his or her scope of practice, training 7
and experience; 8
(c) Conducted by a provider of health care or a facility that does 9
not participate in the network plan of the insurer; or 10
(d) That has not been determined to be medically necessary by a 11
provider of health care for whom such a determination is within his 12
or her scope of practice, training and experience. 13
5. A policy of group health insurance subject to the provisions 14
of this chapter that is delivered, issued for delivery or renewed on or 15
after October 1, 2023, has the legal effect of including the coverage 16
required by this section, and any provision of the policy or renewal 17
which is in conflict with the provisions of this section is void. 18
6. As used in this section: 19
(a) “Biomarker” means a characteristic that is objectively 20
measured and evaluated as an indicator of a normal biological 21
process, a pathogenic process or a pharmacological response to a 22
specific therapeutic intervention and includes, without limitation: 23
(1) An interaction between a gene and a drug that is being 24
used by or considered for use by the patient; 25
(2) A mutation or characteristic of a gene; and 26
(3) The expression of a protein. 27
(b) “Biomarker testing” means the analysis of the tissue, blood 28
or other biospecimen of a patient for the presentation of a biomarker 29
and includes, without limitation, single -analyte tests, multiplex 30
panel tests and whole genome, whole exome and whole 31
transcriptome sequencing. 32
(c) “Consensus statement” means a statement aimed at a specific 33
clinical circumstance that is: 34
(1) Made for the purpose of optimizing the outcomes of 35
clinical care; 36
(2) Made by an independent, multidisciplinary panel of 37
experts that has established a policy to avoid conflicts of interest; 38
(3) Based on scientific evidence; and 39
(4) Made using a transparent methodology and reporting 40
procedure. 41
(d) “Medically necessary” means health care services or 42
products that a prudent provider of health care would provide to a 43
patient to prevent, diagnose or treat an illness, injury or disease, or 44
any symptoms thereof, that are necessary and: 45

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(1) Provided in accordance with generally accepted standards 1
of medical practice; 2
(2) Not primarily provided for the convenience of the patient 3
or provider of health care; and 4
(3) Significant in guiding and informing the provider of 5
health care in providing the most appropriate course of treatment for 6
the patient in order to prevent, delay or lessen the magnitude of an 7
adverse health outcome. 8
(e) “Nationally recognized clinical practice guidelines” means 9
evidence-based guidelines establishing standards of care that 10
include, without limitation, recommendations intended to optimize 11
care of patients and are: 12
(1) Informed by a syst emic review of evidence and an 13
assessment of the risks and benefits of alternative options for care; 14
and 15
(2) Developed using a transparent methodology and 16
reporting procedure by an independent organization or society of 17
medical professionals that has established a policy to avoid conflicts 18
of interest. 19
[(f) “Network plan” means a policy of group health insurance 20
offered by an insurer under which the financing and delivery of 21
medical care, including items and services paid for as medical care, 22
are provided, in whole or in part, through a defined set of pro viders 23
under contract with the insurer. The term does not include an 24
arrangement for the financing of premiums. 25
(g) “Provider of health care” has the meaning ascribed to it in 26
NRS 629.031.] 27
Sec. 168. NRS 689B.0374 is here by amended to read as 28
follows: 29
689B.0374 1. A policy of group health insurance must 30
provide coverage for benefits payable for expenses incurred for: 31
(a) A mammogram to screen for breast cancer annually for 32
insureds who are 40 years of age or older. 33
(b) An imaging test to screen for breast cancer on an interval 34
and at the age deemed most appropriate, when medically necessary, 35
as recommended by the insured’s provider of health care based on 36
personal or family medical history or additional factors that ma y 37
increase the risk of breast cancer for the insured. 38
(c) A diagnostic imaging test for breast cancer at the age deemed 39
most appropriate, when medically necessary, as recommended by 40
the insured’s provider of health care to evaluate an abnormality 41
which is: 42
(1) Seen or suspected from a mammogram described in 43
paragraph (a) or an imaging test described in paragraph (b); or 44
(2) Detected by other means of examination. 45

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2. An insurer must ensure that the benefits required by 1
subsection 1 are made available to an insured through a provider of 2
health care who participates in the network plan of the insurer. 3
3. Except as otherwise provided in subsection 5, an insurer that 4
offers or issues a policy of group health insurance shall not: 5
(a) Except as otherwise provided in subsection 6, require an 6
insured to pay a deductible, copayment, coinsurance or any other 7
form of cost -sharing or require a longer waiting period or other 8
condition to obtain any benefit provided in the policy of group 9
health insurance pursuant to subsection 1; 10
(b) Refuse to issue a policy of group health insurance or cancel a 11
policy of group health insurance solely because the person applying 12
for or covered by the policy uses or may use any such benefit; 13
(c) Offer or pay any type of material inducement or financial 14
incentive to an insured to discourage the insured from obtaining any 15
such benefit; 16
(d) Penalize a provider of health care who provides any such 17
benefit to an insured, including, without limitation, reducing the 18
reimbursement of the provider of health care; 19
(e) Offer or pay any type of material inducement, bonus or other 20
financial incentive to a provider of health care to deny, reduce, 21
withhold, limit or delay access to any such benefit to an insured; or 22
(f) Impose any other restrictions or delays on the access of an 23
insured to any such benefit. 24
4. A policy subject to the provisions of this chapter which is 25
delivered, issued for delivery or renewed on or after January 1, 26
2024, has the legal effect of including the coverage r equired by 27
subsection 1, and any provision of the policy or the renewal which is 28
in conflict with this section is void. 29
5. Except as otherwise provided in this section and federal law, 30
an insurer may use medical management techniques, including, 31
without limitation, any available clinical evidence, to determine the 32
frequency of or treatment relating to any benefit required by this 33
section or the type of provider of health care to use for such 34
treatment. 35
6. If the application of paragraph (a) of subsectio n 3 would 36
result in the ineligibility of a health savings account of an insured 37
pursuant to 26 U.S.C. § 223, the prohibitions of paragraph (a) of 38
subsection 3 shall apply only for a qualified policy of group health 39
insurance with respect to the deductible of such a policy of group 40
health insurance after the insured has satisfied the minimum 41
deductible pursuant to 26 U.S.C. § 223, except with respect to items 42
or services that constitute preventive care pursuant to 26 U.S.C. § 43
223(c)(2)(C), in which case the prohibitions of paragraph (a) of 44

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subsection 3 shall apply regardless of whether the minimum 1
deductible under 26 U.S.C. § 223 has been satisfied. 2
7. As used in this section [: 3
(a) “Medical management technique” means a practice which is 4
used to control t he cost or utilization of health care services or 5
prescription drug use. The term includes, without limitation, the use 6
of step therapy, prior authorization or categorizing drugs and 7
devices based on cost, type or method of administration. 8
(b) “Network plan” means a policy of group health insurance 9
offered by an insurer under which the financing and delivery of 10
medical care, including items and services paid for as medical care, 11
are provided, in whole or in part, through a defined set of providers 12
under contract with the insurer. The term does not include an 13
arrangement for the financing of premiums. 14
(c) “Provider of health care” has the meaning ascribed to it in 15
NRS 629.031. 16
(d) “Qualified] , “qualified policy of group health insurance” 17
means a policy of group health insurance that has a high deductible 18
and is in compliance with 26 U.S.C. § 223 for the purposes of 19
establishing a health savings account. 20
Sec. 169. NRS 689B.0376 is hereby amended to read as 21
follows: 22
689B.0376 1. An insurer that offers or issues a policy of 23
group health insurance which provides coverage for prescription 24
drugs or devices shall include in the policy coverage for any type of 25
hormone replacement therapy which is lawfully prescribed or 26
ordered and which has been approved by the Food and Drug 27
Administration. 28
2. An insurer that offers or issues a policy of group health 29
insurance that provides coverage for prescription drugs shall not: 30
(a) Require an insured to pay a higher deductible, any 31
copayment or coinsurance or require a longer waiting period or 32
other condition for coverage for a prescription for hormone 33
replacement therapy; 34
(b) Refuse to issue a policy of group health insurance or cancel a 35
policy of group health insurance solely because the person applying 36
for or covered by the policy uses or may use in the future hormone 37
replacement therapy; 38
(c) Offer or pay any type of material inducement or financial 39
incentive to an insured to discourage the insured from accessing 40
hormone replacement therapy; 41
(d) Penalize a provider of health care who provides hormone 42
replacement therapy to an insured, including, without limitation, 43
reducing the reimbursement of the provider of health care; or 44

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(e) Offer or pay any type of material inducement, bonus or other 1
financial incentive to a provider of health care to deny, reduce, 2
withhold, limit or delay hormone replacement therapy to an insured. 3
3. A policy subject to the provisions of this chapter that is 4
delivered, issued for delivery or renewed on or af ter October 1, 5
1999, has the legal effect of including the coverage required by 6
subsection 1, and any provision of the policy or the renewal which is 7
in conflict with this section is void. 8
4. The provisions of this section do not require an insurer to 9
provide coverage for fertility drugs. 10
[5. As used in this section, “provider of health care” has the 11
meaning ascribed to it in NRS 629.031.] 12
Sec. 170. NRS 689B.03765 is hereby amended to read as 13
follows: 14
689B.03765 1. A policy of group health insurance which 15
provides coverage for prescription drugs must not require an insured 16
to submit to a step therapy protocol before covering a drug approved 17
by the Food and Drug Administration that is prescribed to treat a 18
psychiatric condition of the insured, if: 19
(a) The drug has been approved by the Food and Drug 20
Administration with indications for the psychiatric condition of the 21
insured or the use of the drug to treat that psychiatric condition is 22
otherwise supported by medical or scientific evidence; 23
(b) The drug is prescribed by: 24
(1) A psychiatrist; 25
(2) A physician assistant under the supervision of a 26
psychiatrist; 27
(3) An advanced practice registered nurse who has the 28
psychiatric training and experience prescribed by the State Board of 29
Nursing pursuant to NRS 632.120; or 30
(4) A primary care provider that is providing care to an 31
insured in consultation with a practitioner listed in subparagraph (1), 32
(2) or (3), if the closest practitioner listed in subparagraph (1), (2) or 33
(3) who participates in the networ k plan of the insurer is located 60 34
miles or more from the residence of the insured; and 35
(c) The practitioner listed in paragraph (b) who prescribed the 36
drug knows, based on the medical history of the insured, or 37
reasonably expects each alternative drug t hat is required to be used 38
earlier in the step therapy protocol to be ineffective at treating the 39
psychiatric condition. 40
2. Any provision of a policy of group health insurance subject 41
to the provisions of this chapter that is delivered, issued for deliv ery 42
or renewed on or after July 1, 2023, which is in conflict with this 43
section is void. 44
3. As used in this section: 45

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(a) “Medical or scientific evidence” has the meaning ascribed to 1
it in NRS 695G.053. 2
(b) [“Network plan” means a policy of group health insurance 3
offered by an insurer under which the financing and delivery of 4
medical care is provided, in whole or in part, through a defined set 5
of providers under contract with the insurer. The term does not 6
include an arrangement for the financing of premiums. 7
(c)] “Step therapy protocol” means a procedure that requires an 8
insured to use a prescription drug or sequence of prescription drugs 9
other than a drug that a practitioner recommends for treatment of a 10
psychiatric condition of the insured before his or her policy of group 11
health insurance provides coverage for the recommended drug. 12
Sec. 171. NRS 689B.0377 is hereby amended to read as 13
follows: 14
689B.0377 1. An insurer that offers or issues a policy of 15
group health insurance which provides coverage for outpatient care 16
shall include in the policy coverage for any health care service 17
related to hormone replacement therapy. 18
2. An insurer that offers or issues a policy of group health 19
insurance that provides coverage for outpatient care shall not: 20
(a) Require an insured to pay a higher deductible, any 21
copayment or coinsurance or require a longer waiting period or 22
other condition for coverage for outpatient care related to hormone 23
replacement therapy; 24
(b) Refuse to issue a policy of group health insurance or cancel a 25
policy of group health insurance solely because the person applying 26
for or covered by the policy uses or may use in the future hormone 27
replacement therapy; 28
(c) Offer or pay any type of material inducement or financial 29
incentive to an insured to discourage the insured from accessing 30
hormone replacement therapy; 31
(d) Penalize a provider of health care who provides hormone 32
replacement therapy to an insured, including, without limitation, 33
reducing the reimbursement of the provider of health care; or 34
(e) Offer or pay any type of material inducement, bonus or other 35
financial incentive to a provider of health care to deny, reduce, 36
withhold, limit or delay hormone replacement therapy to an insured. 37
3. A policy su bject to the provisions of this chapter that is 38
delivered, issued for delivery or renewed on or after October 1, 39
1999, has the legal effect of including the coverage required by 40
subsection 1, and any provision of the policy or the renewal which is 41
in conflict with this section is void. 42
[4. As used in this section, “provider of health care” has the 43
meaning ascribed to it in NRS 629.031.] 44

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Sec. 172. NRS 689B.0378 is hereby amended to read as 1
follows: 2
689B.0378 1. Except as otherwise provided in subsection 8, 3
an insurer that offers or issues a policy of group health insurance 4
shall include in the policy coverage for: 5
(a) Up to a 12 -month supply, per prescription, of any type of 6
drug for contraception or its therapeutic equivalent which is: 7
(1) Lawfully prescribed or ordered; 8
(2) Approved by the Food and Drug Administration; 9
(3) Listed in subsection 12; and 10
(4) Dispensed in accordance with NRS 639.28075; 11
(b) Any type of device for contraception which is: 12
(1) Lawfully prescribed or ordered; 13
(2) Approved by the Food and Drug Administration; and 14
(3) Listed in subsection 12; 15
(c) Self-administered hormonal contraceptives dispensed by a 16
pharmacist pursuant to NRS 639.28078; 17
(d) Insertion of a device for contracep tion or removal of such a 18
device if the device was inserted while the insured was covered by 19
the same policy of group health insurance; 20
(e) Education and counseling relating to the initiation of the use 21
of contraception and any necessary follow -up after i nitiating such 22
use; 23
(f) Management of side effects relating to contraception; and 24
(g) Voluntary sterilization for women. 25
2. An insurer shall provide coverage for any services listed in 26
subsection 1 which are within the authorized scope of practice of a 27
pharmacist when such services are provided by a pharmacist who is 28
employed by or serves as an independent contractor of an in -29
network pharmacy and in accordance with the applicable network 30
contract. Such coverage must be provided to the same extent as if 31
the services were provided by another provider of health care, as 32
applicable to the services being provided. The terms of the policy 33
must not limit: 34
(a) Coverage for services listed in subsection 1 and provided by 35
such a pharmacist to a number of occasio ns less than the coverage 36
for such services when provided by another provider of health care. 37
(b) Reimbursement for services listed in subsection 1 and 38
provided by such a pharmacist to an amount less than the amount 39
reimbursed for similar services provided by a physician, physician 40
assistant or advanced practice registered nurse. 41
3. An insurer must ensure that the benefits required by 42
subsection 1 are made available to an insured through a provider of 43
health care who participates in the network plan of the insurer. 44

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4. If a covered therapeutic equivalent listed in subsection 1 is 1
not available or a provider of health care deems a covered 2
therapeutic equivalent to be medically inappropriate, an alternate 3
therapeutic equivalent prescribed by a provi der of health care must 4
be covered by the insurer. 5
5. Except as otherwise provided in subsections 10, 11 and 13, 6
an insurer that offers or issues a policy of group health insurance 7
shall not: 8
(a) Require an insured to pay a higher deductible, any 9
copayment or coinsurance or require a longer waiting period or 10
other condition to obtain any benefit included in the policy pursuant 11
to subsection 1; 12
(b) Refuse to issue a policy of group health insurance or cancel a 13
policy of group health insurance solel y because the person applying 14
for or covered by the policy uses or may use any such benefit; 15
(c) Offer or pay any type of material inducement or financial 16
incentive to an insured to discourage the insured from obtaining any 17
such benefit; 18
(d) Penalize a p rovider of health care who provides any such 19
benefit to an insured, including, without limitation, reducing the 20
reimbursement to the provider of health care; 21
(e) Offer or pay any type of material inducement, bonus or other 22
financial incentive to a provide r of health care to deny, reduce, 23
withhold, limit or delay access to any such benefit to an insured; or 24
(f) Impose any other restrictions or delays on the access of an 25
insured to any such benefit. 26
6. Coverage pursuant to this section for the covered d ependent 27
of an insured must be the same as for the insured. 28
7. Except as otherwise provided in subsection 8, a policy 29
subject to the provisions of this chapter that is delivered, issued for 30
delivery or renewed on or after January 1, 2024, has the legal e ffect 31
of including the coverage required by this section, and any provision 32
of the policy or the renewal which is in conflict with this section is 33
void. 34
8. An insurer that offers or issues a policy of group health 35
insurance and which is affiliated with a religious organization is not 36
required to provide the coverage required by subsection 1 if the 37
insurer objects on religious grounds. Such an insurer shall, before 38
the issuance of a policy of group health insurance and before the 39
renewal of such a policy, provide to the group policyholder or 40
prospective insured, as applicable, written notice of the coverage 41
that the insurer refuses to provide pursuant to this subsection. 42
9. If an insurer refuses, pursuant to subsection 8, to provide the 43
coverage required by subsection 1, an employer may otherwise 44
provide for the coverage for the employees of the employer. 45

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10. An insurer may require an insured to pay a higher 1
deductible, copayment or coinsurance for a drug for contraception if 2
the insured refuses to accept a therapeutic equivalent of the drug. 3
11. For each of the 18 methods of contraception listed in 4
subsection 12 that have been approved by the Food and Drug 5
Administration, a policy of group health insurance must include at 6
least one drug or device for c ontraception within each method for 7
which no deductible, copayment or coinsurance may be charged to 8
the insured, but the insurer may charge a deductible, copayment or 9
coinsurance for any other drug or device that provides the same 10
method of contraception. If the insurer charges a copayment or 11
coinsurance for a drug for contraception, the insurer may only 12
require an insured to pay the copayment or coinsurance: 13
(a) Once for the entire amount of the drug dispensed for the plan 14
year; or 15
(b) Once for each 1-month supply of the drug dispensed. 16
12. The following 18 methods of contraception must be 17
covered pursuant to this section: 18
(a) Voluntary sterilization for women; 19
(b) Surgical sterilization implants for women; 20
(c) Implantable rods; 21
(d) Copper-based intrauterine devices; 22
(e) Progesterone-based intrauterine devices; 23
(f) Injections; 24
(g) Combined estrogen- and progestin-based drugs; 25
(h) Progestin-based drugs; 26
(i) Extended- or continuous-regimen drugs; 27
(j) Estrogen- and progestin-based patches; 28
(k) Vaginal contraceptive rings; 29
(l) Diaphragms with spermicide; 30
(m) Sponges with spermicide; 31
(n) Cervical caps with spermicide; 32
(o) Female condoms; 33
(p) Spermicide; 34
(q) Combined estrogen - and progestin -based drugs for 35
emergency contraception or progestin -based drugs for emergency 36
contraception; and 37
(r) Ulipristal acetate for emergency contraception. 38
13. Except as otherwise provided in this section and federal 39
law, an insurer may use medical management techniques, including, 40
without limitation, any avai lable clinical evidence, to determine the 41
frequency of or treatment relating to any benefit required by this 42
section or the type of provider of health care to use for such 43
treatment. 44
14. An insurer shall not: 45

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(a) Use medical management techniques to require an insured to 1
use a method of contraception other than the method prescribed or 2
ordered by a provider of health care; 3
(b) Require an insured to obtain prior authorization for the 4
benefits described in paragraphs (a) and (c) of subsection 1; or 5
(c) Refuse to cover a contraceptive injection or the insertion of a 6
device described in paragraph (c), (d) or (e) of subsection 12 at a 7
hospital immediately after an insured gives birth. 8
15. An insurer must provide an accessible, transparent and 9
expedited pro cess which is not unduly burdensome by which an 10
insured, or the authorized representative of the insured, may request 11
an exception relating to any medical management technique used by 12
the insurer to obtain any benefit required by this section without a 13
higher deductible, copayment or coinsurance. 14
16. As used in this section: 15
(a) “In-network pharmacy” means a pharmacy that has entered 16
into a contract with an insurer to provide services to insureds 17
through a network plan offered or issued by the insurer. 18
(b) [“Medical management technique” means a practice which is 19
used to control the cost or utilization of health care services or 20
prescription drug use. The term includes, without limitation, the use 21
of step therapy, prior authorization or categorizing drug s and 22
devices based on cost, type or method of administration. 23
(c) “Network plan” means a policy of group health insurance 24
offered by an insurer under which the financing and delivery of 25
medical care, including items and services paid for as medical care, 26
are provided, in whole or in part, through a defined set of providers 27
under contract with the insurer. The term does not include an 28
arrangement for the financing of premiums. 29
(d)] “Provider network contract” [means] includes a contract 30
between an insurer and a [provider of health care or ] pharmacy 31
specifying the rights and responsibilities of the insurer and the 32
[provider of health care or ] pharmacy [, as applicable,] for delivery 33
of health care services pursuant to a network plan. 34
[(e) “Provider of heal th care” has the meaning ascribed to it in 35
NRS 629.031. 36
(f) “Therapeutic equivalent” means a drug which: 37
(1) Contains an identical amount of the same active 38
ingredients in the same dosage and method of administration as 39
another drug; 40
(2) Is expected to have the same clinical effect when 41
administered to a patient pursuant to a prescription or order as 42
another drug; and 43
(3) Meets any other criteria required by the Food and Drug 44
Administration for classification as a therapeutic equivalent.] 45

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Sec. 173. NRS 689B.03785 is hereby amended to read as 1
follows: 2
689B.03785 1. An insurer that offers or issues a policy of 3
group health insurance shall include in the policy coverage for: 4
(a) Counseling, support and supplies for b reastfeeding, 5
including breastfeeding equipment, counseling and education during 6
the antenatal, perinatal and postpartum period for not more than 1 7
year; 8
(b) Screening and counseling for interpersonal and domestic 9
violence for women at least annually with initial intervention 10
services consisting of education, strategies to reduce harm, 11
supportive services or a referral for any other appropriate services; 12
(c) Behavioral counseling concerning sexually transmitted 13
diseases from a provider of health care for sexually active women 14
who are at increased risk for such diseases; 15
(d) Such prenatal screenings and tests as recommended by the 16
American College of Obstetricians and Gynecologists or its 17
successor organization; 18
(e) Screening for blood pressure abnormalit ies and diabetes, 19
including gestational diabetes, after at least 24 weeks of gestation or 20
as ordered by a provider of health care; 21
(f) Screening for cervical cancer at such intervals as are 22
recommended by the American College of Obstetricians and 23
Gynecologists or its successor organization; 24
(g) Screening for depression; 25
(h) Screening and counseling for the human immunodeficiency 26
virus consisting of a risk assessment, annual education relating to 27
prevention and at least one screening for the virus during the 28
lifetime of the insured or as ordered by a provider of health care; 29
(i) Smoking cessation programs for an insured who is 18 years 30
of age or older consisting of not more than two cessation attempts 31
per year and four counseling sessions per year; 32
(j) All vaccinations recommended by the Advisory Committee 33
on Immunization Practices of the Centers for Disease Control and 34
Prevention of the United States Department of Health and Human 35
Services or its successor organization; and 36
(k) Such well-woman preventative visits as recommended by the 37
Health Resources and Services Administration, which must include 38
at least one such visit per year beginning at 14 years of age. 39
2. An insurer must ensure that the benefits required by 40
subsection 1 are made availab le to an insured through a provider of 41
health care who participates in the network plan of the insurer. 42
3. Except as otherwise provided in subsection 5, an insurer that 43
offers or issues a policy of group health insurance shall not: 44

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(a) Require an insure d to pay a higher deductible, any 1
copayment or coinsurance or require a longer waiting period or 2
other condition to obtain any benefit provided in the policy of group 3
health insurance pursuant to subsection 1; 4
(b) Refuse to issue a policy of group health insurance or cancel a 5
policy of group health insurance solely because the person applying 6
for or covered by the policy uses or may use any such benefit; 7
(c) Offer or pay any type of material inducement or financial 8
incentive to an insured to discourage the insured from obtaining any 9
such benefit; 10
(d) Penalize a provider of health care who provides any such 11
benefit to an insured, including, without limitation, reducing the 12
reimbursement of the provider of health care; 13
(e) Offer or pay any type of material inducement, bonus or other 14
financial incentive to a provider of health care to deny, reduce, 15
withhold, limit or delay access to any such benefit to an insured; or 16
(f) Impose any other restrictions or delays on the access of an 17
insured to any such benefit. 18
4. A policy subject to the provisions of this chapter that is 19
delivered, issued for delivery or renewed on or after January 1, 20
2018, has the legal effect of including the coverage required by 21
subsection 1, and any provision of the policy or the renewal which is 22
in conflict with this section is void. 23
5. Except as otherwise provided in this section and federal law, 24
an insurer may use medical management techniques, including, 25
without limitation, any available clinical evidence, to determine the 26
frequency of or treatment relating to any benefit required by this 27
section or the type of provider of health care to use for such 28
treatment. 29
[6. As used in this section: 30
(a) “Medical management technique” means a practice which is 31
used to control the cost or utilization of health care services or 32
prescription drug use. The term includes, without limitation, the use 33
of step therapy, prior authorization or categorizing drugs and 34
devices based on cost, type or method of administration. 35
(b) “Network plan” means a policy of group health insurance 36
offered by an insurer under which the financing and delivery of 37
medical care, including items and services paid for as medical care, 38
are provided, in whole or in part, through a defined set of providers 39
under contract with the insurer. The term does not include an 40
arrangement for the financing of premiums. 41
(c) “Provider of health care” has the meaning ascribed to it in 42
NRS 629.031.] 43

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Sec. 174. NRS 689B.570 is hereby amended to read as 1
follows: 2
689B.570 [1.] A carrier that offers coverage through a 3
network plan is not required to offer coverage to or accept an 4
application from an employer that does not employ or no longer 5
employs any enrollees who reside or work in the geographic service 6
area of the carrier, provided that such coverage is refused or 7
terminated uniformly without regard to any health status -related 8
factor for any employee of the employer. 9
[2. As used in this section, “network plan” means a health 10
benefit plan offered by a health carrier under which the financing 11
and delivery of medical care, including items and services paid for 12
as medical care, are provided, in whole or in part, through a defined 13
set of providers under contract with the carrier. The term does not 14
include an arrangement for the financing of premiums.] 15
Sec. 175. Chapter 689C of NRS is hereby amended by adding 16
thereto the provisions set forth as sections 176 to 179, inclusive, of 17
this act. 18
Sec. 176. “Medical management technique” has the 19
meaning ascribed to it in section 299 of this act. 20
Sec. 177. “Provider network c ontract” has the meaning 21
ascribed to it in NRS 687B.658. 22
Sec. 178. “Provider of health care” has the meaning 23
ascribed to it in NRS 629.031. 24
Sec. 179. “Therapeutic equivalent” has the meaning 25
ascribed to it in section 302 of this act. 26
Sec. 180. NRS 689C.015 is hereby amended to read as 27
follows: 28
689C.015 Except as otherwise provided in this chapter, as used 29
in this chapter, unless the context otherwise requires, the words and 30
terms defined in NRS 689C.017 to 689C.106, inclusive, and 31
sections 176 to 179, inclusive, of this act have the meanings 32
ascribed to them in those sections. 33
Sec. 181. NRS 689C.077 is hereby amended to read as 34
follows: 35
689C.077 “Network plan” [means a health benefit plan offered 36
by a health carrier under which ] has the [financing and delivery of 37
medical care, including items and ser vices paid for as medical care, 38
are provided, in whole or in part, through a defined set of providers 39
under contract with the carrier. The term does not include an 40
arrangement for the financing of premiums.] meaning ascribed to it 41
in NRS 687B.645. 42

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Sec. 182. NRS 689C.1565 is hereby amended to read as 1
follows: 2
689C.1565 1. A carrier is not required to provide coverage to 3
small employers pursuant to NRS 689C.156: 4
(a) During any period in which the Commissioner determines 5
that requiring the carrier to provide such coverage would place the 6
carrier in a financially impaired condition. 7
(b) If the carrier elects not to offer any new coverage to any 8
small employers in this State. A carrier that elects not to offer new 9
coverage in accordance with this paragraph may maintain its 10
existing policies issued to small employers in this State, subject to 11
the requirements of NRS 689B.560 and 689C.310 . [and 689C.320.] 12
2. A carrier that elects not to offer new coverage pursuant to 13
paragraph (b) of subsection 1 shall notify the Commissioner 14
forthwith of that election and shall not thereafter write any new 15
business to small employers in this State for 5 years after the date of 16
the notification. 17
Sec. 183. NRS 689C.1652 is hereby amended to read as 18
follows: 19
689C.1652 1. Except as otherwise provided in this section, a 20
carrier that issues a health benefit plan shall include in the health 21
benefit plan coverage for the medically necessary treatment of 22
conditions relating to gender dysphoria and gender incongruence. 23
Such coverage must include coverage of medically necessary 24
psychosocial and surgical intervention and any other medically 25
necessary treatment for such disorders provided by: 26
(a) Endocrinologists; 27
(b) Pediatric endocrinologists; 28
(c) Social workers; 29
(d) Psychiatrists; 30
(e) Psychologists; 31
(f) Gynecologists; 32
(g) Speech-language pathologists; 33
(h) Primary care physicians; 34
(i) Advanced practice registered nurses; 35
(j) Physician assistants; and 36
(k) Any other providers of medically necessary services for the 37
treatment of gender dysphoria or gender incongruence. 38
2. This section does not require a health benefit plan to include 39
coverage for cosmetic surgery performed by a plastic surgeon or 40
reconstructive surgeon that is not medically necessary. 41
3. A carrier that issues a health benefit plan shall not 42
categorically refuse to cover medically necessary gender -affirming 43
treatments or procedures or revisions to prior treatments if the plan 44

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provides coverage for any such services, procedures or revisions for 1
purposes other than gender transition or affirmation. 2
4. A carrier that issues a health benefit plan may prescribe 3
requirements that must be satisfied before the carrier covers surgical 4
treatment of con ditions relating to gender dysphoria or gender 5
incongruence for an insured who is less than 18 years of age. Such 6
requirements may include, without limitation, requirements that: 7
(a) The treatment must be recommended by a psychologist, 8
psychiatrist or other mental health professional; 9
(b) The treatment must be recommended by a physician; 10
(c) The insured must provide a written expression of the desire 11
of the insured to undergo the treatment; 12
(d) A written plan for treatment that covers at least 1 yea r must 13
be developed and approved by at least two providers of health care; 14
and 15
(e) Parental consent is provided for the insured unless the 16
insured is expressly authorized by law to consent on his or her own 17
behalf. 18
5. When determining whether treatment is medically necessary 19
for the purposes of this section, a carrier must consider the most 20
recent Standards of Care published by the World Professional 21
Association for Transgender Health, or its successor organization. 22
6. A carrier shall make a reasonable effort to ensure that the 23
benefits required by subsection 1 are made available to an insured 24
through a provider of health care who participates in the network 25
plan of the carrier. If, after a reasonable effort, the carrier is unable 26
to make such benefits available through such a provider of health 27
care, the carrier may treat the treatment that the carrier is unable to 28
make available through such a provider of health care in the same 29
manner as other services provided by a provider of health care who 30
does not participate in the network plan of the carrier. 31
7. If an insured appeals the denial of a claim or coverage under 32
this section on the grounds that the treatment requested by the 33
insured is not medically necessary, the carrier must consult with a 34
provider of health care who has experience in prescribing or 35
delivering gender -affirming treatment concerning the medical 36
necessity of the treatment requested by the insured when 37
considering the appeal. 38
8. A health benefit plan subject to the provisions of this chapter 39
that is delivered, issued for delivery or renewed on or after July 1, 40
2023, has the legal effect of including the coverage required by 41
subsection 1, and any provision of the plan or renewal which is in 42
conflict with the provisions of this section is void. 43
9. As used in this section: 44
(a) “Cosmetic surgery”: 45

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(1) Means a surgical procedure that: 1
(I) Does not meaningfully promote the proper function of 2
the body; 3
(II) Does not prevent or treat illness or disease; and 4
(III) Is primarily directed at improving the appearance of 5
a person. 6
(2) Includes, without limitation, cosmetic surgery directed at 7
preserving beauty. 8
(b) “Gender dysphoria” means distress or impairment in social, 9
occupational or other areas of functioning caused by a mar ked 10
difference between the gender identity or expression of a person and 11
the sex assigned to the person at birth which lasts at least 6 months 12
and is shown by at least two of the following: 13
(1) A marked difference between gender identity or 14
expression a nd primary or secondary sex characteristics or 15
anticipated secondary sex characteristics in young adolescents. 16
(2) A strong desire to be rid of primary or secondary sex 17
characteristics because of a marked difference between such sex 18
characteristics and gender identity or expression or a desire to 19
prevent the development of anticipated secondary sex characteristics 20
in young adolescents. 21
(3) A strong desire for the primary or secondary sex 22
characteristics of the gender opposite from the sex assigned at birth. 23
(4) A strong desire to be of the opposite gender or a gender 24
different from the sex assigned at birth. 25
(5) A strong desire to be treated as the opposite gender or a 26
gender different from the sex assigned at birth. 27
(6) A strong conviction of ex periencing typical feelings and 28
reactions of the opposite gender or a gender different from the sex 29
assigned at birth. 30
(c) “Medically necessary” means health care services or 31
products that a prudent provider of health care would provide to a 32
patient to pr event, diagnose or treat an illness, injury or disease, or 33
any symptoms thereof, that are necessary and: 34
(1) Provided in accordance with generally accepted standards 35
of medical practice; 36
(2) Clinically appropriate with regard to type, frequency, 37
extent, location and duration; 38
(3) Not provided primarily for the convenience of the patient 39
or provider of health care; 40
(4) Required to improve a specific health condition of a 41
patient or to preserve the existing state of health of the patient; and 42
(5) The most clinically appropriate level of health care that 43
may be safely provided to the patient. 44

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 A provider of health care prescribing, ordering, recommending or 1
approving a health care service or product does not, by itself, make 2
that health care service or product medically necessary. 3
[(d) “Network plan” means a health benefit plan offered by a 4
carrier under which the financing and delivery of medical care, 5
including items and services paid for as medical care, are provided, 6
in whole or in part, through a defined set of providers under contract 7
with the carrier. The term does not include an arrangement for the 8
financing of premiums. 9
(e) “Provider of health care” has the meaning ascribed to it in 10
NRS 629.031.] 11
Sec. 184. NRS 689C.1665 is hereby amended to read as 12
follows: 13
689C.1665 1. A carrier that offers or issues a health benefit 14
plan shall include in the plan coverage for: 15
(a) All drugs approved by the United States Food and Drug 16
Administration to support safe w ithdrawal from substance use 17
disorder, including, without limitation, lofexidine. 18
(b) All drugs approved by the United States Food and Drug 19
Administration to provide medication -assisted treatment for opioid 20
use disorder, including, without limitation, bup renorphine, 21
methadone and naltrexone. 22
(c) The services described in NRS 639.28079 when provided by 23
a pharmacist or pharmacy that participates in the network plan of the 24
carrier. The Commissioner shall adopt regulations governing the 25
provision of reimbursement for such services. 26
(d) Any service for the treatment of substance use disorder 27
provided by a provider of primary care if the service is covered 28
when provided by a specialist and: 29
(1) The service is within the scope of practice of the provider 30
of primary care; or 31
(2) The provider of primary care is capable of providing the 32
service safely and effectively in consultation with a specialist and 33
the provider engages in such consultation. 34
2. A carrier that offers or issues a health benefit plan shall 35
reimburse a pharmacist or pharmacy that participates in the network 36
plan of the carrier for the services described in NRS 639.28079 at a 37
rate equal to the rate of reimbursement provided to a physician, 38
physician assistant or advanced practice registered nu rse for similar 39
services. 40
3. A carrier shall provide the coverage required by paragraphs 41
(a) and (b) of subsection 1 regardless of whether the drug is 42
included in the formulary of the carrier. 43
4. Except as otherwise provided in this subsection, a carri er 44
shall not subject the benefits required by paragraphs (a), (b) and (c) 45

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of subsection 1 to medical management techniques, other than step 1
therapy. A carrier may subject the benefits required by paragraphs 2
(b) and (c) of subsection 1 to other reasonable m edical management 3
techniques when the benefits are provided by a pharmacist in 4
accordance with NRS 639.28079. 5
5. A carrier shall not: 6
(a) Limit the covered amount of a drug described in paragraph 7
(a) or (b) of subsection 1; or 8
(b) Refuse to cover a dru g described in paragraph (a) or (b) of 9
subsection 1 because the drug is dispensed by a pharmacy through 10
mail order service. 11
6. A carrier shall ensure that the benefits required by 12
subsection 1 are made available to an insured through a provider of 13
health care who participates in the network plan of the carrier. 14
7. A health benefit plan subject to the provisions of this chapter 15
that is delivered, issued for delivery or renewed on or after 16
January 1, 2024, has the legal effect of including the coverage 17
required by subsection 1, and any provision of the plan that conflicts 18
with the provisions of this section is void. 19
8. As used in this section [: 20
(a) “Medical management technique” means a practice which is 21
used to control the cost or use of health care services or prescription 22
drugs. The term includes, without limitation, the use of step therapy, 23
prior authorization and categorizing drugs and devices based on 24
cost, type or method of administration. 25
(b) “Network plan” means a health benefit plan offered by a 26
carrier under which the financing and delivery of medical care, 27
including items and services paid for as medical care, are provided, 28
in whole or in part, through a defined set of providers under contract 29
with the carrier. The term does not include an arrangement for the 30
financing of premiums. 31
(c) “Primary] , “primary care” means the practice of family 32
medicine, pediatrics, internal medicine, obstetrics and gynecology 33
and midwifery. 34
[(d) “Provider of health care” has the meaning ascribed to it in 35
NRS 629.031.] 36
Sec. 185. NRS 689C.1671 is hereby amended to read as 37
follows: 38
689C.1671 1. A carrier that offers or issues a health benefit 39
plan shall include in the plan coverage for: 40
(a) All drugs approved by the United States Food and Drug 41
Administration for preventing the acquisition of human 42
immunodeficiency virus or treating human immunodeficiency virus 43
or hepatitis C in the form recommended by the prescribing 44

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practitioner, regardless of whether the drug is included in the 1
formulary of the carrier; 2
(b) Laboratory testing that is necessary for therapy that uses a 3
drug to prevent the acquisition of human immunodeficiency virus; 4
(c) Any service to test for, prevent or treat human 5
immunodeficiency virus or hepatitis C provided by a provider of 6
primary care if the service is covered when provided by a specialist 7
and: 8
(1) The service is within the scope of practice of the provider 9
of primary care; or 10
(2) The provider of primary care is capable of providing the 11
service safely and effectively in consultation with a specialist and 12
the provider engages in such consultation; and 13
(d) The services described in NRS 639.28085, when provided 14
by a pharmacist wh o participates in the health benefit plan of the 15
carrier. 16
2. A carrier that offers or issues a health benefit plan shall 17
reimburse: 18
(a) A pharmacist who participates in the health benefit plan of 19
the carrier for the services described in NRS 639.28085 at a rate 20
equal to the rate of reimbursement provided to a physician, 21
physician assistant or advanced practice registered nurse for similar 22
services. 23
(b) An advanced practice registered nurse or a physician 24
assistant who participates in the network plan of the carrier for any 25
service to test for, prevent or treat human immunodeficiency virus 26
or hepatitis C at a rate equal to the rate of reimbursement provided 27
to a physician for similar services. 28
3. A carrier shall not: 29
(a) Subject the benefits required by subsection 1 to medical 30
management techniques, other than step therapy; 31
(b) Limit the covered amount of a drug described in paragraph 32
(a) of subsection 1; 33
(c) Refuse to cover a drug described in paragraph (a) of 34
subsection 1 because the drug is disp ensed by a pharmacy through 35
mail order service; or 36
(d) Prohibit or restrict access to any service or drug to treat 37
human immunodeficiency virus or hepatitis C on the same day on 38
which the insured is diagnosed. 39
4. A carrier shall ensure that the benefits required by 40
subsection 1 are made available to an insured through a provider of 41
health care who participates in the network plan of the carrier. 42
5. A health benefit plan subject to the provisions of this chapter 43
that is delivered, issued for delivery o r renewed on or after 44
January 1, 2024, has the legal effect of including the coverage 45

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required by subsection 1, and any provision of the plan that conflicts 1
with the provisions of this section is void. 2
6. As used in this section [: 3
(a) “Medical management technique” means a practice which is 4
used to control the cost or use of health care services or prescription 5
drugs. The term includes, without limitation, the use of step therapy, 6
prior authorization and categorizing drugs and devices based on 7
cost, type or method of administration. 8
(b) “Network plan” means a health benefit plan offered by a 9
carrier under which the financing and delivery of medical care, 10
including items and services paid for as medical care, are provided, 11
in whole or in part, through a defined set of providers under contract 12
with the carrier. The term does not include an arrangement for the 13
financing of premiums. 14
(c) “Primary] , “primary care” means the practice of family 15
medicine, pediatrics, internal medicine, obstetrics and gynecology 16
and midwifery. 17
[(d) “Provider of health care” has the meaning ascribed to it in 18
NRS 629.031.] 19
Sec. 186. NRS 689C.1672 is hereby amended to read as 20
follows: 21
689C.1672 1. A health benefit plan must provide coverage 22
for benefits payable for expenses incurred for: 23
(a) Deoxyribonucleic acid testing for high -risk strains of human 24
papillomavirus every 3 years for women 30 years of age or older; 25
and 26
(b) Administering the human papillomavirus vaccine as 27
recommended for vaccination by a competent authority, including, 28
without limitation, the Centers for Disease Control and Prevention 29
of the United States Department of Health and Human Services, the 30
Food and Drug Administration or the manufacturer of the vaccine. 31
2. A carrier must ensure that the benefits required by 32
subsection 1 are made available to an insured through a provider of 33
health care who participates in the network plan of the carrier. 34
3. Except as otherwise provide d in subsection 5, a carrier that 35
offers or issues a health benefit plan shall not: 36
(a) Require an insured to pay a higher deductible, any 37
copayment or coinsurance or require a longer waiting period or 38
other condition to obtain any benefit provided in the health benefit 39
plan pursuant to subsection 1; 40
(b) Refuse to issue a health benefit plan or cancel a health 41
benefit plan solely because the person applying for or covered by 42
the plan uses or may use any such benefit; 43

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(c) Offer or pay any type of material inducement or financial 1
incentive to an insured to discourage the insured from obtaining any 2
such benefit; 3
(d) Penalize a provider of health care who provides any such 4
benefit to an insured, including, without limitation, reducing the 5
reimbursement of the provider of health care; 6
(e) Offer or pay any type of material inducement, bonus or other 7
financial incentive to a provider of health care to deny, reduce, 8
withhold, limit or delay access to any such benefit to an insured; or 9
(f) Impose any other rest rictions or delays on the access of an 10
insured to any such benefit. 11
4. A plan subject to the provisions of this chapter which is 12
delivered, issued for delivery or renewed on or after January 1, 13
2018, has the legal effect of including the coverage require d by 14
subsection 1, and any provision of the plan or the renewal which is 15
in conflict with this section is void. 16
5. Except as otherwise provided in this section and federal law, 17
a carrier may use medical management techniques, including, 18
without limitation, any available clinical evidence, to determine the 19
frequency of or treatment relating to any benefit required by this 20
section or the type of provider of health care to use for such 21
treatment. 22
6. As used in this section [: 23
(a) “Human] , “human papillomavirus vaccine” means the 24
Quadrivalent Human Papillomavirus Recombinant Vaccine or its 25
successor which is approved by the Food and Drug Administration 26
for the prevention of human papillomavirus infection and cervical 27
cancer. 28
[(b) “Medical management technique” means a practice which is 29
used to control the cost or utilization of health care services or 30
prescription drug use. The term includes, without limitation, the use 31
of step therapy, prior authorization or categorizing drugs and 32
devices based on cost, type or method of administration. 33
(c) “Network plan” means a health benefit plan offered by a 34
carrier under which the financing and delivery of medical care, 35
including items and services paid for as medical care, are provided, 36
in whole or in part, through a defined set of providers under contract 37
with the carrier. The term does not include an arrangement for the 38
financing of premiums. 39
(d) “Provider of health care” has the meaning ascribed to it in 40
NRS 629.031.] 41
Sec. 187. NRS 689C.1673 is hereby amended to read as 42
follows: 43
689C.1673 1. A carrier that issues a health benefit plan shall 44
provide coverage for screening, genetic counseling and testing for 45

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harmful mutations in the BRCA gene for women under 1
circumstances where such screening, genetic counseling or testing, 2
as applicable, is required by NRS 457.301. 3
2. A carrier shall ensure that the benefits required by 4
subsection 1 are made available to an insured through a provider of 5
health care who participates in the network plan of the carrier. 6
3. A health benefit plan subject to the provisions of this chapter 7
that is delivered, issued for delivery or renewed on or after 8
January 1, 2022, has the legal effect of including the coverage 9
required by subsection 1, and any provision of the plan that conflicts 10
with the provisions of this section is void. 11
[4. As used in this section, “provider of health care” has the 12
meaning ascribed to it in NRS 629.031.] 13
Sec. 188. NRS 689C.1674 is hereby amended to read as 14
follows: 15
689C.1674 1. A health benefit plan must provide coverage 16
for benefits payable for expenses incurred for: 17
(a) A mammogram to screen for breast cancer annually for 18
insureds who are 40 years of age or older. 19
(b) An imaging test to screen for breast cancer on an interval 20
and at the age deemed most appropriate, when medically necessary, 21
as recommended by the insured’s provider of health care based on 22
personal or family medical history or additional factor s that may 23
increase the risk of breast cancer for the insured. 24
(c) A diagnostic imaging test for breast cancer at the age deemed 25
most appropriate, when medically necessary, as recommended by 26
the insured’s provider of health care to evaluate an abnormality 27
which is: 28
(1) Seen or suspected from a mammogram described in 29
paragraph (a) or an imaging test described in paragraph (b); or 30
(2) Detected by other means of examination. 31
2. A carrier must ensure that the benefits required by 32
subsection 1 are made available to an insured through a provider of 33
health care who participates in the network plan of the carrier. 34
3. Except as otherwise provided in subsection 5, a carrier that 35
offers or issues a health benefit plan shall not: 36
(a) Except as otherwise prov ided in subsection 6, require an 37
insured to pay a deductible, copayment, coinsurance or any other 38
form of cost -sharing or require a longer waiting period or other 39
condition to obtain any benefit provided in the health benefit plan 40
pursuant to subsection 1; 41
(b) Refuse to issue a health benefit plan or cancel a health 42
benefit plan solely because the person applying for or covered by 43
the plan uses or may use any such benefit; 44

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(c) Offer or pay any type of material inducement or financial 1
incentive to an insured to discourage the insured from obtaining any 2
such benefit; 3
(d) Penalize a provider of health care who provides any such 4
benefit to an insured, including, without limitation, reducing the 5
reimbursement of the provider of health care; 6
(e) Offer or pay any type of material inducement, bonus or other 7
financial incentive to a provider of health care to deny, reduce, 8
withhold, limit or delay access to any such benefit to an insured; or 9
(f) Impose any other restrictions or delays on the access of an 10
insured to any such benefit. 11
4. A plan subject to the provisions of this chapter which is 12
delivered, issued for delivery or renewed on or after January 1, 13
2024, has the legal effect of including the coverage required by 14
subsection 1, and any provision of t he plan or the renewal which is 15
in conflict with this section is void. 16
5. Except as otherwise provided in this section and federal law, 17
a carrier may use medical management techniques, including, 18
without limitation, any available clinical evidence, to de termine the 19
frequency of or treatment relating to any benefit required by this 20
section or the type of provider of health care to use for such 21
treatment. 22
6. If the application of paragraph (a) of subsection 3 would 23
result in the ineligibility of a health savings account of an insured 24
pursuant to 26 U.S.C. § 223, the prohibitions of paragraph (a) of 25
subsection 3 shall apply only for a qualified health benefit plan with 26
respect to the deductible of such a health benefit plan after the 27
insured has satisfied t he minimum deductible pursuant to 26 U.S.C. 28
§ 223, except with respect to items or services that constitute 29
preventive care pursuant to 26 U.S.C. § 223(c)(2)(C), in which case 30
the prohibitions of paragraph (a) of subsection 3 shall apply 31
regardless of whet her the minimum deductible under 26 U.S.C. § 32
223 has been satisfied. 33
7. As used in this section [: 34
(a) “Medical management technique” means a practice which is 35
used to control the cost or utilization of health care services or 36
prescription drug use. The term includes, without limitation, the use 37
of step therapy, prior authorization or categorizing drugs and 38
devices based on cost, type or method of administration. 39
(b) “Network plan” means a health benefit plan offered by a 40
carrier under which the financi ng and delivery of medical care, 41
including items and services paid for as medical care, are provided, 42
in whole or in part, through a defined set of providers under contract 43
with the carrier. The term does not include an arrangement for the 44
financing of premiums. 45

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(c) “Provider of health care” has the meaning ascribed to it in 1
NRS 629.031. 2
(d) “Qualified] , “qualified health benefit plan” means a health 3
benefit plan that has a high deductible and is in compliance with 26 4
U.S.C. § 223 for the purposes of est ablishing a health savings 5
account. 6
Sec. 189. NRS 689C.1675 is hereby amended to read as 7
follows: 8
689C.1675 1. A carrier that issues a health benefit plan shall 9
provide coverage for the examination of a person who is pre gnant 10
for the discovery of: 11
(a) Chlamydia trachomatis, gonorrhea, hepatitis B and hepatitis 12
C in accordance with NRS 442.013. 13
(b) Syphilis in accordance with NRS 442.010. 14
2. The coverage required by this section must be provided: 15
(a) Regardless of whether the benefits are provided to the 16
insured by a provider of health care, facility or medical laboratory 17
that participates in the network plan of the carrier; and 18
(b) Without prior authorization. 19
3. A health benefit plan subject to the provisions of this chapter 20
that is delivered, issued for delivery or renewed on or after July 1, 21
2021, has the legal effect of including the coverage required by 22
subsection 1, and any provision of the plan that conflicts with the 23
provisions of this section is void. 24
4. As used in this section [: 25
(a) “Medical] , “medical laboratory” has the meaning ascribed 26
to it in NRS 652.060. 27
[(b) “Provider of health care” has the meaning ascribed to it in 28
NRS 629.031.] 29
Sec. 190. NRS 689C.1676 is hereby amended to read as 30
follows: 31
689C.1676 1. Except as otherwise provided in subsection 8, a 32
carrier that offers or issues a health benefit plan shall include in the 33
plan coverage for: 34
(a) Up to a 12 -month supply, per prescription, of any type of 35
drug for contraception or its therapeutic equivalent which is: 36
(1) Lawfully prescribed or ordered; 37
(2) Approved by the Food and Drug Administration; 38
(3) Listed in subsection 11; and 39
(4) Dispensed in accordance with NRS 639.28075; 40
(b) Any type of device for contraception which is: 41
(1) Lawfully prescribed or ordered; 42
(2) Approved by the Food and Drug Administration; and 43
(3) Listed in subsection 11; 44

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(c) Self-administered hormonal contraceptives dispensed by a 1
pharmacist pursuant to NRS 639.28078; 2
(d) Insertion of a device for contraception or removal of such a 3
device if the device was inserted while the insured was covered by 4
the same health benefit plan; 5
(e) Education and counseling relating to the initiation of the use 6
of contraception and any necessary follow -up after initiating such 7
use; 8
(f) Management of side effects relating to contraception; and 9
(g) Voluntary sterilization for women. 10
2. A carrier shall provide coverage for any services listed in 11
subsection 1 which are within the authorized scope of practice of a 12
pharmacist when such services are provided by a pharmacist who is 13
employed by or serves as an independent contractor of an in -14
network pharmacy and in accordance with the applicable provider 15
network contract. Such coverage must be provided to the same 16
extent as if the services were provided by another provider of health 17
care, as applicable to the services being provided. The terms of the 18
policy must not limit: 19
(a) Coverage for services listed in s ubsection 1 and provided by 20
such a pharmacist to a number of occasions less than the coverage 21
for such services when provided by another provider of health care. 22
(b) Reimbursement for services listed in subsection 1 and 23
provided by such a pharmacist to an amount less than the amount 24
reimbursed for similar services provided by a physician, physician 25
assistant or advanced practice registered nurse. 26
3. A carrier must ensure that the benefits required by 27
subsection 1 are made available to an insured through a provider of 28
health care who participates in the network plan of the carrier. 29
4. If a covered therapeutic equivalent listed in subsection 1 is 30
not available or a provider of health care deems a covered 31
therapeutic equivalent to be medically inappropriat e, an alternate 32
therapeutic equivalent prescribed by a provider of health care must 33
be covered by the carrier. 34
5. Except as otherwise provided in subsections 9, 10 and 12, a 35
carrier that offers or issues a health benefit plan shall not: 36
(a) Require an i nsured to pay a higher deductible, any 37
copayment or coinsurance or require a longer waiting period or 38
other condition to obtain any benefit included in the health benefit 39
plan pursuant to subsection 1; 40
(b) Refuse to issue a health benefit plan or cancel a health 41
benefit plan solely because the person applying for or covered by 42
the plan uses or may use any such benefit; 43

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(c) Offer or pay any type of material inducement or financial 1
incentive to an insured to discourage the insured from obtaining any 2
such benefit; 3
(d) Penalize a provider of health care who provides any such 4
benefit to an insured, including, without limitation, reducing the 5
reimbursement to the provider of health care; 6
(e) Offer or pay any type of material inducement, bonus or other 7
financial incentive to a provider of health care to deny, reduce, 8
withhold, limit or delay access to any such benefit to an insured; or 9
(f) Impose any other restrictions or delays on the access of an 10
insured to any such benefit. 11
6. Coverage pursuant to this section for the covered dependent 12
of an insured must be the same as for the insured. 13
7. Except as otherwise provided in subsection 8, a health 14
benefit plan subject to the provisions of this chapter that is 15
delivered, issued for delivery or renewed on or after January 1, 16
2024, has the legal effect of including the coverage required by this 17
section, and any provision of the plan or the renewal which is in 18
conflict with this section is void. 19
8. A carrier that offers or issues a health benefit plan and which 20
is affiliated with a religious organization is not required to provide 21
the coverage required by subsection 1 if the carrier objects on 22
religious grounds. Such a carrier shall, before the issuance of a 23
health benefit plan and before the renewal of s uch a plan, provide to 24
the prospective insured written notice of the coverage that the 25
carrier refuses to provide pursuant to this subsection. 26
9. A carrier may require an insured to pay a higher deductible, 27
copayment or coinsurance for a drug for contraception if the insured 28
refuses to accept a therapeutic equivalent of the drug. 29
10. For each of the 18 methods of contraception listed in 30
subsection 11 that have been approved by the Food and Drug 31
Administration, a health benefit plan must include at least one drug 32
or device for contraception within each method for which no 33
deductible, copayment or coinsurance may be charged to the 34
insured, but the carrier may charge a deductible, copayment or 35
coinsurance for any other drug or device that provides the same 36
method of contraception. If the carrier charges a copayment or 37
coinsurance for a drug for contraception, the carrier may only 38
require an insured to pay the copayment or coinsurance: 39
(a) Once for the entire amount of the drug dispensed for the plan 40
year; or 41
(b) Once for each 1-month supply of the drug dispensed. 42
11. The following 18 methods of contraception must be 43
covered pursuant to this section: 44
(a) Voluntary sterilization for women; 45

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(b) Surgical sterilization implants for women; 1
(c) Implantable rods; 2
(d) Copper-based intrauterine devices; 3
(e) Progesterone-based intrauterine devices; 4
(f) Injections; 5
(g) Combined estrogen- and progestin-based drugs; 6
(h) Progestin-based drugs; 7
(i) Extended- or continuous-regimen drugs; 8
(j) Estrogen- and progestin-based patches; 9
(k) Vaginal contraceptive rings; 10
(l) Diaphragms with spermicide; 11
(m) Sponges with spermicide; 12
(n) Cervical caps with spermicide; 13
(o) Female condoms; 14
(p) Spermicide; 15
(q) Combined estrogen - and progestin -based drugs for 16
emergency contraception or progestin -based drugs for emergency 17
contraception; and 18
(r) Ulipristal acetate for emergency contraception. 19
12. Except as otherwise provided in this section and federal 20
law, a carrier may use medical management techniques, including, 21
without limitation, any available clinical evidence, to determine the 22
frequency of or treatment relating to any benefit required by this 23
section or the type of provider of health care to use for such 24
treatment. 25
13. A carrier shall not: 26
(a) Use medical management techniques to require an insured to 27
use a method of contraception other than the method prescribed or 28
ordered by a provider of health care; 29
(b) Require an insured to obtain prior authorization for the 30
benefits described in paragraphs (a) and (c) of subsection 1; or 31
(c) Refuse to cover a contraceptive injection or the insertion of a 32
device described in paragraph (c), (d) or (e) of subsection 11 at a 33
hospital immediately after an insured gives birth. 34
14. A carrier must provide an accessible, tr ansparent and 35
expedited process which is not unduly burdensome by which an 36
insured, or the authorized representative of the insured, may request 37
an exception relating to any medical management technique used by 38
the carrier to obtain any benefit required by this section without a 39
higher deductible, copayment or coinsurance. 40
15. As used in this section: 41
(a) “In-network pharmacy” means a pharmacy that has entered 42
into a contract with a carrier to provide services to insureds through 43
a network plan offered or issued by the carrier. 44

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(b) [“Medical management technique” means a practice which is 1
used to control the cost or utilization of health care services or 2
prescription drug use. The term includes, without limitation, the use 3
of step therapy, prior authoriz ation or categorizing drugs and 4
devices based on cost, type or method of administration. 5
(c) “Network plan” means a health benefit plan offered by a 6
carrier under which the financing and delivery of medical care, 7
including items and services paid for as medical care, are provided, 8
in whole or in part, through a defined set of providers under contract 9
with the carrier. The term does not include an arrangement for the 10
financing of premiums. 11
(d)] “Provider network contract” [means] includes a contract 12
between a carrier and a [provider of health care or ] pharmacy 13
specifying the rights and responsibilities of the carrier and the 14
[provider of health care or ] pharmacy [, as applicable,] for delivery 15
of health care services pursuant to a network plan. 16
[(e) “Provider of health care” has the meaning ascribed to it in 17
NRS 629.031. 18
(f) “Therapeutic equivalent” means a drug which: 19
(1) Contains an identical amount of the same active 20
ingredients in the same dosage and method of administration as 21
another drug; 22
(2) Is expected to have the same clinical effect when 23
administered to a patient pursuant to a prescription or order as 24
another drug; and 25
(3) Meets any other criteria required by the Food and Drug 26
Administration for classification as a therapeutic equivalent.] 27
Sec. 191. NRS 689C.1678 is hereby amended to read as 28
follows: 29
689C.1678 1. A carrier that offers or issues a health benefit 30
plan shall include in the plan coverage for: 31
(a) Counseling, support and supplies for breastfe eding, 32
including breastfeeding equipment, counseling and education during 33
the antenatal, perinatal and postpartum period for not more than 1 34
year; 35
(b) Screening and counseling for interpersonal and domestic 36
violence for women at least annually, with initi al intervention 37
services consisting of education, strategies to reduce harm, 38
supportive services or a referral for any other appropriate services; 39
(c) Behavioral counseling concerning sexually transmitted 40
diseases from a provider of health care for sexual ly active women 41
who are at increased risk for such diseases; 42
(d) Hormone replacement therapy; 43

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(e) Such prenatal screenings and tests as recommended by the 1
American College of Obstetricians and Gynecologists or its 2
successor organization; 3
(f) Screening f or blood pressure abnormalities and diabetes, 4
including gestational diabetes, after at least 24 weeks of gestation or 5
as ordered by a provider of health care; 6
(g) Screening for cervical cancer at such intervals as are 7
recommended by the American College o f Obstetricians and 8
Gynecologists or its successor organization; 9
(h) Screening for depression; 10
(i) Screening and counseling for the human immunodeficiency 11
virus consisting of a risk assessment, annual education relating to 12
prevention and at least one screening for the virus during the 13
lifetime of the insured or as ordered by a provider of health care; 14
(j) Smoking cessation programs for an insured who is 18 years 15
of age or older consisting of not more than two cessation attempts 16
per year and four counseling sessions per year; 17
(k) All vaccinations recommended by the Advisory Committee 18
on Immunization Practices of the Centers for Disease Control and 19
Prevention of the United States Department of Health and Human 20
Services or its successor organization; and 21
(l) Such well-woman preventative visits as recommended by the 22
Health Resources and Services Administration, which must include 23
at least one such visit per year beginning at 14 years of age. 24
2. A carrier must ensure that the benefits required by 25
subsection 1 are made available to an insured through a provider of 26
health care who participates in the network plan of the carrier. 27
3. Except as otherwise provided in subsection 5, a carrier that 28
offers or issues a health benefit plan shall not: 29
(a) Require a n insured to pay a higher deductible, any 30
copayment or coinsurance or require a longer waiting period or 31
other condition to obtain any benefit provided in the health benefit 32
plan pursuant to subsection 1; 33
(b) Refuse to issue a health benefit plan or cance l a health 34
benefit plan solely because the person applying for or covered by 35
the plan uses or may use any such benefit; 36
(c) Offer or pay any type of material inducement or financial 37
incentive to an insured to discourage the insured from obtaining any 38
such benefit; 39
(d) Penalize a provider of health care who provides any such 40
benefit to an insured, including, without limitation, reducing the 41
reimbursement of the provider of health care; 42
(e) Offer or pay any type of material inducement, bonus or other 43
financial incentive to a provider of health care to deny, reduce, 44
withhold, limit or delay access to any such benefit to an insured; or 45

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(f) Impose any other restrictions or delays on the access of an 1
insured to any such benefit. 2
4. A plan subject to the provisions of this chapter that is 3
delivered, issued for delivery or renewed on or after January 1, 4
2018, has the legal effect of including the coverage required by 5
subsection 1, and any provision of the plan or the renewal which is 6
in conflict with this section is void. 7
5. Except as otherwise provided in this section and federal law, 8
a carrier may use medical management techniques, including, 9
without limitation, any available clinical evidence, to determine the 10
frequency of or treatment relating to any b enefit required by this 11
section or the type of provider of health care to use for such 12
treatment. 13
[6. As used in this section: 14
(a) “Medical management technique” means a practice which is 15
used to control the cost or utilization of health care services or 16
prescription drug use. The term includes, without limitation, the use 17
of step therapy, prior authorization or categorizing drugs and 18
devices based on cost, type or method of administration. 19
(b) “Network plan” means a health benefit plan offered by a 20
carrier under which the financing and delivery of medical care, 21
including items and services paid for as medical care, are provided, 22
in whole or in part, through a defined set of providers under contract 23
with the carrier. The term does not include an arrange ment for the 24
financing of premiums. 25
(c) “Provider of health care” has the meaning ascribed to it in 26
NRS 629.031.] 27
Sec. 192. NRS 689C.1682 is hereby amended to read as 28
follows: 29
689C.1682 1. A health benefit plan which pr ovides coverage 30
for prescription drugs must not require an insured to submit to a step 31
therapy protocol before covering a drug approved by the Food and 32
Drug Administration that is prescribed to treat a psychiatric 33
condition of the insured, if: 34
(a) The drug has been approved by the Food and Drug 35
Administration with indications for the psychiatric condition of the 36
insured or the use of the drug to treat that psychiatric condition is 37
otherwise supported by medical or scientific evidence; 38
(b) The drug is prescribed by: 39
(1) A psychiatrist; 40
(2) A physician assistant under the supervision of a 41
psychiatrist; 42
(3) An advanced practice registered nurse who has the 43
psychiatric training and experience prescribed by the State Board of 44
Nursing pursuant to NRS 632.120; or 45

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(4) A primary care provider that is providing care to an 1
insured in consultation with a practitioner listed in subparagraph (1), 2
(2) or (3), if the closest practitioner listed in subparagraph (1), (2) or 3
(3) who participates in the networ k plan of the health carrier is 4
located 60 miles or more from the residence of the insured; and 5
(c) The practitioner listed in paragraph (b) who prescribed the 6
drug knows, based on the medical history of the insured, or 7
reasonably expects each alternative drug that is required to be used 8
earlier in the step therapy protocol to be ineffective at treating the 9
psychiatric condition. 10
2. Any provision of a health benefit plan subject to the 11
provisions of this chapter that is delivered, issued for delivery or 12
renewed on or after July 1, 2023, which is in conflict with this 13
section is void. 14
3. As used in this section: 15
(a) “Medical or scientific evidence” has the meaning ascribed to 16
it in NRS 695G.053. 17
(b) [“Network plan” means a health benefit plan offered by a 18
health carrier under which the financing and delivery of medical 19
care is provided, in whole or in part, through a defined set of 20
providers under contract with the health carrier. The term does not 21
include an arrangement for the financing of premiums. 22
(c)] “Step therapy protocol” means a procedure that requires an 23
insured to use a prescription drug or sequence of prescription drugs 24
other than a drug that a practitioner recommends for treatment of a 25
psychiatric condition of the insured before his or her health benefit 26
plan provides coverage for the recommended drug. 27
Sec. 193. NRS 689C.1687 is hereby amended to read as 28
follows: 29
689C.1687 1. A carrier that issues a health benefit plan shall 30
include in the plan coverage for: 31
(a) Necessary case management services for an insured who has 32
been diagnosed with sickle cell disease and its variants; and 33
(b) Medically necessary care for an insured who has been 34
diagnosed with sickle cell disease and its variants. 35
2. A carrier that issues a health benefit plan which provides 36
coverage for prescription drugs shall include in the plan coverage 37
for medically necessary prescription drugs to treat sickle cell disease 38
and its variants. 39
3. A carrier may use medical management techniqu es, 40
including, without limitation, any available clinical evidence, to 41
determine the frequency of or treatment relating to any benefit 42
required by this section or the type of provider of health care to use 43
for such treatment. 44
4. As used in this section: 45

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(a) “Case management services” means medical or other health 1
care management services to assist patients and providers of health 2
care, including, without limitation, identifying and facilitating 3
additional resources and treatments, providing information a bout 4
treatment options and facilitating communication between providers 5
of services to a patient. 6
(b) [“Medical management technique” means a practice which is 7
used to control the cost or utilization of health care services. The 8
term includes, without lim itation, the use of step therapy, prior 9
authorization or categorizing drugs and devices based on cost, type 10
or method of administration. 11
(c)] “Medically necessary” has the meaning ascribed to it in 12
NRS 695G.055. 13
[(d)] (c) “Sickle cell disease and its variants” has the meaning 14
ascribed to it in NRS 439.4927. 15
Sec. 194. NRS 689C.1688 is hereby amended to read as 16
follows: 17
689C.1688 1. Subject to the limitations prescribed by 18
subsection 4, a carrier that issues a health b enefit plan shall include 19
in the plan coverage for medically necessary biomarker testing for 20
the diagnosis, treatment, appropriate management and ongoing 21
monitoring of cancer when such biomarker testing is supported by 22
medical and scientific evidence. Such evidence includes, without 23
limitation: 24
(a) The labeled indications for a biomarker test or medication 25
that has been approved or cleared by the United States Food and 26
Drug Administration; 27
(b) The indicated tests for a drug that has been approved by the 28
United States Food and Drug Administration or the warnings and 29
precautions included on the label of such a drug; 30
(c) A national coverage determination or local coverage 31
determination, as those terms are defined in 42 C.F.R. § 400.202; or 32
(d) Nationally re cognized clinical practice guidelines or 33
consensus statements. 34
2. A carrier shall: 35
(a) Provide the coverage required by subsection 1 in a manner 36
that limits disruptions in care and the need for multiple specimens. 37
(b) Establish a clear and readily acce ssible process for an 38
insured or provider of health care to: 39
(1) Request an exception to a policy excluding coverage for 40
biomarker testing for the diagnosis, treatment, management or 41
ongoing monitoring of cancer; or 42
(2) Appeal a denial of coverage for such biomarker testing; 43
and 44

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(c) Make the process described in paragraph (b) available on an 1
Internet website maintained by the carrier. 2
3. If a carrier requires an insured to obtain prior authorization 3
for a biomarker test described in subsection 1, t he carrier shall 4
respond to a request for such prior authorization: 5
(a) Within 24 hours after receiving an urgent request; or 6
(b) Within 72 hours after receiving any other request. 7
4. The provisions of this section do not require a carrier to 8
provide coverage of biomarker testing: 9
(a) For screening purposes; 10
(b) Conducted by a provider of health care for whom the 11
biomarker testing is not within his or her scope of practice, training 12
and experience; 13
(c) Conducted by a provider of health care or a fac ility that is 14
not in the applicable network plan of the carrier; or 15
(d) That has not been determined to be medically necessary by a 16
provider of health care for whom such a determination is within his 17
or her scope of practice, training and experience. 18
5. A health benefit plan subject to the provisions of this chapter 19
that is delivered, issued for delivery or renewed on or after 20
October 1, 2023, has the legal effect of including the coverage 21
required by this section, and any provision of the plan or re newal 22
which is in conflict with the provisions of this section is void. 23
6. As used in this section: 24
(a) “Biomarker” means a characteristic that is objectively 25
measured and evaluated as an indicator of a normal biological 26
process, a pathogenic process or a pharmacological response to a 27
specific therapeutic intervention and includes, without limitation: 28
(1) An interaction between a gene and a drug that is being 29
used by or considered for use by the patient; 30
(2) A mutation or characteristic of a gene; and 31
(3) The expression of a protein. 32
(b) “Biomarker testing” means the analysis of the tissue, blood 33
or other biospecimen of a patient for the presentation of a biomarker 34
and includes, without limitation, single -analyte tests, multiplex 35
panel tests and whole genome, whole exome and whole 36
transcriptome sequencing. 37
(c) “Consensus statement” means a statement aimed at a specific 38
clinical circumstance that is: 39
(1) Made for the purpose of optimizing the outcomes of 40
clinical care; 41
(2) Made by an independ ent, multidisciplinary panel of 42
experts that has established a policy to avoid conflicts of interest; 43
(3) Based on scientific evidence; and 44

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(4) Made using a transparent methodology and reporting 1
procedure. 2
(d) “Medically necessary” means health care s ervices or 3
products that a prudent provider of health care would provide to a 4
patient to prevent, diagnose or treat an illness, injury or disease, or 5
any symptoms thereof, that are necessary and: 6
(1) Provided in accordance with generally accepted standards 7
of medical practice; 8
(2) Not primarily provided for the convenience of the patient 9
or provider of health care; and 10
(3) Significant in guiding and informing the provider of 11
health care in providing the most appropriate course of treatment for 12
the patient in order to prevent, delay or lessen the magnitude of an 13
adverse health outcome. 14
(e) “Nationally recognized clinical practice guidelines” means 15
evidence-based guidelines establishing standards of care that 16
include, without limitation, recommendations intended to optimize 17
care of patients and are: 18
(1) Informed by a systemic review of evidence and an 19
assessment of the risks and benefits of alternative options for care; 20
and 21
(2) Developed using a transparent methodology and 22
reporting procedure by an i ndependent organization or society of 23
medical professionals that has established a policy to avoid conflicts 24
of interest. 25
[(f) “Provider of health care” has the meaning ascribed to it in 26
NRS 629.031.] 27
Sec. 195. NRS 689C.325 is hereby amended to read as 28
follows: 29
689C.325 A carrier that offers coverage through a network 30
plan is not required to offer coverage to or accept any applications 31
for coverage from the eligible employees of a small employer 32
pursuant to NRS 689B.560 and 689C.310 [and 689C.320] if: 33
1. The eligible employees do not reside or work in the 34
geographic service area of the network plan. 35
2. For a small employer whose eligible employees reside or 36
work in the geographic service area of the network plan , the carrier 37
demonstrates to the satisfaction of the Commissioner that the carrier 38
does not have the capacity to deliver adequate service to additional 39
small employers and eligible employees because of the existing 40
obligations of the carrier. If a carrier is authorized by the 41
Commissioner not to offer coverage pursuant to this subsection, the 42
carrier shall not thereafter offer coverage to additional small 43
employers and eligible employees within that geographic service 44
area until the carrier demonstrates to the satisfaction of the 45

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Commissioner that it has regained the capacity to deliver adequate 1
service to additional small employers and eligible employees within 2
that service area. 3
Sec. 196. NRS 689C.425 is hereby amended to read as 4
follows: 5
689C.425 A voluntary purchasing group and any contract 6
issued to such a group pursuant to NRS 689C.360 to 689C.600, 7
inclusive, are subject to the provisions of NRS 689C.015 to 8
689C.355, inclusive, and sections 176 to 179, inclusive, of this act 9
to the extent applicable and not in conflict with the express 10
provisions of NRS 687B.408 and 689C.360 to 689C.600, inclusive. 11
Sec. 197. NRS 690A.260 is hereby amended to read a s 12
follows: 13
690A.260 1. Except as otherwise provided in subsection 2, 14
an authorized insurer issuing consumer credit insurance may not 15
enter into any agreement whereby the authorized insurer transfers, 16
by reinsurance or otherwise, to an unauthorized insur er, as they 17
relate to consumer credit insurance written or issued in this State: 18
(a) A substantial portion of the risk of loss under the consumer 19
credit insurance written by the authorized insurer in this State; 20
(b) All of one or more kinds, lines, types or classes of consumer 21
credit insurance; 22
(c) All of the consumer credit insurance produced through one 23
or more agents, agencies or creditors; 24
(d) All of the consumer credit insurance written or issued in a 25
designated geographical area; or 26
(e) All of the consumer credit insurance under a policy of group 27
insurance. 28
2. An authorized insurer may make the transfers listed in 29
subsection 1 to an unauthorized insurer if the unauthorized insurer: 30
(a) Maintains security on deposit with the Commissioner in an 31
amount which when added to the actual capital and surplus of the 32
insurer is equal to the capital and surplus required of an authorized 33
stock insurer pursuant to NRS 680A.120. The security may consist 34
only of the following: 35
(1) Cash. 36
(2) General obligations of, or obligations guaranteed by, the 37
Federal Government, this State or any of its political subdivisions. 38
These obligations must be valued at the lower of market value or par 39
value. 40
(3) Any other type of security that would be acceptable if 41
posted by a domestic or foreign insurer. 42
(b) Files an annual statement with the Commissioner pursuant to 43
NRS 680A.270. 44

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(c) Maintains reserves on its consumer credit insurance business 1
pursuant to NRS 681B.050. 2
(d) Values its assets and liabilities pursuant to NRS 681B.010 to 3
681B.040, inclusive. 4
(e) Agrees to examinations conducted by the Commissioner 5
pursuant to [NRS 679B.230.] section 15 of this act. 6
(f) Complies with the standards adopted by the Commissioner 7
pursuant to NRS 679A.150. 8
(g) Does not hold, issue or have an arrangement for holding or 9
issuing any of its stock for which dividends are paid based on: 10
(1) The experience of a specific risk of all of one or more 11
kinds, lines, types or classes of insurance; 12
(2) All of the business produced through one or more agents, 13
agencies or creditors; 14
(3) All of the business written in a designated geographical 15
area; or 16
(4) All of the business written for one or more forms of 17
insurance. 18
Sec. 198. Chapter 690C of NRS is hereby amended by adding 19
thereto the provisions set forth as sections 199 and 200 of this act. 20
Sec. 199. 1. A person who wishes to act as an administrator 21
for a provider must obtain a certificate of registration issued by 22
the Commissioner pursuant to NRS 683A.08524. 23
2. A person who acts as an administrator pursuant to this 24
chapter shall: 25
(a) Administer from one or more offices loca ted in this State 26
all of the claims arising under each service contract that the 27
person administers; 28
(b) Maintain in the offices described in paragraph (a) all of 29
the records concerning the claims described in paragraph (a); 30
(c) Administer each service c ontract directly without 31
subcontracting with another administrator or person; 32
(d) If the contract between the administrator and the provider 33
is terminated, transfer all of the records in possession of the 34
administrator concerning any claim arising under a service 35
contract to any other administrator that is chosen by the provider; 36
and 37
(e) Comply with the requirements of chapter 683A of NRS and 38
all other relevant provisions of this title for administrators. 39
Sec. 200. The Commissioner may order any person to cease 40
and desist any conduct that violates any provision of this chapter. 41

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Sec. 201. NRS 690C.020 is hereby amended to read as 1
follows: 2
690C.020 “Administrator” means a person who [is responsible 3
for administering] administers a service contract that is issued, sold 4
or offered for sale by a provider. 5
Sec. 202. NRS 690C.070 is hereby amended to read as 6
follows: 7
690C.070 “Provider” means a person who [is obligated to a 8
holder pursuant] : 9
1. Issues, sells or offers for sale service contracts; or 10
2. Pursuant to the terms of a service contract [to repair, 11
replace] , repairs, replaces or [perform] performs maintenance on, 12
or [to indemnify] indemnifies the holder for the costs of repairing, 13
replacing or performing maintenance on, goods. 14
Sec. 203. NRS 690C.120 is hereby amended to read as 15
follows: 16
690C.120 1. Except as otherwise provided in this chapter, the 17
marketing, issu ance, sale, offering for sale, making, proposing to 18
make and administration of service contracts are not subject to the 19
provisions of this title, except, when applicable, the provisions of: 20
(a) NRS 679B.020 to 679B.152, inclusive; 21
(b) NRS 679B.159 to [679B.300,] 679B.228, inclusive; 22
(c) NRS 679B.310 to 679B.370, inclusive; 23
(d) NRS 679B.600 to 679B.690, inclusive; 24
(e) Sections 2 to 41, inclusive, of this act; 25
(f) NRS 685B.090 to 685B.190, inclusive; 26
[(f)] (g) NRS 686A.010 to 686A.095, inclusive; 27
[(g)] (h) NRS 686A.160 to 686A.187, inclusive; and 28
[(h)] (i) NRS 686A.260, 686A.270, 686A.280, 686A.300 and 29
686A.310. 30
2. A provider, person who sells service contracts, administrator 31
or any other person is not required to obtain a certificate of authority 32
from the Commissioner pursuant to chapter 680A of NRS to issue, 33
sell, offer for sale or administer service contracts. 34
Sec. 204. NRS 690C.150 is hereby amended to read as 35
follows: 36
690C.150 1. A [provider] person shall not [issue, sell or offer 37
for sale service contracts in t his state ] act or offer to act in the 38
capacity of a provider, perform any of the functions, duties or 39
powers prescribed for a provider or hold himself or herself out to 40
the public as a provider unless the [provider] person is qualified 41
and has been issued a certificate of registration as a provider 42
pursuant to the provisions of this chapter. 43
2. A person shall not act or offer to act in the capacity of an 44
administrator, perform any of the functions, duties or powers 45

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prescribed for an admini strator or hold himself or herself out to 1
the public as an administrator unless the person is qualified and 2
has obtained a certificate of registration issued by the 3
Commissioner pursuant to NRS 683A.08524. 4
3. The Commissioner may impose an administrative fine of 5
not more than $5,000 for each act or violation of the provisions of 6
subsection 1 or 2. 7
4. For the protection of the people of this State, the 8
Commissioner shall not issue or renew, or permit to exist, any 9
certificate or registration: 10
(a) For a provider or administrator except in compliance with 11
the provisions of this chapter and chapter 683A of NRS, as 12
applicable. 13
(b) For any person found to be untrustworthy or incompetent, 14
or who has not established to the satisfaction of the Commissioner 15
that the person is qualified for a certificate or registration in 16
accordance with this chapter and chapter 683A of NRS, as 17
applicable. 18
Sec. 205. NRS 690C.160 is hereby amended to read as 19
follows: 20
690C.160 1. A [provider] person who wishes to issue, sell or 21
offer for sale service contracts in this state must submit to the 22
Commissioner: 23
(a) A registration application on a form prescribed by the 24
Commissioner; 25
(b) Proof that the [provider] person has complied with the 26
requirements for financial security set forth in NRS 690C.170; 27
(c) A copy of each type of service contract the [provider] person 28
proposes to issue, sell or offer for sale; 29
(d) The name, address and telephone number of each 30
administrator with whom the [provider] person intends to contract; 31
(e) A fee of [$2,000] $1,000 and all applicable fees required 32
pursuant to NRS 680C.110 to be paid at the time of application; and 33
(f) The following information for each controlling person: 34
(1) Whether the person, in the last 10 years, has been: 35
(I) Convicted of a felony or misdemeanor of which an 36
essential element is fraud; 37
(II) Insolvent or adjudged bankrupt; 38
(III) Refused a license or registration as a service contract 39
provider or had an existing license or regis tration as a service 40
contract provider suspended or revoked by any state or 41
governmental agency or authority; or 42
(IV) Fined by any state or governmental agency or 43
authority in any matter regarding service contracts; and 44

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(2) Whether there are any pendi ng criminal actions against 1
the person other than moving traffic violations. 2
2. In addition to the fee required by subsection 1, a [provider] 3
person must pay a fee of $25 for each type of service contract the 4
[provider] person files with the Commissioner. 5
3. Each year, not later than the anniversary date of his or her 6
certificate of registration, a provider must pay the annual fee 7
required pursuant to NRS 680C.110 in addition to any other fee 8
required pursuant to this section. 9
4. A certificate of registration is valid for [2 years] 1 year after 10
the date the Commissioner issues the certificate to the provider. A 11
provider may renew his or her certificate of registration if, not later 12
than 60 days before the certificate expires, the provider s ubmits to 13
the Commissioner: 14
(a) An application on a form prescribed by the Commissioner; 15
(b) A fee of [$2,000] $1,000 and, in addition to any other fee or 16
charge, all applicable fees required pursuant to subsection 3; and 17
(c) The information required by paragraph (f) of subsection 1: 18
(1) If an existing controlling person has had a change in any 19
of the information previously submitted to the Commissioner; or 20
(2) For a controlling person who has not previously 21
submitted the information required by para graph (f) of subsection 1 22
to the Commissioner. 23
5. All fees paid pursuant to this section are nonrefundable. 24
6. Each application submitted pursuant to this section, 25
including, without limitation, an application for renewal, must: 26
(a) Be signed by an e xecutive officer, if any, of the [provider] 27
applicant or, if the [provider] applicant does not have an executive 28
officer, by a controlling person of the [provider;] applicant; and 29
(b) Have attached to it an affidavit signed by the person 30
described in paragraph (a) which meets the requirements of 31
subsection 7. 32
7. Before signing the application described in subsection 6, the 33
person who signs the application shall verify that the information 34
provided is accurate to the best of his or her knowledge. 35
Sec. 206. NRS 690C.170 is hereby amended to read as 36
follows: 37
690C.170 1. To be issued a certificate of registration, a 38
provider must comply with one of the following to provide for 39
financial security: 40
(a) Purchase a contrac tual liability insurance policy which 41
insures the obligations of each service contract the provider issues, 42
sells or offers for sale. The contractual liability insurance policy 43
must: 44

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(1) Be issued by an insurer which is licensed, registered or 1
otherwise authorized to transact insurance in this state or pursuant to 2
the provisions of chapter 685A of NRS. 3
(2) Contain a provision prohibiting the insurer from 4
terminating the policy until a notice of termination has been mailed 5
or delivered to the Commissione r at least 60 days prior to the 6
termination of the policy. Any such termination shall not reduce 7
the responsibility of the insurer for service contracts issued by the 8
provider prior to the effective date of termination. 9
(b) [Maintain a reserve account in this State and deposit with the 10
Commissioner security as provided in this subsection. The reserve 11
account must contain at all times an amount of money equal to at 12
least 40 percent of the unearned gross consideration received by the 13
provider for any unexpi red service contracts. The reserve account 14
must be kept separate from the operating accounts of the provider 15
and must be clearly identified as the “ (Provider’s Name) Nevada 16
Service Contracts Funded Reserve Account.” The Commissioner 17
may examine the reserv e account at any time. The provider shall 18
also deposit with the Commissioner security in an amount that is 19
equal to $25,000 or 10 percent of the unearned gross consideration 20
received by the provider for any unexpired service contracts, 21
whichever is greater. The security must be: 22
(1) A surety bond issued by a surety company authorized to 23
do business in this State; 24
(2) Securities of the type eligible for deposit pursuant to 25
NRS 682B.030; 26
(3) Cash; 27
(4) An irrevocable letter of credit issued by a financial 28
institution approved by the Commissioner; or 29
(5) In any other form prescribed by the Commissioner. 30
(c)] Maintain, or be a subsidiary of a parent company that 31
maintains, a net worth or stockholders’ equity of at least 32
$100,000,000. Upon request , a provider shall provide to the 33
Commissioner a copy of the most recent Form 10 -K report or Form 34
20-F report filed by the provider or parent company of the provider 35
with the Securities and Exchange Commission within the previous 36
year. If the provider or p arent company is not required to file those 37
reports with the Securities and Exchange Commission, the provider 38
shall provide to the Commissioner a copy of the most recently 39
audited financial statements of the provider or parent company. If 40
the net worth or stockholders’ equity of the parent company of the 41
provider is used to comply with the requirements of this subsection, 42
the parent company must guarantee to carry out the duties of the 43
provider under any service contract issued or sold by the provider. 44

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2. [A provider shall not use any money in a reserve account 1
described in paragraph (b) of subsection 1 for any purpose other 2
than to pay an obligation of the provider under an unexpired service 3
contract. 4
3.] A provider shall maintain the financial security required by 5
subsection 1 until: 6
(a) The provider ceases doing business in this State; and 7
(b) The provider has performed or otherwise satisfied all 8
liabilities and obligations under all unexpired service contracts 9
issued by the provider. 10
[4.] 3. If th e certificate of registration of a provider has not 11
expired and the provider fails to maintain the financial security 12
required by subsection 1, including, without limitation, if the 13
financial security is cancelled or lapses, the provider shall not issue 14
or sell a service contract on or after the effective date of such failure 15
until the provider submits to the Commissioner proof satisfactory 16
to the Commissioner that the provider is in compliance with 17
subsection 1. 18
Sec. 207. NRS 690C.200 is hereby amended to read as 19
follows: 20
690C.200 1. Except as otherwise provided in this section, a 21
provider shall not include in the name of the business of the 22
provider: 23
(a) The words “insurance,” “casualty,” “surety,” “mutual” or 24
any other word or term that implies that the provider is [engaged in 25
the business of transacting ] an insurance or [is a] surety company; 26
or 27
(b) A name that is deceptively similar to the name or description 28
of an insurer or surety company or the name of another provider. 29
2. A provider may include the word “guaranty” or a similar 30
word in the name of the business of the provider. 31
3. This section does not apply to a provider who, before 32
January 1, 2000, includes in the name of the business of the provider 33
a name t hat does not comply with the provisions of subsection 1. 34
Such a provider shall include in each service contract the provider 35
issues, sells or offers for sale a statement that the service contract is 36
not a contract of insurance. 37
Sec. 208. NRS 690C.260 is hereby amended to read as 38
follows: 39
690C.260 1. A service contract must: 40
(a) Be written in language that is understandable and printed in a 41
typeface that is easy to read. 42
(b) Indicate that it is insured by a contractual l iability insurance 43
policy if it is so insured, and include the name and address of the 44
issuer of the policy or that it is backed by the full faith and credit of 45

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the provider if the service contract is not insured by a contractual 1
liability insurance policy. 2
(c) Include the amount of any deductible that the holder is 3
required to pay. 4
(d) Include the name and address of the provider and : [, if 5
applicable:] 6
(1) The name and address of the administrator [;] , if 7
applicable; and 8
(2) The name of the holder . [, if provided by the holder.] 9
 The names and addresses of such persons are not required to be 10
preprinted on the service contract and may be added to the service 11
contract at the time of the sale. 12
(e) Include the purchase price of the service contract. The 13
purchase price must be determined pursuant to a schedule of fees 14
established by the provider. The purchase price is not required to be 15
preprinted on the service contract and may be negotiated with the 16
holder and added to the service contract at the time of sale. 17
(f) Include a description of the goods covered by the service 18
contract. 19
(g) Specify the duties of the provider and any limitations, 20
exceptions or exclusions. 21
(h) If the service contract covers a motor vehicle, indicate 22
whether replacement parts that are not made for or by the original 23
manufacturer of the motor vehicle may be used to comply with the 24
terms of the service contract. 25
(i) Include any restrictions on transferring or renewing the 26
service contract. 27
(j) Include the terms, restrictions or conditions for cancelling the 28
service contract before it expires and the procedure for cancelling 29
the service contract. The conditions for cancelling the service 30
contract must include, without limitation, the provisions o f 31
NRS 690C.270. 32
(k) Include the duties of the holder under the contract, including, 33
without limitation, the duty to protect against damage to the goods 34
covered by the service contract or to comply with any instructions 35
included in the owner’s manual for the goods. 36
(l) Indicate whether the service contract authorizes the holder to 37
recover consequential damages. 38
(m) Indicate whether any defect in the goods covered by the 39
service contract existing on the date the contract is purchased is not 40
covered under the service contract. 41
2. A provider shall not allow, make or cause to be made a false 42
or misleading statement in any of the service contracts of the 43
provider or intentionally omit a material statement that causes a 44
service contract to be misleading. The Commissioner may require 45

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the provider to amend any service contract that the Commissioner 1
determines is false or misleading. 2
Sec. 209. NRS 690C.310 is hereby amended to read as 3
follows: 4
690C.310 1. A provider shall maint ain records of the 5
transactions governed by this chapter. The records of a provider 6
must include: 7
(a) A copy of each type of service contract that the provider 8
issues, sells or offers for sale; 9
(b) The name and address of each holder who possesses a 10
service contract under which the provider has a duty to perform ; [, 11
to the extent that the provider knows the name and address of each 12
holder;] 13
(c) A list that includes each location where the provider issues, 14
sells or offers for sale service contracts; and 15
(d) The date and a description of each claim made by a holder 16
under a service contract. 17
2. Except as otherwise provided in this subsection, a provider 18
shall retain all records relating to a service contract for at least [1 19
year] 3 years after the contract has expired. A provider who intends 20
to discontinue doing business in this state shall provide the 21
Commissioner with satisfactory proof that the provider has 22
discharged his or her duties to the holders in this state and shall not 23
destroy his or her recor ds without the prior approval of the 24
Commissioner. 25
3. The records required to be maintained pursuant to this 26
section may be stored on a computer disc or other storage device for 27
a computer from which the records can be readily printed. 28
Sec. 210. NRS 690C.320 is hereby amended to read as 29
follows: 30
690C.320 1. Except as otherwise provided in this subsection, 31
the Commissioner may conduct examinations to enforce the 32
provisions of this chapter pursuant to the provisions of [NRS 33
679B.230 to 679B.300, ] sections 2 to 41, inclusive, of this act at 34
such times as the Commissioner deems necessary. The 35
Commissioner is not required to comply with the requirement in 36
[NRS 679B.230] section 15 of this act that insurers be examined not 37
less frequently than every 5 years in the enforcement of this chapter. 38
2. A provider shall, upon the request of the Commissioner, 39
make availab le to the Commissioner for inspection any accounts, 40
books and records concerning any service contract issued, sold or 41
offered for sale by the provider which are reasonably necessary to 42
enable the Commissioner to determine whether the provider is in 43
compliance with the provisions of this chapter. 44

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Sec. 211. NRS 690C.325 is hereby amended to read as 1
follows: 2
690C.325 1. The Commissioner may refuse to renew or may 3
suspend, limit or revoke a provider’s certificate of registration if the 4
Commissioner finds after a hearing thereon, or upon waiver of 5
hearing by the provider, that the provider has: 6
(a) Violated or failed to comply with any lawful order of the 7
Commissioner; 8
(b) Conducted business in an unsuitable manner; 9
(c) Willfully violated or willfully failed to comply with any 10
lawful regulation of the Commissioner; or 11
(d) Violated any provision of this chapter. 12
 In lieu of such a suspension or revocation, the Commissioner 13
may levy upon the provider, and the provider shall pay forthwith, an 14
administrative fine of not more than $1,000 for each act or violation. 15
2. The Commissioner shall suspend or revoke a provider’s 16
certificate of registration on any of the following grounds if the 17
Commissioner finds after a hearing thereon that the provider: 18
(a) Is in unsound condition, is being fraudulently conducted, or 19
is in such a condition or is using such methods and practices in the 20
conduct of its business as to render its further transaction of service 21
contracts in this State currently or prospectively injurious to service 22
contract holders or to the public. 23
(b) Refuses to be examined, or its directors, officers, employees 24
or representatives refuse to submit to examination relative to its 25
affairs, or to produce its books, papers, records, contracts, 26
correspondence or other documents for examination by the 27
Commissioner when required, or refuse to perform any legal 28
obligation relative to the examination. 29
(c) Has failed to pay any final judgment rendered against it in 30
this S tate upon any policy, bond, recognizance or undertaking as 31
issued or guaranteed by it, within 30 days after the judgment 32
became final or within 30 days after dismissal of an appeal before 33
final determination, whichever date is the later. 34
3. The Commissioner may, without advance notice or a hearing 35
thereon, immediately suspend the certificate of registration of any 36
provider that has [filed] : 37
(a) Violated a cease and desist order of the Commissioner; or 38
(b) Filed for bankruptcy or otherwise been deemed insolvent. 39
Sec. 212. NRS 690C.330 is hereby amended to read as 40
follows: 41
690C.330 [A] Except as otherwise provided in NRS 42
690C.150, a person who violates any provision of this chapter or an 43
order or regulation of the Commi ssioner issued or adopted pursuant 44
thereto may be assessed a civil penalty by the Commissioner of not 45

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more than [$500] $1,000 for each act or violation . [, not to exceed 1
an aggregate amount of $10,000 for violations of a similar nature. 2
For the purposes of this section, violations shall be deemed to be of 3
a similar nature if the violations consist of the same or similar 4
conduct, regardless of the number of times the conduct occurred.] 5
Sec. 213. NRS 691C.380 is hereby amended to read as 6
follows: 7
691C.380 1. Except as otherwise provided in subsection 2, an 8
authorized insurer issuing credit personal property insurance may 9
not enter into any agreement whereby the authorized insurer 10
transfers, by reinsurance or otherwise, to an unauthorized insurer, as 11
they relate to credit personal property insurance written or issued in 12
this State: 13
(a) A substantial portion of the risk of loss under the credit 14
personal property insurance written by the authorized insurer in this 15
State; 16
(b) All of one or more kinds, lines, types or classes of credit 17
personal property insurance; 18
(c) All of the credit personal property insurance produced 19
through one or more agents, agencies or creditors; 20
(d) All of the credit personal property insurance written or 21
issued in a designated geographical area; or 22
(e) All of the credit personal property insurance under a policy 23
of group insurance. 24
2. An authorized insurer may make the transfers listed in 25
subsection 1 to an unauthorized insurer if the unauthorized insurer: 26
(a) Maintains security on deposit with the Commissioner in an 27
amount which when added to the actual capital and surplus of the 28
insurer is equal to the capital and surplus required of an authorized 29
stock insurer pursuant to NRS 680A.120. Th e security may consist 30
only of the following: 31
(1) Cash. 32
(2) General obligations of, or obligations guaranteed by, the 33
Federal Government, this State or any of its political subdivisions. 34
These obligations must be valued at the lower of market value or par 35
value. 36
(3) Any other type of security that would be acceptable if 37
posted by a domestic or foreign insurer. 38
(b) Files an annual statement with the Commissioner pursuant to 39
NRS 680A.270. 40
(c) Maintains reserves on its credit personal property insuranc e 41
business pursuant to NRS 681B.050. 42
(d) Values its assets and liabilities pursuant to NRS 681B.010 to 43
681B.040, inclusive. 44

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(e) Agrees to examinations conducted by the Commissioner 1
pursuant to [NRS 679B.230.] section 15 of this act. 2
(f) Complies with the standards adopted by the Commissioner 3
pursuant to NRS 679A.150. 4
(g) Does not hold, issue or have an arrangement for holding or 5
issuing any of its stock for which dividends are paid based on: 6
(1) The experience of a specific risk of all of one or more 7
kinds, lines, types or classes of insurance; 8
(2) All of the business produced through one or more agents, 9
agencies or creditors; 10
(3) All of the business written in a designated geographical 11
area; or 12
(4) All of the business written for one or more forms of 13
insurance. 14
Sec. 214. NRS 692A.100 is hereby amended to read as 15
follows: 16
692A.100 1. The Commissioner shall provide by regulation 17
for the licensing of title agents, their branch offices, direct writing 18
title insurers and escrow officers. 19
2. Each title agent shall maintain his or her books of account 20
and record and his or her vouchers pertaining to title insurance 21
business in a manner which permits the Commissioner or a 22
representative of the Commissioner to ascertain readily whether the 23
agent has complied with the provisions of this chapter. 24
3. A title agent or escrow officer may engage in the business of 25
handling escrows, settlements and closings if the title agent or 26
escrow officer maintains a separate record of all receipts and 27
disbursements of money held in escrow and does not commingle 28
that money with his or her own. 29
4. For the purpose of determini ng its financial condition, 30
fulfillment of its contractual obligations and compliance with law, 31
the Commissioner or a representative of the Commissioner or the 32
Commissioner of [Financial Institutions] Mortgage Lending of the 33
Department of Business and Indu stry or a representative of 34
the Commissioner of [Financial Institutions] Mortgage Lending of 35
the Department of Business and Industry when requested by the 36
Commissioner of Insurance shall each year examine or cause to be 37
examined the affairs, transactions, agreements, assets, records and 38
accounts, including the escrow accounts, of a title agent, title insurer 39
or escrow officer. 40
5. A title agent or insurer may engage a certified public 41
accountant to perform such an examination in lieu of the 42
Commissioner. In such a case, the examination must be equivalent 43
to the type of examination made by the Commissioner and the 44
expense must be borne by the title agent or insurer being examined. 45

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6. The Commissioner shall determine whether an examination 1
performed by an accountant pursuant to subsection 5 is equivalent to 2
an examination conducted by the Commissioner. The Commissioner 3
may examine any area of the operation of a title agent or insurer if 4
the Commissioner determines that the examination of that area is 5
not equivalent to an examination conducted by the Commissioner. 6
7. A person shall not become licensed to circumvent the 7
provisions of this chapter or any other law of this state. 8
Sec. 215. NRS 692A.1045 is hereby amended to read as 9
follows: 10
692A.1045 1. The Commissioner shall establish by 11
regulation the fees to be paid by title agents and title insurers for 12
their supervision and examination by the Commissioner or a 13
representative of the Commissioner. 14
2. In establishing t he fees pursuant to subsection 1, the 15
Commissioner shall consider: 16
(a) The complexity of the various examinations to which the 17
fees apply; 18
(b) The skill required to conduct such examinations; 19
(c) The expenses associated with conducting such examinations 20
and preparing reports; and 21
(d) Any other factors the Commissioner deems relevant. 22
3. The Commissioner shall, with the approval of the 23
Commissioner of [Financial Institutions,] Mortgage Lending of the 24
Department of Business and Industry, adopt regulatio ns 25
prescribing the standards for determining whether a title insurer or 26
title agent has maintained adequate supervision of a title agent or 27
escrow officer pursuant to the provisions of this chapter. 28
Sec. 216. NRS 692C.290 i s hereby amended to read as 29
follows: 30
692C.290 1. Each registered insurer shall keep current the 31
information required to be disclosed in its registration statement by 32
reporting all material changes or additions on forms provided by the 33
Commissioner within 15 days after the end of the month in which it 34
learns of each such change or addition, and not less often than 35
annually, except that, subject to the provisions of NRS 692C.390, 36
each registered insurer shall report all dividends and other 37
distributions to shareholders within 5 business days following the 38
declaration and 10 days before payment. 39
2. The principal of a registered insurer shall file an annual 40
report of enterprise risk pursuant to this subsection. If the principal 41
of a registered insurer does not file a report of enterprise risk with 42
the commissioner of the lead state of the insurance company system, 43
as determined by the most recent edition of the Financial Analysis 44
Handbook, published by the NAIC, in a calendar year, the principal 45

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shall file a report of enterprise risk with the Commissioner. The 1
principal shall include in the report the material risks within the 2
insurance holding company system that, to the best of his or her 3
knowledge and belief, may pose enterprise risk to the registered 4
insurer. 5
3. Except as otherwise provided in this subsection, the ultimate 6
controlling person of ev ery insurer subject to registration shall 7
concurrently file with the registration an annual group capital 8
calculation as directed by the lead state commissioner. The report 9
shall be completed in accordance with the Group Capital 10
Calculation Instructions, w hich may permit the lead state 11
commissioner to allow a controlling person that is not the ultimate 12
controlling person to file the group capital calculation. The report 13
shall be filed with the lead state commissioner of the insurance 14
holding company system as determined by the Commissioner in 15
accordance with the procedures within the Financial Analysis 16
Handbook adopted by the NAIC. An insurance holding company 17
system is exempt from filing the group capital calculation if it is: 18
(a) An insurance holding comp any system that has only one 19
insurer within its holding company structure, that only writes 20
business and is only licensed in its domestic state and that assumes 21
no business from any other insurer. 22
(b) Except as otherwise provided in this paragraph, an ins urance 23
holding company system that is required to perform a group capital 24
calculation specified by the United States Federal Reserve Board. 25
The lead state commissioner shall request the calculation from the 26
Federal Reserve Board under the terms of informat ion sharing 27
agreements currently in effect. If the Federal Reserve Board cannot 28
share the calculation with the lead state commissioner, the insurance 29
holding company system is not exempt from the group capital 30
calculation filing. 31
(c) An insurance holding company system whose non -United 32
States group -wide supervisor is located within a reciprocal 33
jurisdiction as defined in NRS 681A.062 that recognizes the United 34
States’s state regulatory approach to group supervision and group 35
capital. 36
(d) An insurance holding company system: 37
(1) That provides information to the lead state that meets the 38
requirements for accreditation under the NAIC financial standards 39
and accreditation program, either directly or indirectly through the 40
group-wide supervisor, who has deter mined such information is 41
satisfactory to allow the lead state to comply with the NAIC group 42
supervision approach, as detailed in the NAIC Financial Analysis 43
Handbook; and 44

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(2) Whose non -United States group -wide supervisor that is 1
not in a reciprocal juri sdiction as defined in NRS 681A.062 2
recognizes and accepts, as specified by the Commissioner in 3
regulation, the group capital calculation as the world -wide group 4
capital assessment for United States insurance groups who operate 5
in that jurisdiction. 6
4. Notwithstanding the provisions of paragraphs (c) and (d) of 7
subsection 3, a lead state commissioner shall require the group 8
capital calculation for United States operations of any non -United 9
States based insurance holding company system where, after an y 10
necessary consultation with other supervisors or officials, it is 11
deemed appropriate by the lead state commissioner for prudential 12
oversight and solvency monitoring purposes or for ensuring the 13
competitiveness of the insurance marketplace. 14
5. Notwithstanding the exemptions from filing the group 15
capital calculation stated in paragraphs (a) to (d), inclusive, of 16
subsection 3, the lead state commissioner has the discretion to 17
exempt the ultimate controlling person from filing the annual group 18
capital calcu lation or to accept a limited group capital filing or 19
report in accordance with criteria as specified by the Commissioner 20
in regulation. 21
6. If the lead state commissioner determines that an insurance 22
holding company system no longer meets one or more of the 23
requirements for an exemption from filing the group capital 24
calculation under subsection 3, the insurance holding company 25
system shall file the group capital calculation at the next annual 26
filing date unless given an extension by the lead state commiss ioner 27
based on reasonable grounds shown. 28
7. The ultimate controlling person of every insurer subject to 29
registration and also scoped into the NAIC Liquidity Stress Test 30
Framework shall file the results of a specific year’s liquidity stress 31
test. The fili ng shall be made to the lead state insurance 32
commissioner of the insurance holding company system as 33
determined by the procedures within the Financial Analysis 34
Handbook adopted by the NAIC. 35
8. For the purposes of subsection 7: 36
(a) The NAIC Liquidity Stress Test Framework and the included 37
scope criteria applicable to a specific data year, which are reviewed 38
at least annually by the NAIC Financial Stability Task Force or its 39
successor, and any change to the NAIC Liquidity Stress Test 40
Framework or to the da ta year for which the scope criteria are to be 41
measured, are effective on January 1 of the year following the 42
calendar year when such changes are adopted by the NAIC. 43
(b) An insurer which meets at least one threshold of the scope 44
criteria is considered sc oped into the NAIC Liquidity Stress Test 45

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Framework for the specified data year unless the lead state 1
insurance commissioner, in consultation with the NAIC Financial 2
Stability Task Force or its successor, determines the insurer should 3
not be scoped into the NAIC Liquidity Stress Test Framework for 4
that data year. 5
(c) An insurer that does not trigger at least one threshold of the 6
scope criteria is not considered scoped into the NAIC Liquidity 7
Stress Test Framework for the specified data year unless the lead 8
state insurance commissioner, in consultation with the NAIC 9
Financial Stability Task Force or its successor, determines the 10
insurer should be scoped into the NAIC Liquidity Stress Test 11
Framework for that data year. 12
9. The lead state commissioner, in con sultation with the NAIC 13
Financial Stability Task Force or its successor, will assess whether 14
an insurer is scoped in or not scoped into the NAIC Liquidity Stress 15
Test Framework as part of the lead state commissioner’s 16
determinations pursuant to this section for an insurer. 17
10. The performance of, and filing of the results from, a 18
specific year’s liquidity stress test shall comply with the NAIC 19
Liquidity Stress Test Framework’s instructions and reporting 20
templates for that year and any lead state insurance commissioner’s 21
determination, in conjunction with the Financial Stability Task 22
Force or its successor, as provided within the NAIC Liquidity Stress 23
Test Framework. 24
11. Whenever it appears to the Commissioner that any person 25
has committed a violation of subsection 2 which prevents the full 26
understanding of the enterprise risk to the insurer by affiliates or by 27
the insurance holding company system, the violation may serve as 28
an independent basis for disapproving dividends or distributions and 29
for conductin g an examination of the insurer pursuant to [NRS 30
679B.230 to 679B.287,] sections 2 to 41, inclusive [.] , of this act. 31
Sec. 217. NRS 692C.3503 is hereby amended to read as 32
follows: 33
692C.3503 1. The requirements of NRS 692C.3501 to 34
692C.3509, inclusive, apply to all insurers domiciled in this State, 35
including, without limitation: 36
(a) Insurers, as identified in chapter 680A of NRS; 37
(b) Hospital, medical or dental service corporations, as 38
identified in chapter 695B of NRS; 39
(c) Health maintenance organizations, as identified in chapter 40
695C of NRS; 41
(d) Plans for dental care, as identified in chapter 695D of NRS; 42
(e) Prepaid limited health service organizations, as identified in 43
chapter 695F of NRS; and 44

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(f) Risk retention groups and state -chartered risk retention 1
groups, as identified in 15 U.S.C. § 3902, 42 U.S.C. § 9673 and 2
chapters 694C and 695E of NRS. 3
2. Except as otherwise provided in subsection 3, nothing in 4
NRS 692C.3501 to 692C.3509, inclusive, shall be construed to limit 5
the Commission er’s authority, or the rights or obligations of third 6
parties, under [NRS 679B.230 to 679B.300, ] sections 2 to 41, 7
inclusive [.] , of this act. 8
3. Nothing in NRS 692C.3501 to 692C.3509, inclusive, shall 9
be construed to prescribe or impose corporate governance standards 10
and internal procedures beyond those whi ch are required by the 11
appropriate provisions of title 7 of NRS. 12
Sec. 218. NRS 692C.410 is hereby amended to read as 13
follows: 14
692C.410 1. Subject to the limitation contained in this 15
section and in addition to the powers which the Commissioner has 16
under [NRS 679B.230 to 679B.287, ] sections 2 to 41, inclusive, of 17
this act relating to the examination of insurers, the Commissioner 18
may examine any insurer registered under NRS 692C.260 to 19
692C.350, inclusive, and any affiliate of the insurer to ascertain the 20
financial condition of the insurer, including, without limitation, 21
the enterprise risk posed to the insurer by a person controlling the 22
insurer, any entity or combination of entities within the insurance 23
holding company system or by the insurance holding company 24
system. The Commissioner may order any insurer registered und er 25
NRS 692C.260 to 692C.350, inclusive, to produce any information 26
not in the possession of the insurer if the insurer is able to obtain the 27
information pursuant to any contractual or statutory requirement or 28
any other method. If the insurer is unable to o btain any information 29
requested by the Commissioner pursuant to this section, the insurer 30
shall provide to the Commissioner a statement setting forth the 31
reasons the insurer is unable to obtain the information and the 32
identity of the holder of the informat ion, if known to the insurer. 33
Whenever it appears to the Commissioner that the detailed 34
explanation is without merit, the Commissioner may require, after 35
notice and hearing, the insurer to pay a penalty of $100 for each day 36
the requested information is not produced or may suspend or revoke 37
the license of the insurer. In the event such insurer fails to comply 38
with such order, the Commissioner may examine such affiliates to 39
obtain such information. 40
2. The Commissioner shall exercise his or her power under 41
subsections 1 and 5 only if the examination of the insurer under 42
[NRS 679B.230 to 679B.287,] sections 2 to 41, inclusive, of this act 43
is inadequate or the interests of the policyholders of such insurer 44
may be adversely affected. 45

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3. The Commissioner may retain at the registered insurer’s 1
expense such attorneys, actuaries, accountants and other experts not 2
otherwise a part of the Commissioner’s staff as may be reasonably 3
necessary to assist in the conduct of the examination under 4
subsections 1 and 5. Any persons so retained shall be under the 5
direction and control of the Commissioner and shall act in a purely 6
advisory capacity. 7
4. Each insurer producing for examination any information 8
pursuant to subsection 1 or any records, books and papers pursuant 9
to subsection 5 shall be liable for and shall pay the expense of such 10
examination in accordance with [NRS 679B.290.] section 19 of this 11
act. 12
5. To carry out the provisions of this section and except as 13
otherwise provided in subsection 2, the Commissioner may 14
subpoena witnesses, compel their attendance, administer oaths, 15
examine any person under oath concerning the subject of the 16
examination and require the production of any books, papers, 17
records, correspondence or any other documents which the 18
Commissioner deems relevant to the examina tion. If any person 19
fails to obey a subpoena or refuses to testify as to any matter relating 20
to the subject of the examination, the Commissioner may file a 21
written report describing the refusal and proof of service of the 22
subpoena in any court of competent jurisdiction in the county in 23
which the examination is being conducted, for such action as the 24
court may determine. Failure by the person to obey an order of the 25
court pursuant to this section is punishable as contempt of court. 26
6. A person subpoenaed u nder subsection 5 is entitled to 27
witness fees and mileage as allowed for testimony in a court of 28
record. The insurer or affiliate being examined must pay the witness 29
fees and mileage, as well as any other expense incurred in securing 30
the attendance of witn esses for the examination in accordance with 31
[NRS 679B.290.] section 19 of this act. 32
Sec. 219. NRS 693A.260 is hereby amended to read as 33
follows: 34
693A.260 1. If at any time [the amount of assets of ] a 35
domestic stock or mutual insurer [are less than the sum of its 36
liabilities plus its paid -in capital stock and minimum surplus 37
required to be maintained (in the case of a stock insurer), or the 38
minimum surplus required to be maintained (in the case of a mutual 39
insurer), under this Code for authority to transact the kinds of 40
insurance being transacted, ] is impaired, as defined in NRS 41
696B.100, the Commissioner shall at once determine the amount of 42
the deficiency and give written notice to the insurer of the amount of 43
impairment and require that the impairment be cured and proof 44
thereof filed with the Commissioner within such period, not less 45

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than 30 days nor more than 90 days from date of the notice, as the 1
Commissioner may designate. 2
2. If the impairment of assets is 10 percent or less of the 3
combined required paid -in capital stock and surplus (as to a stock 4
insurer) or surplus (as to a mutual insurer), and the Commissioner 5
believes that the impairment might be made good by an extension of 6
time, the Commissioner may extend the time within which the 7
impairment may be cured by not to exceed an additional 90 days. 8
3. The Commissioner shall require such restriction of, or 9
arrangements as to, operations of the insurer while the impairment 10
exists as the Commissioner deems advisable for the protection of 11
policyholders, the insurer or the public. 12
Sec. 220. Chapter 694C of NRS is hereby amended by ad ding 13
thereto a new section to read as follows: 14
1. Except as otherwise provided in subsection 2, all of the 15
following documents and information and any copies thereof 16
which are produced by, obtained by or disclosed to the 17
Commissioner and which are related to an examination conducted 18
pursuant to the provisions of this chapter are confidential, are not 19
subject to subpoena, and may not be made public by the 20
Commissioner, unless the Commissioner obtains the prior written 21
consent of the captive insurance compa ny to which the document 22
or information pertains: 23
(a) License applications that are designated as confidential by 24
or on behalf of an applicant captive insurance company , if the 25
designation is reasonable; 26
(b) Examination reports, other than an examination report of 27
any state-chartered risk retention group; 28
(c) Preliminary examination reports; 29
(d) Examination working papers; and 30
(e) Any other recorded information or other documents. 31
2. The provisions of subsection 1 do not apply to: 32
(a) A subpoena iss ued in connection with an administrative, 33
civil or criminal investigation by a governmental agency. 34
(b) Any document or information disclosed by a captive 35
insurer which is used by the Division in the course of any 36
regulatory proceeding, disciplinary actio n or hearing. The 37
Commissioner shall disclose to a captive insurance company a 38
copy of any document or information which the Commissioner 39
believes is related to a violation of this title or which justifies any 40
regulatory proceeding, disciplinary action or hearing involving the 41
captive insurance company. A disclosure made pursuant to this 42
subsection shall not be construed as a waiver of any applicable 43
privilege or claim of confidentiality. 44

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Sec. 221. NRS 694C.160 is hereby amended to read as 1
follows: 2
694C.160 1. The terms and conditions set forth in chapter 3
696B of NRS pertaining to insurance reorganization, receiverships 4
and injunctions apply to captive insurers incorporated pursuant to 5
this chapter. 6
2. The provisions of NRS [679B.285] 679B.122 pertaining to 7
the confidentiality and disclosure of certain records and information 8
relating to an insurer apply to such records and information relating 9
to a captive insurer incorporated pursuant to this chapter. 10
3. An agency captive insurer, a rental captive insurer and an 11
association captive insurer are subject to those provisions of chapter 12
686A of NRS which are applicable to insurers. 13
4. A state -chartered risk retention group is subject to the 14
following: 15
(a) The provisi ons of NRS 681A.250 to 681A.580, inclusive, 16
regarding intermediaries; 17
(b) The provisions of NRS 681B.550 regarding risk -based 18
capital; 19
(c) The provisions of chapter 683A of NRS regarding managing 20
general agents; 21
(d) The provisions of chapter 686A of NRS which are applicable 22
to insurers; and 23
(e) The provisions of NRS 693A.110 and any regulations 24
adopted pursuant thereto regarding management and agency 25
contracts of insurers. 26
Sec. 222. NRS 694C.180 is hereby amended to read as 27
follows: 28
694C.180 1. Unless otherwise approved by the 29
Commissioner, a pure captive insurer, an agency captive insurer, a 30
rental captive insurer or a sponsored captive insurer must be 31
incorporated as a stock insurer. 32
2. An association captive insur er or a state -chartered risk 33
retention group must be formed as a: 34
(a) Stock insurer; 35
(b) Mutual insurer; or 36
(c) Reciprocal insurer, except that its attorney -in-fact must be a 37
corporation incorporated in this State. 38
3. A captive insurer shall have not less than three incorporators 39
or organizers, at least one of whom must be a resident of this State. 40
4. Before the articles of incorporation of a captive insurer may 41
be filed with the Secretary of State, the Commissioner must approve 42
the articles of incor poration. In determining whether to grant that 43
approval, the Commissioner shall consider: 44

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(a) The character, reputation, financial standing and purposes of 1
the incorporators or organizers; 2
(b) The character, reputation, financial responsibility, experience 3
relating to insurance and business qualifications of the officers and 4
directors of the captive insurer; 5
(c) The competence of any person who, pursuant to a contract 6
with the captive insurer, will manage the affairs of the captive 7
insurer; 8
(d) The comp etence, reputation and experience of the legal 9
counsel of the captive insurer relating to the regulation of insurance; 10
(e) If the captive insurer is a rental captive insurer, the 11
competence, reputation and experience of the underwriter of the 12
captive insurer; 13
(f) The business plan of the captive insurer; and 14
(g) Such other aspects of the captive insurer as the 15
Commissioner deems advisable. 16
5. The capital stock of a captive insurer incorporated as a stock 17
insurer must be issued at not less than par value. 18
6. At least one member of the board of directors of a captive 19
insurer formed as a corporation, or one member of the subscribers 20
advisory committee or the attorney -in-fact of a captive insurer 21
formed as a reciprocal insurer, must be a resident of this State. 22
7. A captive insurer formed pursuant to the provisions of this 23
chapter has the privileges of, and is subject to, the provisions of 24
general corporation law set forth in chapter 78 of NRS and, if 25
formed as a nonprofit corporation, the provisions set forth in chapter 26
82 of NRS, as well as the applicable provisions contained in this 27
chapter. If the provisions of this chapter conflict with the general 28
provisions in chapter 78 or 82 of NRS governing corporations, the 29
provisions of this chapter control. [The] Except as otherwise 30
provided in this subsection, the provisions of chapter 693A of NRS 31
relating to mergers, consolidations, conversions, mutualizations and 32
transfers of domicile to this State apply to determine the procedures 33
to be followed by captive insurers in carrying out any of those 34
transactions in accordance with this chapter. The Commissioner 35
may approve an exemption from the provisions of chapter 693A 36
for a pure captive insurer if the Commissioner determines the 37
exemption is appropriate. 38
8. The articles of association, articles of incorporation, charter 39
or bylaws of a captive insurer formed as a corporation must require 40
that a quorum of the board of directors consists of not less than one -41
third of the number of directors prescribed by the ar ticles of 42
association, articles of incorporation, charter or bylaws. 43
9. The agreement of the subscribers or other organizing 44
document of a captive insurer formed as a reciprocal insurer must 45

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require that a quorum of its subscribers advisory committee con sists 1
of not less than one-third of the number of its members. 2
Sec. 223. NRS 694C.220 is hereby amended to read as 3
follows: 4
694C.220 An application by a captive insurer for licensure 5
must include a nonrefundable applicati on fee of $500. The 6
Commissioner may retain legal, financial and examination services 7
from outside the Division to review and make recommendations 8
regarding the qualifying examination of the applicant. The cost of 9
those services must be paid by the applica nt. The provisions of 10
[NRS 679B.230 to 679B.287,] sections 2 to 41, inclusive, of this act 11
apply to examinations, investigations and processing conducted 12
pursuant to this section. 13
Sec. 224. NRS 694C.259 is hereby amended to read as 14
follows: 15
694C.259 1. A captive insurer which is not transacting the 16
business of insurance, including, without limitation, the issuance of 17
insurance policies and the assumption of reinsurance, may apply to 18
the Commissioner for a certificate of dormancy. 19
2. Upon application by a captive insurer pursuant to subsection 20
1, the Commissioner may issue a certificate of dormancy to the 21
captive insurer. The Commissioner may issue a certificate of 22
dormancy to a captive insurer even if the captive insurer retains 23
liabilities that are associated with policies that were written or 24
assumed by the captive insurer provided that the captive insurer 25
otherwise is not transacting the business of insurance. 26
3. A dormant captive insurer shall: 27
(a) Possess and thereafter maintain unimpaired paid -in capital 28
and surplus [of] in an amount the Commissioner determines is 29
sufficient to cover liabilities retained pursuant to subsection 2 but 30
not less than $25,000. 31
(b) Pursuant to NRS 694C.230, pay an a nnual fee and, in 32
addition to any other fee or charge, all applicable fees required 33
pursuant to NRS 680C.110 for the renewal of a license. 34
(c) Be subject to examination for any year for which the 35
dormant captive insurer is not in compliance with the provi sions of 36
this section. 37
4. A dormant captive insurer may: 38
(a) At the discretion of the Commissioner, be subject to 39
examination for any year for which the dormant captive insurer is in 40
compliance with the provisions of this section. 41
(b) Continue to adjudicate and settle insurance claims under any 42
contract of insurance or reinsurance that the captive insurer issued 43
during any period in which the captive insurer was not a dormant 44
captive insurer. The effective date of such a contract of insurance or 45

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reinsurance must be before the date on which the Commissioner 1
issued a certificate of dormancy to the captive insurer. 2
5. [After] Except as otherwise provided in subsection 6, after 3
being issued a certificate of dormancy, and until the certificate of 4
dormancy expires or is revoked, a dormant captive insurer is not: 5
(a) Subject to or liable for the payment of any tax pursuant to 6
NRS 694C.450. 7
(b) Required to: 8
(1) Prepare audited financial statements; 9
(2) Obtain actuarial certifications or opinions; or 10
(3) File annual reports with the Commissioner pursuant to 11
NRS 694C.400. 12
6. The provisions of subsection 5 do not absolve a captive 13
insurer from complying with any applicable responsibilities or 14
requirements of this title which accrued before the date o n which 15
the certificate of dormancy was issued to the captive insurer, but 16
are due on or after the date on which the certificate of dormancy 17
was issued, including, without limitation, an annual report or 18
audit based on the preceding calendar or fiscal year. 19
7. A certificate of dormancy is subject to renewal after 5 years. 20
If not timely renewed, the certificate of dormancy expires. 21
Immediately upon the expiration of the certificate of dormancy, the 22
captive insurer must be in compliance with all provisions of this 23
chapter applicable to a captive insurer which holds an active license 24
to transact the business of insurance issued pursuant to this chapter. 25
[7.] 8. Except as otherwise provided [by] in this section, before 26
issuing any insurance policy or otherwise transacting the business of 27
insurance, a dormant captive insurer must apply to the 28
Commissioner for approval to surrender its certificate of dormancy 29
and resume transacting the business of insurance. 30
[8.] 9. The Commissioner shall revoke the certifica te of 31
dormancy of a dormant captive insurer that is not in compliance 32
with the provisions of this section. 33
[9.] 10. The Commissioner may adopt regulations necessary to 34
carry out the provisions of this section. 35
Sec. 225. NRS 694C.310 is hereby amended to read as 36
follows: 37
694C.310 1. The board of directors of a captive insurer shall 38
meet at least once each year in this State. The captive insurer shall: 39
(a) Maintain its principal place of business in this State; and 40
(b) Appoint a resident of this State as a registered agent to 41
accept service of process and otherwise act on behalf of the captive 42
insurer in this State. If the registered agent cannot be located with 43
reasonable diligence for the purpose of serving a notice or demand 44
on the captive insurer, the notice or demand may be served on the 45

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Secretary of State who shall be deemed to be the agent for the 1
captive insurer. 2
2. A captive insurer shall not transact insurance in this State 3
unless: 4
(a) The captive insurer has made adequate arrangements with: 5
(1) A state-chartered bank, a state-chartered credit union or a 6
thrift company licensed pursuant to chapter 677 of NRS that is 7
located in this State; or 8
(2) A federally chartered bank or federally chartered credit 9
union that has a branch which is located in this State, 10
 that is authorized pursuant to state or federal law to transfer 11
money. 12
(b) If the captive insurer employs or has entered into a contract 13
with a natural person or business organization to manage the aff airs 14
of the captive insurer, the natural person or business organization 15
meets the standards described in paragraph (b) of subsection 4 of 16
NRS 694C.210 to the satisfaction of the Commissioner. 17
(c) The captive insurer employs or has entered into a contract 18
with a qualified and experienced certified public accountant who is 19
approved by the Commissioner or a firm of certified public 20
accountants that is nationally recognized. 21
(d) The captive insurer employs or has entered into a contract 22
with qualified, exper ienced actuaries who are approved by the 23
Commissioner to perform reviews and evaluations of the operations 24
of the captive insurer. 25
(e) The captive insurer employs or has entered into a contract 26
with an attorney who is licensed to practice law in this Stat e . [and 27
who meets the standards of competence and experience in matters 28
concerning the regulation of insurance in this State established by 29
the Commissioner by regulation.] 30
3. The Commissioner may periodically review the 31
qualifications of a natural person or business organization described 32
in paragraph (b) of subsection 2 and, if appropriate: 33
(a) Disqualify the manager pursuant to the authority of the 34
Commissioner under NRS 679B.125; or 35
(b) Suspend or revoke the license of the captive insurer pursuant 36
to NRS 694C.270. 37
Sec. 226. NRS 694C.330 is hereby amended to read as 38
follows: 39
694C.330 1. Except as otherwise provided in this section, a 40
captive insurer shall pay dividends out of, or make any other 41
distributions from, its capital or surplus, or both, in accordance with 42
the provisions set forth in NRS 692C.370, 693A.140, 693A.150 and 43
693A.160. 44

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2. A captive insurer other than a state -chartered risk retention 1
group shall not pay extraordinary dividends out of, or make any 2
other extraordinary distribution with respect to, its capital or surplus, 3
or both, in violation of this section unless the captive insurer has 4
obtained the prior approval of the Commissioner to make such a 5
payment or distribution. As used in this subsection, “extraordinary 6
dividend” and “extraordinary distribution” mean any dividend or 7
distribution of cash or other property, t he fair market value of 8
which, together with that of other dividends or distributions within 9
the preceding 12 months, exceeds the greater of: 10
(a) Ten percent of the surplus of the captive insurer as of 11
December 31 or the last day of the fiscal year of the captive 12
insurer next preceding the date of the dividend or distribution; or 13
(b) The net income of the captive insurer for the 12 -month 14
period ending December 31 or the last day of the fiscal year of the 15
captive insurer next preceding the date of the divi dend or 16
distribution. 17
3. A state -chartered risk retention group shall not pay any 18
dividend or distribution without prior approval of the 19
Commissioner. 20
Sec. 227. NRS 694C.388 is hereby amended to read as 21
follows: 22
694C.388 Before June 30 of each year or, if approved by the 23
Commissioner, not more than [60] 180 days after the expiration of 24
the fiscal year of the branch captive insurer, the branch captive 25
insurer shall file with the Commissioner a copy of all reports and 26
statements required to be filed under the laws of the jurisdiction in 27
which the alien captive insurer is domiciled. The reports and 28
statements must be verified by oath of two of the executive officers 29
of the alien captive insurer. If the Commissioner is satisf ied that the 30
annual report filed by the alien captive insurer in the jurisdiction in 31
which it is domiciled provides adequate information concerning the 32
financial condition of the alien captive insurer, the Commissioner 33
may waive the requirement for complet ion of the captive annual 34
statement for business written in the alien jurisdiction. 35
Sec. 228. NRS 694C.400 is hereby amended to read as 36
follows: 37
694C.400 1. On or before June 30 of each year, a captive 38
insurer, other than a state -chartered risk retention group, shall 39
submit to the Commissioner a report of its financial condition. A 40
captive insurer shall use generally accepted accounting principles 41
and include any useful or necessary modifications or adaptations 42
thereof that have been approved or accepted by the Commissioner 43
for the type of insurance and kinds of insurers to be reported upon, 44
and as supplemented by additional information required by the 45

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Commissioner. Except as otherwise provided in this section, each 1
association captive insurer, agency captive insurer, rental captive 2
insurer or sponsored captive insurer shall file its report in the time 3
and form required by the Commissioner. Each state -chartered risk 4
retention group shall file its report in the time and f orm required by 5
NRS 680A.270. The Commissioner shall adopt regulations 6
designating the form in which pure captive insurers must report. 7
2. Each captive insurer, other than a state -chartered risk 8
retention group, shall submit to the Commissioner, on or be fore 9
June 30 of each year, an annual audit as of December 31 of the 10
preceding calendar year that is certified by a certified public 11
accountant who is not an employee of the insurer. An annual audit 12
submitted pursuant to this subsection must comply with the 13
requirements set forth in regulations adopted by the Commissioner 14
which govern such an annual audit, including, without limitation, 15
criteria for extensions and exemptions. 16
3. Each state-chartered risk retention group shall file a financial 17
statement pursuant to NRS 680A.265. 18
4. A pure captive insurer may apply, in writing, for 19
authorization to file its annual report based on a fiscal year that is 20
consistent with the fiscal year of the parent company of the pure 21
captive insurer. If an alternative date i s granted, the annual report is 22
due not later than [60] 180 days after the end of each such fiscal 23
year. 24
5. A pure captive insurer shall file on or before March 1 of 25
each year such forms as required by the Commissioner by regulation 26
to provide sufficient detail to support its premium tax return filed 27
pursuant to NRS 694C.450. 28
6. Any captive insurer failing, without just cause beyond the 29
reasonable control of the captive insurer, to file its annual report of 30
financial condition as required by subsection 1, its annual audit as 31
required by subsection 2 or its financial statement as required by 32
subsection 3 shall pay a penalty of $100 for each day the captive 33
insurer fails to file the report of financial condition, the annual audit 34
or the financial statement, but not to exceed an aggregate amount of 35
$3,000, to be recovered in the name of the State of Nevada by the 36
Attorney General. 37
7. Any director, officer, agent or employee of a captive insurer 38
who subscribes to, makes or concurs in making or publishing, a ny 39
annual or other statement required by law, knowing the same to 40
contain any material statement which is false, is guilty of a gross 41
misdemeanor. 42

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Sec. 229. NRS 694C.410 is hereby amended to read as 1
follows: 2
694C.410 1. Except as otherwise provided in this section, at 3
least once every 3 years, and at such other times as the 4
Commissioner determines necessary, the Commissioner, or a 5
designee of the Commissioner, shall visit each captive insurer and 6
thoroughly inspect and ex amine the affairs of the captive insurer to 7
ascertain: 8
(a) The financial condition of the captive insurer; 9
(b) The ability of the captive insurer to fulfill its obligations; and 10
(c) Whether the captive insurer has complied with the provisions 11
of this chapter and the regulations adopted pursuant thereto. 12
2. Upon the application of a captive insurer, the Commissioner 13
may conduct the visits required pursuant to subsection 1 every 5 14
years if the captive insurer conducts comprehensive annual audits: 15
(a) The scope of which is satisfactory to the Commissioner; and 16
(b) Which are conducted by an independent auditor appointed 17
by the Commissioner. 18
3. The provisions of subsections 1 and 2 do not apply to a pure 19
captive insurer. The Commissioner may conduct an examination of 20
a pure captive insurer at any reasonable time to ascertain: 21
(a) The financial condition of the pure captive insurer; 22
(b) The ability of the pure captive insurer to fulfill its 23
obligations; and 24
(c) Whether the pure captive insurer has com plied with the 25
provisions of this chapter and the regulations adopted pursuant 26
thereto. 27
4. The Commissioner may contract to obtain legal, financial 28
and examination services from outside the Division to conduct the 29
examination and make recommendations to the Commissioner. The 30
cost of the examination must be paid to the Commissioner by the 31
captive insurer. 32
5. The provisions of [NRS 679B.230 to 679B.287, ] sections 2 33
to 41, inclusive, of this act apply to examinations conducted 34
pursuant to this section. 35
Sec. 230. NRS 694C.450 is hereby amended to read as 36
follows: 37
694C.450 1. Except as otherwise provided in this section, a 38
captive insurer shall pay to the Division, not later than March 1 of 39
each year, a tax at the rate of: 40
(a) Two-fifths of 1 percent on the first $20,000,000 of its net 41
direct premiums; 42
(b) One-fifth of 1 percent on th e next $20,000,000 of its net 43
direct premiums; and 44

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(c) Seventy-five thousandths of 1 percent on each additional 1
dollar of its net direct premiums. 2
2. Except as otherwise provided in this section, a captive 3
insurer shall pay to the Division, not later than March 1 of each 4
year, a tax at a rate of: 5
(a) Two hundred twenty -five thousandths of 1 percent on the 6
first $20,000,000 of revenue from assumed reinsurance premiums; 7
(b) One hundred fifty thousandths of 1 percent on the next 8
$20,000,000 of revenue from assumed reinsurance premiums; and 9
(c) Twenty-five thousandths of 1 percent on each additional 10
dollar of revenue from assumed reinsurance premiums. 11
 The tax on reinsurance premiums pursuant to this subsection 12
must not be levied on premiums for risks o r portions of risks which 13
are subject to taxation on a direct basis pursuant to subsection 1. A 14
captive insurer is not required to pay any reinsurance premium tax 15
pursuant to this subsection on revenue related to the receipt of assets 16
by the captive insure r in exchange for the assumption of loss 17
reserves and other liabilities of another insurer that is under 18
common ownership and control with the captive insurer, if the 19
transaction is part of a plan to discontinue the operation of the other 20
insurer and the i ntent of the parties to the transaction is to renew or 21
maintain such business with the captive insurer. 22
3. If the sum of the taxes to be paid by a captive insurer 23
calculated pursuant to subsections 1 and 2 is less than $5,000 in any 24
given year, including, without limitation, a year in which the 25
captive insurer wrote no direct premiums or assumed no 26
reinsurance premiums and was not a dormant captive insurer , the 27
captive insurer shall pay a tax of $5,000 for that year. The maximum 28
aggregate tax for any year must not exceed $175,000. The 29
maximum aggregate tax to be paid by a sponsored captive insurer 30
applies only to each protected cell and does not apply to the 31
sponsored captive insurer as a whole. 32
4. Two or more captive insurers under common ownership and 33
control must be taxed as if they were a single captive insurer. 34
5. Notwithstanding any specific statute to the contrary and 35
except as otherwise provided in this subsection, the tax provided for 36
by this section constitutes all the taxes collectible pursua nt to the 37
laws of this State from a captive insurer, and no occupation tax or 38
other taxes may be levied or collected from a captive insurer by this 39
State or by any county, city or municipality within this State, except 40
for taxes imposed pursuant to chapter 363A, 363B or 363C of NRS 41
and ad valorem taxes on real or personal property located in this 42
State used in the production of income by the captive insurer. 43
6. Twenty-five percent of the revenues collected from the tax 44
imposed pursuant to this section mus t be deposited with the State 45

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Treasurer for credit to the [Account for the Regulation and 1
Supervision of Captive Insurers ] Fund for Insurance 2
Administration and Enforcement created [pursuant to NRS 3
694C.460.] by NRS 680C.100. The remaining 75 percent of th e 4
revenues collected must be deposited with the State Treasurer for 5
credit to the State General Fund. 6
7. A captive insurer that is issued a license pursuant to this 7
chapter after July 1, 2003, is entitled to receive a nonrefundable 8
credit of $5,000 appli ed against the aggregate taxes owed by the 9
captive insurer for the first year in which the captive insurer incurs 10
any liability for the payment of taxes pursuant to this section. A 11
captive insurer is entitled to a nonrefundable credit pursuant to this 12
section not more than once after the captive insurer is initially 13
licensed pursuant to this chapter. 14
8. As used in this section, unless the context otherwise 15
requires: 16
(a) “Common ownership and control” means: 17
(1) In the case of a stock insurer, the direct or indirect 18
ownership of 80 percent or more of the outstanding voting stock of 19
two or more corporations by the same member or members. 20
(2) In the case of a mutual insurer, the direct or indirect 21
ownership of 80 percent or more of the surplus and the voting power 22
of two or more corporations by the same member or members. 23
(b) “Net direct premiums” means the direct premiums collected 24
or contracted for on policies or contracts of insurance written by a 25
captive insurer during the preceding calendar yea r, less the amounts 26
paid to policyholders as return premiums, including dividends on 27
unabsorbed premiums or premium deposits returned or credited to 28
policyholders. 29
Sec. 231. NRS 694C.460 is hereby amended to read as 30
follows: 31
694C.460 [1. There is hereby created in the Fund for 32
Insurance Administration and Enforcement created by NRS 33
680C.100 an Account for the Regulation and Supervision of Captive 34
Insurers. Money in the Account must be used only to carry out the 35
provisions of this chapter or for any other purpose authorized by the 36
Legislature.] Except as otherwise provided in NRS [680C.110 and] 37
694C.450, all fees and assessments received by the Commissioner 38
or Division pursuant to this chapter must be credited to the 39
[Account. Not more than 2 percent of the tax collected and 40
deposited in the Account pursuant to NRS 694C.450, may, upon 41
application by the Division or an agency for economic development 42
to, and with the approval of, the Interim Finance Committee, be 43
transferred to an agency for economic development to be used by 44

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that agency to promote the industry of captive insurance in this 1
State. 2
2. Except as otherwise provided in this section, all payments 3
from the Account for the maintenance of staff and associated 4
expenses, including contractual services, as necessary, must be 5
disbursed from the State Treasury only upon warrants issued by the 6
State Controller, after receipt of proper documentation of the 7
services rendered and expenses incurred. 8
3. At the end of each fisc al year, that portion of the balance in 9
the Account which exceeds $500,000 must be transferred to the 10
State General Fund. 11
4. The State Controller may anticipate receipts to the Account 12
and issue warrants based thereon. ] Fund for Insurance 13
Administration and Enforcement created by NRS 680C.100. 14
Sec. 232. Chapter 695A of NRS is hereby amended by adding 15
thereto the provisions set forth as sections 233 to 237, inclusive, of 16
this act. 17
Sec. 233. “Medical management technique” has the 18
meaning ascribed to it in section 299 of this act. 19
Sec. 234. “Network plan” has the meaning ascribed to it in 20
NRS 687B.645. 21
Sec. 235. “Provider network contract” has the m eaning 22
ascribed to it in NRS 687B.658. 23
Sec. 236. “Provider of health care” has the meaning 24
ascribed to it in NRS 629.031. 25
Sec. 237. “Therapeutic equivalent” has the meaning 26
ascribed to it in section 302 of this act. 27
Sec. 238. NRS 695A.001 is hereby amended to read as 28
follows: 29
695A.001 As used in this chapter, unless the context otherwise 30
requires, the words and terms defined in NRS 695A.003 to 31
695A.044, inclusive, and sections 233 to 237, inclusive, of this act 32
have the meanings ascribed to them in those sections. 33
Sec. 239. NRS 695A.1843 is hereby amended to read as 34
follows: 35
695A.1843 1. A society that offers or issues a benefit 36
contract shall include in the benefit coverage for: 37
(a) All drugs approved by the United States Food and Drug 38
Administration for preventing the acquisition of human 39
immunodeficiency virus or treating human immunodeficiency virus 40
or hepatitis C in the form recommended by the prescribing 41
practitioner, regardless of whether the drug is included in the 42
formulary of the society; 43
(b) Laboratory testing that is necessary for therapy that uses a 44
drug to prevent the acquisition of human immunodeficiency virus; 45

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(c) Any service to test for, prevent or treat human 1
immunodeficiency virus or hepatitis C provided by a provider of 2
primary care if the service is covered when provided by a specialist 3
and: 4
(1) The service is within the scope of practice of the provider 5
of primary care; or 6
(2) The provider of primary care is capable of providing the 7
service safely and effectively in consultation with a specialist and 8
the provider engages in such consultation; and 9
(d) The services described in NRS 639.28085, when provided 10
by a pharmacist who participates in the network plan of the society. 11
2. A society that offers or issues a benefit contract shall 12
reimburse: 13
(a) A pharmacist who participates in the network plan of the 14
society for the services described in NRS 639.28085 at a rate equal 15
to the rate of reimbursement provided to a physician, physician 16
assistant or advanced practice registered nurse for similar services. 17
(b) An advanced practice registe red nurse or a physician 18
assistant who participates in the network plan of the society for any 19
service to test for, prevent or treat human immunodeficiency virus 20
or hepatitis C at a rate equal to the rate of reimbursement provided 21
to a physician for similar services. 22
3. A society shall not: 23
(a) Subject the benefits required by subsection 1 to medical 24
management techniques, other than step therapy; 25
(b) Limit the covered amount of a drug described in paragraph 26
(a) of subsection 1; 27
(c) Refuse to cover a drug described in paragraph (a) of 28
subsection 1 because the drug is dispensed by a pharmacy through 29
mail order service; or 30
(d) Prohibit or restrict access to any service or drug to treat 31
human immunodeficiency virus or hepatitis C on the same day on 32
which the insured is diagnosed. 33
4. A society shall ensure that the benefits required by 34
subsection 1 are made available to an insured through a provider of 35
health care who participates in the network plan of the society. 36
5. A benefit contract subject to th e provisions of this chapter 37
that is delivered, issued for delivery or renewed on or after 38
January 1, 2024, has the legal effect of including the coverage 39
required by subsection 1, and any provision of the plan that conflicts 40
with the provisions of this section is void. 41
6. As used in this section [: 42
(a) “Medical management technique” means a practice which is 43
used to control the cost or use of health care services or prescription 44
drugs. The term includes, without limitation, the use of step therapy, 45

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prior authorization and categorizing drugs and devices based on 1
cost, type or method of administration. 2
(b) “Network plan” means a benefit contract offered by a society 3
under which the financing and delivery of medical care, including 4
items and services paid for as medical care, are provided, in whole 5
or in part, through a defined set of providers under contract with the 6
society. The term does not include an arrangement for the financing 7
of premiums. 8
(c) “Primary] , “primary care” means the practice of family 9
medicine, pediatrics, internal medicine, obstetrics and gynecology 10
and midwifery. 11
[(d) “Provider of h ealth care” has the meaning ascribed to it in 12
NRS 629.031.] 13
Sec. 240. NRS 695A.1845 is hereby amended to read as 14
follows: 15
695A.1845 1. A benefit contract must provide coverage for 16
benefits payable for expenses incurred for: 17
(a) Deoxyribonucleic acid testing for high -risk strains of human 18
papillomavirus every 3 years for women 30 years of age and older; 19
and 20
(b) Administering the human p apillomavirus vaccine, as 21
recommended for vaccination by a competent authority, including, 22
without limitation, the Centers for Disease Control and Prevention 23
of the United States Department of Health and Human Services, the 24
Food and Drug Administration or the manufacturer of the vaccine. 25
2. A society must ensure that the benefits required by 26
subsection 1 are made available to an insured through a provider of 27
health care who participates in the network plan of the society. 28
3. Except as otherwise provided in subsection 5, a society that 29
offers or issues a benefit contract shall not: 30
(a) Require an insured to pay a higher deductible, any 31
copayment or coinsurance or require a longer waiting period or 32
other condition for coverage to obtain any benefit provid ed in the 33
benefit contract pursuant to subsection 1; 34
(b) Refuse to issue a benefit contract or cancel a benefit contract 35
solely because the person applying for or covered by the contract 36
uses or may use any such benefit; 37
(c) Offer or pay any type of mate rial inducement or financial 38
incentive to an insured to discourage the insured from obtaining any 39
such benefit; 40
(d) Penalize a provider of health care who provides any such 41
benefit to an insured, including, without limitation, reducing the 42
reimbursement of the provider of health care; 43

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(e) Offer or pay any type of material inducement, bonus or other 1
financial incentive to a provider of health care to deny, reduce, 2
withhold, limit or delay access to any such benefit to an insured; or 3
(f) Impose any other r estrictions or delays on the access of an 4
insured to any such benefit. 5
4. A benefit contract subject to the provisions of this chapter 6
which is delivered, issued for delivery or renewed on or after 7
January 1, 2018, has the legal effect of including the c overage 8
required by subsection 1, and any provision of the benefit contract 9
or the renewal which is in conflict with this section is void. 10
5. Except as otherwise provided in this section and federal law, 11
a society may use medical management techniques, i ncluding, 12
without limitation, any available clinical evidence, to determine the 13
frequency of or treatment relating to any benefit required by this 14
section or the type of provider of health care to use for such 15
treatment. 16
6. As used in this section [: 17
(a) “Human] , “human papillomavirus vaccine” means the 18
Quadrivalent Human Papillomavirus Recombinant Vaccine or its 19
successor which is approved by the Food and Drug Administration 20
for the prevention of human papillomavirus infection and cervical 21
cancer. 22
[(b) “Medical management technique” means a practice which is 23
used to control the cost or utilization of health care services or 24
prescription drug use. The term includes, without limitation, the use 25
of step therapy, prior authorization or categorizing drugs and 26
devices based on cost, type or method of administration. 27
(c) “Network plan” means a benefit contract offered by a society 28
under which the financing and delivery of medical care, including 29
items and services paid for as medical care, are provided, in whole 30
or in part, through a defined set of providers under contract with the 31
society. The term does not include an arrangement for the financing 32
of premiums. 33
(d) “Provider of health care” has the meaning ascribed to it in 34
NRS 629.031.] 35
Sec. 241. NRS 695A.1853 is hereby amended to read as 36
follows: 37
695A.1853 1. A society that issues a benefit contract shall 38
provide coverage for screening, genetic counseling and testing for 39
harmful mutations in the BRCA gene for women under 40
circumstances where such screening, genetic counseling or testing, 41
as applicable, is required by NRS 457.301. 42
2. A society shall ensure that the benefits required by 43
subsection 1 are made available to an insured through a provider of 44
health care who participates in the network plan of the society. 45

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3. A benefit contract subject to the provisions of this chapter 1
that is delivered, issued for delivery or renewed on or after 2
January 1, 2022, has the legal effect of including the coverage 3
required by subsection 1, and any provision of the plan that conflicts 4
with the provisions of this section is void. 5
[4. As used in this section: 6
(a) “Network plan” means a benefit contract offered by a society 7
under which the financing and delivery of medical care, i ncluding 8
items and services paid for as medical care, are provided, in whole 9
or in part, through a defined set of providers under contract with the 10
society. The term does not include an arrangement for the financing 11
of premiums. 12
(b) “Provider of health care” has the meaning ascribed to it in 13
NRS 629.031.] 14
Sec. 242. NRS 695A.1855 is hereby amended to read as 15
follows: 16
695A.1855 1. A benefit contract must provide coverage for 17
benefits payable for expenses incurred for: 18
(a) A mammogram to screen for breast cancer annually for 19
insureds who are 40 years of age or older. 20
(b) An imaging test to screen for breast cancer on an interval 21
and at the age deemed most appropriate, when medically necessary, 22
as recommended by the insur ed’s provider of health care based on 23
personal or family medical history or additional factors that may 24
increase the risk of breast cancer for the insured. 25
(c) A diagnostic imaging test for breast cancer at the age deemed 26
most appropriate, when medically necessary, as recommended by 27
the insured’s provider of health care to evaluate an abnormality 28
which is: 29
(1) Seen or suspected from a mammogram described in 30
paragraph (a) or an imaging test described in paragraph (b); or 31
(2) Detected by other means of examination. 32
2. A society must ensure that the benefits required by 33
subsection 1 are made available to an insured through a provider of 34
health care who participates in the network plan of the society. 35
3. Except as otherwise provided in subsection 5, a society that 36
offers or issues a benefit contract shall not: 37
(a) Except as otherwise provided in subsection 6, require an 38
insured to pay a deductible, copayment, coinsurance or any other 39
form of cost -sharing or require a longer waiting period or other 40
condition for coverage to obtain any benefit provided in a benefit 41
contract pursuant to subsection 1; 42
(b) Refuse to issue a benefit contract or cancel a benefit contract 43
solely because the person applying for or covered by the contract 44
uses or may use any such benefit; 45

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(c) Offer or pay any type of material inducement or financial 1
incentive to an insured to discourage the insured from obtaining any 2
such benefit; 3
(d) Penalize a provider of health care who provides any such 4
benefit to an insured, including, wit hout limitation, reducing the 5
reimbursement of the provider of health care; 6
(e) Offer or pay any type of material inducement, bonus or other 7
financial incentive to a provider of health care to deny, reduce, 8
withhold, limit or delay access to any such benefit to an insured; or 9
(f) Impose any other restrictions or delays on the access of an 10
insured to any such benefit. 11
4. A benefit contract subject to the provisions of this chapter 12
which is delivered, issued for delivery or renewed on or after 13
January 1, 2024, has the legal effect of including the coverage 14
required by subsection 1, and any provision of the benefit contract 15
or the renewal which is in conflict with this section is void. 16
5. Except as otherwise provided in this section and federal law, 17
a so ciety may use medical management techniques, including, 18
without limitation, any available clinical evidence, to determine the 19
frequency of or treatment relating to any benefit required by this 20
section or the type of provider of health care to use for such 21
treatment. 22
6. If the application of paragraph (a) of subsection 3 would 23
result in the ineligibility of a health savings account of an insured 24
pursuant to 26 U.S.C. § 223, the prohibitions of paragraph (a) of 25
subsection 3 shall apply only for a qualified benefit contract with 26
respect to the deductible of such a benefit contract after the insured 27
has satisfied the minimum deductible pursuant to 26 U.S.C. § 223, 28
except with respect to items or services that constitute preventive 29
care pursuant to 26 U.S.C. § 223(c)(2)(C), in which case the 30
prohibitions of paragraph (a) of subsection 3 shall apply regardless 31
of whether the minimum deductible under 26 U.S.C. § 223 has been 32
satisfied. 33
7. As used in this section [: 34
(a) “Medical management technique” means a pra ctice which is 35
used to control the cost or utilization of health care services or 36
prescription drug use. The term includes, without limitation, the use 37
of step therapy, prior authorization or categorizing drugs and 38
devices based on cost, type or method of administration. 39
(b) “Network plan” means a benefit contract offered by a society 40
under which the financing and delivery of medical care, including 41
items and services paid for as medical care, are provided, in whole 42
or in part, through a defined set of pro viders under contract with the 43
society. The term does not include an arrangement for the financing 44
of premiums. 45

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(c) “Provider of health care” has the meaning ascribed to it in 1
NRS 629.031. 2
(d) “Qualified] , “qualified benefit contract” means a benefit 3
contract that has a high deductible and is in compliance with 26 4
U.S.C. § 223 for the purposes of establishing a health savings 5
account. 6
Sec. 243. NRS 695A.1856 is hereby amended to read as 7
follows: 8
695A.1856 1. A societ y that issues a benefit contract shall 9
provide coverage for the examination of a person who is pregnant 10
for the discovery of: 11
(a) Chlamydia trachomatis, gonorrhea, hepatitis B and hepatitis 12
C in accordance with NRS 442.013. 13
(b) Syphilis in accordance with NRS 442.010. 14
2. The coverage required by this section must be provided: 15
(a) Regardless of whether the benefits are provided to the 16
insured by a provider of health care, facility or medical laboratory 17
that participates in the network plan of the society; and 18
(b) Without prior authorization. 19
3. A benefit contract subject to the provisions of this chapter 20
that is delivered, issued for delivery or renewed on or after July 1, 21
2021, has the legal effect of including the coverage required by 22
subsection 1, and any provision of the contract that conflicts with 23
the provisions of this section is void. 24
4. As used in this section [: 25
(a) “Medical] , “medical laboratory” has the meaning ascribed 26
to it in NRS 652.060. 27
[(b) “Network plan” means a benefit contract offered by a 28
society under which the financing and delivery of medical care, 29
including items and services paid for as medical care, are provided, 30
in whole or in part, through a defined set of providers under contract 31
with the society. The term does not include an arrangement for the 32
financing of premiums. 33
(c) “Provider of health care” has the meaning ascribed to it in 34
NRS 629.031.] 35
Sec. 244. NRS 695A.1859 is hereby amended to rea d as 36
follows: 37
695A.1859 1. Subject to the limitations prescribed by 38
subsection 4, a society that issues a benefit contract shall include in 39
the contract coverage for medically necessary biomarker testing for 40
the diagnosis, treatment, appropriate managem ent and ongoing 41
monitoring of cancer when such biomarker testing is supported by 42
medical and scientific evidence. Such evidence includes, without 43
limitation: 44

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(a) The labeled indications for a biomarker test or medication 1
that has been approved or cleared by the United States Food and 2
Drug Administration; 3
(b) The indicated tests for a drug that has been approved by the 4
United States Food and Drug Administration or the warnings and 5
precautions included on the label of such a drug; 6
(c) A national coverage d etermination or local coverage 7
determination, as those terms are defined in 42 C.F.R. § 400.202; or 8
(d) Nationally recognized clinical practice guidelines or 9
consensus statements. 10
2. A society shall: 11
(a) Provide the coverage required by subsection 1 in a manner 12
that limits disruptions in care and the need for multiple specimens. 13
(b) Establish a clear and readily accessible process for an 14
insured or provider of health care to: 15
(1) Request an exception to a policy excluding coverage for 16
biomarker testing for the diagnosis, treatment, management or 17
ongoing monitoring of cancer; or 18
(2) Appeal a denial of coverage for such biomarker testing; 19
and 20
(c) Make the process described in paragraph (b) available on an 21
Internet website maintained by the society. 22
3. If a society requires an insured to obtain prior authorization 23
for a biomarker test described in subsection 1, the society shall 24
respond to a request for such prior authorization: 25
(a) Within 24 hours after receiving an urgent request; or 26
(b) Within 72 hours after receiving any other request. 27
4. The provisions of this section do not require a society to 28
provide coverage of biomarker testing: 29
(a) For screening purposes; 30
(b) Conducted by a provider of health care for whom the 31
biomarker testing is not within his or her scope of practice, training 32
and experience; 33
(c) Conducted by a provider of health care or a facility that does 34
not participate in the network plan of the society; or 35
(d) That has not been determined to be medically necessary by a 36
provider of health care for whom such a determination is within his 37
or her scope of practice, training and experience. 38
5. A benefit contract subject to the provisions of this chapter 39
that is delivered, issued for delivery or renewed on or after 40
October 1, 2023, has the legal effect of including the coverage 41
required by this section, and any provision of the benefit contr act or 42
renewal which is in conflict with the provisions of this section is 43
void. 44
6. As used in this section: 45

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(a) “Biomarker” means a characteristic that is objectively 1
measured and evaluated as an indicator of a normal biological 2
process, a pathogenic p rocess or a pharmacological response to a 3
specific therapeutic intervention and includes, without limitation: 4
(1) An interaction between a gene and a drug that is being 5
used by or considered for use by the patient; 6
(2) A gene mutation or characteristic; and 7
(3) The expression of a protein. 8
(b) “Biomarker testing” means the analysis of the tissue, blood 9
or other biospecimen of a patient for the presentation of a biomarker 10
and includes, without limitation, single -analyte tests, multiplex 11
panel tests a nd whole genome, whole exome and whole 12
transcriptome sequencing. 13
(c) “Consensus statement” means a statement aimed at a specific 14
clinical circumstance that is: 15
(1) Made for the purpose of optimizing the outcomes of 16
clinical care; 17
(2) Made by an indepe ndent, multidisciplinary panel of 18
experts that has established a policy to avoid conflicts of interest; 19
(3) Based on scientific evidence; and 20
(4) Made using a transparent methodology and reporting 21
procedure. 22
(d) “Medically necessary” means health care services or 23
products that a prudent provider of health care would provide to a 24
patient to prevent, diagnose or treat an illness, injury or disease, or 25
any symptoms thereof, that are necessary and: 26
(1) Provided in accordance with generally accepted standards 27
of medical practice; 28
(2) Not primarily provided for the convenience of the patient 29
or provider of health care; and 30
(3) Significant in guiding and informing the provider of 31
health care in providing the most appropriate course of treatment for 32
the patient in order to prevent, delay or lessen the magnitude of an 33
adverse health outcome. 34
(e) “Nationally recognized clinical practice guidelines” means 35
evidence-based guidelines establishing standards of care that 36
include, without limitation, recommendatio ns intended to optimize 37
care of patients and are: 38
(1) Informed by a systemic review of evidence and an 39
assessment of the risks and benefits of alternative options for care; 40
and 41
(2) Developed using a transparent methodology and 42
reporting procedure by an independent organization or society of 43
medical professionals that has established a policy to avoid conflicts 44
of interest. 45

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[(f) “Network plan” means a benefit contract offered by a 1
society under which the financing and delivery of medical care, 2
including items and services paid for as medical care, are provided, 3
in whole or in part, through a defined set of providers under contract 4
with the society. The term does not include an arrangement for the 5
financing of premiums. 6
(g) “Provider of health care” has the meaning ascribed to it in 7
NRS 629.031.] 8
Sec. 245. NRS 695A.1865 is hereby amended to rea d as 9
follows: 10
695A.1865 1. Except as otherwise provided in subsection 8, 11
a society that offers or issues a benefit contract which provides 12
coverage for prescription drugs or devices shall include in the 13
contract coverage for: 14
(a) Up to a 12 -month suppl y, per prescription, of any type of 15
drug for contraception or its therapeutic equivalent which is: 16
(1) Lawfully prescribed or ordered; 17
(2) Approved by the Food and Drug Administration; 18
(3) Listed in subsection 11; and 19
(4) Dispensed in accordance with NRS 639.28075; 20
(b) Any type of device for contraception which is: 21
(1) Lawfully prescribed or ordered; 22
(2) Approved by the Food and Drug Administration; and 23
(3) Listed in subsection 11; 24
(c) Self-administered hormonal contraceptives dispensed by a 25
pharmacist pursuant to NRS 639.28078; 26
(d) Insertion of a device for contraception or removal of such a 27
device if the device was inserted while the insured was covered by 28
the same benefit contract; 29
(e) Education and counseling relating to the initiation of the use 30
of contraception and any necessary follow -up after initiating such 31
use; 32
(f) Management of side effects relating to contraception; and 33
(g) Voluntary sterilization for women. 34
2. A society shall provide coverage for any services listed in 35
subsection 1 which are within the authorized scope of practice of a 36
pharmacist when such services are provided by a pharmacist who is 37
employed by or serves as an independent contractor of an in -38
network pharmacy and in accordance with the applicable provider 39
network contract. Such coverage must be provided to the same 40
extent as if the services were provided by another provider of health 41
care, as applicable to the services being provided. The terms of the 42
policy must not limit: 43

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(a) Coverage for services listed i n subsection 1 and provided by 1
such a pharmacist to a number of occasions less than the coverage 2
for such services when provided by another provider of health care. 3
(b) Reimbursement for services listed in subsection 1 and 4
provided by such a pharmacist to an amount less than the amount 5
reimbursed for similar services provided by a physician, physician 6
assistant or advanced practice registered nurse. 7
3. A society must ensure that the benefits required by 8
subsection 1 are made available to an insured throu gh a provider of 9
health care who participates in the network plan of the society. 10
4. If a covered therapeutic equivalent listed in subsection 1 is 11
not available or a provider of health care deems a covered 12
therapeutic equivalent to be medically inappropr iate, an alternate 13
therapeutic equivalent prescribed by a provider of health care must 14
be covered by the society. 15
5. Except as otherwise provided in subsections 9, 10 and 12, a 16
society that offers or issues a benefit contract shall not: 17
(a) Require an i nsured to pay a higher deductible, any 18
copayment or coinsurance or require a longer waiting period or 19
other condition for coverage for any benefit included in the benefit 20
contract pursuant to subsection 1; 21
(b) Refuse to issue a benefit contract or cancel a benefit contract 22
solely because the person applying for or covered by the contract 23
uses or may use any such benefit; 24
(c) Offer or pay any type of material inducement or financial 25
incentive to an insured to discourage the insured from obtaining any 26
such benefit; 27
(d) Penalize a provider of health care who provides any such 28
benefit to an insured, including, without limitation, reducing the 29
reimbursement to the provider of health care; 30
(e) Offer or pay any type of material inducement, bonus or other 31
financial incentive to a provider of health care to deny, reduce, 32
withhold, limit or delay access to any such benefit to an insured; or 33
(f) Impose any other restrictions or delays on the access of an 34
insured to any such benefit. 35
6. Coverage pursuant to this section for the covered dependent 36
of an insured must be the same as for the insured. 37
7. Except as otherwise provided in subsection 8, a benefit 38
contract subject to the provisions of this chapter that is delivered, 39
issued for delivery or renewed on or aft er January 1, 2024, has the 40
legal effect of including the coverage required by this section, and 41
any provision of the contract or the renewal which is in conflict with 42
this section is void. 43
8. A society that offers or issues a benefit contract and which is 44
affiliated with a religious organization is not required to provide the 45

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coverage required by subsection 1 if the society objects on religious 1
grounds. Such a society shall, before the issuance of a benefit 2
contract and before the renewal of such a contr act, provide to the 3
prospective insured written notice of the coverage that the society 4
refuses to provide pursuant to this subsection. 5
9. A society may require an insured to pay a higher deductible, 6
copayment or coinsurance for a drug for contraception if the insured 7
refuses to accept a therapeutic equivalent of the drug. 8
10. For each of the 18 methods of contraception listed in 9
subsection 11 that have been approved by the Food and Drug 10
Administration, a benefit contract must include at least one drug or 11
device for contraception within each method for which no 12
deductible, copayment or coinsurance may be charged to the 13
insured, but the society may charge a deductible, copayment or 14
coinsurance for any other drug or device that provides the same 15
method of contraception. If the society charges a copayment or 16
coinsurance for a drug for contraception, the society may only 17
require an insured to pay the copayment or coinsurance: 18
(a) Once for the entire amount of the drug dispensed for the plan 19
year; or 20
(b) Once for each 1-month supply of the drug dispensed. 21
11. The following 18 methods of contraception must be 22
covered pursuant to this section: 23
(a) Voluntary sterilization for women; 24
(b) Surgical sterilization implants for women; 25
(c) Implantable rods; 26
(d) Copper-based intrauterine devices; 27
(e) Progesterone-based intrauterine devices; 28
(f) Injections; 29
(g) Combined estrogen- and progestin-based drugs; 30
(h) Progestin-based drugs; 31
(i) Extended- or continuous-regimen drugs; 32
(j) Estrogen- and progestin-based patches; 33
(k) Vaginal contraceptive rings; 34
(l) Diaphragms with spermicide; 35
(m) Sponges with spermicide; 36
(n) Cervical caps with spermicide; 37
(o) Female condoms; 38
(p) Spermicide; 39
(q) Combined estrogen - and progestin -based drugs for 40
emergency contraception or progestin -based drugs for emergency 41
contraception; and 42
(r) Ulipristal acetate for emergency contraception. 43
12. Except as otherwise provided in this section and federal 44
law, a society may use medical management techniques, including, 45

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without limitation, any available clinical evidence, to determine the 1
frequency of or treatment relating to any benefit required by this 2
section or the type of provider of health care to use for such 3
treatment. 4
13. A society shall not: 5
(a) Use medical management techniques to require an insured to 6
use a method of contraception other than the method prescribed or 7
ordered by a provider of health care; 8
(b) Require an insured to obtain prior authorization for the 9
benefits described in paragraphs (a) and (c) of subsection 1; or 10
(c) Refuse to cover a contraceptive injection or the insertion of a 11
device described in paragraph (c), (d) or (e) of subsection 11 at a 12
hospital immediately after an insured gives birth. 13
14. A society must provide an accessible, tr ansparent and 14
expedited process which is not unduly burdensome by which an 15
insured, or the authorized representative of the insured, may request 16
an exception relating to any medical management technique used by 17
the society to obtain any benefit required by this section without a 18
higher deductible, copayment or coinsurance. 19
15. As used in this section: 20
(a) “In-network pharmacy” means a pharmacy that has entered 21
into a contract with a society to provide services to insureds through 22
a network plan offered or issued by the society. 23
(b) [“Medical management technique” means a practice which is 24
used to control the cost or utilization of health care services or 25
prescription drug use. The term includes, without limitation, the use 26
of step therapy, prior authoriz ation or categorizing drugs and 27
devices based on cost, type or method of administration. 28
(c) “Network plan” means a benefit contract offered by a society 29
under which the financing and delivery of medical care, including 30
items and services paid for as medi cal care, are provided, in whole 31
or in part, through a defined set of providers under contract with the 32
society. The term does not include an arrangement for the financing 33
of premiums. 34
(d)] “Provider network contract” [means] includes a contract 35
between a society and a [provider of health care or ] pharmacy 36
specifying the rights and responsibilities of the society and the 37
[provider of health care or ] pharmacy [, as applicable,] for delivery 38
of health care services pursuant to a network plan. 39
[(e) “Provider of health care” has the meaning ascribed to it in 40
NRS 629.031. 41
(f) “Therapeutic equivalent” means a drug which: 42
(1) Contains an identical amount of the same active 43
ingredients in the same dosage and method of administration as 44
another drug; 45

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(2) Is ex pected to have the same clinical effect when 1
administered to a patient pursuant to a prescription or order as 2
another drug; and 3
(3) Meets any other criteria required by the Food and Drug 4
Administration for classification as a therapeutic equivalent.] 5
Sec. 246. NRS 695A.1867 is hereby amended to read as 6
follows: 7
695A.1867 1. Except as otherwise provided in this section, a 8
society that issues a benefit contract shall include in the benefit 9
contract coverage for the medically necessary treatment of 10
conditions relating to gender dysphoria and gender incongruence. 11
Such coverage must include coverage of medically necessary 12
psychosocial and surgical intervention and any other medically 13
necessary treatment for such disorders provided by: 14
(a) Endocrinologists; 15
(b) Pediatric endocrinologists; 16
(c) Social workers; 17
(d) Psychiatrists; 18
(e) Psychologists; 19
(f) Gynecologists; 20
(g) Speech-language pathologists; 21
(h) Primary care physicians; 22
(i) Advanced practice registered nurses; 23
(j) Physician assistants; and 24
(k) Any other providers of medically necessary services for the 25
treatment of gender dysphoria or gender incongruence. 26
2. This section does not require a benefit contract to include 27
coverage for cosmetic surgery perfor med by a plastic surgeon or 28
reconstructive surgeon that is not medically necessary. 29
3. A society that issues a benefit contract shall not 30
categorically refuse to cover medically necessary gender -affirming 31
treatments or procedures or revisions to prior tr eatments if the 32
contract provides coverage for any such services, procedures or 33
revisions for purposes other than gender transition or affirmation. 34
4. A society that issues a benefit contract may prescribe 35
requirements that must be satisfied before the s ociety covers 36
surgical treatment of conditions relating to gender dysphoria or 37
gender incongruence for an insured who is less than 18 years of age. 38
Such requirements may include, without limitation, requirements 39
that: 40
(a) The treatment must be recommende d by a psychologist, 41
psychiatrist or other mental health professional; 42
(b) The treatment must be recommended by a physician; 43
(c) The insured must provide a written expression of the desire 44
of the insured to undergo the treatment; 45

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(d) A written plan f or treatment that covers at least 1 year must 1
be developed and approved by at least two providers of health care; 2
and 3
(e) Parental consent is provided for the insured unless the 4
insured is expressly authorized by law to consent on his or her own 5
behalf. 6
5. When determining whether treatment is medically necessary 7
for the purposes of this section, a society must consider the most 8
recent Standards of Care published by the World Professional 9
Association for Transgender Health, or its successor organization. 10
6. A society shall make a reasonable effort to ensure that the 11
benefits required by subsection 1 are made available to an insured 12
through a provider of health care who participates in the network 13
plan of the society. If, after a reasonable effort, the society is unable 14
to make such benefits available through such a provider of health 15
care, the society may treat the treatment that the society is unable to 16
make available through such a provider of health care in the same 17
manner as other services provided b y a provider of health care who 18
does not participate in the network plan of the society. 19
7. If an insured appeals the denial of a claim or coverage under 20
this section on the grounds that the treatment requested by the 21
insured is not medically necessary, the society must consult with a 22
provider of health care who has experience in prescribing or 23
delivering gender -affirming treatment concerning the medical 24
necessity of the treatment requested by the insured when 25
considering the appeal. 26
8. A benefit contra ct subject to the provisions of this chapter 27
that is delivered, issued for delivery or renewed on or after July 1, 28
2023, has the legal effect of including the coverage required by 29
subsection 1, and any provision of the benefit contract or renewal 30
which is in conflict with the provisions of this section is void. 31
9. As used in this section: 32
(a) “Cosmetic surgery”: 33
(1) Means a surgical procedure that: 34
(I) Does not meaningfully promote the proper function of 35
the body; 36
(II) Does not prevent or treat illness or disease; and 37
(III) Is primarily directed at improving the appearance of 38
a person. 39
(2) Includes, without limitation, cosmetic surgery directed at 40
preserving beauty. 41
(b) “Gender dysphoria” means distress or impairment in social, 42
occupational or other areas of functioning caused by a marked 43
difference between the gender identity or expression of a person and 44

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the sex assigned to the person at birth which lasts at least 6 months 1
and is shown by at least two of the following: 2
(1) A marked diff erence between gender identity or 3
expression and primary or secondary sex characteristics or 4
anticipated secondary sex characteristics in young adolescents. 5
(2) A strong desire to be rid of primary or secondary sex 6
characteristics because of a marked di fference between such sex 7
characteristics and gender identity or expression or a desire to 8
prevent the development of anticipated secondary sex characteristics 9
in young adolescents. 10
(3) A strong desire for the primary or secondary sex 11
characteristics of the gender opposite from the sex assigned at birth. 12
(4) A strong desire to be of the opposite gender or a gender 13
different from the sex assigned at birth. 14
(5) A strong desire to be treated as the opposite gender or a 15
gender different from the sex assigned at birth. 16
(6) A strong conviction of experiencing typical feelings and 17
reactions of the opposite gender or a gender different from the sex 18
assigned at birth. 19
(c) “Medically necessary” means health care services or 20
products that a prudent provider o f health care would provide to a 21
patient to prevent, diagnose or treat an illness, injury or disease, or 22
any symptoms thereof, that are necessary and: 23
(1) Provided in accordance with generally accepted standards 24
of medical practice; 25
(2) Clinically appr opriate with regard to type, frequency, 26
extent, location and duration; 27
(3) Not provided primarily for the convenience of the patient 28
or provider of health care; 29
(4) Required to improve a specific health condition of a 30
patient or to preserve the existing state of health of the patient; and 31
(5) The most clinically appropriate level of health care that 32
may be safely provided to the patient. 33
 A provider of health care prescribing, ordering, recommending or 34
approving a health care service or produc t does not, by itself, make 35
that health care service or product medically necessary. 36
[(d) “Network plan” means a benefit contract offered by a 37
society under which the financing and delivery of medical care, 38
including items and services paid for as medica l care, are provided, 39
in whole or in part, through a defined set of providers under contract 40
with the society. The term does not include an arrangement for the 41
financing of premiums. 42
(e) “Provider of health care” has the meaning ascribed to it in 43
NRS 629.031.] 44

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Sec. 247. NRS 695A.1873 is hereby amended to read as 1
follows: 2
695A.1873 1. A society that issues a benefit contract shall 3
include in the benefit contract coverage for: 4
(a) Necessary case management services for an insured who has 5
been diagnosed with sickle cell disease and its variants; and 6
(b) Medically necessary care for an insured who has been 7
diagnosed with sickle cell disease and its variants. 8
2. A society that issues a benefit contract which provides 9
coverage for prescription drugs shall include in the benefit contract 10
coverage for medically necessary prescription drugs to treat sickle 11
cell disease and its variants. 12
3. A society may use medi cal management techniques, 13
including, without limitation, any available clinical evidence, to 14
determine the frequency of or treatment relating to any benefit 15
required by this section or the type of provider of health care to use 16
for such treatment. 17
4. As used in this section: 18
(a) “Case management services” means medical or other health 19
care management services to assist patients and providers of health 20
care, including, without limitation, identifying and facilitating 21
additional resources and treatments, providing information about 22
treatment options and facilitating communication between providers 23
of services to a patient. 24
(b) [“Medical management technique” means a practice which is 25
used to control the cost or utilization of health care services. The 26
term includes, without limitation, the use of step therapy, prior 27
authorization or categorizing drugs and devices based on cost, type 28
or method of administration. 29
(c)] “Medically necessary” has the meaning ascribed to it in 30
NRS 695G.055. 31
[(d)] (c) “Sickle cell disease and its variants” has the meaning 32
ascribed to it in NRS 439.4927. 33
Sec. 248. NRS 695A.1874 is hereby amended to read as 34
follows: 35
695A.1874 1. A society that offers or issues a benefit 36
contract shall include in the contract coverage for: 37
(a) All drugs approved by the United States Food and Drug 38
Administration to support safe withdrawal from substance use 39
disorder, including, without limitation, lofexidine. 40
(b) All drugs approved by the United States Food and D rug 41
Administration to provide medication -assisted treatment for opioid 42
use disorder, including, without limitation, b uprenorphine, 43
methadone and naltrexone. 44

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(c) The services described in NRS 639.28079 when provided by 1
a pharmacist or pharmacy that participates in the network plan of the 2
society. The Commissioner shall adopt regulations governing the 3
provision of reimbursement for such services. 4
(d) Any service for the treatment of substance use disorder 5
provided by a provider of primary care if the servic e is covered 6
when provided by a specialist and: 7
(1) The service is within the scope of practice of the provider 8
of primary care; or 9
(2) The provider of primary care is capable of providing the 10
service safely and effectively in consultation with a spec ialist and 11
the provider engages in such consultation. 12
2. A society that offers or issues a benefit contract shall 13
reimburse a pharmacist or pharmacy that participates in the network 14
plan of the society for the services described in NRS 639.28079 at a 15
rate equal to the rate of reimbursement provided to a physician, 16
physician assistant or advanced practice registered nurse for similar 17
services. 18
3. A society shall provide the coverage required by paragraphs 19
(a) and (b) of subsection 1 regardless of whether the drug is 20
included in the formulary of the society. 21
4. Except as otherwise provided in this subsection, a society 22
shall not subject the benefits required by paragraphs (a), (b) and (c) 23
of subsection 1 to medical management techniques, other than step 24
therapy. A society may subject the benefits required by paragraphs 25
(b) and (c) of subsection 1 to other reasonable medical management 26
techniques when the benefits are provided by a pharmacist in 27
accordance with NRS 639.28079. 28
5. A society shall not: 29
(a) Limit the covered amount of a drug described in paragraph 30
(a) or (b) of subsection 1; or 31
(b) Refuse to cover a drug described in paragraph (a) or (b) of 32
subsection 1 because the drug is dispensed by a pharmacy through 33
mail order service. 34
6. A society s hall ensure that the benefits required by 35
subsection 1 are made available to an insured through a provider of 36
health care who participates in the network plan of the society. 37
7. A benefit contract subject to the provisions of this chapter 38
that is deliver ed, issued for delivery or renewed on or after 39
January 1, 2024, has the legal effect of including the coverage 40
required by subsection 1, and any provision of the contract that 41
conflicts with the provisions of this section is void. 42
8. As used in this section [: 43
(a) “Medical management technique” means a practice which is 44
used to control the cost or use of health care services or prescription 45

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drugs. The term includes, without limitation, the use of step therapy, 1
prior authorization and categorizing dr ugs and devices based on 2
cost, type or method of administration. 3
(b) “Network plan” means a benefit contract offered by a society 4
under which the financing and delivery of medical care, including 5
items and services paid for as medical care, are provided, in whole 6
or in part, through a defined set of providers under contract with the 7
society. The term does not include an arrangement for the financing 8
of premiums. 9
(c) “Primary] , “primary care” means the practice of family 10
medicine, pediatrics, internal me dicine, obstetrics and gynecology 11
and midwifery. 12
[(d) “Provider of health care” has the meaning ascribed to it in 13
NRS 629.031.] 14
Sec. 249. NRS 695A.1875 is hereby amended to read as 15
follows: 16
695A.1875 1. A society that offers or issues a benefit 17
contract shall include in the contract coverage for: 18
(a) Counseling, support and supplies for breastfeeding, 19
including breastfeeding equipment, counseling and education during 20
the antenatal, perinatal and postpartum period for n ot more than 1 21
year; 22
(b) Screening and counseling for interpersonal and domestic 23
violence for women at least annually with initial intervention 24
services consisting of education, strategies to reduce harm, 25
supportive services or a referral for any other appropriate services; 26
(c) Behavioral counseling concerning sexually transmitted 27
diseases from a provider of health care for sexually active women 28
who are at increased risk for such diseases; 29
(d) Hormone replacement therapy; 30
(e) Such prenatal screenings an d tests as recommended by the 31
American College of Obstetricians and Gynecologists or its 32
successor organization; 33
(f) Screening for blood pressure abnormalities and diabetes, 34
including gestational diabetes, after at least 24 weeks of gestation or 35
as ordered by a provider of health care; 36
(g) Screening for cervical cancer at such intervals as are 37
recommended by the American College of Obstetricians and 38
Gynecologists or its successor organization; 39
(h) Screening for depression; 40
(i) Screening and counseling f or the human immunodeficiency 41
virus consisting of a risk assessment, annual education relating to 42
prevention and at least one screening for the virus during the 43
lifetime of the insured or as ordered by a provider of health care; 44

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(j) Smoking cessation prog rams for an insured who is 18 years 1
of age or older consisting of not more than two cessation attempts 2
per year and four counseling sessions per year; 3
(k) All vaccinations recommended by the Advisory Committee 4
on Immunization Practices of the Centers for Disease Control and 5
Prevention of the United States Department of Health and Human 6
Services or its successor organization; and 7
(l) Such well-woman preventative visits as recommended by the 8
Health Resources and Services Administration, which must include 9
at least one such visit per year beginning at 14 years of age. 10
2. A society must ensure that the benefits required by 11
subsection 1 are made available to an insured through a provider of 12
health care who participates in the network plan of the society. 13
3. Except as otherwise provided in subsection 5, a society that 14
offers or issues a benefit contract shall not: 15
(a) Require an insured to pay a higher deductible, any 16
copayment or coinsurance or require a longer waiting period or 17
other condition to obtain any benefit provided in the benefit contract 18
pursuant to subsection 1; 19
(b) Refuse to issue a benefit contract or cancel a benefit contract 20
solely because the person applying for or covered by the contract 21
uses or may use any such benefit; 22
(c) Offer or pay any type of material inducement or financial 23
incentive to an insured to discourage the insured from obtaining any 24
such benefit; 25
(d) Penalize a provider of health care who provides any such 26
benefit to an insured, including, without limitation, reducing the 27
reimbursement of the provider of health care; 28
(e) Offer or pay any type of material inducement, bonus or other 29
financial incentive to a provider of health care to deny, reduce, 30
withhold, limit or delay access to any such benefit to an insured; or 31
(f) Impose any other restrictions or delays on the access of an 32
insured to any such benefit. 33
4. A benefit contract subject to the provisions of this chapter 34
that is delivered, issued for delivery or renewed on or after 35
January 1, 2018, has the legal effect o f including the coverage 36
required by subsection 1, and any provision of the benefit contract 37
or the renewal which is in conflict with this section is void. 38
5. Except as otherwise provided in this section and federal law, 39
a society may use medical managem ent techniques, including, 40
without limitation, any available clinical evidence, to determine the 41
frequency of or treatment relating to any benefit required by this 42
section or the type of provider of health care to use for such 43
treatment. 44
[6. As used in this section: 45

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(a) “Medical management technique” means a practice which is 1
used to control the cost or utilization of health care services or 2
prescription drug use. The term includes, without limitation, the use 3
of step therapy, prior authorization or cate gorizing drugs and 4
devices based on cost, type or method of administration. 5
(b) “Network plan” means a benefit contract offered by a society 6
under which the financing and delivery of medical care, including 7
items and services paid for as medical care, are provided, in whole 8
or in part, through a defined set of providers under contract with the 9
society. The term does not include an arrangement for the financing 10
of premiums. 11
(c) “Provider of health care” has the meaning ascribed to it in 12
NRS 629.031.] 13
Sec. 250. NRS 695A.256 is hereby amended to read as 14
follows: 15
695A.256 1. A benefit contract which provides coverage for 16
prescription drugs must not require an insured to submit to a step 17
therapy protocol before covering a drug approved by the Food and 18
Drug Administration that is prescribed to treat a psychiatric 19
condition of the insured, if: 20
(a) The drug has been approved by the Food and Drug 21
Administration with indications for the psychiatric condition of the 22
insured or the use of the drug to treat that psychiatric condition is 23
otherwise supported by medical or scientific evidence; 24
(b) The drug is prescribed by: 25
(1) A psychiatrist; 26
(2) A physician assistant under the supervision of a 27
psychiatrist; 28
(3) An advanced practice registered nurse who has the 29
psychiatric training and experience prescribed by the State Boar d of 30
Nursing pursuant to NRS 632.120; or 31
(4) A primary care provider that is providing care to an 32
insured in consultation with a practitioner listed in subparagraph (1), 33
(2) or (3), if the closest practitioner listed in subparagraph (1), (2) or 34
(3) who participates in the network plan of the society is located 60 35
miles or more from the residence of the insured; and 36
(c) The practitioner listed in paragraph (b) who prescribed the 37
drug knows, based on the medical history of the insured, or 38
reasonably expects each alternative drug that is required to be used 39
earlier in the step therapy protocol to be ineffective at treating the 40
psychiatric condition. 41
2. Any provision of a benefit contract subject to the provisions 42
of this chapter that is delivered, issued for delivery or renewed on or 43
after July 1, 2023, which is in conflict with this section is void. 44
3. As used in this section: 45

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(a) “Medical or scientific evidence” has the meaning ascribed to 1
it in NRS 695G.053. 2
(b) [“Network plan” means a benefit contr act offered by a 3
society under which the financing and delivery of medical care is 4
provided, in whole or in part, through a defined set of providers 5
under contract with the society. The term does not include an 6
arrangement for the financing of premiums. 7
(c)] “Step therapy protocol” means a procedure that requires an 8
insured to use a prescription drug or sequence of prescription drugs 9
other than a drug that a practitioner recommends for treatment of a 10
psychiatric condition of the insured before his or her benefit contract 11
provides coverage for the recommended drug. 12
Sec. 251. NRS 695A.500 is hereby amended to read as 13
follows: 14
695A.500 The Commissioner, or any person the Commissioner 15
may appoint, may examine any domestic, foreign or alien society 16
which is transacting business or applying for admission to transact 17
business in this state in the same manner as authorized for the 18
examination of domestic, foreign or alien insurers. For the purposes 19
of this section, the provisions of [NRS 679B.230 to 679B.300, ] 20
sections 2 to 41, inclusive, of this act are applicable to societies. 21
Sec. 252. NRS 695B.030 is hereby amended to read as 22
follows: 23
695B.030 As used in this chapter: 24
1. “Dental services” means general and special dental services 25
ordinarily provided by dentists licensed under the provisions of 26
chapter 631 of NRS to practice in the State of Nevada in accordance 27
with the generally accepted practice s of the community at the time 28
the service is rendered, and the furnishing of necessary appliances, 29
drugs, medicines and supplies, prosthetic appliances, orthodontic 30
appliances, metal, ceramic and other restorations. 31
2. “Hospital services” means the furnishing or providing of any 32
or all of the following: 33
(a) Maintenance and care in the hospital, including but not 34
limited to, nursing care, drugs, medicines, supplies, physiotherapy, 35
transportation and use of facilities and appliances. 36
(b) Reimbursement of the beneficiary or subscriber for, but 37
without requiring that the beneficiary or subscriber first pay, 38
expenses incurred for any of the items included in paragraph (a). 39
(c) Reimbursement, at a uniform rate, of the beneficiary or 40
subscriber for, but witho ut requiring that the beneficiary or 41
subscriber first pay, the costs and expenses incurred for medical 42
supplies. 43
(d) Reimbursement for expenses incurred outside of the hospital 44
for continued care and treatment following the subscriber’s 45

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discharge from the hospital, for nursing service, necessary 1
appliances, drugs, medicines, supplies and any other services which 2
would have been available in the hospital (excluding physicians’ 3
services), whether or not provided through a hospital. 4
(e) Reimbursement for ambulance service expenses. 5
3. “Medical management technique” has the meaning 6
ascribed to it in section 299 of this act. 7
4. “Medical services” means the furnishing or providing of any 8
or all of the following: 9
(a) Medical or surgical services, in or out of a hospital, by a 10
physician licensed to practice under the laws of Nevada. 11
(b) Reimbursement for expenses incurred for nursing services, 12
necessary appliances, drugs, medicines, supplies and any other 13
health care services. 14
5. “Network plan” has the meaning ascribed to it in 15
NRS 687B.645. 16
6. “Provider network contract” has the meaning ascribed to it 17
in NRS 687B.658. 18
7. “Provider of health care” has the meaning ascribed to it in 19
NRS 629.031. 20
8. “Therapeutic equivalent” has the meaning ascribed to it in 21
section 302 of this act. 22
Sec. 253. NRS 695B.160 is hereby amended to read as 23
follows: 24
695B.160 1. Every corporation subject to the provisions of 25
this chapter shall annually: 26
(a) On or before March 1, file in the Office of the Commissioner 27
a statement verified by at least two of the principal officers of the 28
corporation, showing its condition and affairs as of December 31 of 29
the preceding calendar year. The statement must be in the form 30
required by the Commissioner and must contain statements relative 31
to the matters required to be established as a condition precedent to 32
maintaining or operating a nonprofit hospital, medical or dental 33
service plan and to other matters which the Commissioner may 34
prescribe. 35
(b) Pay all applicable fees for the renewal of a certifica te of 36
authority and the fee for the filing of an annual statement. 37
2. Every corporation subject to the provisions of this chapter 38
shall file a financial statement pursuant to NRS 680A.265, 39
as required pursuant to paragraph (c) of subsection 1 of 40
NRS 680A.265. 41
3. Every corporation subject to the provisions of this chapter 42
shall file with the Commissioner and the National Association of 43
Insurance Commissioners a quarterly statement in the form most 44
recently adopted by the National Association of Insura nce 45

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Commissioners for that type of insurer. The quarterly statement 1
must be: 2
(a) Prepared in accordance with the instructions which are 3
applicable to that form, including, without limitation, the required 4
date of submission for the form; and 5
(b) Filed by electronic means. 6
4. The Commissioner may examine, as often as the 7
Commissioner deems it desirable, the affairs of every corporation 8
subject to the provisions of this chapter. The Commissioner shall, if 9
practicable, examine each such corporation at leas t once in every 3 10
years, and in any event, at least once in every 5 years, as to its 11
condition, fulfillment of its contractual obligations and compliance 12
with applicable laws. The actual expenses of the examination must 13
be paid by the corporation in accord ance with the provisions of 14
[NRS 679B.290. ] section 19 of this act. The Commissioner shall 15
refuse to issue a certificate of authority or shall revoke a certificate 16
of authority issued to any corporation which neglects or refuses to 17
pay such expenses. 18
Sec. 254. NRS 695B.185 is hereby amended to read as 19
follows: 20
695B.185 A group contract for hospital, medical or dental 21
services which offers a difference of payment between preferred 22
providers of health care and providers of health care who are not 23
preferred: 24
1. [May not require a deductible of more than $600 difference 25
per admission to a facility for inpatient treatment which is not a 26
preferred provider of health care. 27
2. May not require a deductible of more than $500 difference 28
per treatment, other than inpatient treatment at a hospital, by a 29
provider which is not preferred. 30
3.] May not require an insured, another insurer who issues 31
policies of group health insurance, a nonprofit medical service 32
corporation or a health maintenance organization to pay any amount 33
in excess of the deductible or coinsurance due from the insured 34
based on the rates agreed upon with a provider. 35
[4. May not provide for a difference in percentage rates of 36
payment for coinsurance of more than 30 percentage points between 37
the copayment required to be paid by the insured to a preferred 38
provider of health care and the copayment required to be paid by the 39
insured to a provider of health care who is not preferred. 40
5.] 2. Must require that the ded uctible and payment for 41
coinsurance paid by the insured to a preferred provider of health 42
care be applied to the negotiated reduced rates of that provider. 43
[6.] 3. Must provide that if there is a particular service which a 44
preferred provider of health ca re does not provide and the provider 45

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of health care who is treating the insured determines that the use of 1
the service is necessary for the health of the insured, the service 2
shall be deemed to be provided by the preferred provider of health 3
care. 4
[7.] 4. Must require the corporation to process a claim of a 5
provider of health care who is not preferred not later than 30 6
working days after the date on which proof of the claim is received. 7
Sec. 255. NRS 695B.19046 is hereby amended to read as 8
follows: 9
695B.19046 1. A policy of health insurance offered or issued 10
by a hospital or medical services corporation which provides 11
coverage for prescription drugs must not require an insured to 12
submit to a step therapy protocol before covering a drug approved 13
by the Food and Drug Administration that is prescribed to treat a 14
psychiatric condition of the insured, if: 15
(a) The drug has been approved by the Food and Drug 16
Administration with indications for the psychiatric condition of the 17
insured or the use of the drug to treat that psychiatric condition is 18
otherwise supported by medical or scientific evidence; 19
(b) The drug is prescribed by: 20
(1) A psychiatrist; 21
(2) A physician assistant under the supervision of a 22
psychiatrist; 23
(3) An advanced practice registered nurse who has the 24
psychiatric training and experience prescribed by the State Board of 25
Nursing pursuant to NRS 632.120; or 26
(4) A primary care provider that is providing care to an 27
insured in consultation with a practitioner listed in subparagraph (1), 28
(2) or (3), if the closest practitioner listed in subparagraph (1), (2) or 29
(3) who participates in the network plan of the hospital or medical 30
services corporation is located 60 miles or more from the residence 31
of the insured; and 32
(c) The practitioner listed in paragraph (b) who prescribed the 33
drug knows, based on the medical history of the insured, or 34
reasonably expects each alternative drug that is required to be used 35
earlier in the step therapy protocol to be ineffectiv e at treating the 36
psychiatric condition. 37
2. Any provision of a policy of health insurance subject to the 38
provisions of this chapter that is delivered, issued for delivery or 39
renewed on or after July 1, 2023, which is in conflict with this 40
section is void. 41
3. As used in this section: 42
(a) “Medical or scientific evidence” has the meaning ascribed to 43
it in NRS 695G.053. 44

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(b) [“Network plan” means a policy of health insurance offered 1
by a hospital or medical services corporation under which the 2
financing and delivery of medical care is provided, in whole or in 3
part, through a defined set of providers under contract with the 4
hospital or medical services corporation. The term does not include 5
an arrangement for the financing of premiums. 6
(c)] “Step therapy p rotocol” means a procedure that requires an 7
insured to use a prescription drug or sequence of prescription drugs 8
other than a drug that a practitioner recommends for treatment of a 9
psychiatric condition of the insured before his or her policy of health 10
insurance offered or issued by a hospital or medical services 11
corporation provides coverage for the recommended drug. 12
Sec. 256. NRS 695B.19087 is hereby amended to read as 13
follows: 14
695B.19087 1. Subject to the limitations prescribed by 15
subsection 4, a hospital or medical service corporation that issues a 16
policy of health insurance shall include in the policy coverage for 17
medically necessary biomarker testing for the diagnosis, treatment, 18
appropriate management and ongoing m onitoring of cancer when 19
such biomarker testing is supported by medical and scientific 20
evidence. Such evidence includes, without limitation: 21
(a) The labeled indications for a biomarker test or medication 22
that has been approved or cleared by the United Sta tes Food and 23
Drug Administration; 24
(b) The indicated tests for a drug that has been approved by the 25
United States Food and Drug Administration or the warnings and 26
precautions included on the label of such a drug; 27
(c) A national coverage determination or l ocal coverage 28
determination, as those terms are defined in 42 C.F.R. § 400.202; or 29
(d) Nationally recognized clinical practice guidelines or 30
consensus statements. 31
2. A hospital or medical service corporation shall: 32
(a) Provide the coverage required by subsection 1 in a manner 33
that limits disruptions in care and the need for multiple specimens. 34
(b) Establish a clear and readily accessible process for an 35
insured or provider of health care to: 36
(1) Request an exception to a policy excluding coverage for 37
biomarker testing for the diagnosis, treatment, management or 38
ongoing monitoring of cancer; or 39
(2) Appeal a denial of coverage for such biomarker testing; 40
and 41
(c) Make the process described in paragraph (b) available on an 42
Internet website maintained by the hospital or medical service 43
corporation. 44

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3. If a hospital or medical service corporation requires an 1
insured to obtain prior authorization for a biomarker test described 2
in subsection 1, the hospital or medical service corporation shall 3
respond to a request for such prior authorization: 4
(a) Within 24 hours after receiving an urgent request; or 5
(b) Within 72 hours after receiving any other request. 6
4. The provisions of this section do not require a hospital or 7
medical service corporation to provid e coverage of biomarker 8
testing: 9
(a) For screening purposes; 10
(b) Conducted by a provider of health care for whom the 11
biomarker testing is not within his or her scope of practice, training 12
and experience; 13
(c) Conducted by a provider of health care or a facility that does 14
not participate in the network plan of the hospital or medical service 15
corporation; or 16
(d) That has not been determined to be medically necessary by a 17
provider of health care for whom such a determination is within his 18
or her scope of practice, training and experience. 19
5. A policy of health insurance subject to the provisions of this 20
chapter that is delivered, issued for delivery or renewed on or after 21
October 1, 2023, has the legal effect of including the coverage 22
required by this se ction, and any provision of the policy or renewal 23
which is in conflict with the provisions of this section is void. 24
6. As used in this section: 25
(a) “Biomarker” means a characteristic that is objectively 26
measured and evaluated as an indicator of a normal biological 27
process, a pathogenic process or a pharmacological response to a 28
specific therapeutic intervention and includes, without limitation: 29
(1) An interaction between a gene and a drug that is being 30
used by or considered for use by the patient; 31
(2) A mutation or characteristic of a gene; and 32
(3) The expression of a protein. 33
(b) “Biomarker testing” means the analysis of the tissue, blood 34
or other biospecimen of a patient for the presentation of a biomarker 35
and includes, without limitation, singl e-analyte tests, multiplex 36
panel tests and whole genome, whole exome and whole 37
transcriptome sequencing. 38
(c) “Consensus statement” means a statement aimed at a specific 39
clinical circumstance that is: 40
(1) Made for the purpose of optimizing the outcomes o f 41
clinical care; 42
(2) Made by an independent, multidisciplinary panel of 43
experts that has established a policy to avoid conflicts of interest; 44
(3) Based on scientific evidence; and 45

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(4) Made using a transparent methodology and reporting 1
procedure. 2
(d) “Medically necessary” means health care services or 3
products that a prudent provider of health care would provide to a 4
patient to prevent, diagnose or treat an illness, injury or disease, or 5
any symptoms thereof, that are necessary and: 6
(1) Provided in accordance with generally accepted standards 7
of medical practice; 8
(2) Not primarily provided for the convenience of the patient 9
or provider of health care; and 10
(3) Significant in guiding and informing the provider of 11
health care in providing the most appropriate course of treatment for 12
the patient in order to prevent, delay or lessen the magnitude of an 13
adverse health outcome. 14
(e) “Nationally recognized clinical practice guidelines” means 15
evidence-based guidelines establishing standards of care that 16
include, without limitation, recommendations intended to optimize 17
care of patients and are: 18
(1) Informed by a systemic review of evidence and an 19
assessment of the risks and benefits of alternative options for care; 20
and 21
(2) Developed using a transparent m ethodology and 22
reporting procedure by an independent organization or society of 23
medical professionals that has established a policy to avoid conflicts 24
of interest. 25
[(f) “Network plan” means a policy of health insurance offered 26
by a hospital or medical ser vice corporation under which the 27
financing and delivery of medical care, including items and services 28
paid for as medical care, are provided, in whole or in part, through a 29
defined set of providers under contract with the hospital or medical 30
service corporation. The term does not include an arrangement for 31
the financing of premiums. 32
(g) “Provider of health care” has the meaning ascribed to it in 33
NRS 629.031.] 34
Sec. 257. NRS 695B.1911 is hereby amended to read as 35
follows: 36
695B.1911 1. A hospital or medical services corporation that 37
issues a policy of health insurance shall provide coverage for 38
screening, genetic counseling and testing for harmful mutations in 39
the BRCA gene for women under circumstances where such 40
screening, genetic counseling or testing, as applicable, is required by 41
NRS 457.301. 42
2. A hospital or medical services corporation shall ensure that 43
the benefits required by subsection 1 are made available to an 44

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insured through a provider of health care who part icipates in the 1
network plan of the hospital or medical services corporation. 2
3. A policy of health insurance subject to the provisions of this 3
chapter that is delivered, issued for delivery or renewed on or after 4
January 1, 2022, has the legal effect of including the coverage 5
required by subsection 1, and any provision of the policy that 6
conflicts with the provisions of this section is void. 7
[4. As used in this section: 8
(a) “Network plan” means a policy of health insurance offered 9
by a hospital or medical services corporation under which the 10
financing and delivery of medical care, including items and services 11
paid for as medical care, are provided, in whole or in part, through a 12
defined set of providers under contract with the hospital or medical 13
services corporation. The term does not include an arrangement for 14
the financing of premiums. 15
(b) “Provider of health care” has the meaning ascribed to it in 16
NRS 629.031.] 17
Sec. 258. NRS 695B.1912 is hereby amended to read as 18
follows: 19
695B.1912 1. An insurer that offers or issues a contract for 20
hospital or medical service must provide coverage for benefits 21
payable for expenses incurred for: 22
(a) A mammogram to screen for breast cancer annually for 23
insureds who are 40 years of age or older. 24
(b) An imaging test to screen for breast cancer on an interval 25
and at the age deemed most appropriate, when medically necessary, 26
as recommended by the insured’s provider of health care based on 27
personal or family medical history or additi onal factors that may 28
increase the risk of breast cancer for the insured. 29
(c) A diagnostic imaging test for breast cancer at the age deemed 30
most appropriate, when medically necessary, as recommended by 31
the insured’s provider of health care to evaluate an abnormality 32
which is: 33
(1) Seen or suspected from a mammogram described in 34
paragraph (a) or an imaging test described in paragraph (b); or 35
(2) Detected by other means of examination. 36
2. An insurer must ensure that the benefits required by 37
subsection 1 are made available to an insured through a provider of 38
health care who participates in the network plan of the insurer. 39
3. Except as otherwise provided in subsection 5, an insurer that 40
offers or issues a contract for hospital or medical service shall not: 41
(a) Except as otherwise provided in subsection 6, require an 42
insured to pay a deductible, copayment, coinsurance or any other 43
form of cost -sharing or require a longer waiting period or other 44

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condition to obtain any benefit provided in a contract for ho spital or 1
medical service pursuant to subsection 1; 2
(b) Refuse to issue a contract for hospital or medical service or 3
cancel a contract for hospital or medical service solely because the 4
person applying for or covered by the contract uses or may use any 5
such benefit; 6
(c) Offer or pay any type of material inducement or financial 7
incentive to an insured to discourage the insured from obtaining any 8
such benefit; 9
(d) Penalize a provider of health care who provides any such 10
benefit to an insured, including, w ithout limitation, reducing the 11
reimbursement of the provider of health care; 12
(e) Offer or pay any type of material inducement, bonus or other 13
financial incentive to a provider of health care to deny, reduce, 14
withhold, limit or delay access to any such benefit to an insured; or 15
(f) Impose any other restrictions or delays on the access of an 16
insured to any such benefit. 17
4. A contract for hospital or medical service subject to the 18
provisions of this chapter which is delivered, issued for delivery or 19
renewed on or after January 1, 2024, has the legal effect of 20
including the coverage required by subsection 1, and any provision 21
of the contract or the renewal which is in conflict with this section is 22
void. 23
5. Except as otherwise provided in this section and federal law, 24
an insurer may use medical management techniques, including, 25
without limitation, any available clinical evidence, to determine the 26
frequency of or treatment relating to any benefit required by this 27
section or the type of provider of health car e to use for such 28
treatment. 29
6. If the application of paragraph (a) of subsection 3 would 30
result in the ineligibility of a health savings account of an insured 31
pursuant to 26 U.S.C. § 223, the prohibitions of paragraph (a) of 32
subsection 3 shall apply onl y for a qualified contract for hospital or 33
medical service with respect to the deductible of such a contract for 34
hospital or medical service after the insured has satisfied the 35
minimum deductible pursuant to 26 U.S.C. § 223, except with 36
respect to items or services that constitute preventive care pursuant 37
to 26 U.S.C. § 223(c)(2)(C), in which case the prohibitions of 38
paragraph (a) of subsection 3 shall apply regardless of whether the 39
minimum deductible under 26 U.S.C. § 223 has been satisfied. 40
7. As used in this section [: 41
(a) “Medical management technique” means a practice which is 42
used to control the cost or utilization of health care services or 43
prescription drug use. The term includes, without limitation, the use 44

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of step therapy, prior authorization o r categorizing drugs and 1
devices based on cost, type or method of administration. 2
(b) “Network plan” means a contract for hospital or medical 3
service offered by an insurer under which the financing and delivery 4
of medical care, including items and service s paid for as medical 5
care, are provided, in whole or in part, through a defined set of 6
providers under contract with the insurer. The term does not include 7
an arrangement for the financing of premiums. 8
(c) “Provider of health care” has the meaning ascrib ed to it in 9
NRS 629.031. 10
(d) “Qualified] , “qualified contract for hospital or medical 11
service” means a contract for hospital or medical service that has a 12
high deductible and is in compliance with 26 U.S.C. § 223 for the 13
purposes of establishing a health savings account. 14
Sec. 259. NRS 695B.1913 is hereby amended to read as 15
follows: 16
695B.1913 1. A hospital or medical services corporation that 17
issues a policy of health insurance shall provide coverage for the 18
examination of a person who is pregnant for the discovery of: 19
(a) Chlamydia trachomatis, gonorrhea, hepatitis B and hepatitis 20
C in accordance with NRS 442.013. 21
(b) Syphilis in accordance with NRS 442.010. 22
2. The coverage required by this section must be provided: 23
(a) Regardless of whether the benefits are provided to the 24
insured by a provider of health care, facility or medical laboratory 25
that participates in the network plan of the hospital or medical 26
services corporation; and 27
(b) Without prior authorization. 28
3. A policy of health insurance subject to the provisions of this 29
chapter that is delivered, issued for delivery or renewed on or after 30
July 1, 2021, has the legal effect of including the coverage required 31
by subsection 1, and any provision of the policy t hat conflicts with 32
the provisions of this section is void. 33
4. As used in this section [: 34
(a) “Medical] , “medical laboratory” has the meaning ascribed 35
to it in NRS 652.060. 36
[(b) “Network plan” means a policy of health insurance offered 37
by a hospital or medical services corporation under which the 38
financing and delivery of medical care, including items and services 39
paid for as medical care, are provided, in whole or in part, through a 40
defined set of providers under contract with the hospital or medical 41
services corporation. The term does not include an arrangement for 42
the financing of premiums. 43
(c) “Provider of health care” has the meaning ascribed to it in 44
NRS 629.031.] 45

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Sec. 260. NRS 695B.1915 is hereby amended to read a s 1
follows: 2
695B.1915 1. Except as otherwise provided in this section, a 3
hospital or medical services corporation that issues a policy of 4
health insurance shall include in the policy coverage for the 5
medically necessary treatment of conditions relating t o gender 6
dysphoria and gender incongruence. Such coverage must include 7
coverage of medically necessary psychosocial and surgical 8
intervention and any other medically necessary treatment for such 9
disorders provided by: 10
(a) Endocrinologists; 11
(b) Pediatric endocrinologists; 12
(c) Social workers; 13
(d) Psychiatrists; 14
(e) Psychologists; 15
(f) Gynecologists; 16
(g) Speech-language pathologists; 17
(h) Primary care physicians; 18
(i) Advanced practice registered nurses; 19
(j) Physician assistants; and 20
(k) Any other providers of medically necessary services for the 21
treatment of gender dysphoria or gender incongruence. 22
2. This section does not require a policy of health insurance to 23
include coverage for cosmetic surgery performed by a plastic 24
surgeon or reconstructive surgeon that is not medically necessary. 25
3. A hospital or medical services corporation that issues a 26
policy of health insurance shall not categorically refuse to cover 27
medically necessary gender -affirming treatments or procedures or 28
revisions to prior treatments if the policy provides coverage for any 29
such services, procedures or revisions for purposes other than 30
gender transition or affirmation. 31
4. A hospital or medical services corporation that issues a 32
policy of health insurance may pres cribe requirements that must be 33
satisfied before the hospital or medical services corporation covers 34
surgical treatment of conditions relating to gender dysphoria or 35
gender incongruence for an insured who is less than 18 years of age. 36
Such requirements may include, without limitation, requirements 37
that: 38
(a) The treatment must be recommended by a psychologist, 39
psychiatrist or other mental health professional; 40
(b) The treatment must be recommended by a physician; 41
(c) The insured must provide a written e xpression of the desire 42
of the insured to undergo the treatment; 43

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(d) A written plan for treatment that covers at least 1 year must 1
be developed and approved by at least two providers of health care; 2
and 3
(e) Parental consent is provided for the insured unless the 4
insured is expressly authorized by law to consent on his or her own 5
behalf. 6
5. When determining whether treatment is medically necessary 7
for the purposes of this section, a hospital or medical services 8
corporation must consider the most recent Standards of Care 9
published by the World Professional Association for Transgender 10
Health, or its successor organization. 11
6. A hospital or medical services corporation shall make a 12
reasonable effort to ensure that the benefits required by subsection 1 13
are made available to an insured through a provider of health care 14
who participates in the network plan of the hospital or medical 15
services corporation. If, after a reasonable effort, the hospital or 16
medical services corporation is unable to make such benefi ts 17
available through such a provider of health care, the hospital or 18
medical services corporation may treat the treatment that the 19
hospital or medical services corporation is unable to make available 20
through such a provider of health care in the same manne r as other 21
services provided by a provider of health care who does not 22
participate in the network plan of the hospital or medical services 23
corporation. 24
7. If an insured appeals the denial of a claim or coverage under 25
this section on the grounds that the treatment requested by the 26
insured is not medically necessary, the hospital or medical services 27
corporation must consult with a provider of health care who has 28
experience in prescribing or delivering gender -affirming treatment 29
concerning the medical neces sity of the treatment requested by the 30
insured when considering the appeal. 31
8. A policy of health insurance subject to the provisions of this 32
chapter that is delivered, issued for delivery or renewed on or after 33
July 1, 2023, has the legal effect of incl uding the coverage required 34
by subsection 1, and any provision of the policy or renewal which is 35
in conflict with the provisions of this section is void. 36
9. As used in this section: 37
(a) “Cosmetic surgery”: 38
(1) Means a surgical procedure that: 39
(I) Does not meaningfully promote the proper function of 40
the body; 41
(II) Does not prevent or treat illness or disease; and 42
(III) Is primarily directed at improving the appearance of 43
a person. 44

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(2) Includes, without limitation, cosmetic surgery direct ed at 1
preserving beauty. 2
(b) “Gender dysphoria” means distress or impairment in social, 3
occupational or other areas of functioning caused by a marked 4
difference between the gender identity or expression of a person and 5
the sex assigned to the person at bi rth which lasts at least 6 months 6
and is shown by at least two of the following: 7
(1) A marked difference between gender identity or 8
expression and primary or secondary sex characteristics or 9
anticipated secondary sex characteristics in young adolescents. 10
(2) A strong desire to be rid of primary or secondary sex 11
characteristics because of a marked difference between such sex 12
characteristics and gender identity or expression or a desire to 13
prevent the development of anticipated secondary sex characteristics 14
in young adolescents. 15
(3) A strong desire for the primary or secondary sex 16
characteristics of the gender opposite from the sex assigned at birth. 17
(4) A strong desire to be of the opposite gender or a gender 18
different from the sex assigned at birth. 19
(5) A strong desire to be treated as the opposite gender or a 20
gender different from the sex assigned at birth. 21
(6) A strong conviction of experiencing typical feelings and 22
reactions of the opposite gender or a gender different from the sex 23
assigned at birth. 24
(c) “Medically necessary” means health care services or 25
products that a prudent provider of health care would provide to a 26
patient to prevent, diagnose or treat an illness, injury or disease, or 27
any symptoms thereof, that are necessary and: 28
(1) Provided in accordance with generally accepted standards 29
of medical practice; 30
(2) Clinically appropriate with regard to type, frequency, 31
extent, location and duration; 32
(3) Not provided primarily for the convenience of the patient 33
or provider of health care; 34
(4) Required to improve a specific health condition of a 35
patient or to preserve the existing state of health of the patient; and 36
(5) The most clinically appropriate level of health care that 37
may be safely provided to the patient. 38
 A provider of health care prescribing, ordering, recommending or 39
approving a health care service or product does not, by itself, make 40
that health care service or product medically necessary. 41
[(d) “Network plan” means a policy of health insurance offered 42
by a hospital or medical services corporation under which the 43
financing and delivery of medical care, including items and services 44
paid for as medical care, are provided, in whole or in part, throug h a 45

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defined set of providers under contract with the hospital or medical 1
services corporation. The term does not include an arrangement for 2
the financing of premiums. 3
(e) “Provider of health care” has the meaning ascribed to it in 4
NRS 629.031.] 5
Sec. 261. NRS 695B.1916 is hereby amended to read as 6
follows: 7
695B.1916 1. An insurer that offers or issues a contract for 8
hospital or medical service which provides coverage for prescription 9
drugs or devices shall include in the contract coverage for any type 10
of hormone replacement therapy which is lawfully prescribed or 11
ordered and which has been approved by the Food and Drug 12
Administration. 13
2. An insurer that offers or issues a contract for hospital or 14
medical service that provides coverage for prescription drugs shall 15
not: 16
(a) Require an insured to pay a higher deductible, any 17
copayment or coinsurance or require a longer waiting period or 18
other condition for coverage for a prescription for hormone 19
replacement therapy; 20
(b) Refuse to issue a contract for hospital or medical service or 21
cancel a contract for hospital or medical service solely because the 22
person applying for or covered by the contract uses or may use in 23
the future hormone replacement therapy; 24
(c) Offer or pay any type of material inducement or financial 25
incentive to an insured to discourage the insured from accessing 26
hormone replacement therapy; 27
(d) Penalize a provider of health care who provides hormone 28
replacement therapy to an insured, including, without l imitation, 29
reducing the reimbursement of the provider of health care; or 30
(e) Offer or pay any type of material inducement, bonus or other 31
financial incentive to a provider of health care to deny, reduce, 32
withhold, limit or delay hormone replacement therapy to an insured. 33
3. A contract for hospital or medical service subject to the 34
provisions of this chapter that is delivered, issued for delivery or 35
renewed on or after October 1, 1999, has the legal effect of 36
including the coverage required by subsection 1, and any provision 37
of the contract or the renewal which is in conflict with this section is 38
void. 39
4. The provisions of this section do not require an insurer to 40
provide coverage for fertility drugs. 41
[5. As used in this section, “provider of health ca re” has the 42
meaning ascribed to it in NRS 629.031.] 43

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Sec. 262. NRS 695B.1918 is hereby amended to read as 1
follows: 2
695B.1918 1. An insurer that offers or issues a contract for 3
hospital or medical service which provides co verage for outpatient 4
care shall include in the contract coverage for any health care 5
service related to hormone replacement therapy. 6
2. An insurer that offers or issues a contract for hospital or 7
medical service that provides coverage for outpatient care shall not: 8
(a) Require an insured to pay a higher deductible, any 9
copayment or coinsurance or require a longer waiting period or 10
other condition for coverage for outpatient care related to hormone 11
replacement therapy; 12
(b) Refuse to issue a contract for hospital or medical service or 13
cancel a contract for hospital or medical service solely because the 14
person applying for or covered by the contract uses or may use in 15
the future hormone replacement therapy; 16
(c) Offer or pay any type of material inducem ent or financial 17
incentive to an insured to discourage the insured from accessing 18
hormone replacement therapy; 19
(d) Penalize a provider of health care who provides hormone 20
replacement therapy to an insured, including, without limitation, 21
reducing the reimbursement of the provider of health care; or 22
(e) Offer or pay any type of material inducement, bonus or other 23
financial incentive to a provider of health care to deny, reduce, 24
withhold, limit or delay hormone replacement therapy to an insured. 25
3. A contr act for hospital or medical service subject to the 26
provisions of this chapter that is delivered, issued for delivery or 27
renewed on or after October 1, 1999, has the legal effect of 28
including the coverage required by subsection 1, and any provision 29
of the contract or the renewal which is in conflict with this section is 30
void. 31
[4. As used in this section, “provider of health care” has the 32
meaning ascribed to it in NRS 629.031.] 33
Sec. 263. NRS 695B.1919 is hereby amended to read as 34
follows: 35
695B.1919 1. Except as otherwise provided in subsection 8, 36
an insurer that offers or issues a contract for hospital or medical 37
service shall include in the contract coverage for: 38
(a) Up to a 12 -month supply, per prescription, of any ty pe of 39
drug for contraception or its therapeutic equivalent which is: 40
(1) Lawfully prescribed or ordered; 41
(2) Approved by the Food and Drug Administration; 42
(3) Listed in subsection 12; and 43
(4) Dispensed in accordance with NRS 639.28075; 44
(b) Any type of device for contraception which is: 45

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(1) Lawfully prescribed or ordered; 1
(2) Approved by the Food and Drug Administration; and 2
(3) Listed in subsection 12; 3
(c) Self-administered hormonal contraceptives dispensed by a 4
pharmacist pursuant to NRS 639.28078; 5
(d) Insertion of a device for contraception or removal of such a 6
device if the device was inserted while the insured was covered by 7
the same contract for hospital or medical service; 8
(e) Education and counseling relating to the initiation of the use 9
of contraception and any necessary follow -up after initiating such 10
use; 11
(f) Management of side effects relating to contraception; and 12
(g) Voluntary sterilization for women. 13
2. An insurer shall provide coverage for any services listed in 14
subsection 1 which are within the authorized scope of practice of a 15
pharmacist when such services are provided by a pharmacist who is 16
employed by or serves as an independent contractor of an in -17
network pharmacy and in accordance with the applicable provider 18
network contract. Such coverage must be provided to the same 19
extent as if the services were provided by another provider of health 20
care, as applicable to the services being provided. The terms of the 21
policy must not limit: 22
(a) Coverage for services listed in s ubsection 1 and provided by 23
such a pharmacist to a number of occasions less than the coverage 24
for such services when provided by another provider of health care. 25
(b) Reimbursement for services listed in subsection 1 and 26
provided by such a pharmacist to an amount less than the amount 27
reimbursed for similar services provided by a physician, physician 28
assistant or advanced practice registered nurse. 29
3. An insurer that offers or issues a contract for hospital or 30
medical services must ensure that the benefits required by 31
subsection 1 are made available to an insured through a provider of 32
health care who participates in the network plan of the insurer. 33
4. If a covered therapeutic equivalent listed in subsection 1 is 34
not available or a provider of health care deems a covered 35
therapeutic equivalent to be medically inappropriate, an alternate 36
therapeutic equivalent prescribed by a provider of health care must 37
be covered by the insurer. 38
5. Except as otherwise provided in subsections 10, 11 and 13, 39
an insurer tha t offers or issues a contract for hospital or medical 40
service shall not: 41
(a) Require an insured to pay a higher deductible, any 42
copayment or coinsurance or require a longer waiting period or 43
other condition to obtain any benefit included in the contract f or 44
hospital or medical service pursuant to subsection 1; 45

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(b) Refuse to issue a contract for hospital or medical service or 1
cancel a contract for hospital or medical service solely because the 2
person applying for or covered by the contract uses or may use any 3
such benefit; 4
(c) Offer or pay any type of material inducement or financial 5
incentive to an insured to discourage the insured from obtaining any 6
such benefit; 7
(d) Penalize a provider of health care who provides any such 8
benefit to an insured, includi ng, without limitation, reducing the 9
reimbursement to the provider of health care; 10
(e) Offer or pay any type of material inducement, bonus or other 11
financial incentive to a provider of health care to deny, reduce, 12
withhold, limit or delay access to any such benefit to an insured; or 13
(f) Impose any other restrictions or delays on the access of an 14
insured to any such benefit. 15
6. Coverage pursuant to this section for the covered dependent 16
of an insured must be the same as for the insured. 17
7. Except as otherwise provided in subsection 8, a contract for 18
hospital or medical service subject to the provisions of this chapter 19
that is delivered, issued for delivery or renewed on or after 20
January 1, 2024, has the legal effect of including the coverage 21
required by this section, and any provision of the contract or the 22
renewal which is in conflict with this section is void. 23
8. An insurer that offers or issues a contract for hospital or 24
medical service and which is affiliated with a religious organization 25
is not required to provide the coverage required by subsection 1 if 26
the insurer objects on religious grounds. Such an insurer shall, 27
before the issuance of a contract for hospital or medical service and 28
before the renewal of such a contract, provide to the prosp ective 29
insured written notice of the coverage that the insurer refuses to 30
provide pursuant to this subsection. 31
9. If an insurer refuses, pursuant to subsection 8, to provide the 32
coverage required by subsection 1, an employer may otherwise 33
provide for the coverage for the employees of the employer. 34
10. An insurer may require an insured to pay a higher 35
deductible, copayment or coinsurance for a drug for contraception if 36
the insured refuses to accept a therapeutic equivalent of the drug. 37
11. For each of the 18 methods of contraception listed in 38
subsection 12 that have been approved by the Food and Drug 39
Administration, a contract for hospital or medical service must 40
include at least one drug or device for contraception within each 41
method for w hich no deductible, copayment or coinsurance may be 42
charged to the insured, but the insurer may charge a deductible, 43
copayment or coinsurance for any other drug or device that provides 44
the same method of contraception. If the insurer charges a 45

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copayment or coinsurance for a drug for contraception, the insurer 1
may only require an insured to pay the copayment or coinsurance: 2
(a) Once for the entire amount of the drug dispensed for the plan 3
year; or 4
(b) Once for each 1-month supply of the drug dispensed. 5
12. The following 18 methods of contraception must be 6
covered pursuant to this section: 7
(a) Voluntary sterilization for women; 8
(b) Surgical sterilization implants for women; 9
(c) Implantable rods; 10
(d) Copper-based intrauterine devices; 11
(e) Progesterone-based intrauterine devices; 12
(f) Injections; 13
(g) Combined estrogen- and progestin-based drugs; 14
(h) Progestin-based drugs; 15
(i) Extended- or continuous-regimen drugs; 16
(j) Estrogen- and progestin-based patches; 17
(k) Vaginal contraceptive rings; 18
(l) Diaphragms with spermicide; 19
(m) Sponges with spermicide; 20
(n) Cervical caps with spermicide; 21
(o) Female condoms; 22
(p) Spermicide; 23
(q) Combined estrogen - and progestin -based drugs for 24
emergency contraception or progestin -based drugs for emergency 25
contraception; and 26
(r) Ulipristal acetate for emergency contraception. 27
13. Except as otherwise provided in this section and federal 28
law, an insurer that offers or issues a contract for hospital or medical 29
services may use medical management techniques, including, 30
without limitation, any available clinical evidence, to determine the 31
frequency of or treatment relating to any benefit required by this 32
section or the type of provider of health care to use for such 33
treatment. 34
14. An insurer shall not: 35
(a) Use medical management techniques to require an insured to 36
use a method of contraception other than the method prescribed or 37
ordered by a provider of health care; 38
(b) Require an insured to obtain prior authorization for the 39
benefits described in paragraphs (a) and (c) of subsection 1; or 40
(c) Refuse to cover a contraceptive injection or the insertion of a 41
device described in paragraph (c), (d) or (e) of subsection 12 at a 42
hospital immediately after an insured gives birth. 43
15. An insurer must provide an accessible, transparent and 44
expedited process which is not unduly burdensome by which an 45

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insured, or the authorized representative of the insured, may request 1
an exception relating to any medical management technique used by 2
the insurer to obtain any benefit required by this section without a 3
higher deductible, copayment or coinsurance. 4
16. As used in this section: 5
(a) “In-network pharmacy” means a pharmacy that has entered 6
into a contract with an insurer to provide services to insureds 7
through a network plan offered or issued by the insurer. 8
(b) [“Medical management technique” means a practice which is 9
used to control the cost or utilization of health care services or 10
prescription drug use. The term includes, without limitation, the use 11
of step therapy, prior authorization or categorizing drugs and 12
devices based on cost, type or method of administration. 13
(c) “Network plan” means a contract for hospital or medical 14
service offered by an insurer under which the financing and delivery 15
of medical care, including it ems and services paid for as medical 16
care, are provided, in whole or in part, through a defined set of 17
providers under contract with the insurer. The term does not include 18
an arrangement for the financing of premiums. 19
(d)] “Provider network contract” [means] includes a contract 20
between an insurer and a [provider of health care or ] pharmacy 21
specifying the rights and responsibilities of the insurer and the 22
[provider of health care or ] pharmacy [, as applicable,] for delivery 23
of health care services pursuant to a network plan. 24
[(e) “Provider of health care” has the meaning ascribed to it in 25
NRS 629.031. 26
(f) “Therapeutic equivalent” means a drug which: 27
(1) Contains an identical amount of the same active 28
ingredients in the same dosage and method of administration as 29
another drug; 30
(2) Is expected to have the same clinical effect when 31
administered to a patient pursuant to a prescription or order as 32
another drug; and classification as a therapeutic equivalent.] 33
Sec. 264. NRS 695B.19195 is hereby amended to read as 34
follows: 35
695B.19195 1. An insurer that offers or issues a contract for 36
hospital or medical service shall include in the contract coverage 37
for: 38
(a) Counseling, support and supplies for breastfeeding, 39
including breastfeeding equipment, counseling and education during 40
the antenatal, perinatal and postpartum period for not more than 1 41
year; 42
(b) Screening and counseling for interpersonal and domestic 43
violence for women at least annually with initial interventio n 44

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services consisting of education, strategies to reduce harm, 1
supportive services or a referral for any other appropriate services; 2
(c) Behavioral counseling concerning sexually transmitted 3
diseases from a provider of health care for sexually active wome n 4
who are at increased risk for such diseases; 5
(d) Such prenatal screenings and tests as recommended by the 6
American College of Obstetricians and Gynecologists or its 7
successor organization; 8
(e) Screening for blood pressure abnormalities and diabetes, 9
including gestational diabetes, after at least 24 weeks of gestation or 10
as ordered by a provider of health care; 11
(f) Screening for cervical cancer at such intervals as are 12
recommended by the American College of Obstetricians and 13
Gynecologists or its successor organization; 14
(g) Screening for depression; 15
(h) Screening and counseling for the human immunodeficiency 16
virus consisting of a risk assessment, annual education relating to 17
prevention and at least one screening for the virus during the 18
lifetime of the insured or as ordered by a provider of health care; 19
(i) Smoking cessation programs for an insured who is 18 years 20
of age or older consisting of not more than two cessation attempts 21
per year and four counseling sessions per year; 22
(j) All vaccinatio ns recommended by the Advisory Committee 23
on Immunization Practices of the Centers for Disease Control and 24
Prevention of the United States Department of Health and Human 25
Services or its successor organization; and 26
(k) Such well-woman preventative visits as recommended by the 27
Health Resources and Services Administration, which must include 28
at least one such visit per year beginning at 14 years of age. 29
2. An insurer must ensure that the benefits required by 30
subsection 1 are made available to an insured thro ugh a provider of 31
health care who participates in the network plan of the insurer. 32
3. Except as otherwise provided in subsection 5, an insurer that 33
offers or issues a contract for hospital or medical service shall not: 34
(a) Require an insured to pay a hi gher deductible, any 35
copayment or coinsurance or require a longer waiting period or 36
other condition to obtain any benefit provided in the contract for 37
hospital or medical service pursuant to subsection 1; 38
(b) Refuse to issue a contract for hospital or med ical service or 39
cancel a contract for hospital or medical service solely because the 40
person applying for or covered by the contract uses or may use any 41
such benefit; 42
(c) Offer or pay any type of material inducement or financial 43
incentive to an insured to discourage the insured from obtaining any 44
such benefit; 45

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(d) Penalize a provider of health care who provides any such 1
benefit to an insured, including, without limitation, reducing the 2
reimbursement of the provider of health care; 3
(e) Offer or pay any type of material inducement, bonus or other 4
financial incentive to a provider of health care to deny, reduce, 5
withhold, limit or delay access to any such benefit to an insured; or 6
(f) Impose any other restrictions or delays on the access of an 7
insured to any such benefit. 8
4. A contract for hospital or medical service subject to the 9
provisions of this chapter that is delivered, issued for delivery or 10
renewed on or after January 1, 2018, has the legal effect of 11
including the coverage required by subsection 1, and any provision 12
of the contract or the renewal which is in conflict with this section is 13
void. 14
5. Except as otherwise provided in this section and federal law, 15
an insurer may use medical management techniques, including, 16
without limitation, any availa ble clinical evidence, to determine the 17
frequency of or treatment relating to any benefit required by this 18
section or the type of provider of health care to use for such 19
treatment. 20
[6. As used in this section: 21
(a) “Medical management technique” means a practice which is 22
used to control the cost or utilization of health care services or 23
prescription drug use. The term includes, without limitation, the use 24
of step therapy, prior authorization or categorizing drugs and 25
devices based on cost, type or method of administration. 26
(b) “Network plan” means a contract for hospital or medical 27
service offered by an insurer under which the financing and delivery 28
of medical care, including items and services paid for as medical 29
care, are provided, in whole or in part, through a defined set of 30
providers under contract with the insurer. The term does not include 31
an arrangement for the financing of premiums. 32
(c) “Provider of health care” has the meaning ascribed to it in 33
NRS 629.031.] 34
Sec. 265. NRS 695B.19197 is hereby amended to read as 35
follows: 36
695B.19197 1. A hospital or medical services corporation 37
that offers or issues a policy of health insurance shall include in the 38
policy coverage for: 39
(a) All drugs approved by the United States Food and Drug 40
Administration to support safe withdrawal from substance use 41
disorder, including, without limitation, lofexidine. 42
(b) All drugs approved by the United States Food and Drug 43
Administration to provide medication -assisted treatment for opioid 44

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use disorder, including, without limitation, buprenorphine, 1
methadone and naltrexone. 2
(c) The services described in NRS 639.28079 when provided by 3
a pharmacist or pharmacy that participates in the network plan of the 4
hospital or medical services corporatio n. The Commissioner shall 5
adopt regulations governing the provision of reimbursement for 6
such services. 7
(d) Any service for the treatment of substance use disorder 8
provided by a provider of primary care if the service is covered 9
when provided by a specialist and: 10
(1) The service is within the scope of practice of the provider 11
of primary care; or 12
(2) The provider of primary care is capable of providing the 13
service safely and effectively in consultation with a specialist and 14
the provider engages in such consultation. 15
2. A hospital or medical services corporation that offers or 16
issues a policy of health insurance shall reimburse a pharmacist 17
or pharmacy that participates in the network plan of the hospital or 18
medical services corporation for the servic es described in NRS 19
639.28079 at a rate equal to the rate of reimbursement provided to a 20
physician, physician assistant or advanced practice registered nurse 21
for similar services. 22
3. A hospital or medical services corporation shall provide the 23
coverage r equired by paragraphs (a) and (b) of subsection 1 24
regardless of whether the drug is included in the formulary of the 25
hospital or medical services corporation. 26
4. Except as otherwise provided in this subsection, a hospital or 27
medical services corporation shall not subject the benefits required 28
by paragraphs (a), (b) and (c) of subsection 1 to medical 29
management techniques, other than step therapy. A hospital or 30
medical services corporation may subject the benefits required by 31
paragraphs (b) and (c) of subs ection 1 to other reasonable medical 32
management techniques when the benefits are provided by a 33
pharmacist in accordance with NRS 639.28079. 34
5. A hospital or medical services corporation shall not: 35
(a) Limit the covered amount of a drug described in para graph 36
(a) or (b) of subsection 1; or 37
(b) Refuse to cover a drug described in paragraph (a) or (b) of 38
subsection 1 because the drug is dispensed by a pharmacy through 39
mail order service. 40
6. A hospital or medical services corporation shall ensure that 41
the benefits required by subsection 1 are made available to an 42
insured through a provider of health care who participates in the 43
network plan of the hospital or medical services corporation. 44

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7. A policy of health insurance subject to the provisions of this 1
chapter that is delivered, issued for delivery or renewed on or after 2
January 1, 2024, has the legal effect of including the coverage 3
required by subsection 1, and any provision of the policy that 4
conflicts with the provisions of this section is void. 5
8. As used in this section [: 6
(a) “Medical management technique” means a practice which is 7
used to control the cost or use of health care services or prescription 8
drugs. The term includes, without limitation, the use of step therapy, 9
prior authorization and categorizing drugs and devices based on 10
cost, type or method of administration. 11
(b) “Network plan” means a policy of health insurance offered 12
by a hospital or medical services corporation under which the 13
financing and delivery of medical care, including items and services 14
paid for as medical care, are provided, in whole or in part, through a 15
defined set of providers under contract with the hospital or medical 16
services corporation. The term does not include an arrangement for 17
the financing of premiums. 18
(c) “Primary] , “primary care” means the practice of family 19
medicine, pediatrics, internal medicine, obstetrics and gynecology 20
and midwifery. 21
[(d) “Provider of health care” has the meaning ascribed to it in 22
NRS 629.031.] 23
Sec. 266. NRS 695B.1924 is hereby amended to read as 24
follows: 25
695B.1924 1. A hospital or medical services corporation that 26
offers or issues a policy of health insurance shall include in the 27
policy coverage for: 28
(a) All drugs approved by the United States Food and Drug 29
Administration for preventing the acquisition of human 30
immunodeficiency virus or treating human immunodeficiency virus 31
or hepatitis C in the form recommended by the prescribing 32
practitioner, regardless of whether the drug is included i n the 33
formulary of the hospital or medical services organization; 34
(b) Laboratory testing that is necessary for therapy using a drug 35
to prevent the acquisition of human immunodeficiency virus; 36
(c) Any service to test for, prevent or treat human 37
immunodeficiency virus or hepatitis C provided by a provider of 38
primary care if the service is covered when provided by a specialist 39
and: 40
(1) The service is within the scope of practice of the provider 41
of primary care; or 42
(2) The provider of primary c are is capable of providing the 43
service safely and effectively in consultation with a specialist and 44
the provider engages in such consultation; and 45

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(d) The services described in NRS 639.28085, when provided 1
by a pharmacist who participates in the network plan of the hospital 2
or medical services corporation. 3
2. A hospital or medical services corporation that offers or 4
issues a policy of health insurance shall reimburse: 5
(a) A pharmacist who participates in the network plan of the 6
hospital or medical services corporation for the services described in 7
NRS 639.28085 at a rate equal to the rate of reimbursement 8
provided to a physician, physician assistant or advanced practice 9
registered nurse for similar services. 10
(b) An advanced practice registered nurse or a physician 11
assistant who participates in the network plan of the hospital or 12
medical services corporation for any service to test for, prevent or 13
treat human immunodeficiency virus or hepatitis C at a rate equal to 14
the rate of reimbursement provided to a physician for similar 15
services. 16
3. A hospital or medical services corporation shall not: 17
(a) Subject the benefits required by subsection 1 to medical 18
management techniques, other than step therapy; 19
(b) Limit the covered amount of a drug described in paragraph 20
(a) of subsection 1; 21
(c) Refuse to cover a drug described in paragraph (a) of 22
subsection 1 because the drug is dispensed by a pharmacy through 23
mail order service; or 24
(d) Prohibit or restrict access to any service or drug to treat 25
human immunodeficiency virus or hepatitis C on the same day on 26
which the insured is diagnosed. 27
4. A hospital or medical services corporation shall ensure that 28
the benefits required by subsection 1 are made available to an 29
insured through a provider of health care who participates in the 30
network plan of the hospital or medical services corporation. 31
5. A policy of health insurance subject to the provisions of this 32
chapter that is delivered, issued for delivery or renewed on or after 33
January 1, 2024, has the legal effec t of including the coverage 34
required by subsection 1, and any provision of the policy that 35
conflicts with the provisions of this section is void. 36
6. As used in this section [: 37
(a) “Medical management technique” means a practice which is 38
used to control the cost or use of health care services or prescription 39
drugs. The term includes, without limitation, the use of step therapy, 40
prior authorization and categorizing drugs and devices based on 41
cost, type or method of administration. 42
(b) “Network plan” means a policy of health insurance offered 43
by a hospital or medical services corporation under which the 44
financing and delivery of medical care, including items and services 45

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paid for as medical care, are provided, in whole or in part, through a 1
defined set of p roviders under contract with the hospital or medical 2
services corporation. The term does not include an arrangement for 3
the financing of premiums. 4
(c) “Primary] , “primary care” means the practice of family 5
medicine, pediatrics, internal medicine, obstetr ics and gynecology 6
and midwifery. 7
[(d) “Provider of health care” has the meaning ascribed to it in 8
NRS 629.031.] 9
Sec. 267. NRS 695B.1925 is hereby amended to read as 10
follows: 11
695B.1925 1. An insurer that offers or issues a contract for 12
hospital or medical service must provide coverage for benefits 13
payable for expenses incurred for: 14
(a) Deoxyribonucleic acid testing for high -risk strains of human 15
papillomavirus every 3 years for women 30 years of age and older; 16
and 17
(b) Administering the human papillomavirus vaccine at such 18
ages as recommended for vaccination by a competent authority, 19
including, without limitation, the Centers for Disease Control and 20
Prevention of the United States Department of Health and Human 21
Services, the Food and Drug Administration or the manufacturer of 22
the vaccine. 23
2. An insurer must ensure that the benefits required by 24
subsection 1 are made available to an insured through a provider of 25
health care who participates in the network plan of the insurer. 26
3. Except as otherwise required by subsection 5, an insurer that 27
offers or issues a contract for hospital or medical service shall not: 28
(a) Require an insured to pay a higher deductible, any 29
copayment or coinsurance or require a longer waiting period or 30
other condition to obtain any benefit provided in the contract for 31
hospital or medical service pursuant to subsection 1; 32
(b) Refuse to issue a contract for hospital or medical service or 33
cancel a contract for hospital or medical service solely because the 34
person applying for or covered by the contract uses or may use any 35
such benefit; 36
(c) Offer or pay any type of material inducement or financial 37
incentive to an insured to discourage the insured from obtaining any 38
such benefit; 39
(d) Penalize a provider of health care who provides any such 40
benefit to an insured, including, without limitation, reducing the 41
reimbursement of the provider of health care; 42
(e) Offer or pay any type of material inducement, bonus or other 43
financial incentive to a provid er of health care to deny, reduce, 44
withhold, limit or delay access to any such benefit to an insured; or 45

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(f) Impose any other restrictions or delays on the access of an 1
insured to any such benefit. 2
4. A contract for hospital or medical service subject t o the 3
provisions of this chapter which is delivered, issued for delivery or 4
renewed on or after January 1, 2018, has the legal effect of 5
including the coverage required by subsection 1, and any provision 6
of the contract or the renewal which is in conflict with this section is 7
void. 8
5. Except as otherwise provided in this section and federal law, 9
an insurer may use medical management techniques, including, 10
without limitation, any available clinical evidence, to determine the 11
frequency of or treatment relat ing to any benefit required by this 12
section or the type of provider of health care to use for such 13
treatment. 14
6. As used in this section [: 15
(a) “Human] , “ human papillomavirus vaccine” means the 16
Quadrivalent Human Papillomavirus Recombinant Vaccine or its 17
successor which is approved by the Food and Drug Administration 18
for the prevention of human papillomavirus infection and cervical 19
cancer. 20
[(b) “Medical management technique” means a practice which is 21
used to control the cost or utilization of health c are services or 22
prescription drug use. The term includes, without limitation, the use 23
of step therapy, prior authorization or categorizing drugs and 24
devices based on cost, type or method of administration. 25
(c) “Network plan” means a contract for hospital or medical 26
service offered by an insurer under which the financing and delivery 27
of medical care, including items and services paid for as medical 28
care, are provided, in whole or in part, through a defined set of 29
providers under contract with the insurer. The term does not include 30
an arrangement for the financing of premiums. 31
(d) “Provider of health care” has the meaning ascribed to it in 32
NRS 629.031.] 33
Sec. 268. NRS 695B.1929 is hereby amended to read as 34
follows: 35
695B.1929 1. A hospital or medical service corporation that 36
issues a policy of health insurance shall include in the policy 37
coverage for: 38
(a) Necessary case management services for an insured who has 39
been diagnosed with sickle cell disease and its variants; and 40
(b) Medically necessary care for an insured who has been 41
diagnosed with sickle cell disease and its variants. 42
2. A hospital or medical service corporation that issues a policy 43
of health insurance which provides coverage for prescription drugs 44

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shall include in the policy coverage for medically necessary 1
prescription drugs to treat sickle cell disease and its variants. 2
3. A hospital or medical service corporation may use medical 3
management techniques, including, without limitation, any available 4
clinical evidence, to determine the frequency of or treatment relating 5
to any benefit required by this section or the type of provider of 6
health care to use for such treatment. 7
4. As used in this section: 8
(a) “Case management services” means medical or other health 9
care management services to assist patients and providers of health 10
care, including, without limitation, identifying and facilitating 11
additional resources and treatments, providing information about 12
treatment options and facilitating communication between providers 13
of services to a patient. 14
(b) [“Medical management technique” means a practice which is 15
used to control the cost or utilization of health care services. The 16
term includes, without limitation, the use of step therapy, prior 17
authorization or categorizing drugs and devices based on cost, type 18
or method of administration. 19
(c)] “Medically necessary” has the meaning ascribed to it in 20
NRS 695G.055. 21
[(d)] (c) “Sickle cell disease and its variants” has the meaning 22
ascribed to it in NRS 439.4927. 23
Sec. 269. NRS 695B.320 is hereby amended to read as 24
follows: 25
695B.320 1. Nonprofit hospital and medical or dental service 26
corporations are subject to the provisions of this chapter, and to the 27
provisions of chapters 679A and 679B of NRS, sections 2 to 41, 28
inclusive, of this act, subsections 2, 4, 17, 18 and 30 of NRS 29
680B.010, NRS 680B.025 to 680B.060, inclusive, chapter 681B of 30
NRS, NRS 686A.010 to [686A.315,] 686A.325, inclusive, and 31
sections 80 to 93, inclusive, of this act, NRS 686B.010 to 32
686B.175, inclusive, 687B.010 to 687B.040, inclusiv e, 687B.070 33
to 687B.140, inclusive, 687B.150, 687B.160, 687B.180, 687B.200 34
to 687B.255, inclusive, 687B.270, 687B.310 to 687B.380, inclusive, 35
[687B.410, 687B.420,] 687B.402 to 687B.430, inclusive, 687B.500 36
and chapters 692B, 692C, 693A and 696B of NRS, to the extent 37
applicable and not in conflict with the express provisions of this 38
chapter. 39
2. For the purposes of this section and the provisions set forth 40
in subsection 1, a nonprofit hospital and medical or dental service 41
corporation is included in the meaning of the term “insurer.” 42

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Sec. 270. NRS 695C.030 is hereby amended to read as 1
follows: 2
695C.030 As used in this chapter, unless the context otherwise 3
requires: 4
1. “Comprehensive health care services” means medical 5
services, dentistry, drugs, psychiatric and optometric and all other 6
care necessary for the delivery of services to the consumer. 7
2. “Enrollee” means a natural person who has been voluntarily 8
enrolled in a health care plan. 9
3. “Evidence of coverage” means any certificate, agreement or 10
contract issued to an enrollee setting forth the coverage to which the 11
enrollee is entitled. 12
4. “Health care plan” means any arrangement whereby any 13
person undertakes to provide, arrange for, pay for or reimburse any 14
part of the cost of any health care services and at least part of the 15
arrangement consists of arranging for or the provision of health care 16
services paid for by or on behalf of the enrollee on a periodic 17
prepaid basis. 18
5. “Health care services” means any services included in the 19
furnishing to any natural person of medical or dental care or 20
hospitalization or incident to the furnishing of such care or 21
hospitalization, as well as the furnishing to any person of any other 22
services for the purpose of preventin g, alleviating, curing or healing 23
human illness or injury. 24
6. “Health maintenance organization” means any person which 25
provides or arranges for provision of a health care service or 26
services and is responsible for the availability and accessibility of 27
such service or services to its enrollees, which services are paid for 28
or on behalf of the enrollees on a periodic prepaid basis without 29
regard to the dates health services are rendered and without regard 30
to the extent of services actually furnished to the e nrollees, except 31
that supplementing the fixed prepayments by nominal additional 32
payments for services in accordance with regulations adopted by the 33
Commissioner shall not be deemed to render the arrangement not to 34
be on a prepaid basis. A health maintenanc e organization, in 35
addition to offering health care services, may offer indemnity or 36
service benefits provided through insurers or otherwise. 37
7. “Medical management technique” has the meaning 38
ascribed to it in section 299 of this act. 39
8. “Network plan” has the meaning ascribed to it in 40
NRS 687B.645. 41
9. “Provider” means any physician, hospital or other person 42
who is licensed or otherwise authorized in this state to furnish health 43
care services. 44

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10. “Provider network contract” has the meaning ascribed to 1
it in NRS 687B.658. 2
11. “Provider of health care” has the meaning ascribed to it 3
in NRS 629.031. 4
12. “Therapeutic equivalent” has the meaning a scribed to it 5
in section 302 of this act. 6
Sec. 271. NRS 695C.055 is hereby amended to read as 7
follows: 8
695C.055 1. The provisions of NRS 449.465, 679A.200, 9
679B.152, 679B.700, subsections 7 and 8 of NRS 680A.270, 10
subsections 2, 4, 17, 18 and 30 of NRS 680B.010, NRS 680B.020 to 11
680B.060, inclusive, chapters 681B and 686A of NRS, NRS 12
686B.010 to 686B.175, inclusive, 687B .122 to 687B.128, inclusive, 13
687B.310 to 687B.420, inclusive, [and] 687B.500 and 687B.600 to 14
687B.850, inclusive, and chapters 692C and 695G of NRS apply to 15
a health maintenance organization. 16
2. For the purposes of subsection 1, unless the context requir es 17
that a provision apply only to insurers, any reference in those 18
sections to “insurer” must be replaced by “health maintenance 19
organization.” 20
Sec. 272. NRS 695C.070 is hereby amended to read as 21
follows: 22
695C.070 Each ap plication for a certificate of authority must 23
be verified by an officer or authorized representative of the 24
applicant, must be in a form prescribed by the Commissioner, and 25
must set forth or be accompanied by the following: 26
1. A copy of the basic organiz ational document, if any, of the 27
applicant, and all amendments thereto; 28
2. A copy of the bylaws, rules or regulations, or a similar 29
document, if any, regulating the conduct of the internal affairs of the 30
applicant; 31
3. A list of the names, addresses and official positions of the 32
persons who will be responsible for the conduct of the affairs of the 33
applicant, including all members of the board of directors, board of 34
trustees, executive committee, or other governing board or 35
committee, the officers in the case of a corporation, and the partners 36
or members in the case of a partnership or association; 37
4. A copy of any contract made or to be made between any 38
providers or persons listed in subsection 3 and the applicant; 39
5. A statement generally describing the health maintenance 40
organization, its health care plan or plans, the location of facilities at 41
which health care services will be regularly available to enrollees 42
and the type of health care personnel who will provide the health 43
care services; 44

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6. A copy of the form of evidence of coverage to be issued to 1
the enrollees; 2
7. A copy of the form of the group contract, if any, which is to 3
be issued to employers, unions, trustees or other organizations; 4
8. Certified financial statements showing the applicant’s assets, 5
liabilities and sources of financial support; 6
9. The proposed method of marketing the plan, a financial plan 7
which includes a 3 -year projection of the initial operating results 8
anticipated and the sources of [working] capital and surplus and 9
any other sources of funding; 10
10. A power of attorney, executed by the applicant, appointing 11
the Commissioner and the authorized deputies of the Commissioner 12
as the true and lawful attorney of such applicant in and for this State 13
upon whom all lawful p rocess in any legal action or proceeding 14
against the health maintenance organization on a cause of action 15
arising in this State may be served; 16
11. A statement reasonably describing the geographic area to 17
be served; 18
12. A description of the procedures f or resolving complaints 19
and procedures for external reviews to be used as required under 20
NRS 695C.260; 21
13. A description of the procedures and programs to be 22
implemented to meet the quality of health care requirements in 23
NRS 695C.080; 24
14. A description of the mechanism by which enrollees will be 25
afforded an opportunity to participate in matters of program content 26
under subsection 2 of NRS 695C.110; and 27
15. Such other information as the Commissioner may require 28
to make the determinations required in NRS 695C.080. 29
Sec. 273. NRS 695C.090 is hereby amended to read as 30
follows: 31
695C.090 The Commissioner shall issue or deny a certificate 32
of authority to any person filing an application pursuant to NRS 33
695C.060 within 90 days after certification. Issuance of a certificate 34
of authority must be granted upon payment of the fees prescribed in 35
NRS 695C.230 if the Commissioner is satisfied that the following 36
conditions are met: 37
1. The persons responsible for the cond uct of the affairs of the 38
applicant are competent, trustworthy and possess good reputations. 39
2. The Commissioner certifies, in accordance with NRS 40
695C.080, that the health maintenance organization’s proposed plan 41
of operation meets the requirements of s ubsection 1 of 42
NRS 695C.080. 43
3. The health care plan furnishes comprehensive health care 44
services. 45

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4. The health maintenance organization is financially 1
responsible and may reasonably be expected to meet its obligations 2
to enrollees and prospective enrollees. In making this determination, 3
the Commissioner may consider: 4
(a) The financial soundness of the health care plan’s 5
arrangements for health care services and the schedule of charges 6
used in connection therewith; 7
(b) The adequacy of [working] capital [;] and surplus; 8
(c) Any agreement with an insurer, a government, or any other 9
organization for insuring the payment of the cost of health care 10
services; 11
(d) Any agreement with providers for the provision of health 12
care services; and 13
(e) Any surety bond or deposit of cash or securities submitted in 14
accordance with NRS 695C.270 as a guarantee that the obligations 15
will be duly performed. 16
5. The enrollees will be afforded an opportunity to participate 17
in matters of program content pursuant to NRS 695C.110. 18
6. Nothing in the proposed method of operation, as shown by 19
the information submitted pursuant to NRS 695C.060, 695C.070 20
and 695C.140, or by independent investigation is contrary to the 21
public interest. 22
Sec. 274. NRS 695C.16932 is hereby amended to read as 23
follows: 24
695C.16932 1. Subject to the limitations prescribed by 25
subsection 4, a health maintenance organization that issues a health 26
care plan shall include in the plan coverage for medically necessary 27
biomarker testing for the diagnosis, treatment, appropriate 28
management and ongoing monitoring of cancer when such 29
biomarker testing is supported by medical and scientific evidence. 30
Such evidence includes, without limitation: 31
(a) The labeled indications for a bioma rker test or medication 32
that has been approved or cleared by the United States Food and 33
Drug Administration; 34
(b) The indicated tests for a drug that has been approved by the 35
United States Food and Drug Administration or the warnings and 36
precautions included on the label of such a drug; 37
(c) A national coverage determination or local coverage 38
determination, as those terms are defined in 42 C.F.R. § 400.202; or 39
(d) Nationally recognized clinical practice guidelines or 40
consensus statements. 41
2. A health maintenance organization shall: 42
(a) Provide the coverage required by subsection 1 in a manner 43
that limits disruptions in care and the need for multiple specimens. 44

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(b) Establish a clear and readily accessible process for an 1
enrollee or provider of health care to: 2
(1) Request an exception to a policy excluding coverage for 3
biomarker testing for the diagnosis, treatment, management or 4
ongoing monitoring of cancer; or 5
(2) Appeal a denial of coverage for such biomarker testing; 6
and 7
(c) Make the process descr ibed in paragraph (b) available on an 8
Internet website maintained by the health maintenance organization. 9
3. If a health maintenance organization requires an enrollee to 10
obtain prior authorization for a biomarker test described in 11
subsection 1, the health maintenance organization shall respond to a 12
request for such prior authorization: 13
(a) Within 24 hours after receiving an urgent request; or 14
(b) Within 72 hours after receiving any other request. 15
4. The provisions of this section do not require a health 16
maintenance organization to provide coverage of biomarker testing: 17
(a) For screening purposes; 18
(b) Conducted by a provider of health care for whom the 19
biomarker testing is not within his or her scope of practice, training 20
and experience; 21
(c) Conducted by a provider of health care or a facility that does 22
not participate in the network plan of the health maintenance 23
organization; or 24
(d) That has not been determined to be medically necessary by a 25
provider of health care for whom such a determinati on is within his 26
or her scope of practice, training and experience. 27
5. A health care plan subject to the provisions of this chapter 28
that is delivered, issued for delivery or renewed on or after 29
October 1, 2023, has the legal effect of including the cov erage 30
required by this section, and any provision of the plan or renewal 31
which is in conflict with the provisions of this section is void. 32
6. As used in this section: 33
(a) “Biomarker” means a characteristic that is objectively 34
measured and evaluated as a n indicator of a normal biological 35
process, a pathogenic process or a pharmacological response to a 36
specific therapeutic intervention and includes, without limitation: 37
(1) An interaction between a gene and a drug that is being 38
used by or considered for use by the patient; 39
(2) A mutation or characteristic of a gene; and 40
(3) The expression of a protein. 41
(b) “Biomarker testing” means the analysis of the tissue, blood 42
or other biospecimen of a patient for the presentation of a biomarker 43
and includes, wi thout limitation, single -analyte tests, multiplex 44

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panel tests and whole genome, whole exome and whole 1
transcriptome sequencing. 2
(c) “Consensus statement” means a statement aimed at a specific 3
clinical circumstance that is: 4
(1) Made for the purpose of op timizing the outcomes of 5
clinical care; 6
(2) Made by an independent, multidisciplinary panel of 7
experts that has established a policy to avoid conflicts of interest; 8
(3) Based on scientific evidence; and 9
(4) Made using a transparent methodology and re porting 10
procedure. 11
(d) “Medically necessary” means health care services or 12
products that a prudent provider of health care would provide to a 13
patient to prevent, diagnose or treat an illness, injury or disease, or 14
any symptoms thereof, that are necessary and: 15
(1) Provided in accordance with generally accepted standards 16
of medical practice; 17
(2) Not primarily provided for the convenience of the patient 18
or provider of health care; and 19
(3) Significant in guiding and informing the provider of 20
health care in providing the most appropriate course of treatment for 21
the patient in order to prevent, delay or lessen the magnitude of an 22
adverse health outcome. 23
(e) “Nationally recognized clinical practice guidelines” means 24
evidence-based guidelines establishing st andards of care that 25
include, without limitation, recommendations intended to optimize 26
care of patients and are: 27
(1) Informed by a systemic review of evidence and an 28
assessment of the risks and benefits of alternative options for care; 29
and 30
(2) Developed using a transparent methodology and 31
reporting procedure by an independent organization or society of 32
medical professionals that has established a policy to avoid conflicts 33
of interest. 34
[(f) “Network plan” means a health care plan offered by a health 35
maintenance organization under which the financing and delivery of 36
medical care, including items and services paid for as medical care, 37
are provided, in whole or in part, through a defined set of providers 38
under contract with the health maintenance organiz ation. The term 39
does not include an arrangement for the financing of premiums. 40
(g) “Provider of health care” has the meaning ascribed to it in 41
NRS 629.031.] 42

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Sec. 275. NRS 695C.16934 is hereby amended to read as 1
follows: 2
695C.16934 1. Except as otherwise provided in this section, 3
a health maintenance organization that issues a health care plan shall 4
include in the health care plan coverage for the medically necessary 5
treatment of conditions relating to gender dysphoria a nd gender 6
incongruence. Such coverage must include coverage of medically 7
necessary psychosocial and surgical intervention and any other 8
medically necessary treatment for such disorders provided by: 9
(a) Endocrinologists; 10
(b) Pediatric endocrinologists; 11
(c) Social workers; 12
(d) Psychiatrists; 13
(e) Psychologists; 14
(f) Gynecologists; 15
(g) Speech-language pathologists; 16
(h) Primary care physicians; 17
(i) Advanced practice registered nurses; 18
(j) Physician assistants; and 19
(k) Any other providers of medically necessary services for the 20
treatment of gender dysphoria or gender incongruence. 21
2. This section does not require a health care plan to include 22
coverage for cosmetic surgery performed by a plastic surgeon or 23
reconstructive surgeon that is not medically necessary. 24
3. A health maintenance organization that issues a health care 25
plan shall not categorically refuse to cover medically necessary 26
gender-affirming treatments or procedures or revisions to prior 27
treatments if the plan provides coverage for any such services, 28
procedures or revisions for purposes other than gender transition or 29
affirmation. 30
4. A health maintenance organization that issues a health care 31
plan may prescribe requirements that must be satisfied before t he 32
health maintenance organization covers surgical treatment of 33
conditions relating to gender dysphoria or gender incongruence for 34
an enrollee who is less than 18 years of age. Such requirements may 35
include, without limitation, requirements that: 36
(a) The treatment must be recommended by a psychologist, 37
psychiatrist or other mental health professional; 38
(b) The treatment must be recommended by a physician; 39
(c) The enrollee must provide a written expression of the desire 40
of the enrollee to undergo the treatment; 41
(d) A written plan for treatment that covers at least 1 year must 42
be developed and approved by at least two providers of health care; 43
and 44

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(e) Parental consent is provided for the enrollee unless the 1
enrollee is expressly authorized by law to co nsent on his or her own 2
behalf. 3
5. When determining whether treatment is medically necessary 4
for the purposes of this section, a health maintenance organization 5
must consider the most recent Standards of Care prescribed by the 6
World Professional Associat ion for Transgender Health, or its 7
successor organization. 8
6. A health maintenance organization shall make a reasonable 9
effort to ensure that the benefits required by subsection 1 are made 10
available to an enrollee through a provider of health care who 11
participates in the network plan of the health maintenance 12
organization. If, after a reasonable effort, the health maintenance 13
organization is unable to make such benefits available through such 14
a provider of health care, the health maintenance organization may 15
treat the treatment that the health maintenance organization is 16
unable to make available through such a provider of health care in 17
the same manner as other services provided by a provider of health 18
care who does not participate in the network plan of t he health 19
maintenance organization. 20
7. If an enrollee appeals the denial of a claim or coverage under 21
this section on the grounds that the treatment requested by the 22
enrollee is not medically necessary, the health maintenance 23
organization must consult w ith a provider of health care who has 24
experience in prescribing or delivering gender -affirming treatment 25
concerning the medical necessity of the treatment requested by the 26
enrollee when considering the appeal. 27
8. A health care plan subject to the provisi ons of this chapter 28
that is delivered, issued for delivery or renewed on or after July 1, 29
2023, has the legal effect of including the coverage required by 30
subsection 1, and any provision of the plan or renewal which is in 31
conflict with the provisions of this section is void. 32
9. As used in this section: 33
(a) “Cosmetic surgery”: 34
(1) Means a surgical procedure that: 35
(I) Does not meaningfully promote the proper function of 36
the body; 37
(II) Does not prevent or treat illness or disease; and 38
(III) Is primarily directed at improving the appearance of 39
a person. 40
(2) Includes, without limitation, cosmetic surgery directed at 41
preserving beauty. 42
(b) “Gender dysphoria” means distress or impairment in social, 43
occupational or other areas of functioning cause d by a marked 44
difference between the gender identity or expression of a person and 45

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the sex assigned to the person at birth which lasts at least 6 months 1
and is shown by at least two of the following: 2
(1) A marked difference between gender identity or 3
expression and primary or secondary sex characteristics or 4
anticipated secondary sex characteristics in young adolescents. 5
(2) A strong desire to be rid of primary or secondary sex 6
characteristics because of a marked difference between such sex 7
characteristics and gender identity or expression or a desire to 8
prevent the development of anticipated secondary sex characteristics 9
in young adolescents. 10
(3) A strong desire for the primary or secondary sex 11
characteristics of the gender opposite from the sex assigned at birth. 12
(4) A strong desire to be of the opposite gender or a gender 13
different from the sex assigned at birth. 14
(5) A strong desire to be treated as the opposite gender or a 15
gender different from the sex assigned at birth. 16
(6) A strong convict ion of experiencing typical feelings and 17
reactions of the opposite gender or a gender different from the sex 18
assigned at birth. 19
(c) “Medically necessary” means health care services or 20
products that a prudent provider of health care would provide to a 21
patient to prevent, diagnose or treat an illness, injury or disease, or 22
any symptoms thereof, that are necessary and: 23
(1) Provided in accordance with generally accepted standards 24
of medical practice; 25
(2) Clinically appropriate with regard to type, frequenc y, 26
extent, location and duration; 27
(3) Not provided primarily for the convenience of the patient 28
or provider of health care; 29
(4) Required to improve a specific health condition of a 30
patient or to preserve the existing state of health of the patient; and 31
(5) The most clinically appropriate level of health care that 32
may be safely provided to the patient. 33
 A provider of health care prescribing, ordering, recommending or 34
approving a health care service or product does not, by itself, make 35
that health care service or product medically necessary. 36
[(d) “Network plan” means a health care plan offered by a health 37
maintenance organization under which the financing and delivery of 38
medical care, including items and services paid for as medical care, 39
are provided, in whole or in part, through a defined set of providers 40
under contract with the health maintenance organization. The term 41
does not include an arrangement for the financing of premiums. 42
(e) “Provider of health care” has the meaning ascribed to it in 43
NRS 629.031.] 44

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Sec. 276. NRS 695C.1694 is hereby amended to read as 1
follows: 2
695C.1694 1. A health maintenance organization which 3
offers or issues a health care plan that provides coverage for 4
prescription drugs or devices shall include in the plan coverage for 5
any type o f hormone replacement therapy which is lawfully 6
prescribed or ordered and which has been approved by the Food and 7
Drug Administration. 8
2. A health maintenance organization that offers or issues a 9
health care plan that provides coverage for prescription d rugs shall 10
not: 11
(a) Require an enrollee to pay a higher deductible, any 12
copayment or coinsurance or require a longer waiting period or 13
other condition for coverage for hormone replacement therapy; 14
(b) Refuse to issue a health care plan or cancel a health care plan 15
solely because the person applying for or covered by the plan uses 16
or may use in the future hormone replacement therapy; 17
(c) Offer or pay any type of material inducement or financial 18
incentive to an enrollee to discourage the enrollee from acce ssing 19
hormone replacement therapy; 20
(d) Penalize a provider of health care who provides hormone 21
replacement therapy to an enrollee, including, without limitation, 22
reducing the reimbursement of the provider of health care; or 23
(e) Offer or pay any type of material inducement, bonus or other 24
financial incentive to a provider of health care to deny, reduce, 25
withhold, limit or delay hormone replacement therapy to an 26
enrollee. 27
3. Evidence of coverage subject to the provisions of this 28
chapter that is delivered, issued for delivery or renewed on or after 29
October 1, 1999, has the legal effect of including the coverage 30
required by subsection 1, and any provision of the evidence of 31
coverage or the renewal which is in conflict with this section is void. 32
4. The prov isions of this section do not require a health 33
maintenance organization to provide coverage for fertility drugs. 34
[5. As used in this section, “provider of health care” has the 35
meaning ascribed to it in NRS 629.031.] 36
Sec. 277. NRS 695C.16947 is hereby amended to read as 37
follows: 38
695C.16947 1. A health care plan which provides coverage 39
for prescription drugs must not require an enrollee to submit to a 40
step therapy protocol before covering a drug approved by the Food 41
and D rug Administration that is prescribed to treat a psychiatric 42
condition of the enrollee, if: 43
(a) The drug has been approved by the Food and Drug 44
Administration with indications for the psychiatric condition of the 45

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enrollee or the use of the drug to treat t hat psychiatric condition is 1
otherwise supported by medical or scientific evidence; 2
(b) The drug is prescribed by: 3
(1) A psychiatrist; 4
(2) A physician assistant under the supervision of a 5
psychiatrist; 6
(3) An advanced practice registered nurse who has the 7
psychiatric training and experience prescribed by the State Board of 8
Nursing pursuant to NRS 632.120; or 9
(4) A primary care provider that is providing care to an 10
enrollee in consultation with a practitioner listed in subparagraph 11
(1), (2) or (3) , if the closest practitioner listed in subparagraph (1), 12
(2) or (3) who participates in the network plan of the health 13
maintenance organization is located 60 miles or more from the 14
residence of the enrollee; and 15
(c) The practitioner listed in paragraph ( b) who prescribed the 16
drug knows, based on the medical history of the enrollee, or 17
reasonably expects each alternative drug that is required to be used 18
earlier in the step therapy protocol to be ineffective at treating the 19
psychiatric condition. 20
2. Any provision of a health care plan subject to the provisions 21
of this chapter that is delivered, issued for delivery or renewed on or 22
after July 1, 2023, which is in conflict with this section is void. 23
3. As used in this section: 24
(a) “Medical or scientific evidence” has the meaning ascribed to 25
it in NRS 695G.053. 26
(b) [“Network plan” means a health care plan offered by a health 27
maintenance organization under which the financing and delivery of 28
medical care is provided, in whole or in part, through a defined set 29
of providers under contract with the health maintenance 30
organization. The term does not include an arrangement for the 31
financing of premiums. 32
(c)] “Step therapy protocol” means a procedure that requires an 33
enrollee to use a prescription drug or seque nce of prescription drugs 34
other than a drug that a practitioner recommends for treatment of a 35
psychiatric condition of the enrollee before his or her health care 36
plan provides coverage for the recommended drug. 37
Sec. 278. NRS 695C.1695 is hereby amended to read as 38
follows: 39
695C.1695 1. A health maintenance organization that offers 40
or issues a health care plan which provides coverage for outpatient 41
care shall include in the plan coverage for any health care service 42
related to hormone replacement therapy. 43
2. A health maintenance organization that offers or issues a 44
health care plan that provides coverage for outpatient care shall not: 45

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(a) Require an enrollee to pay a higher deductible, any 1
copayment or coinsurance or require a longer waiting period or 2
other condition for coverage for outpatient care related to hormone 3
replacement therapy; 4
(b) Refuse to issue a health care plan or cancel a health care plan 5
solely because the person applying for or covered by the plan u ses 6
or may use in the future hormone replacement therapy; 7
(c) Offer or pay any type of material inducement or financial 8
incentive to an enrollee to discourage the enrollee from accessing 9
hormone replacement therapy; 10
(d) Penalize a provider of health care who provides hormone 11
replacement therapy to an enrollee, including, without limitation, 12
reducing the reimbursement of the provider of health care; or 13
(e) Offer or pay any type of material inducement, bonus or other 14
financial incentive to a provider of he alth care to deny, reduce, 15
withhold, limit or delay hormone replacement therapy to an 16
enrollee. 17
3. Evidence of coverage subject to the provisions of this 18
chapter that is delivered, issued for delivery or renewed on or after 19
October 1, 1999, has the legal effect of including the coverage 20
required by subsection 1, and any provision of the evidence of 21
coverage or the renewal which is in conflict with this section is void. 22
[4. As used in this section, “provider of health care” has the 23
meaning ascribed to it in NRS 629.031.] 24
Sec. 279. NRS 695C.1696 is hereby amended to read as 25
follows: 26
695C.1696 1. Except as otherwise provided in subsection 8, a 27
health maintenance organization that offers or issues a health care 28
plan shall include in the plan coverage for: 29
(a) Up to a 12 -month supply, per prescription, of any type of 30
drug for contraception or its therapeutic equivalent which is: 31
(1) Lawfully prescribed or ordered; 32
(2) Approved by the Food and Drug Administration; 33
(3) Listed in subsection 12; and 34
(4) Dispensed in accordance with NRS 639.28075; 35
(b) Any type of device for contraception which is: 36
(1) Lawfully prescribed or ordered; 37
(2) Approved by the Food and Drug Administration; and 38
(3) Listed in subsection 12; 39
(c) Self-administered hormonal contraceptives dispensed by a 40
pharmacist pursuant to NRS 639.28078; 41
(d) Insertion of a device for contraception or removal of such a 42
device if the device was inserted while the enrollee was covered by 43
the same health care plan; 44

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(e) Education and counseling relating to the initiation of the use 1
of contraception and any necessary follow -up after initiating such 2
use; 3
(f) Management of side effects relating to contraception; and 4
(g) Voluntary sterilization for women. 5
2. A health maintenance organization shall provide coverage 6
for any services listed in subsection 1 which are within the 7
authorized scope of practice of a pharmacist when such services are 8
provided by a pharmacist who is employed by or serves as an 9
independent contractor of an in -network pharmacy and in 10
accordance with the applicable provider network contract. Such 11
coverage must be provided to the same extent as if the services were 12
provided by another provider of health care, as applicable to the 13
services being provided. The terms of the policy must not limit: 14
(a) Coverage for services listed in subsection 1 and provided by 15
such a pharmacist to a number of occasions less than the coverage 16
for such services when provided by another provider of health care. 17
(b) Reimbursement for services listed in subsection 1 and 18
provided by such a pharmacist to an amount less than the amount 19
reimbursed for similar services provided by a physician, physician 20
assistant or advanced practice registered nurse. 21
3. A health maint enance organization must ensure that the 22
benefits required by subsection 1 are made available to an enrollee 23
through a provider of health care who participates in the network 24
plan of the health maintenance organization. 25
4. If a covered therapeutic equiva lent listed in subsection 1 is 26
not available or a provider of health care deems a covered 27
therapeutic equivalent to be medically inappropriate, an alternate 28
therapeutic equivalent prescribed by a provider of health care must 29
be covered by the health maintenance organization. 30
5. Except as otherwise provided in subsections 10, 11 and 13, a 31
health maintenance organization that offers or issues a health care 32
plan shall not: 33
(a) Require an enrollee to pay a higher deductible, any 34
copayment or coinsurance or r equire a longer waiting period or 35
other condition to obtain any benefit included in the health care plan 36
pursuant to subsection 1; 37
(b) Refuse to issue a health care plan or cancel a health care plan 38
solely because the person applying for or covered by the plan uses 39
or may use any such benefit; 40
(c) Offer or pay any type of material inducement or financial 41
incentive to an enrollee to discourage the enrollee from obtaining 42
any such benefit; 43

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(d) Penalize a provider of health care who provides any such 1
benefit to an enrollee, including, without limitation, reducing the 2
reimbursement of the provider of health care; 3
(e) Offer or pay any type of material inducement, bonus or other 4
financial incentive to a provider of health care to deny, reduce, 5
withhold, limit or delay access to any such benefit to an enrollee; or 6
(f) Impose any other restrictions or delays on the access of an 7
enrollee to any such benefit. 8
6. Coverage pursuant to this section for the covered dependent 9
of an enrollee must be the same as for the enrollee. 10
7. Except as otherwise provided in subsection 8, a health care 11
plan subject to the provisions of this chapter that is delivered, issued 12
for delivery or renewed on or after January 1, 2024, has the legal 13
effect of including the coverage requi red by this section, and any 14
provision of the plan or the renewal which is in conflict with this 15
section is void. 16
8. A health maintenance organization that offers or issues a 17
health care plan and which is affiliated with a religious organization 18
is not required to provide the coverage required by subsection 1 if 19
the health maintenance organization objects on religious grounds. 20
Such an organization shall, before the issuance of a health care plan 21
and before the renewal of such a plan, provide to the prosp ective 22
enrollee written notice of the coverage that the health maintenance 23
organization refuses to provide pursuant to this subsection. 24
9. If a health maintenance organization refuses, pursuant to 25
subsection 8, to provide the coverage required by subsect ion 1, an 26
employer may otherwise provide for the coverage for the employees 27
of the employer. 28
10. A health maintenance organization may require an enrollee 29
to pay a higher deductible, copayment or coinsurance for a drug for 30
contraception if the enrollee r efuses to accept a therapeutic 31
equivalent of the drug. 32
11. For each of the 18 methods of contraception listed in 33
subsection 12 that have been approved by the Food and Drug 34
Administration, a health care plan must include at least one drug or 35
device for contraception within each method for which no 36
deductible, copa yment or coinsurance may be charged to the 37
enrollee, but the health maintenance organization may charge a 38
deductible, copayment or coinsurance for any other drug or device 39
that provides the same method of contraception. If the health 40
maintenance organization charges a copayment or coinsurance for a 41
drug for contraception, the health maintenance organization may 42
only require an enrollee to pay the copayment or coinsurance: 43
(a) Once for the entire amount of the drug dispensed for the plan 44
year; or 45

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(b) Once for each 1-month supply of the drug dispensed. 1
12. The following 18 methods of contraception must be 2
covered pursuant to this section: 3
(a) Voluntary sterilization for women; 4
(b) Surgical sterilization implants for women; 5
(c) Implantable rods; 6
(d) Copper-based intrauterine devices; 7
(e) Progesterone-based intrauterine devices; 8
(f) Injections; 9
(g) Combined estrogen- and progestin-based drugs; 10
(h) Progestin-based drugs; 11
(i) Extended- or continuous-regimen drugs; 12
(j) Estrogen- and progestin-based patches; 13
(k) Vaginal contraceptive rings; 14
(l) Diaphragms with spermicide; 15
(m) Sponges with spermicide; 16
(n) Cervical caps with spermicide; 17
(o) Female condoms; 18
(p) Spermicide; 19
(q) Combined estrogen - and progestin -based drugs for 20
emergency contraception o r progestin -based drugs for emergency 21
contraception; and 22
(r) Ulipristal acetate for emergency contraception. 23
13. Except as otherwise provided in this section and federal 24
law, a health maintenance organization may use medical 25
management techniques, including, without limitation, any available 26
clinical evidence, to determine the frequency of or treatment relating 27
to any benefit required by this section or the type of provider of 28
health care to use for such treatment. 29
14. A health maintenance organization shall not: 30
(a) Use medical management techniques to require an enrollee 31
to use a method of contraception other than the method prescribed 32
or ordered by a provider of health care; 33
(b) Require an enrollee to obtain prior authorization for the 34
benefits described in paragraphs (a) and (c) of subsection 1; or 35
(c) Refuse to cover a contraceptive injection or the insertion of a 36
device described in paragraph (c), (d) or (e) of subsection 12 at a 37
hospital immediately after an enrollee gives birth. 38
15. A health maintenance organization must provide an 39
accessible, transparent and expedited process which is not unduly 40
burdensome by which an enrollee, or the authorized representative 41
of the enrollee, may request an exception relating to any medical 42
management technique used by the health maintenance organization 43
to obtain any benefit required by this section without a higher 44
deductible, copayment or coinsurance. 45

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16. As used in this section: 1
(a) “In-network pharmacy” means a pharmacy that has entered 2
into a contra ct with a health maintenance organization to provide 3
services to enrollees through a network plan offered or issued by the 4
health maintenance organization. 5
(b) [“Medical management technique” means a practice which is 6
used to control the cost or utilization of health care services or 7
prescription drug use. The term includes, without limitation, the use 8
of step therapy, prior authorization or categorizing drugs and 9
devices based on cost, type or method of administration. 10
(c) “Network plan” means a health care plan offered by a health 11
maintenance organization under which the financing and delivery of 12
medical care, including items and services paid for as medical care, 13
are provided, in whole or in part, through a defined set of providers 14
under contract with the health maintenance organization. The term 15
does not include an arrangement for the financing of premiums. 16
(d)] “Provider network contract” [means] includes a contract 17
between a health maintenance organization and a [provider of health 18
care or ] pharmacy specifying the rights and responsibilities of the 19
health maintenance organization and the [provider of health care or] 20
pharmacy [, as applicable, ] for delivery of health care services 21
pursuant to a network plan. 22
[(e) “Provider of health care” has the meaning ascribed to it in 23
NRS 629.031. 24
(f) “Therapeutic equivalent” means a drug which: 25
(1) Contains an identical amount of the same active 26
ingredients in the same dosage and method of administration as 27
another drug; 28
(2) Is expected to have the same clinical effect when 29
administered to a patient pursuant to a prescription or order as 30
another drug; and 31
(3) Meets any other criteria required by the Food and Drug 32
Administration for classification as a therapeutic equivalent.] 33
Sec. 280. NRS 695C.1698 is hereby amended to read as 34
follows: 35
695C.1698 1. A health maintenance organization that offers 36
or issues a health care plan shall include in the plan coverage for: 37
(a) Counseling, support and supplies for breastfeed ing, 38
including breastfeeding equipment, counseling and education during 39
the antenatal, perinatal and postpartum period for not more than 1 40
year; 41
(b) Screening and counseling for interpersonal and domestic 42
violence for women at least annually with initial intervention 43
services consisting of education, strategies to reduce harm, 44
supportive services or a referral for any other appropriate services; 45

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(c) Behavioral counseling concerning sexually transmitted 1
diseases from a provider of health care for sexually active women 2
who are at increased risk for such diseases; 3
(d) Such prenatal screenings and tests as recommended by the 4
American College of Obstetricians and Gynecologists or its 5
successor organization; 6
(e) Screening for blood pressure abnormalities and diabetes, 7
including gestational diabetes, after at least 24 weeks of gestation or 8
as ordered by a provider of health care; 9
(f) Screening for cervical cancer at such intervals as are 10
recommended by the American College of Obstetricians and 11
Gynecologists or its successor organization; 12
(g) Screening for depression; 13
(h) Screening and counseling for the human immunodeficiency 14
virus consisting of a risk assessment, annual education relating to 15
prevention and at least one screening for the virus during the 16
lifetime of the enrollee or as ordered by a provider of health care; 17
(i) Smoking cessation programs for an enrollee who is 18 years 18
of age or older not more than two cessation attempts per year and 19
four counseling sessions per year; 20
(j) All vaccinations reco mmended by the Advisory Committee 21
on Immunization Practices of the Centers for Disease Control and 22
Prevention of the United States Department of Health and Human 23
Services or its successor organization; and 24
(k) Such well-woman preventative visits as recommended by the 25
Health Resources and Services Administration, which must include 26
at least one such visit per year beginning at 14 years of age. 27
2. A health maintenance organization must ensure that the 28
benefits required by subsection 1 are made available to an enrollee 29
through a provider of health care who participates in the network 30
plan of the health maintenance organization. 31
3. Except as otherwise provided in subsection 5, a health 32
maintenance organization that offers or issues a health care plan 33
shall not: 34
(a) Require an enrollee to pay a higher deductible, any 35
copayment or coinsurance or require a longer waiting period or 36
other condition to obtain any benefit provided in the health care plan 37
pursuant to subsection 1; 38
(b) Refuse to issue a health care plan or cancel a health care plan 39
solely because the person applying for or covered by the plan uses 40
or may use any such benefit; 41
(c) Offer or pay any type of material inducement or financial 42
incentive to an enrollee to discourage the enrollee from obtai ning 43
any such benefit; 44

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(d) Penalize a provider of health care who provides any such 1
benefit to an enrollee, including, without limitation, reducing the 2
reimbursement of the provider of health care; 3
(e) Offer or pay any type of material inducement, bonus or other 4
financial incentive to a provider of health care to deny, reduce, 5
withhold, limit or delay access to any such benefit to an enrollee; or 6
(f) Impose any other restrictions or delays on the access of an 7
enrollee to any such benefit. 8
4. A health care plan subject to the provisions of this chapter 9
that is delivered, issued for delivery or renewed on or after 10
January 1, 2018, has the legal effect of including the coverage 11
required by subsection 1, and any provision of the plan or the 12
renewal which is in conflict with this section is void. 13
5. Except as otherwise provided in this section and federal law, 14
a health maintenance organization may use medical management 15
techniques, including, without limitation, any available clinical 16
evidence, to determine the frequency of or treatment relating to any 17
benefit required by this section or the type of provider of health care 18
to use for such treatment. 19
[6. As used in this section: 20
(a) “Medical management technique” means a practice which is 21
used to control the cost or utilization of health care services or 22
prescription drug use. The term includes, without limitation, the use 23
of step therapy, prior authorization or categorizing drugs and 24
devices based on cost, type or method of administration. 25
(b) “Network plan” means a health care plan offered by a health 26
maintenance organization under which the financing and delivery of 27
medical care, including items and services paid for as medical care, 28
are provided, in whole or in part, through a defined set of providers 29
under contract with the health maintenance organization. The term 30
does not include an arrangement for the financing of premiums. 31
(c) “Provider of health care” has the meaning ascribed to it in 32
NRS 629.031.] 33
Sec. 281. NRS 695C.1699 is hereby amended to read as 34
follows: 35
695C.1699 1. A health maintenance organization that offers 36
or issues a health care plan shall include in the plan coverage for: 37
(a) All drugs approved by the United States Food and Drug 38
Administration to support safe withdrawal from substance use 39
disorder, including, without limitation, lofexidine. 40
(b) All drugs approved by the United States Food and Drug 41
Administration to provide medication -assisted treatment for opioid 42
use disorder, including, without l imitation, buprenorphine, 43
methadone and naltrexone. 44

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(c) The services described in NRS 639.28079 when provided by 1
a pharmacist or pharmacy that participates in the network plan of the 2
health maintenance organization. The Commissioner shall adopt 3
regulations governing the provision of reimbursement for such 4
services. 5
(d) Any service for the treatment of substance use disorder 6
provided by a provider of primary care if the service is covered 7
when provided by a specialist and: 8
(1) The service is within the scope of practice of the provider 9
of primary care; or 10
(2) The provider of primary care is capable of providing the 11
service safely and effectively in consultation with a specialist and 12
the provider engages in such consultation. 13
2. A health maintenance o rganization that offers or issues a 14
health care plan shall reimburse a pharmacist or pharmacy that 15
participates in the network plan of the health maintenance 16
organization for the services described in NRS 639.28079 at a rate 17
equal to the rate of reimbursem ent provided to a physician, 18
physician assistant or advanced practice registered nurse for similar 19
services. 20
3. A health maintenance organization shall provide the 21
coverage required by paragraphs (a) and (b) of subsection 1 22
regardless of whether the drug is included in the formulary of the 23
health maintenance organization. 24
4. Except as otherwise provided in this subsection, a health 25
maintenance organization shall not subject the benefits required by 26
paragraphs (a), (b) and (c) of subsection 1 to medical management 27
techniques, other than step therapy. A health maintenance 28
organization may subject the benefits required by paragraphs (b) and 29
(c) of subsection 1 to other reasonable medical management 30
techniques when the benefits are provided by a pharmacist i n 31
accordance with NRS 639.28079. 32
5. A health maintenance organization shall not: 33
(a) Limit the covered amount of a drug described in paragraph 34
(a) or (b) of subsection 1; or 35
(b) Refuse to cover a drug described in paragraph (a) or (b) of 36
subsection 1 because the drug is dispensed by a pharmacy through 37
mail order service. 38
6. A health maintenance organization shall ensure that the 39
benefits required by subsection 1 are made available to an enrollee 40
through a provider of health care who participates in t he network 41
plan of the health maintenance organization. 42
7. A health care plan subject to the provisions of this chapter 43
that is delivered, issued for delivery or renewed on or after 44
January 1, 2024, has the legal effect of including the coverage 45

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required by subsection 1, and any provision of the plan that conflicts 1
with the provisions of this section is void. 2
8. As used in this section [: 3
(a) “Medical management technique” means a practice which is 4
used to control the cost or use of health care services or prescription 5
drugs. The term includes, without limitation, the use of step therapy, 6
prior authorization and categorizing drugs and devices based on 7
cost, type or method of administration. 8
(b) “Network plan” means a health care plan offered by a health 9
maintenance organization under which the financing and delivery of 10
medical care, including items and services paid for as medical care, 11
are provided, in whole or in part, through a defined set of providers 12
under contract with the health maintenanc e organization. The term 13
does not include an arrangement for the financing of premiums. 14
(c) “Primary] , “primary care” means the practice of family 15
medicine, pediatrics, internal medicine, obstetrics and gynecology 16
and midwifery. 17
[(d) “Provider of health care” has the meaning ascribed to it in 18
NRS 629.031.] 19
Sec. 282. NRS 695C.1728 is hereby amended to read as 20
follows: 21
695C.1728 1. A health maintenance organization that issues 22
a health care plan shall include in the plan coverage for: 23
(a) Necessary case management services for an enrollee who has 24
been diagnosed with sickle cell disease and its variants; and 25
(b) Medically necessary care for an enrollee who has been 26
diagnosed with sickle cell disease and its variants. 27
2. A health maintenance organization that issues a health care 28
plan which provides coverage for prescription drugs shall include in 29
the plan coverage for medically necessary prescription drugs to treat 30
sickle cell disease and its variants. 31
3. A health maintenance organization shall establish a plan for 32
each enrollee under 18 years of age who has been diagnosed with 33
sickle cell disease and its variants to transition the enrollee from 34
pediatric care to adult care when the enrollee reaches 18 years of 35
age. 36
4. A health maintenance organization may use medical 37
management techniques, including, without limitation, any available 38
clinical evidence, to determine the frequency of or treatment relating 39
to any benefit required by this section or the type of provider of 40
health care to use for such treatment. 41
5. As used in this section: 42
(a) “Case management services” means medical or other health 43
care management services to assist patients and providers of health 44
care, including, without limitation, identif ying and facilitating 45

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additional resources and treatments, providing information about 1
treatment options and facilitating communication between providers 2
of services to a patient. 3
(b) [“Medical management technique” means a practice which is 4
used to contr ol the cost or utilization of health care services. The 5
term includes, without limitation, the use of step therapy, prior 6
authorization or categorizing drugs and devices based on cost, type 7
or method of administration. 8
(c)] “Medically necessary” has the m eaning ascribed to it in 9
NRS 695G.055. 10
[(d)] (c) “Sickle cell disease and its variants” has the meaning 11
ascribed to it in NRS 439.4927. 12
Sec. 283. NRS 695C.17347 is hereby amended to read as 13
follows: 14
695C.17347 1. A health maintenance organization that issues 15
a health care plan shall provide coverage for screening, genetic 16
counseling and testing for harmful mutations in the BRCA gene for 17
women under circumstances where such screening, genetic 18
counseling or testing, as applicable, is required by NRS 457.301. 19
2. A health maintenance organization shall ensure that the 20
benefits required by subsection 1 are made available to an enrollee 21
through a provider of health care who participates in the network 22
plan of the health maintenance organization. 23
3. A health care plan subject to the provisions of this chapter 24
that is delivered, issued for delivery or renewed on or after 25
January 1, 2022, has the legal effect of including the coverage 26
required by subsection 1, and any provision of the plan that conflicts 27
with the provisions of this section is void. 28
[4. As used in this section: 29
(a) “Network plan” means a health care plan offered by a health 30
maintenance organization under which the financing and delivery of 31
medical care, including items and services paid for as medical care, 32
are provided, in whole or in part, through a defined set of providers 33
under contract with the health maintenance organization. The term 34
does not include an arrangement for the financing of premiums. 35
(b) “Provider of health care” has the meaning ascribed to it in 36
NRS 629.031.] 37
Sec. 284. NRS 695C.1735 is hereby amended to read as 38
follows: 39
695C.1735 1. A health care plan of a health maintenance 40
organization must provide coverage for benefits payable for 41
expenses incurred for: 42
(a) A mammogram to screen for breast cancer annually for 43
enrollees who are 40 years of age or older. 44

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(b) An imaging test to screen for breast cancer on an interval 1
and at the age deeme d most appropriate, when medically necessary, 2
as recommended by the enrollee’s provider of health care based on 3
personal or family medical history or additional factors that may 4
increase the risk of breast cancer for the enrollee. 5
(c) A diagnostic imaging test for breast cancer at the age deemed 6
most appropriate, when medically necessary, as recommended by 7
the enrollee’s provider of health care to evaluate an abnormality 8
which is: 9
(1) Seen or suspected from a mammogram described in 10
paragraph (a) or an imaging test described in paragraph (b); or 11
(2) Detected by other means of examination. 12
2. A health maintenance organization must ensure that the 13
benefits required by subsection 1 are made available to an enrollee 14
through a provider of health care who participates in the network 15
plan of the health maintenance organization. 16
3. Except as otherwise provided in subsection 5, a health 17
maintenance organization that offers or issues a health care plan 18
shall not: 19
(a) Except as otherwise provided in subsectio n 6, require an 20
enrollee to pay a deductible, copayment, coinsurance or any other 21
form of cost -sharing or require a longer waiting period or other 22
condition to obtain any benefit provided in the health care plan 23
pursuant to subsection 1; 24
(b) Refuse to issue a health care plan or cancel a health care plan 25
solely because the person applying for or covered by the plan uses 26
or may use any such benefit; 27
(c) Offer or pay any type of material inducement or financial 28
incentive to an enrollee to discourage the enr ollee from obtaining 29
any benefit provided in the health care plan pursuant to 30
subsection 1; 31
(d) Penalize a provider of health care who provides any such 32
benefit to an enrollee, including, without limitation, reducing the 33
reimbursement of the provider of health care; 34
(e) Offer or pay any type of material inducement, bonus or other 35
financial incentive to a provider of health care to deny, reduce, 36
withhold, limit or delay access to any such benefit to an enrollee; or 37
(f) Impose any other restrictions or d elays on the access of an 38
enrollee to any such benefit. 39
4. A health care plan subject to the provisions of this chapter 40
which is delivered, issued for delivery or renewed on or after 41
January 1, 2024, has the legal effect of including the coverage 42
required by subsection 1, and any provision of the plan or the 43
renewal which is in conflict with this section is void. 44

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5. Except as otherwise provided in this section and federal law, 1
a health maintenance organization may use medical management 2
techniques, incl uding, without limitation, any available clinical 3
evidence, to determine the frequency of or treatment relating to any 4
benefit required by this section or the type of provider of health care 5
to use for such treatment. 6
6. If the application of paragraph ( a) of subsection 3 would 7
result in the ineligibility of a health savings account of an enrollee 8
pursuant to 26 U.S.C. § 223, the prohibitions of paragraph (a) of 9
subsection 3 shall apply only for a qualified health care plan with 10
respect to the deductible of such a health care plan after the enrollee 11
has satisfied the minimum deductible pursuant to 26 U.S.C. § 223, 12
except with respect to items or services that constitute preventive 13
care pursuant to 26 U.S.C. § 223(c)(2)(C), in which case the 14
prohibitions of paragraph (a) of subsection 3 shall apply regardless 15
of whether the minimum deductible under 26 U.S.C. § 223 has been 16
satisfied. 17
7. As used in this section [: 18
(a) “Medical management technique” means a practice which is 19
used to control the cost or util ization of health care services or 20
prescription drug use. The term includes, without limitation, the use 21
of step therapy, prior authorization or categorizing drugs and 22
devices based on cost, type or method of administration. 23
(b) “Network plan” means a health care plan offered by a health 24
maintenance organization under which the financing and delivery of 25
medical care, including items and services paid for as medical care, 26
are provided, in whole or in part, through a defined set of providers 27
under contract w ith the health maintenance organization. The term 28
does not include an arrangement for the financing of premiums. 29
(c) “Provider of health care” has the meaning ascribed to it in 30
NRS 629.031. 31
(d) “Qualified] , “qualified health care plan” means a health 32
care plan of a health maintenance organization that has a high 33
deductible and is in compliance with 26 U.S.C. § 223 for the 34
purposes of establishing a health savings account. 35
Sec. 285. NRS 695C.1737 is hereby amended to read as 36
follows: 37
695C.1737 1. A health maintenance organization that issues 38
a health care plan shall provide coverage for the examination of a 39
person who is pregnant for the discovery of: 40
(a) Chlamydia trachomatis, gonorrhea, hepatitis B and hepatitis 41
C in accordance with NRS 442.013. 42
(b) Syphilis in accordance with NRS 442.010. 43
2. The coverage required by this section must be provided: 44

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(a) Regardless of whether the benefits are provided to the 1
enrollee by a provider of health care, facility or medical l aboratory 2
that participates in the network plan of the health maintenance 3
organization; and 4
(b) Without prior authorization. 5
3. A health care plan subject to the provisions of this chapter 6
that is delivered, issued for delivery or renewed on or after Ju ly 1, 7
2021, has the legal effect of including the coverage required by 8
subsection 1, and any provision of the plan that conflicts with the 9
provisions of this section is void. 10
4. As used in this section [: 11
(a) “Medical] , “medical laboratory” has the m eaning ascribed 12
to it in NRS 652.060. 13
[(b) “Network plan” means a health care plan offered by a health 14
maintenance organization under which the financing and delivery of 15
medical care, including items and services paid for as medical care, 16
are provided, in whole or in part, through a defined set of providers 17
under contract with the health maintenance organization. The term 18
does not include an arrangement for the financing of premiums. 19
(c) “Provider of health care” has the meaning ascribed to it in 20
NRS 629.031.] 21
Sec. 286. NRS 695C.1743 is hereby amended to read as 22
follows: 23
695C.1743 1. A health maintenance organization that offers 24
or issues a health care plan shall include in the plan coverage for: 25
(a) All drugs approved by the Unit ed States Food and Drug 26
Administration for preventing the acquisition of human 27
immunodeficiency virus or treating human immunodeficiency virus 28
or hepatitis C in the form recommended by the prescribing 29
practitioner, regardless of whether the drug is include d in the 30
formulary of the health maintenance organization; 31
(b) Laboratory testing that is necessary for therapy that uses a 32
drug to prevent the acquisition of human immunodeficiency virus; 33
(c) Any service to test for, prevent or treat human 34
immunodeficiency virus or hepatitis C provided by a provider of 35
primary care if the service is covered when provided by a specialist 36
and: 37
(1) The service is within the scope of practice of the provider 38
of primary care; or 39
(2) The provider of primary care is capab le of providing the 40
service safely and effectively in consultation with a specialist and 41
the provider engages in such consultation; and 42
(d) The services described in NRS 639.28085, when provided 43
by a pharmacist who participates in the network plan of the health 44
maintenance organization. 45

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2. A health maintenance organization that offers or issues a 1
health care plan shall reimburse: 2
(a) A pharmacist who participates in the network plan of the 3
health maintenance organization for the services described in NRS 4
639.28085 at a rate equal to the rate of reimbursement provided to a 5
physician, physician assistant or advanced practice registered nurse 6
for similar services. 7
(b) An advanced practice registered nurse or a physician 8
assistant who participates in the network plan of the health 9
maintenance organization for any service to test for, prevent or treat 10
human immunodeficiency virus or hepatitis C at a rate equal to the 11
rate of reimbursement provided to a physician for similar services. 12
3. A health maintenance organization shall not: 13
(a) Subject the benefits required by subsection 1 to medical 14
management techniques, other than step therapy; 15
(b) Limit the covered amount of a drug described in paragraph 16
(a) of subsection 1; 17
(c) Refuse to cover a drug described in paragraph (a) of 18
subsection 1 because the drug is dispensed by a pharmacy through 19
mail order service; or 20
(d) Prohibit or restrict access to any service or drug to treat 21
human immunodeficiency virus or hepatitis C on the same day on 22
which the enrollee is diagnosed. 23
4. A health maintenance organization shall ensure that the 24
benefits required by subsection 1 are made available to an enrollee 25
through a provider of health care who participates in the network 26
plan of the health maintenance organization. 27
5. A health care plan subject to the provisions of this chapter 28
that is delivered, issued for delivery or renewed on or after 29
January 1, 2024, has the legal effect of including the coverage 30
required by subsection 1, and any provision of the plan that conflicts 31
with the provisions of this section is void. 32
6. As used in this section [: 33
(a) “Medical management technique” means a practice which is 34
used to control the cost or use of health care services or prescription 35
drugs. The term includes, without limitation, the use of step therapy, 36
prior authorization and categorizing drugs and devices based on 37
cost, type or method of administration. 38
(b) “Network plan” means a health care plan offered by a health 39
maintenance organization under which the financing and delivery of 40
medical care, including items and services paid for as medical care, 41
are provided, in whole or in part, through a defined set of providers 42
under contract with the health maintenance organization. The term 43
does not include an arrangement for the financing of premiums. 44

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(c) “Primary] , “primary care” means the practice of family 1
medicine, pediatrics, internal medicine, obstetrics and gynecology 2
and midwifery. 3
[(d) “Provider of health care” has the meaning ascribed to it in 4
NRS 629.031.] 5
Sec. 287. NRS 695C.1745 is hereby amended to read as 6
follows: 7
695C.1745 1. A health care plan of a health maintenance 8
organization must provide coverage for benefits payable for 9
expenses incurred for: 10
(a) Deoxyribonucleic acid testing for high -risk strains of human 11
papillomavirus every 3 years for women 30 years of age and older; 12
and 13
(b) Administering the human papillomavirus vaccine as 14
recommended for vaccination by a competent authority, including, 15
without limitation, the Centers for Disease Control and Prevention 16
of the United States Department of Health and Human Services, the 17
Food and Drug Administration or the manufacturer of the vaccine. 18
2. A health maintenance organization must ensure that the 19
benefits required by subsection 1 are made available to an enrollee 20
through a provider of health care who participates in the network 21
plan of the health maintenance organization. 22
3. Except as otherwise provided in subsection 5, a health 23
maintenance organizatio n that offers or issues a health care plan 24
shall not: 25
(a) Require an enrollee to pay a higher deductible, any 26
copayment or coinsurance or require a longer waiting period or 27
other condition to obtain any benefit provided in the health care plan 28
pursuant to subsection 1; 29
(b) Refuse to issue a health care plan or cancel a health care plan 30
solely because the person applying for or covered by the plan uses 31
or may use any such benefit; 32
(c) Offer or pay any type of material inducement or financial 33
incentive to an enrollee to discourage the enrollee from obtaining 34
any such benefit; 35
(d) Penalize a provider of health care who provides any such 36
benefit to an enrollee, including, without limitation, reducing the 37
reimbursement of the provider of health care; 38
(e) Offer or pay any type of material inducement, bonus or other 39
financial incentive to a provider of health care to deny, reduce, 40
withhold, limit or delay access to any such benefit to an enrollee; or 41
(f) Impose any other restrictions or delays on the access o f an 42
enrollee to any such benefit. 43
4. Any evidence of coverage subject to the provisions of this 44
chapter which is delivered, issued for delivery or renewed on or 45

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after January 1, 2018, has the legal effect of including the coverage 1
required by subsection 1, and any provision of the evidence of 2
coverage or the renewal which is in conflict with this section is void. 3
5. Except as otherwise provided in this section and federal law, 4
a health maintenance organization may use medical management 5
techniques, inc luding, without limitation, any available clinical 6
evidence, to determine the frequency of or treatment relating to any 7
benefit required by this section or the type of provider of health care 8
to use for such treatment. 9
6. As used in this section [: 10
(a) “Human] , “human papillomavirus vaccine” means the 11
Quadrivalent Human Papillomavirus Recombinant Vaccine or its 12
successor which is approved by the Food and Drug Administration 13
for the prevention of human papillomavirus infection and cervical 14
cancer. 15
[(b) “Medical management technique” means a practice which is 16
used to control the cost or utilization of health care services or 17
prescription drug use. The term includes, without limitation, the use 18
of step therapy, prior authorization or categorizing drugs and 19
devices based on cost, type or method of administration. 20
(c) “Network plan” means a health care plan offered by a health 21
maintenance organization under which the financing and delivery of 22
medical care, including items and services paid for as medical car e, 23
are provided, in whole or in part, through a defined set of providers 24
under contract with the health maintenance organization. The term 25
does not include an arrangement for the financing of premiums. 26
(d) “Provider of health care” has the meaning ascribed to it in 27
NRS 629.031.] 28
Sec. 288. NRS 695C.300 is hereby amended to read as 29
follows: 30
695C.300 1. No health maintenance organization or 31
representative thereof may cause or knowingly permit the use of 32
advertising w hich is untrue or misleading, solicitation which is 33
untrue or misleading or any form of evidence of coverage which is 34
deceptive. For purposes of this chapter: 35
(a) A statement or item of information shall be deemed to be 36
untrue if it does not conform to fa ct in any respect which is or may 37
be significant to an enrollee of, or person considering enrollment in, 38
a health care plan. 39
(b) A statement or item of information shall be deemed to be 40
misleading, whether or not it may be literally untrue if, in the tota l 41
context in which such statement is made or such item of information 42
is communicated, such statement or item of information may be 43
reasonably understood by a reasonable person not possessing special 44
knowledge regarding health care coverage, as indicating any benefit 45

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or advantage or the absence of any exclusion, limitation or 1
disadvantage of possible significance to an enrollee of, or person 2
considering enrollment in, a health care plan if such benefit or 3
advantage or absence of limitation, exclusion or dis advantage does 4
not in fact exist. 5
(c) An evidence of coverage shall be deemed to be deceptive if 6
the evidence of coverage taken as a whole, and with consideration 7
given to typography and format as well as language, shall be such as 8
to cause a reasonable p erson not possessing special knowledge 9
regarding health care plans and evidences of coverage therefor to 10
expect benefits, services, charges or other advantages which the 11
evidence of coverage does not provide or which the health care plan 12
issuing such evidence of coverage does not regularly make available 13
for enrollees covered under such evidence of coverage. 14
2. NRS 686A.010 to [686A.310,] 686A.325, inclusive, and 15
sections 80 to 93, inclusive, of this act shall be construed to apply 16
to health maintenance organizations, health care plans and evidences 17
of coverage except to the extent that the nature of health 18
maintenance organizations, health care plans and evidences of 19
coverage render the sections therein clearly inappropriate. 20
3. An enrollee may not be cancelled or not r enewed except for 21
the failure to pay the charge for such coverage or for cause as 22
determined in the master contract. 23
4. No health maintenance organization, unless licensed as an 24
insurer, may use in its name, contracts, or literature any of the words 25
“insurance,” “casualty,” “surety,” “mutual” or any other words 26
descriptive of the insurance, casualty or surety business or 27
deceptively similar to the name or description of any insurance or 28
surety corporation doing business in this State. 29
5. No person not c ertificated under this chapter shall use in its 30
name, contracts or literature the phrase “health maintenance 31
organization” or the initials “HMO.” 32
Sec. 289. NRS 695C.310 is hereby amended to read as 33
follows: 34
695C.310 1. The Commissioner shall make an examination 35
of the affairs of any health maintenance organization and providers 36
with whom such organization has contracts, agreements or other 37
arrangements pursuant to its health care plan as often as the 38
Commissioner deems it necessary for the protection of the interests 39
of the people of this State, but not less frequently than once every 3 40
years. 41
2. The Commissioner shall make an examination concerning 42
any compliance program used by a health maintenance organization 43
and an y report, as determined to be appropriate by the 44
Commissioner, regarding the health maintenance organization 45

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produced by an organization which examines best practices in the 1
insurance industry. The Commissioner shall make such an 2
examination as often as the Commissioner deems it necessary for 3
the protection of the interests of the people of this State , but not less 4
frequently than once every 3 years. 5
3. In making an examination pursuant to subsection 1 or 2, the 6
Commissioner: 7
(a) Shall determine whether the health maintenance organization 8
is in compliance with this Code, including, without limitation, 9
whether any relationship or transaction between the health 10
maintenance organization and any other health maintenance 11
organization is in compliance with this Code; and 12
(b) May examine any account, record, document or transaction 13
of any health maintenance organization or any provider which 14
relates to: 15
(1) Compliance with this Code by the health maintenance 16
organization which is the subject of the examination; 17
(2) Any relationship or transaction between the health 18
maintenance organization which is the subject of the examination 19
and any other health maintenance organization; or 20
(3) Any relationship or transaction between the health 21
maintenance organization which is the subject of the examination 22
and any provider. 23
4. Except as otherwise provided in this subsection, for the 24
purposes of an examination pursuant to subsection 1 or 2, each 25
health maintenance organization and provider shall , upon the 26
request of the Commissioner or an examiner designated by the 27
Commissioner, submit its books and records relating to any 28
applicable health care plan to the Commissioner or the examiner, as 29
applicable. Medical records of natural persons and records of 30
physicians provi ding service pursuant to a contract with a health 31
maintenance organization are not subject to such examination, 32
although the records , except privileged medical information, are 33
subject to subpoena upon a showing of good cause. For the purpose 34
of examinatio ns, the Commissioner may administer oaths to and 35
examine the officers and agents of a health maintenance 36
organization and the principals of providers concerning their 37
business. 38
5. The expenses of examinations pursuant to this section must 39
be assessed, bi lled and paid in accordance with the provisions of 40
[NRS 679B.290.] section 19 of this act. 41
6. In lieu of an examination pursuant to this section, the 42
Commissioner may accept the report of an examination made by the 43
insurance commissioner of another state or an applicable regulatory 44
agency of another state. 45

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Sec. 290. NRS 695C.317 is hereby amended to read as 1
follows: 2
695C.317 The Commissioner shall use the procedures required 3
by: 4
1. [NRS 679B.230 to 679B.290,] Sections 2 to 41, inclusive, of 5
this act when conducting an examination of a health maintenance 6
organization. 7
2. NRS 679B.310 to 679B.370, inclusive, when conducting a 8
hearing involving a health maintenance organization. 9
Sec. 291. NRS 695D.270 is hereby amended to read as 10
follows: 11
695D.270 1. The Commissioner shall, not less frequently 12
than once every 3 years, conduct an examination of an organization 13
for dental care pursuant to [NRS 679B.250 to 679B.300,] sections 2 14
to 41, inclusive [.] , of this act. 15
2. The Commissioner may examine any organization which 16
holds a certificate of authority from this State or another state at any 17
other time the Commissioner deems necessary. For those 18
organizations transacting business in this State whic h are not 19
organized in this State, the Commissioner may accept a full report 20
of the last examination of the organization certified by the state 21
officer who supervises those organizations in the other state, if that 22
examination is equivalent to an examinati on conducted by the 23
Commissioner. 24
3. The Commissioner shall, in like manner, examine all 25
organizations applying for a certificate of authority. 26
Sec. 292. NRS 695D.290 is hereby amended to read as 27
follows: 28
695D.290 The provisions of NRS 686A.010 to [686A.310,] 29
686A.325, inclusive, and sections 80 to 93, inclusive, of this act 30
relating to trade practices and frauds apply to organizations for 31
dental care. 32
Sec. 293. NRS 695E.170 is hereby amended to read as 33
follows: 34
695E.170 1. A risk retention group and its agents and 35
representatives are subject to the provisions of: 36
(a) NRS 680A.205 and any regulations adopted pursuant 37
thereto, including, without limitation, regulations relating to the 38
standards which may be used by the Comm issioner in determining 39
whether a risk retention group is in a hazardous financial condition. 40
(b) NRS 686A.010 to [686A.310,] 686A.325, inclusive [.] , and 41
sections 80 to 93, inclusive, of this act. Any injunction obtained 42
pursuant to those sections must be obtained from a court of 43
competent jurisdiction. 44

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2. All premiums paid for coverages within this state to a risk 1
retention group are subject to the provisions of chapter 680B of 2
NRS. Each risk retention group shall report all premiums paid to it 3
and shall pay the taxes on premiums and any related fines or 4
penalties for risks resident, located or to be performed in the state. 5
3. Any person acting as an agent or a broker for a risk retention 6
group pursuant to NRS 695E.210 shall: 7
(a) Report to the Commissioner each premium for direct 8
business for risks resident, located or to be performed in this State 9
which the person has placed with or on behalf of a risk retention 10
group that is not chartered in this State. 11
(b) Maintain a complete and separate record of each policy 12
obtained from each risk retention group. Each record maintained 13
pursuant to this subsection must be made available upon request by 14
the Commissioner for examination pursuant to [NRS 679B.240, ] 15
section 16 of this act, and must include, for each policy and each 16
kind of insurance provided therein: 17
(1) The limit of liability; 18
(2) The period covered; 19
(3) The effective date; 20
(4) The name of the risk retention group which issued the 21
policy; 22
(5) The gross annual premium charged; and 23
(6) The amount of return premiums, if any. 24
4. As used in this section, “premiums for direct business” 25
means any premium written in this State for a policy of insurance. 26
The term does not include any premium for reinsurance or for a 27
contract between members of a risk retention group. 28
Sec. 294. NRS 695E.210 is hereby amended to read as 29
follows: 30
695E.210 1. The provisions of chapters 683A and 685A of 31
NRS apply to any person acting, or offering to act, as an agent or 32
broker for: 33
(a) A purchasing group; 34
(b) A member of a purchasing group under the group policy; or 35
(c) A risk retention group transacting insurance in this State. 36
2. Except as otherwise provided in this chapter, the provisions 37
of chapter 679B of NRS and sections 2 to 41, inclusive, of this act 38
apply to purchasing groups and risk retention groups, and to the 39
provisions of this chapter, to the extent that the provisions of chapter 40
679B of NRS and sections 2 to 41, inclusive, of this act are not 41
specifically preempted by the Product Liability Risk Retention Act 42
of 1981, as amended by the Risk Retention Amendments of 1986. 43
3. A risk retention group that violates any pro vision of this 44
chapter is subject to the fines and penalties, including revocation of 45

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its right to do business in this state, applicable to licensed insurers 1
under this title. 2
Sec. 295. NRS 695F.090 is hereby amended to read as 3
follows: 4
695F.090 1. Prepaid limited health service organizations are 5
subject to the provisions of this chapter and to the following 6
provisions, to the extent reasonably applicable: 7
(a) NRS 686B.010 to 686B.175, inclusive, concerning rates and 8
essential insurance. 9
(b) NRS 687B.310 to 687B.420, inclusive, concerning 10
cancellation and nonrenewal of policies. 11
(c) NRS 687B.122 to 687B.128, inclusive, concerning 12
readability of policies. 13
(d) The requirements of NRS 679B.152. 14
(e) The fees imposed pursuant to NRS 449.465. 15
(f) NRS 686A.010 to [686A.310,] 686A.325, inclusive, and 16
sections 80 to 93, inclusive, of this act concerning trade practices 17
and frauds. 18
(g) The assessment imposed pursuant to NRS 679B.700. 19
(h) Chapter 683A of NRS. 20
(i) To the extent applicable, the provisions of NRS 689B .340 to 21
689B.580, inclusive, and chapter 689C of NRS relating to the 22
portability and availability of health insurance. 23
(j) NRS 689A.035, 689A.0463, 689A.410 [, 689A.413 ] and 24
689A.415. 25
(k) NRS 680B.025 to 680B.060, inclusive, concerning premium 26
tax, premi um tax rate, annual report and estimated quarterly tax 27
payments. For the purposes of this paragraph, unless the context 28
otherwise requires that a section apply only to insurers, any 29
reference in those sections to “insurer” must be replaced by a 30
reference to “prepaid limited health service organization.” 31
(l) Chapter 692C of NRS, concerning holding companies. 32
(m) NRS 689A.637, concerning health centers. 33
(n) Chapter 681B of NRS, concerning assets and liabilities. 34
(o) NRS 682A.400 to 682A.468, inclusive, concerning 35
investments. 36
2. For the purposes of this section and the provisions set forth 37
in subsection 1, a prepaid limited health service organization is 38
included in the meaning of the term “insurer.” 39
Sec. 296. NRS 695F.159 is hereby amended to read as 40
follows: 41
695F.159 1. Evidence of coverage which provides coverage 42
for prescription drugs must not require an enrollee to use a step 43
therapy protocol before covering a drug approved by the Food and 44

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Drug Administratio n that is prescribed to treat a psychiatric 1
condition of the enrollee, if: 2
(a) The drug has been approved by the Food and Drug 3
Administration with indications for the psychiatric condition of the 4
enrollee or the use of the drug to treat that psychiatric c ondition is 5
otherwise supported by medical or scientific evidence; 6
(b) The drug is prescribed by: 7
(1) A psychiatrist; 8
(2) A physician assistant under the supervision of a 9
psychiatrist; 10
(3) An advanced practice registered nurse who has the 11
psychiatric training and experience prescribed by the State Board of 12
Nursing pursuant to NRS 632.120; or 13
(4) A primary care provider that is providing care to an 14
enrollee in consultation with a practitioner listed in subparagraph 15
(1), (2) or (3), if the closest practitioner listed in subparagraph (1), 16
(2) or (3) who participates in the network plan of the prepaid limited 17
health service organization is located 60 miles or more from the 18
residence of the enrollee; and 19
(c) The practitioner listed in paragraph (b) wh o prescribed the 20
drug knows, based on the medical history of the enrollee, or 21
reasonably expects each alternative drug that is required to be used 22
earlier in the step therapy protocol to be ineffective at treating the 23
psychiatric condition. 24
2. Any provi sion of an evidence of coverage subject to the 25
provisions of this chapter that is delivered, issued for delivery or 26
renewed on or after July 1, 2023, which is in conflict with this 27
section is void. 28
3. As used in this section: 29
(a) “Medical or scientific evidence” has the meaning ascribed to 30
it in NRS 695G.053. 31
(b) “Network plan” [means evidence of coverage offered by a 32
prepaid limited health service organization under which ] has the 33
[financing and delivery of medical care is provided, in whole or ] 34
meaning ascribed to it in [part, through a defined set of providers 35
under contract with the prepaid limited health service organization. 36
The term does not include an arrangement for the financing of 37
premiums.] NRS 687B.645. 38
(c) “Step therapy protocol” mea ns a procedure that requires an 39
enrollee to use a prescription drug or sequence of prescription drugs 40
other than a drug that a practitioner recommends for treatment of a 41
psychiatric condition of the enrollee before his or her evidence of 42
coverage provides coverage for the recommended drug. 43

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Sec. 297. NRS 695F.310 is hereby amended to read as 1
follows: 2
695F.310 1. The Commissioner may examine the affairs of 3
any prepaid limited health service organization as often as is 4
reasonably necessary to protect the interests of the residents of this 5
State, but not less frequently than once every 3 years. 6
2. A prepaid limited health service organization shall make its 7
books and records available for examination and cooperate with the 8
Commissioner to facilitate the examination. 9
3. In lieu of such an examination, the Commissioner may 10
accept the report of an examination conducted by the commissioner 11
of insurance of another state. 12
4. An examination conducted pursuant to this section mus t be 13
conducted in accordance with the provisions of [NRS 679B.230 to 14
679B.300,] sections 2 to 41, inclusive [.] , of this act. 15
5. A prepaid limited health service organization may be 16
investigated in accordance with NRS 679B.600 to 679B.700, 17
inclusive. 18
Sec. 298. Chapter 695G of NRS is hereby amended by adding 19
thereto the provisions set forth as sections 299 to 302, inclusive, of 20
this act. 21
Sec. 299. “Medical management t echnique” means a 22
practice which is used to control the cost or use of health care 23
services or prescription drugs. The term includes, without 24
limitation, the use of step therapy, prior authorization and 25
categorizing drugs and devices based on cost, type or method of 26
administration. 27
Sec. 300. “Network plan” has the meaning ascribed to it in 28
NRS 687B.645. 29
Sec. 301. “Provider network contract” has the meaning 30
ascribed to it in NRS 687B.658. 31
Sec. 302. “Therapeutic equivalent” means a drug which: 32
1. Contains an identical amount of the same active 33
ingredients in the same dosage and method of administration as 34
another drug; 35
2. Is expected to have the same clini cal effect when 36
administered to a patient pursuant to a prescription or order as 37
another drug; and 38
3. Meets any other criteria required by the Food and Drug 39
Administration for classification as a therapeutic equivalent. 40
Sec. 303. NRS 695G.010 is hereby amended to read as 41
follows: 42
695G.010 As used in this chapter, unless the context otherwise 43
requires, the words and terms defined in NRS 695G.012 to 44

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695G.085, inclusive, and sections 299 to 302, inclusive, of this act 1
have the meanings ascribed to them in those sections. 2
Sec. 304. NRS 695G.019 is hereby amended to read as 3
follows: 4
695G.019 “Health benefit plan” [means a policy, contract, 5
certificate or agreement offered or issued by a health carrier to 6
provide, deliver, arrange for, pay for or reimburse any of ] has the 7
[costs of health care services. ] meaning ascribed to it in 8
NRS 687B.470. 9
Sec. 305. NRS 695G.070 is hereby amended to read as 10
follows: 11
695G.070 “Provider of health care” [means: 12
1. A physician or other health care practitioner who is licensed 13
or otherwise authorized ] has the meaning ascribed to it in [this 14
State to furnish any health care service; and 15
2. An institution providing health care services or other setting 16
in which h ealth care services are provided, including, without 17
limitation, a hospital, surgical center for ambulatory patients, facility 18
for skilled nursing, residential facility for groups, laboratory and any 19
other such licensed facility.] NRS 629.031. 20
Sec. 306. NRS 695G.1702 is hereby amended to read as 21
follows: 22
695G.1702 1. A health care plan which provides coverage for 23
prescription drugs must not require an insured to submit to a step 24
therapy protocol before covering a drug approved by the Food and 25
Drug Administration that is prescribed to treat a psychiatric 26
condition of the insured, if: 27
(a) The drug has been approved by the Food and Drug 28
Administration with indications for the psychiatric condition of the 29
insured or the us e of the drug to treat that psychiatric condition is 30
otherwise supported by medical or scientific evidence; 31
(b) The drug is prescribed by: 32
(1) A psychiatrist; 33
(2) A physician assistant under the supervision of a 34
psychiatrist; 35
(3) An advanced pract ice registered nurse who has the 36
psychiatric training and experience prescribed by the State Board of 37
Nursing pursuant to NRS 632.120; or 38
(4) A primary care provider that is providing care to an 39
insured in consultation with a practitioner listed in subparagraph (1), 40
(2) or (3), if the closest practitioner listed in subparagraph (1), (2) or 41
(3) who participates in the network plan of the managed care 42
organization is located 60 miles or more from the residence of the 43
insured; and 44

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(c) The practitioner liste d in paragraph (b) who prescribed the 1
drug knows, based on the medical history of the insured, or 2
reasonably expects each alternative drug that is required to be used 3
earlier in the step therapy protocol to be ineffective at treating the 4
psychiatric condition. 5
2. Any provision of a health care plan subject to the provisions 6
of this chapter that is delivered, issued for delivery or renewed on or 7
after July 1, 2023, which is in conflict with this section is void. 8
3. As used in this section: 9
(a) “Medical or scientific evidence” has the meaning ascribed to 10
it in NRS 695G.053. 11
(b) [“Network plan” means a health care plan offered by a 12
managed care organization under which the financing and delivery 13
of medical care is provided, in whole or in part, through a defined 14
set of providers under contract with the managed care organization. 15
The term does not include an arrangement for the financing of 16
premiums. 17
(c)] “Step therapy protocol” means a procedure that requires an 18
insured to use a prescription drug or sequ ence of prescription drugs 19
other than a drug that a practitioner recommends for treatment of a 20
psychiatric condition of the insured before his or her health care 21
plan provides coverage for the recommended drug. 22
Sec. 307. NRS 695G.1703 is hereby amended to read as 23
follows: 24
695G.1703 1. Subject to the limitations prescribed by 25
subsection 4, a managed care organization that issues a health care 26
plan shall include in the plan coverage for medically necessary 27
biomarker testing for the diagnosis, treatment, appropriate 28
management and ongoing monitoring of cancer when such 29
biomarker testing is supported by medical and scientific evidence. 30
Such evidence includes, without limitation: 31
(a) The labeled indications for a biomar ker test or medication 32
that has been approved or cleared by the United States Food and 33
Drug Administration; 34
(b) The indicated tests for a drug that has been approved by the 35
United States Food and Drug Administration or the warnings and 36
precautions included on the label of such a drug; 37
(c) A national coverage determination or local coverage 38
determination, as those terms are defined in 42 C.F.R. § 400.202; or 39
(d) Nationally recognized clinical practice guidelines or 40
consensus statements. 41
2. A managed care organization shall: 42
(a) Provide the coverage required by subsection 1 in a manner 43
that limits disruptions in care and the need for multiple specimens. 44

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(b) Establish a clear and readily accessible process for an 1
insured or provider of health care to: 2
(1) Request an exception to a policy excluding coverage for 3
biomarker testing for the diagnosis, treatment, management or 4
ongoing monitoring of cancer; or 5
(2) Appeal a denial of coverage for such biomarker testing; 6
and 7
(c) Make the process described in paragraph (b) available on an 8
Internet website maintained by the managed care organization. 9
3. If a managed care organization requires an insured to obtain 10
prior authorization for a biomarker test described in subsection 1, 11
the managed care organization shall respond to a request for such 12
prior authorization: 13
(a) Within 24 hours after receiving an urgent request; or 14
(b) Within 72 hours after receiving any other request. 15
4. The provisions of this section do not require a managed care 16
organization to provide coverage of biomarker testing: 17
(a) For screening purposes; 18
(b) Conducted by a provider of health care for whom the 19
biomarker testing is not within his or her scope of practice, training 20
and experience; 21
(c) Conducted by a provider of health care or a facility that does 22
not participate in the network plan of the managed care 23
organization; or 24
(d) That has not been determined to be medically necessary by a 25
provider of health care for whom such a determination is within his 26
or her scope of practice, training and experience. 27
5. A health care plan subject to the provisions of this chapter 28
that is delivered, issued for delivery or renewed on or after 29
October 1, 2023, has the legal effect of including the coverage 30
required by this section, and any pro vision of the plan or renewal 31
which is in conflict with the provisions of this section is void. 32
6. As used in this section: 33
(a) “Biomarker” means a characteristic that is objectively 34
measured and evaluated as an indicator of a normal biological 35
process, a pathogenic process or a pharmacological response to a 36
specific therapeutic intervention and includes, without limitation: 37
(1) An interaction between a gene and a drug that is being 38
used by or considered for use by the patient; 39
(2) A mutation or characteristic of a gene; and 40
(3) The expression of a protein. 41
(b) “Biomarker testing” means the analysis of the tissue, blood 42
or other biospecimen of a patient for the presentation of a biomarker 43
and includes, without limitation, single -analyte tests, mul tiplex 44

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panel tests and whole genome, whole exome and whole 1
transcriptome sequencing. 2
(c) “Consensus statement” means a statement aimed at a specific 3
clinical circumstance that is: 4
(1) Made for the purpose of optimizing the outcomes of 5
clinical care; 6
(2) Made by an independent, multidisciplinary panel of 7
experts that has established a policy to avoid conflicts of interest; 8
(3) Based on scientific evidence; and 9
(4) Made using a transparent methodology and reporting 10
procedure. 11
(d) “Medically necessary” means health care services or 12
products that a prudent provider of health care would provide to a 13
patient to prevent, diagnose or treat an illness, injury or disease, or 14
any symptoms thereof, that are necessary and: 15
(1) Provided in accordance with generally accepted standards 16
of medical practice; 17
(2) Not primarily provided for the convenience of the patient 18
or provider of health care; and 19
(3) Significant in guiding and informing the provider of 20
health care in providing the most appropriate course of treatment for 21
the patient in order to prevent, delay or lessen the magnitude of an 22
adverse health outcome. 23
(e) “Nationally recognized clinical practice guidelines” means 24
evidence-based guidelines establishing standards of care that 25
include, witho ut limitation, recommendations intended to optimize 26
care of patients and are: 27
(1) Informed by a systemic review of evidence and an 28
assessment of the risks and benefits of alternative options for care; 29
and 30
(2) Developed using a transparent methodology a nd 31
reporting procedure by an independent organization or society of 32
medical professionals that has established a policy to avoid conflicts 33
of interest. 34
[(f) “Network plan” means a health care plan offered by a 35
managed care organization under which the fin ancing and delivery 36
of medical care, including items and services paid for as medical 37
care, are provided, in whole or in part, through a defined set of 38
providers under contract with the managed care organization. The 39
term does not include an arrangement fo r the financing of 40
premiums. 41
(g) “Provider of health care” has the meaning ascribed to it in 42
NRS 629.031.] 43

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Sec. 308. NRS 695G.1705 is hereby amended to read as 1
follows: 2
695G.1705 1. A managed care organization that offers or 3
issues a health care plan shall include in the plan coverage for: 4
(a) All drugs approved by the United States Food and Drug 5
Administration for preventing the acquisition of human 6
immunodeficiency virus or tr eating human immunodeficiency virus 7
or hepatitis C in the form recommended by the prescribing 8
practitioner, regardless of whether the drug is included in the 9
formulary of the managed care organization; 10
(b) Laboratory testing that is necessary for therapy that uses a 11
drug to prevent the acquisition of human immunodeficiency virus; 12
(c) Any service to test for, prevent or treat human 13
immunodeficiency virus or hepatitis C provided by a provider of 14
primary care if the service is covered when provided by a spe cialist 15
and: 16
(1) The service is within the scope of practice of the provider 17
of primary care; or 18
(2) The provider of primary care is capable of providing the 19
service safely and effectively in consultation with a specialist and 20
the provider engages in such consultation; and 21
(d) The services described in NRS 639.28085, when provided 22
by a pharmacist who participates in the network plan of the 23
managed care organization. 24
2. A managed care organization that offers or issues a health 25
care plan shall reimburse: 26
(a) A pharmacist who participates in the network plan of the 27
managed care organization for the services described in NRS 28
639.28085 at a rate equal to the rate of reimbursement provided to a 29
physician, physician assistant or advanced practice regist ered nurse 30
for similar services. 31
(b) An advanced practice registered nurse or a physician 32
assistant who participates in the network plan of the managed care 33
organization for any service to test for, prevent or treat human 34
immunodeficiency virus or hepatit is C at a rate equal to the rate of 35
reimbursement provided to a physician for similar services. 36
3. A managed care organization shall not: 37
(a) Subject the benefits required by subsection 1 to medical 38
management techniques, other than step therapy; 39
(b) Limit the covered amount of a drug described in paragraph 40
(a) of subsection 1; 41
(c) Refuse to cover a drug described in paragraph (a) of 42
subsection 1 because the drug is dispensed by a pharmacy through 43
mail order service; or 44

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(d) Prohibit or restrict a ccess to any service or drug to treat 1
human immunodeficiency virus or hepatitis C on the same day on 2
which the insured is diagnosed. 3
4. A managed care organization shall ensure that the benefits 4
required by subsection 1 are made available to an insured t hrough a 5
provider of health care who participates in the network plan of the 6
managed care organization. 7
5. A health care plan subject to the provisions of this chapter 8
that is delivered, issued for delivery or renewed on or after 9
January 1, 2024, has the legal effect of including the coverage 10
required by subsection 1, and any provision of the plan that conflicts 11
with the provisions of this section is void. 12
6. As used in this section [: 13
(a) “Medical management technique” means a practice which is 14
used to control the cost or use of health care services or prescription 15
drugs. The term includes, without limitation, the use of step therapy, 16
prior authorization and categorizing drugs and devices based on 17
cost, type or method of administration. 18
(b) “Network plan” means a health care plan offered by a 19
managed care organization under which the financing and delivery 20
of medical care, including items and services paid for as medical 21
care, are provided, in whole or in part, through a defin ed set of 22
providers under contract with the managed care organization. The 23
term does not include an arrangement for the financing of 24
premiums. 25
(c) “Primary] , “primary care” means the practice of family 26
medicine, pediatrics, internal medicine, obstetrics and gynecology 27
and midwifery. 28
[(d) “Provider of health care” has the meaning ascribed to it in 29
NRS 629.031.] 30
Sec. 309. NRS 695G.171 is hereby amended to read as 31
follows: 32
695G.171 1. A health care plan issued by a managed care 33
organization must provide coverage for benefits payable for 34
expenses incurred for: 35
(a) Deoxyribonucleic acid testing for high -risk strains of human 36
papillomavirus every 3 years for women 30 years of age and older; 37
and 38
(b) Administering the human papillomavirus vaccine as 39
recommended for vaccination by a competent authority, including, 40
without limitation, the Centers for Disease Control and Prevention 41
of the United States Department of Health and Human Services, the 42
Food and Drug Administration or the manufacturer of the vaccine. 43
2. A managed care organization must ensure that the benefits 44
required by subsection 1 are made available to an insured through a 45

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provider of health care who participates in the network plan of the 1
managed care organization. 2
3. Except as otherwise provided in subsection 5, a managed 3
care organization that offers or issues a health care plan which 4
provides coverage for prescription drugs shall not: 5
(a) Require an insured to pay a higher deductible, any 6
copayment or coinsurance or require a longer waiting period or 7
other condition to obtain any benefit provided in a health care plan 8
pursuant to subsection 1; 9
(b) Refuse to issue a health care plan or cancel a health care plan 10
solely because the person applying for or covered by the plan uses 11
or may use any such benefit; 12
(c) Offer or pay any type of material inducement or financial 13
incentive to an insured to discourage the insured from obt aining any 14
such benefit; 15
(d) Penalize a provider of health care who provides any such 16
benefit to an insured, including, without limitation, reducing the 17
reimbursement of the provider of health care; 18
(e) Offer or pay any type of material inducement, bonus or other 19
financial incentive to a provider of health care to deny, reduce, 20
withhold, limit or delay access to any such benefit to an insured; or 21
(f) Impose any other restrictions or delays on the access of an 22
insured to any such benefit. 23
4. An evidence of coverage for a health care plan subject to the 24
provisions of this chapter which is delivered, issued for delivery or 25
renewed on or after January 1, 2018, has the legal effect of 26
including the coverage required by subsection 1, and any provision 27
of the evidence of coverage or the renewal thereof which is in 28
conflict with this section is void. 29
5. Except as otherwise provided in this section and federal law, 30
a managed care organization may use medical management 31
techniques, including, without limitation , any available clinical 32
evidence, to determine the frequency of or treatment relating to any 33
benefit required by this section or the type of provider of health care 34
to use for such treatment. 35
6. As used in this section [: 36
(a) “Human] , “human papillomavirus vaccine” means the 37
Quadrivalent Human Papillomavirus Recombinant Vaccine or its 38
successor which is approved by the Food and Drug Administration 39
for the prevention of human papillomavirus infection and cervical 40
cancer. 41
[(b) “Medical management technique” means a practice which is 42
used to control the cost or utilization of health care services or 43
prescription drug use. The term includes, without limitation, the use 44

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of step therapy, prior authorization or categorizing drugs and 1
devices based on cost, type or method of administration. 2
(c) “Network plan” means a health care plan offered by a 3
managed care organization under which the financing and delivery 4
of medical care, including items and services paid for as medical 5
care, are provided, in whole or in part, through a defined set of 6
providers under contract with the managed care organization. The 7
term does not include an arrangement for the financing of 8
premiums. 9
(d) “Provider of health care” has the meaning ascribed to it in 10
NRS 629.031.] 11
Sec. 310. NRS 695G.1712 is hereby amended to read as 12
follows: 13
695G.1712 1. A managed care organization that issues a 14
health care plan shall provide coverage for screening, genetic 15
counseling and testing for harmful mutations i n the BRCA gene for 16
women under circumstances where such screening, genetic 17
counseling or testing, as applicable, is required by NRS 457.301. 18
2. A managed care organization shall ensure that the benefits 19
required by subsection 1 are made available to an insured through a 20
provider of health care who participates in the network plan of the 21
managed care organization. 22
3. A health care plan subject to the provisions of this chapter 23
that is delivered, issued for delivery or renewed on or after 24
January 1, 2022, has the legal effect of including the coverage 25
required by subsection 1, and any provision of the plan that conflicts 26
with the provisions of this section is void. 27
[4. As used in this section: 28
(a) “Network plan” means a health care plan offered by a 29
managed care organization under which the financing and delivery 30
of medical care, including items and services paid for as medical 31
care, are provided, in whole or in part, through a defined set of 32
providers under contract with the managed car e organization. The 33
term does not include an arrangement for the financing of 34
premiums. 35
(b) “Provider of health care” has the meaning ascribed to it in 36
NRS 629.031.] 37
Sec. 311. NRS 695G.1713 is hereby amended to read as 38
follows: 39
695G.1713 1. A health care plan issued by a managed care 40
organization must provide coverage for benefits payable for 41
expenses incurred for: 42
(a) A mammogram to screen for breast cancer annually for 43
insureds who are 40 years of age or older. 44

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(b) An imaging test to screen for breast cancer on an interval 1
and at the age deemed most appropriate, when medically necessary, 2
as recommended by the insured’s provider of health care based on 3
personal or family medical history or additional factors that ma y 4
increase the risk of breast cancer for the insured. 5
(c) A diagnostic imaging test for breast cancer at the age deemed 6
most appropriate, when medically necessary, as recommended by 7
the insured’s provider of health care to evaluate an abnormality 8
which is: 9
(1) Seen or suspected from a mammogram described in 10
paragraph (a) or an imaging test described in paragraph (b); or 11
(2) Detected by other means of examination. 12
2. A managed care organization must ensure that the benefits 13
required by subsection 1 ar e made available to an insured through a 14
provider of health care who participates in the network plan of the 15
managed care organization. 16
3. Except as otherwise provided in subsection 5, a managed 17
care organization that offers or issues a health care plan which 18
provides coverage for prescription drugs shall not: 19
(a) Except as otherwise provided in subsection 6, require an 20
insured to pay a deductible, copayment, coinsurance or any other 21
form of cost -sharing or require a longer waiting period or other 22
condition to obtain any benefit provided in the health care plan 23
pursuant to subsection 1; 24
(b) Refuse to issue a health care plan or cancel a health care plan 25
solely because the person applying for or covered by the plan uses 26
or may use any such benefit; 27
(c) Offer or pay any type of material inducement or financial 28
incentive to an insured to discourage the insured from obtaining any 29
such benefit; 30
(d) Penalize a provider of health care who provides any such 31
benefit to an insured, including, without limitation, reducing the 32
reimbursement of the provider of health care; 33
(e) Offer or pay any type of material inducement, bonus or other 34
financial incentive to a provider of health care to deny, reduce, 35
withhold, limit or delay access to any such benefit to an insured; or 36
(f) Impose any other restrictions or delays on the access of an 37
insured to any such benefit. 38
4. A health care plan subject to the provisions of this chapter 39
that is delivered, issued for delivery or renewed on or after 40
January 1, 2024, has the legal effect of including the coverage 41
required by subsection 1, and any provision of the plan or the 42
renewal which is in conflict with this section is void. 43
5. Except as otherwise provided in this section and federal law, 44
a managed care organization may use medical management 45

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techniques, including, without limitation, any available clinical 1
evidence, to determine the frequency of or treatment relating to any 2
benefit required by this section or the type of provider of health care 3
to use for such treatment. 4
6. If the application of paragraph (a) of subsection 3 would 5
result in the ineligibility of a health savings account of an insured 6
pursuant to 26 U.S.C. § 223, the prohibitions of paragraph (a) of 7
subsection 3 shall apply only for a qualified health ca re plan with 8
respect to the deductible of such a health care plan after the insured 9
has satisfied the minimum deductible pursuant to 26 U.S.C. § 223, 10
except with respect to items or services that constitute preventive 11
care pursuant to 26 U.S.C. § 223(c)(2) (C), in which case the 12
prohibitions of paragraph (a) of subsection 3 shall apply regardless 13
of whether the minimum deductible under 26 U.S.C. § 223 has been 14
satisfied. 15
7. As used in this section [: 16
(a) “Medical management technique” means a practice whi ch is 17
used to control the cost or utilization of health care services or 18
prescription drug use. The term includes, without limitation, the use 19
of step therapy, prior authorization or categorizing drugs and 20
devices based on cost, type or method of administration. 21
(b) “Network plan” means a health care plan offered by a 22
managed care organization under which the financing and delivery 23
of medical care, including items and services paid for as medical 24
care, are provided, in whole or in part, through a defined s et of 25
providers under contract with the managed care organization. The 26
term does not include an arrangement for the financing of 27
premiums. 28
(c) “Provider of health care” has the meaning ascribed to it in 29
NRS 629.031. 30
(d) “Qualified] , “qualified health ca re plan” means a health 31
care plan issued by a managed care organization that has a high 32
deductible and is in compliance with 26 U.S.C. § 223 for the 33
purposes of establishing a health savings account. 34
Sec. 312. NRS 695G.1714 is hereby amended to read as 35
follows: 36
695G.1714 1. A managed care organization that issues a 37
health care plan shall provide coverage for the examination of a 38
person who is pregnant for the discovery of: 39
(a) Chlamydia trachomatis, gonorrhea, hepatitis B and hepatitis 40
C in accordance with NRS 442.013. 41
(b) Syphilis in accordance with NRS 442.010. 42
2. The coverage required by this section must be provided: 43
(a) Regardless of whether the benefits are provided to the 44
insured by a provider of health care, f acility or medical laboratory 45

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that participates in the network plan of the managed care 1
organization; and 2
(b) Without prior authorization. 3
3. A health care plan subject to the provisions of this chapter 4
that is delivered, issued for delivery or renewed on or after July 1, 5
2021, has the legal effect of including the coverage required by 6
subsection 1, and any provision of the plan that conflicts with the 7
provisions of this section is void. 8
4. As used in this section [: 9
(a) “Medical] , “medical laboratory” has the meaning ascribed 10
to it in NRS 652.060. 11
[(b) “Network plan” means a health care plan offered by a 12
managed care organization under which the financing and delivery 13
of medical care, including items and services paid for as medical 14
care, are prov ided, in whole or in part, through a defined set of 15
providers under contract with the managed care organization. The 16
term does not include an arrangement for the financing of 17
premiums. 18
(c) “Provider of health care” has the meaning ascribed to it in 19
NRS 629.031.] 20
Sec. 313. NRS 695G.1715 is hereby amended to read as 21
follows: 22
695G.1715 1. Except as otherwise provided in subsection 8, 23
a managed care organization that offers or issues a health care plan 24
shall include in the plan coverage for: 25
(a) Up to a 12 -month supply, per prescription, of any type of 26
drug for contraception or its therapeutic equivalent which is: 27
(1) Lawfully prescribed or ordered; 28
(2) Approved by the Food and Drug Administration; 29
(3) Listed in subsection 11; and 30
(4) Dispensed in accordance with NRS 639.28075; 31
(b) Any type of device for contraception which is: 32
(1) Lawfully prescribed or ordered; 33
(2) Approved by the Food and Drug Administration; and 34
(3) Listed in subsection 11; 35
(c) Self-administered hormonal contraceptives dispenses by a 36
pharmacist pursuant to NRS 639.28078; 37
(d) Insertion of a device for contraception or removal of such a 38
device if the device was inserted while the insured was covered by 39
the same health care plan; 40
(e) Education and counseling relating to the initiation of the use 41
of contraception and any necessary follow -up after initiating such 42
use; 43
(f) Management of side effects relating to contraception; and 44
(g) Voluntary sterilization for women. 45

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2. A managed care organization shall provide coverage for any 1
services listed in subsection 1 which are within the authorized scope 2
of practice of a pharmacist when such services are provided by a 3
pharmacist who is employed by or serves as an independent 4
contractor of an in -network pharmacy and in accordance with the 5
applicable provider network contract. Such coverage must be 6
provided to the same extent as if the services were provided by 7
another provider of health care, as applicable to the services being 8
provided. The terms of the policy must not limit: 9
(a) Coverage for services listed in subsection 1 and provided by 10
such a pharmacist to a number of occasions less than the coverage 11
for such services when provided by another provider of health care. 12
(b) Reimbursement for services listed in subsection 1 and 13
provided by such a pharmacist to an amount less than the amount 14
reimbursed for similar services provided by a physician, physician 15
assistant or advanced practice registered nurse. 16
3. A managed care organization must en sure that the benefits 17
required by subsection 1 are made available to an insured through a 18
provider of health care who participates in the network plan of the 19
managed care organization. 20
4. If a covered therapeutic equivalent listed in subsection 1 is 21
not available or a provider of health care deems a covered 22
therapeutic equivalent to be medically inappropriate, an alternate 23
therapeutic equivalent prescribed by a provider of health care must 24
be covered by the managed care organization. 25
5. Except as otherwise provided in subsections 9, 10 and 12, a 26
managed care organization that offers or issues a health care plan 27
shall not: 28
(a) Require an insured to pay a higher deductible, any 29
copayment or coinsurance or require a longer waiting period or 30
other condition to obtain any benefit included in the health care plan 31
pursuant to subsection 1; 32
(b) Refuse to issue a health care plan or cancel a health care plan 33
solely because the person applying for or covered by the plan uses 34
or may use any such benefits; 35
(c) Offer or pay any type of material inducement or financial 36
incentive to an insured to discourage the insured from obtaining any 37
such benefits; 38
(d) Penalize a provider of health care who provides any such 39
benefits to an insured, including, without limitation, reducing the 40
reimbursement of the provider of health care; 41
(e) Offer or pay any type of material inducement, bonus or other 42
financial incentive to a provider of health care to deny, reduce, 43
withhold, limit or delay access to any such benefits to an insured; or 44

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(f) Impose any other restrictions or delays on the access of an 1
insured to any such benefits. 2
6. Coverage pursuant to this section for the covered dependent 3
of an insured must be the same as for the insured. 4
7. Except as otherwise provided in subsection 8, a health care 5
plan subject to the provisions of this chapter that is delivered, issued 6
for delivery or renewed on or after January 1, 2024, has the legal 7
effect of including the coverage required by this section, and any 8
provision of the pla n or the renewal which is in conflict with this 9
section is void. 10
8. A managed care organization that offers or issues a health 11
care plan and which is affiliated with a religious organization is not 12
required to provide the coverage required by subsection 1 if the 13
managed care organization objects on religious grounds. Such an 14
organization shall, before the issuance of a health care plan and 15
before the renewal of such a plan, provide to the prospective insured 16
written notice of the coverage that the managed care organization 17
refuses to provide pursuant to this subsection. 18
9. A managed care organization may require an insured to pay 19
a higher deductible, copayment or coinsurance for a drug for 20
contraception if the insured refuses to accept a therapeutic 21
equivalent of the drug. 22
10. For each of the 18 methods of contraception listed in 23
subsection 11 that have been approved by the Food and Drug 24
Administration, a health care plan must include at least one drug or 25
device for contraception within each method for which no 26
deductible, copayment or coinsurance may be charged to the 27
insured, but the managed care organization may charge a deductible, 28
copayment or coinsurance for any other drug or device that provides 29
the same method of contraception. If the managed care organization 30
charges a copayment or coinsurance for a drug for contraception, the 31
managed care organization may only require an enrollee to pay the 32
copayment or coinsurance: 33
(a) Once for the entire amount of the drug dispensed for the plan 34
year; or 35
(b) Once for each 1-month supply of the drug dispensed. 36
11. The following 18 methods of contraception must be 37
covered pursuant to this section: 38
(a) Voluntary sterilization for women; 39
(b) Surgical sterilization implants for women; 40
(c) Implantable rods; 41
(d) Copper-based intrauterine devices; 42
(e) Progesterone-based intrauterine devices; 43
(f) Injections; 44
(g) Combined estrogen- and progestin-based drugs; 45

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(h) Progestin-based drugs; 1
(i) Extended- or continuous-regimen drugs; 2
(j) Estrogen- and progestin-based patches; 3
(k) Vaginal contraceptive rings; 4
(l) Diaphragms with spermicide; 5
(m) Sponges with spermicide; 6
(n) Cervical caps with spermicide; 7
(o) Female condoms; 8
(p) Spermicide; 9
(q) Combined estrogen - and progestin -based drugs for 10
emergency contraception or progestin -based drugs for emergency 11
contraception; and 12
(r) Ulipristal acetate for emergency contraception. 13
12. Except as otherwise provided in this section and federal 14
law, a managed care organization may use medical management 15
techniques, including, without limitation, any available clinical 16
evidence, to determine the frequency of or treatment relating to any 17
benefit required by this section or the type of provider of health care 18
to use for such treatment. 19
13. A managed care organization shall not: 20
(a) Use medical management techniques to require an insured to 21
use a method of contraception other than the method prescribed or 22
ordered by a provider of health care; 23
(b) Require an insured to obtain prior authorization for the 24
benefits described in paragraphs (a) and (c) of subsection 1; or 25
(c) Refuse to cover a contraceptive injection or the insertion of a 26
device described in paragraph (c), (d) or (e) of subsection 11 at a 27
hospital immediately after an insured gives birth. 28
14. A managed care organization must provide an accessible, 29
transparent and expedited process which is not unduly burdensome 30
by which an insured, or the authorized representative of the insured, 31
may request an exception relating to any medical management 32
technique use d by the managed care organization to obtain any 33
benefit required by this section without a higher deductible, 34
copayment or coinsurance. 35
15. As used in this section: 36
(a) “In-network pharmacy” means a pharmacy that has entered 37
into a contract with a managed care organization to provide services 38
to insureds through a network plan offered or issued by the managed 39
care organization. 40
(b) [“Medical management technique” means a practice which is 41
used to control the cost or utilization of health care services or 42
prescription drug use. The term includes, without limitation, the use 43
of step therapy, prior authorization or categorizing drugs and 44
devices based on cost, type or method of administration. 45

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(c) “Network plan” means a health care plan offered by a 1
managed care organization under which the financing and delivery 2
of medical care, including items and services paid for as medical 3
care, are provided, in whole or in part, through a defined set of 4
providers under contract with the managed care organization. The 5
term does not include an arrangement for the financing of 6
premiums. 7
(d)] “Provider network contract” [means] includes a contract 8
between a managed care organization and a [provider of health care 9
or] pharmacy specifying the rights and responsibilities of the 10
managed care organization and the [provider of health care or ] 11
pharmacy [, as applicable, ] for delivery of health care services 12
pursuant to a network plan. 13
[(e) “Provider of health care” has the meaning ascribed to it in 14
NRS 629.031. 15
(f) “Therapeutic equivalent” means a drug which: 16
(1) Contains an identical amount of the same active 17
ingredients in the same dosage and method of administration as 18
another drug; 19
(2) Is expected to have the same clinical effect when 20
administered to a patient pursuant to a prescription or order as 21
another drug; and 22
(3) Meets any other criteria required by the Food and Drug 23
Administration for classification as a therapeutic equivalent.] 24
Sec. 314. NRS 695G.1717 is hereby amended to read as 25
follows: 26
695G.1717 1. A managed care organization that offers or 27
issues a health care plan shall include in the plan coverage for: 28
(a) Counseling, support and supplies for breastfeeding, 29
including breastfeeding equipment, counseling and education during 30
the antenatal, perinatal and postpartum period for not more than 1 31
year; 32
(b) Screening and counseling for interpersonal and domestic 33
violence for women at least annually with initial intervention 34
services consisting of education, strategies to reduce harm, 35
supportive services or a referral for any other appropriate services; 36
(c) Behavioral counseling concerning sexually transmitted 37
diseases from a provider of health care for sexually active women 38
who are at increased risk for such diseases; 39
(d) Hormone replacement therapy; 40
(e) Such prenatal screenings and tests as recommended by the 41
American College of Obstetricians and Gynecologists or its 42
successor organization; 43

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(f) Screening for blood pressure abnormalities and diabetes, 1
including gestational diabetes, after at least 24 weeks of gestation or 2
as ordered by a provider of health care; 3
(g) Screening for cervical cancer at such intervals as are 4
recommended by the American College of Obstetricians and 5
Gynecologists or its successor organization; 6
(h) Screening for depression; 7
(i) Screening and counseling for the human immunodeficiency 8
virus consisting of a risk assessment, annual education relating to 9
prevention and at least one screening for the virus during the 10
lifetime of the insured or as ordered by a provider of health care; 11
(j) Smoking cessation programs for an insured who is 18 years 12
of age or older consisting of not more than two cessation attempts 13
per year and four counseling sessions per year; 14
(k) All vaccinations recommended by the Adv isory Committee 15
on Immunization Practices of the Centers for Disease Control and 16
Prevention of the United States Department of Health and Human 17
Services or its successor organization; and 18
(l) Such well-woman preventative visits as recommended by the 19
Health Resources and Services Administration, which must include 20
at least one such visit per year beginning at 14 years of age. 21
2. A managed care organization must ensure that the benefits 22
required by subsection 1 are made available to an insured through a 23
provider of health care who participates in the network plan of the 24
managed care organization. 25
3. Except as otherwise provided in subsection 5, a managed 26
care organization that offers or issues a health care plan shall not: 27
(a) Require an insured to pay a higher deductible, any 28
copayment or coinsurance or require a longer waiting period or 29
other condition to obtain any benefit provided in the health care plan 30
pursuant to subsection 1; 31
(b) Refuse to issue a health care plan or cancel a health care plan 32
solely because the person applying for or covered by the plan uses 33
or may use any such benefit; 34
(c) Offer or pay any type of material inducement or financial 35
incentive to an insured to discourage the insured from obtaining any 36
such benefit; 37
(d) Penalize a p rovider of health care who provides any such 38
benefit to an insured, including, without limitation, reducing the 39
reimbursement of the provider of health care; 40
(e) Offer or pay any type of material inducement, bonus or other 41
financial incentive to a provid er of health care to deny, reduce, 42
withhold, limit or delay access to any such benefit to an insured; or 43
(f) Impose any other restrictions or delays on the access of an 44
insured to any such benefit. 45

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4. A health care plan subject to the provisions of this chapter 1
that is delivered, issued for delivery or renewed on or after 2
January 1, 2018, has the legal effect of including the coverage 3
required by subsection 1, and any provision of the plan or the 4
renewal which is in conflict with this section is void. 5
5. Except as otherwise provided in this section and federal law, 6
a managed care organization may use medical management 7
techniques, including, without limitation, any available clinical 8
evidence, to determine the frequency of or treatment relating to any 9
benefit required by this section or the type of provider of health care 10
to use for such treatment. 11
[6. As used in this section: 12
(a) “Medical management technique” means a practice which is 13
used to control the cost or utilization of health care services or 14
prescription drug use. The term includes, without limitation, the use 15
of step therapy, prior authorization or categorizing drugs and 16
devices based on cost, type or method of administration. 17
(b) “Network plan” means a health care plan offered by a 18
managed care organization under which the financing and delivery 19
of medical care, including items and services paid for as medical 20
care, are provided, in whole or in part, through a defined set of 21
providers under contract with the managed care organization. The 22
term does not include an arrangement for the financing of 23
premiums. 24
(c) “Provider of health care” has the meaning ascribed to it in 25
NRS 629.031.] 26
Sec. 315. NRS 695G.1718 is hereby amended to read as 27
follows: 28
695G.1718 1. Except as otherwise provided in this section, a 29
managed care organization that issues a health care plan shall 30
include in the health care plan coverage for the medically necessary 31
treatment of conditions relating to gender dysphoria and gender 32
incongruence. Such coverage must include coverage of medically 33
necessary psychosocial and surgical intervention and any other 34
medically necessary treatment for such disorders provided by: 35
(a) Endocrinologists; 36
(b) Pediatric endocrinologists; 37
(c) Social workers; 38
(d) Psychiatrists; 39
(e) Psychologists; 40
(f) Gynecologists; 41
(g) Speech-language pathologists; 42
(h) Primary care physicians; 43
(i) Advanced practice registered nurses; 44
(j) Physician assistants; and 45

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(k) Any other providers of medically necessary services for the 1
treatment of gender dysphoria or gender incongruence. 2
2. This section does not require a health care plan to include 3
coverage for cosmetic surgery performed by a plastic surgeon or 4
reconstructive surgeon that is not medically necessary. 5
3. A managed care organization that issues a health care plan 6
shall not categorically refuse to cover medically necessary gender -7
affirming treatments or procedures or revisions to prior treatments if 8
the plan provides coverage for any such services, procedures or 9
revisions for purposes other than gender transition or affirmation. 10
4. A managed care organization that issues a health care plan 11
may prescribe requirements that must be satisfied before the 12
managed care organization covers surgical treatment of condi tions 13
relating to gender dysphoria or gender incongruence for an insured 14
who is less than 18 years of age. Such requirements may include, 15
without limitation, requirements that: 16
(a) The treatment must be recommended by a psychologist, 17
psychiatrist or other mental health professional; 18
(b) The treatment must be recommended by a physician; 19
(c) The insured must provide a written expression of the desire 20
of the insured to undergo the treatment; 21
(d) A written plan for treatment that covers at least 1 year must 22
be developed and approved by at least two providers of health care; 23
and 24
(e) Parental consent is provided for the insured unless the 25
insured is expressly authorized by law to consent on his or her own 26
behalf. 27
5. When determining whether treatment is medically necessary 28
for the purposes of this section, a managed care organization must 29
consider the most recent Standards of Care prescribed by the World 30
Professional Association for Transgender Health, or its successor 31
organization. 32
6. A managed care o rganization shall make a reasonable effort 33
to ensure that the benefits required by subsection 1 are made 34
available to an insured through a provider of health care who 35
participates in the network plan of the managed care organization. 36
If, after a reasonable effort, the managed care organization is unable 37
to make such benefits available through such a provider of health 38
care, the managed care organization may treat the treatment that the 39
managed care organization is unable to make available through such 40
a pro vider of health care in the same manner as other services 41
provided by a provider of health care who does not participate in the 42
network plan of the managed care organization. 43
7. If an insured appeals the denial of a claim or coverage under 44
this section on the grounds that the treatment requested by the 45

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insured is not medically necessary, the managed care organization 1
must consult with a provider of health care who has experience in 2
prescribing or delivering gender -affirming treatment concerning the 3
medical necessity of the treatment requested by the insured when 4
considering the appeal. 5
8. Evidence of coverage subject to the provisions of this 6
chapter that is delivered, issued for delivery or renewed on or after 7
July 1, 2023, has the legal effect of incl uding the coverage required 8
by subsection 1, and any provision of the plan or renewal which is 9
in conflict with the provisions of this section is void. 10
9. As used in this section: 11
(a) “Cosmetic surgery”: 12
(1) Means a surgical procedure that: 13
(I) Does not meaningfully promote the proper function of 14
the body; 15
(II) Does not prevent or treat illness or disease; and 16
(III) Is primarily directed at improving the appearance of 17
a person. 18
(2) Includes, without limitation, cosmetic surgery directed at 19
preserving beauty. 20
(b) “Gender dysphoria” means distress or impairment in social, 21
occupational or other areas of functioning caused by a marked 22
difference between the gender identity or expression of a person and 23
the sex assigned to the person at birth w hich lasts at least 6 months 24
and is shown by at least two of the following: 25
(1) A marked difference between gender identity or 26
expression and primary or secondary sex characteristics or 27
anticipated secondary sex characteristics in young adolescents. 28
(2) A strong desire to be rid of primary or secondary sex 29
characteristics because of a marked difference between such sex 30
characteristics and gender identity or expression or a desire to 31
prevent the development of anticipated secondary sex characteristics 32
in young adolescents. 33
(3) A strong desire for the primary or secondary sex 34
characteristics of the gender opposite from the sex assigned at birth. 35
(4) A strong desire to be of the opposite gender or a gender 36
different from the sex assigned at birth. 37
(5) A strong desire to be treated as the opposite gender or a 38
gender different from the sex assigned at birth. 39
(6) A strong conviction of experiencing typical feelings and 40
reactions of the opposite gender or a gender different from the sex 41
assigned at birth. 42
(c) “Medically necessary” means health care services or 43
products that a prudent provider of health care would provide to a 44

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patient to prevent, diagnose or treat an illness, injury or disease, or 1
any symptoms thereof, that are necessary and: 2
(1) Provided in accordance with generally accepted standards 3
of medical practice; 4
(2) Clinically appropriate with regard to type, frequency, 5
extent, location and duration; 6
(3) Not provided primarily for the convenience of the patient 7
or provider of health care; 8
(4) Required to improve a specific health condition of a 9
patient or to preserve the existing state of health of the patient; and 10
(5) The most clinically appropriate level of health care that 11
may be safely provided to the patient. 12
 A provider of health care prescribing, ordering, recommending or 13
approving a health care service or product does not, by itself, make 14
that health care service or product medically necessary. 15
[(d) “Network plan” means a health care plan offered by a 16
managed care organizat ion under which the financing and delivery 17
of medical care, including items and services paid for as medical 18
care, are provided, in whole or in part, through a defined set of 19
providers under contract with the managed care organization. The 20
term does not in clude an arrangement for the financing of 21
premiums. 22
(e) “Provider of health care” has the meaning ascribed to it in 23
NRS 629.031.] 24
Sec. 316. NRS 695G.1719 is hereby amended to read as 25
follows: 26
695G.1719 1. A managed care organization that offers or 27
issues a health care plan shall include in the plan coverage for: 28
(a) All drugs approved by the United States Food and Drug 29
Administration to support safe withdrawal from substance use 30
disorder, including, without limitation, lofexidine. 31
(b) All drugs approved by the United States Food and Drug 32
Administration to provide medication -assisted treatment for opioid 33
use disorder, including, without limitation, buprenorphine, 34
methadone and naltrexone. 35
(c) The services described in NRS 639.28079 when provided by 36
a pharmacist or pharmacy that participates in the network plan of the 37
managed care organization. The Commissioner shall adopt 38
regulations governing the provision of reimbursement for such 39
services. 40
(d) Any service for the treatment of substance use disorder 41
provided by a provider of primary care if the service is covered 42
when provided by a specialist and: 43
(1) The service is within the scope of practice of the provider 44
of primary care; or 45

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(2) The provider of primary ca re is capable of providing the 1
service safely and effectively in consultation with a specialist and 2
the provider engages in such consultation. 3
2. A managed care organization that offers or issues a health 4
care plan shall reimburse a pharmacist or pharmac y that participates 5
in the network plan of the managed care organization for the 6
services described in NRS 639.28079 at a rate equal to the rate of 7
reimbursement provided to a physician, physician assistant or 8
advanced practice registered nurse for similar services. 9
3. A managed care organization shall provide the coverage 10
required by paragraphs (a) and (b) of subsection 1 regardless of 11
whether the drug is included in the formulary of the managed care 12
organization. 13
4. Except as otherwise provided in this subsection, a managed 14
care organization shall not subject the benefits required by 15
paragraphs (a), (b) and (c) of subsection 1 to medical management 16
techniques, other than step therapy. A managed care organization 17
may subject the benefits required by paragraphs (b) and (c) of 18
subsection 1 to other reasonable medical management techniques 19
when the benefits are provided by a pharmacist in accordance with 20
NRS 639.28079. 21
5. A managed care organization shall not: 22
(a) Limit the covered amount of a drug de scribed in paragraph 23
(a) or (b) of subsection 1; or 24
(b) Refuse to cover a drug described in paragraph (a) or (b) of 25
subsection 1 because the drug is dispensed by a pharmacy through 26
mail order service. 27
6. A managed care organization shall ensure that the benefits 28
required by subsection 1 are made available to an insured through a 29
provider of health care who participates in the network plan of the 30
managed care organization. 31
7. A health care plan subject to the provisions of this chapter 32
that is delivered , issued for delivery or renewed on or after 33
January 1, 2024, has the legal effect of including the coverage 34
required by subsection 1, and any provision of the plan that conflicts 35
with the provisions of this section is void. 36
8. As used in this section [: 37
(a) “Medical management technique” means a practice which is 38
used to control the cost or use of health care services or prescription 39
drugs. The term includes, without limitation, the use of step therapy, 40
prior authorization and categorizing drugs and d evices based on 41
cost, type or method of administration. 42
(b) “Network plan” means a health care plan offered by a 43
managed care organization under which the financing and delivery 44
of medical care, including items and services paid for as medical 45

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care, are p rovided, in whole or in part, through a defined set of 1
providers under contract with the managed care organization. The 2
term does not include an arrangement for the financing of 3
premiums. 4
(c) “Primary] , “primary care” means the practice of family 5
medicine, pediatrics, internal medicine, obstetrics and gynecology 6
and midwifery. 7
[(d) “Provider of health care” has the meaning ascribed to it in 8
NRS 629.031.] 9
Sec. 317. NRS 695G.174 is hereby amended to read as 10
follows: 11
695G.174 1. A managed care organization that issues a 12
health care plan shall include in the plan coverage for: 13
(a) Necessary case management services for an insured 14
diagnosed with sickle cell disease and its variants; and 15
(b) Medically necessary care for an insured who has been 16
diagnosed with sickle cell disease and its variants. 17
2. A managed care organization that issues a health care plan 18
which provides coverage for prescription drugs shall include in the 19
plan coverage for medically necessary prescription drugs to treat 20
sickle cell disease and its variants. 21
3. A managed care organization shall establish a plan for each 22
insured under 18 years of age who has been diagnosed with sickle 23
cell disease and its variants to transition the insured from pediatric 24
care to adult care when the insured reaches 18 years of age. 25
4. A managed care organization may use medical management 26
techniques, including, without limitation, any available clinical 27
evidence, to determine the frequency of or treatment relating to any 28
benefit required by this section or the type of provider of health care 29
to use for such treatment. 30
5. As used in this section: 31
(a) “Case management services” means medical or other health 32
care management services to assist patients and providers of health 33
care, including, without limitation, identifying and facilitating 34
additional resources and treatments, providing information about 35
treatment options and facilitating communication between providers 36
of services to a patient. 37
(b) [“Medical management technique” means a practice which is 38
used to control the cost or utilization of health care services. The 39
term includes, without limitation, the use of step therapy, prior 40
authorization or categorizing drugs a nd devices based on cost, type 41
or method of administration. 42
(c)] “Sickle cell disease and its variants” has the meaning 43
ascribed to it in NRS 439.4927. 44

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Sec. 318. NRS 695H.140 is hereby amended to read as 1
follows: 2
695H.140 1. Except as otherwise provided in this subsection, 3
the Commissioner may conduct examinations to enforce the 4
provisions of this chapter pursuant to the provisions of [NRS 5
679B.230 to 679B.300, ] sections 2 to 41, inclusive, of this act at 6
such times as the Commissioner deems necessary. For the purposes 7
of this chapter, the Commissioner is not required to comply with the 8
requirement in [NRS 679B.230] section 16 of this act that insurers 9
be examined not less frequently than every 5 years. 10
2. A person who is responsible for conducting the business 11
activities of a medical discount plan shall, upon the request of the 12
Commissioner, make available to the Commissioner for inspection 13
any accounts, books and records concerning the medical discount 14
plan which are reasonably necessary to enable the Commissioner to 15
determine whether the medical discount plan is in compliance with 16
the provisions of this chapter. 17
Sec. 319. NRS 696A.170 is hereby amended to read as 18
follows: 19
696A.170 1. Every motor club shall be subject to 20
examination by the Commissioner in the manner and under the 21
conditions provided for examination of insurers contained in [NRS 22
679B.230 to 679B.290,] sections 2 to 41, inclusive [.] , of this act. 23
2. The expense of such examination shall be paid by the motor 24
club. 25
Sec. 320. NRS 696A.360 is hereby amended to read as 26
follows: 27
696A.360 Motor clubs are also subject, in the same manner as 28
insurers, to the following provisions of this Code to the extent 29
reasonably applicable: 30
1. Chapter 679A of NRS (scope and definitions); 31
2. Chapter 679B of NRS (Commissioner of Insurance); 32
3. NRS 683A.400 (fiduciary funds); 33
4. Chapter 685B of NRS (unauthorized insurers); 34
5. NRS 686A.010 to [686A.310,] 686A.325, inclusive , and 35
sections 80 to 93, inclusive, of thi s act (trade practices and frauds); 36
[and] 37
6. Chapter 696B of NRS (delinquent insurers) [.] ; and 38
7. Sections 2 to 41, inclusive, of this act (examinations). 39
Sec. 321. NRS 696B.100 is hereby amended to read as 40
follows: 41
696B.100 “Impairment” exists as to: 42
1. A stock insurer when [the] : 43
(a) The insurer’s admitted assets do not at least equal the sum of 44
its liabilities, including also its paid -in capital stock account and the 45

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minimum surplus required to be maintained under this Code for 1
authority to transact the kinds of insurance transacted [.] ; or 2
(b) The insurer has a total adjusted capital that is less than its 3
authorized control level of risk -based capital required pursuant to 4
NRS 681B.550 and any regulations adopted by the Commissioner 5
pursuant to that section. 6
2. A mutual insurer when [the] : 7
(a) The insurer’s admitted assets do not at least equal the sum of 8
the insurer’s liabilities and the minimum surplus required under this 9
Code to be maintained for authority to transact the kinds of 10
insurance transacted [.] ; or 11
(b) The insurer has a total adjusted capital that is less than its 12
authorized control level of risk -based capital required pursuant to 13
NRS 681B.550 and any regulations adopted by the Commissioner 14
pursuant to that section. 15
Sec. 322. NRS 696B.110 is hereby amended to read as 16
follows: 17
696B.110 “Insolvency” exists: 18
1. When the insurer fails to meet its obligations as they mature; 19
2. When [a stock] an insurer’s admitted assets are less than the 20
sum of its liabilities ; [and its paid-in capital stock account;] 21
3. When [a mutual ] an insurer’s [assets are ] total adjusted 22
capital is less than [the sum of ] its [liabilities] mandatory control 23
level of risk-based capital required pursuant to NRS 681B.550 and 24
any regulations adopted by the [minimum basic surplus required ] 25
Commissioner pursuant to [be maintained by the insurer under this 26
Code for authority to transact the kinds of insurance transacted; ] 27
that section; or 28
4. As otherwise expressly provided in this Code. 29
Sec. 323. NRS 696C.110 is hereby amended to read as 30
follows: 31
696C.110 1. During the period an insurer is under 32
administrative supervision pursuant to NRS 696C.100, the 33
Commissioner or an appointee [designated by] of the Commissioner 34
shall serve as the administrative supervisor of the insurer. A person 35
appointed by the Commissioner pursuant to this subsection is not 36
required to be an employee of the Division. 37
2. The Commissioner may identify any one or more action s 38
specified in subsection 3 as actions which the insurer shall not take 39
during the period the insurer remains under administrative 40
supervision pursuant to NRS 696C.100 unless the insurer obtains 41
approval in advance from the administrative supervisor [designated] 42
appointed pursuant to subsection 1. 43

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3. If identified by the Commissioner pursuant to subsection 2, 1
the insurer shall not, without obtaining approval in advance from the 2
administrative supervisor: 3
(a) Dispose of, convey or encumber any of its asse ts or its 4
business in force; 5
(b) Withdraw money from any of its bank accounts; 6
(c) Lend any of its money; 7
(d) Invest any of its money; 8
(e) Transfer any of its property; 9
(f) Incur any debt, obligation or liability; 10
(g) Merge or consolidate with another insurer or any other 11
business entity as defined in NRS 682A.025; 12
(h) Approve new premiums or renew any policies; 13
(i) Enter into any new reinsurance contract or treaty; 14
(j) Terminate, surrender, forfeit, convert or lapse any insurance 15
policy, certificate or contract, except for nonpayment of premiums 16
due; 17
(k) Release, pay or refund premium deposits, accrued cash or 18
loan values, unearned premiums or other reserves on any insurance 19
policy, certificate or contract; 20
(l) Make any material change in management; or 21
(m) Increase any salary or benefit of an officer or director, 22
increase the preferential payment of a bonus or dividend or increase 23
any other payment deemed by the Commissioner to be preferential. 24
Sec. 324. NRS 696C.130 is hereby amended to read as 25
follows: 26
696C.130 1. During the period an insurer is under 27
administrative supervision pursuant to NRS 696C.100, the insurer 28
may contest any action taken or proposed to be taken by the 29
administrative supervisor [designated] appointed pursuant to 30
subsection 1 of NRS 696C.110 on the ground that the action would 31
not result in improving the condition of the insurer. To contest an 32
action taken or proposed to be taken by the administrative 33
supervisor, the insurer must submit a request for reconsideration to 34
the administrative supervisor. If the administrative supervisor, upon 35
reconsideration, denies the insurer’s request, the insurer may request 36
a review of the decision of the administrative supervisor pursuant to 37
NRS 679B.310 to 679B.370, inclusive. 38
2. Any action taken by the Commissioner pursuant to this 39
chapter is subject to: 40
(a) Review pursuant to NRS 679B.310 to 679B.370, inclusive, 41
and any regulations adopted pursuant thereto; and 42
(b) Judicial review pursuant to chapter 233B of NRS. 43

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Sec. 325. NRS 696C.150 is hereby amended to read as 1
follows: 2
696C.150 Notwithstanding any other provision of law, at the 3
time of any proceeding or during the pendency of any proceeding 4
held pursuant to this chapter, the Commissioner may meet with an 5
administrative supervisor [designated] appointed by the 6
Commissioner pursuant to subsection 1 of NRS 696C.110, and with 7
the attorney or other representative of the administrative supervisor 8
[designated] appointed pursuant to subsection 1 of NRS 696C.110, 9
without the presence of any other person: 10
1. To carry out the duties of the Commissioner under this 11
chapter; or 12
2. To allow the administrative supervisor to carry out his or her 13
duties under this chapter. 14
Sec. 326. NRS 696C.160 is hereby amended to read as 15
follows: 16
696C.160 The Commissioner may: 17
1. Adopt any regulations necessary to carry out the purposes 18
and provisions of this chapter; 19
2. In addition to an a dministrative supervisor [designated] 20
appointed by the Commissioner pursuant to subsection 1 of NRS 21
696C.110, employ any other counsels, actuaries, clerks and 22
assistants as the Commissioner deems necessary for the 23
administrative supervision of an insurer; and 24
3. Require an insurer placed under administrative supervision 25
to pay the compensation and expenses of the administrative 26
supervisor [designated] appointed by the Commissioner pursuant to 27
subsection 1 of NRS 696C.110 and any other counsels, actuaries, 28
clerks and assistants described in subsection 2. 29
Sec. 327. NRS 696C.170 is hereby amended to read as 30
follows: 31
696C.170 There shall be no liability on the part of, and no 32
cause of action of any nature against, the Commiss ioner or any 33
employee or agent of the Commissioner, or an administrative 34
supervisor [designated] appointed pursuant to subsection 1 of NRS 35
696C.110, for any action taken by them in the performance of their 36
powers and duties under this chapter. 37
Sec. 328. NRS 695K.080 is hereby amended to read as 38
follows: 39
695K.080 “Provider of health care” has the meaning ascribed 40
to it in NRS [695G.070.] 629.031. 41
Sec. 329. NRS 697.360 is hereby amended to read as follows: 42
697.360 Licensed bail agents, bail solicitors and bail 43
enforcement agents, and general agents are also subject to the 44

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following provisions of this Code, to the extent reasonably 1
applicable: 2
1. Chapter 679A of NRS. 3
2. Chapter 679B of NRS. 4
3. NRS 683A.261. 5
4. NRS 683A.301. 6
5. NRS 683A.311. 7
6. NRS 683A.331. 8
7. NRS 683A.341. 9
8. NRS 683A.361. 10
9. NRS 683A.400. 11
10. NRS 683A.451. 12
11. NRS 683A.461. 13
12. NRS 683A.500. 14
13. NRS 683A.520. 15
14. NRS 686A.010 to [686A.310,] 686A.325, inclusive [.] , 16
and sections 80 to 93, inclusive, of this act. 17
15. Sections 2 to 41, inclusive, of this act. 18
Sec. 330. NRS 7.107 is hereby amended to read as follows: 19
7.107 1. An attorney licensed in this State who performs the 20
functions of a real estate broker in a real estate transaction shall 21
comply with the standards of business ethics that apply to a real 22
estate broker pursuant to chapter 645 of NRS, including, without 23
limitation, such standards set forth in NRS 645.635 . [and 645.645.] 24
2. An attorn ey who performs the functions of a real estate 25
broker and who does not comply with the standards of business 26
ethics that apply to a real estate broker as required pursuant to 27
subsection 1 may be disciplined by the State Bar of Nevada pursuant 28
to the rules of the Supreme Court. 29
3. The provisions of this section do not require an attorney who 30
performs the functions of a real estate broker in a real estate 31
transaction to obtain a license to practice as a real estate broker 32
pursuant to chapter 645 of NRS. 33
Sec. 331. NRS 40.607 is hereby amended to read as follows: 34
40.607 “Builder’s warranty” means a warranty issued or 35
purchased by or on behalf of a contractor for the protection of a 36
claimant. The term: 37
1. Includes a warranty contract issued by or on behalf of a 38
contractor whose liability pursuant to the warranty contract is 39
subsequently insured by a risk retention group that operates in 40
compliance with chapter 695E of NRS and insures all or any part of 41
the liability of a cont ractor for the cost to repair a constructional 42
defect in a residence. 43

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2. Does not include [a policy of insurance for home protection 1
as defined in NRS 690B.100 or ] a service contract as defined in 2
NRS 690C.080. 3
Sec. 332. NRS 118A.290 is hereby amended to read as 4
follows: 5
118A.290 1. The landlord shall at all times during the 6
tenancy maintain the dwelling unit in a habitable condition. A 7
dwelling unit is not habitable if it violates provisions of housing or 8
health codes concerning the health, safety, sanitation or fitness for 9
habitation of the dwelling unit or if it substantially lacks: 10
(a) Effective waterproofing and weather protection of the roof 11
and exterior walls, including windows and doors. 12
(b) Plumbing facilities which conformed to applicable law when 13
installed and which are maintained in good working order. 14
(c) A water supply approved under applicable law, which is: 15
(1) Under the control of the tenant or landlord and is capable 16
of producing hot and cold running water; 17
(2) Furnished to appropriate fixtures; and 18
(3) Connected to a sewage disposal system approved under 19
applicable law and maintained in good working order to the extent 20
that the system can be controlled by the landlord. 21
(d) Adequate heatin g facilities which conformed to applicable 22
law when installed and are maintained in good working order. 23
(e) Electrical lighting, outlets, wiring and electrical equipment 24
which conformed to applicable law when installed and are 25
maintained in good working order. 26
(f) An adequate number of appropriate receptacles for garbage 27
and rubbish in clean condition and good repair at the 28
commencement of the tenancy. The landlord shall arrange for the 29
removal of garbage and rubbish from the premises unless the parties 30
by written agreement provide otherwise. 31
(g) Building, grounds, appurtenances and all other areas under 32
the landlord’s control at the time of the commencement of the 33
tenancy in every part clean, sanitary and reasonably free from all 34
accumulations of debris, filth, rubbish, garbage, rodents, insects and 35
vermin. 36
(h) Floors, walls, ceilings, stairways and railings maintained in 37
good repair. 38
(i) Ventilating, air -conditioning and other facilities and 39
appliances, including elevators, maintained in good repair if 40
supplied or required to be supplied by the landlord. 41
2. The landlord and tenant may agree that the tenant is to 42
perform specified repairs, maintenance tasks and minor remodeling 43
only if: 44

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(a) The agreement of the parties is entered into in good faith; 1
and 2
(b) The agreement does not diminish the obligations of the 3
landlord to other tenants in the premises. 4
3. An agreement pursuant to subsection 2 is not entered into in 5
good faith if the landlord has a duty under subsection 1 to perform 6
the specified re pairs, maintenance tasks or minor remodeling and 7
the tenant enters into the agreement because the landlord or his or 8
her agent has refused to perform them. 9
4. Except as otherwise provided in subsection 5, the landlord 10
shall not require a tenant to pay an y fee or other charge for the 11
performance of any repairs, maintenance tasks or other work for 12
which the landlord has a duty under subsection 1 to perform, 13
including, without limitation, any fee or other charge to cover the 14
costs of any deductible or copaym ent under a [policy of insurance 15
for home protection or ] service contract for the performance of any 16
such repairs, maintenance tasks or other work. 17
5. The landlord may require a tenant to pay any fee or other 18
charge for the performance of any repairs, ma intenance tasks or 19
other work necessary for a condition caused by the tenant’s own 20
deliberate or negligent act or omission or that of a member of his or 21
her household or other person on the premises with his or her 22
consent. 23
6. As used in this section [: 24
(a) “Insurance for home protection” has the meaning ascribed to 25
it in NRS 690B.100. 26
(b) “Service] , “service contract” has the meaning ascribed to it 27
in NRS 690C.080. 28
Sec. 333. NRS 233B.039 is hereby amended to read as 29
follows: 30
233B.039 1. The following agencies are entirely exempted 31
from the requirements of this chapter: 32
(a) The Governor. 33
(b) Except as otherwise provided in subsection 7 and NRS 34
209.221 and 209.2473, the Department of Corrections. 35
(c) The Nevada System of Higher Education. 36
(d) The Office of the Military. 37
(e) The Nevada Gaming Control Board. 38
(f) Except as otherwise provided in NRS 368A.140 and 463.765, 39
the Nevada Gaming Commission. 40
(g) Except as otherwise provided in NRS 425.620, the Division 41
of Welfare and Supportive Services of the Department of Health and 42
Human Services. 43

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(h) Except as otherwise provided in NRS 422.390, the Division 1
of Health Care Financing and Policy of the Department of Health 2
and Human Services. 3
(i) Except as otherwise provided in NRS 533.365, the Office of 4
the State Engineer. 5
(j) The Division of Industrial Relations of the Department of 6
Business and Industry acting to enforce the provisions of 7
NRS 618.375. 8
(k) The Administrator of the Division of Industrial Relations of 9
the Department of Business and Industry in establishing and 10
adjusting the schedule of fees and charges for accident benefits 11
pursuant to subsection 2 of NRS 616C.260. 12
(l) The Board to Review Claims in adopting resolutions to carry 13
out its duties pursuant to NRS 445C.310. 14
(m) The Silver State Health Insurance Exchange. 15
2. Except as otherwise provided in subsection 5 and NRS 16
391.323, the Department of Education, the Board of the Public 17
Employees’ Benefits Program and the Commission on Professional 18
Standards in Education are subject to the provisions of this chapter 19
for the purpose of adopting regulations but not with respect to any 20
contested case. 21
3. The special provisions of: 22
(a) Chapter 612 of NRS for the adoption of an emergency 23
regulation or the distribution of regulations by and the judicial 24
review of decisions of the Employment Security Division of the 25
Department of Employment, Training and Rehabilitation; 26
(b) Chapters 616A to 617, inclusive, of NRS for the 27
determination of contested claims; 28
(c) Chapter 91 of NRS for the judicial review of decisions of the 29
Administrator of the Securities Division of the Office of the 30
Secretary of State; and 31
(d) NRS 90.800 for the use of summary orders in contested 32
cases, 33
 prevail over the general provisions of this chapter. 34
4. The provisions of NRS 233B.122, 233B.124, 233B.125 and 35
233B.126 do not apply to the Department of Health and Human 36
Services in the adjudication of contested cases involving the 37
issuance of letters of approval for health facilities and agencies. 38
5. The provisions of this chapter do not apply to: 39
(a) Any order for immediate action, including, but not limited 40
to, quarantine and the treatment or cleansing of infected or infested 41
animals, objects or premises, made under the authority of the State 42
Board of Agriculture, the State Board of Health, or any other agency 43
of this State in the discharge of a responsibility for the preservation 44
of human or animal health or for insect or pest control; 45

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(b) An extraordinary regulation of the State Bo ard of Pharmacy 1
adopted pursuant to NRS 453.2184; 2
(c) A regulation adopted by the State Board of Education 3
pursuant to NRS 388.255 or 394.1694; 4
(d) The judicial review of decisions of the Public Utilities 5
Commission of Nevada; 6
(e) The adoption, amendmen t or repeal of policies by the 7
Rehabilitation Division of the Department of Employment, Training 8
and Rehabilitation pursuant to NRS 426.561 or 615.178; 9
(f) The adoption or amendment of a rule or regulation to be 10
included in the State Plan for Services for Victims of Crime by the 11
Department of Health and Human Services pursuant to 12
NRS 217.130; 13
(g) The adoption, amendment or repeal of rules governing the 14
conduct of contests and exhibitions of unarmed combat by the 15
Nevada Athletic Commission pursuant to NRS 467.075; 16
(h) The adoption, amendment or repeal of standards of content 17
and performance for courses of study in public schools by the 18
Council to Establish Academic Standards for Public Schools and the 19
State Board of Education pursuant to NRS 389.520; 20
(i) The adoption, amendment or repeal of the statewide plan to 21
allocate money from the Fund for a Resilient Nevada created by 22
NRS 433.732 established by the Department of Health and Human 23
Services pursuant to paragraph (b) of subsection 1 of NRS 433.734; 24
[or] 25
(j) The adoption or amendment of a data request by the 26
Commissioner of Insurance pursuant to NRS 687B.404 [.] ; or 27
(k) An order issued by the Commissioner of Insurance 28
pursuant to subsection 1 of section 42 of this act. 29
6. The State Board of Parole Commissioners is subject to the 30
provisions of this chapter for the purpose of adopting regulations but 31
not with respect to any contested case. 32
7. The Dep artment of Corrections is subject to the provisions 33
of this chapter for the purpose of adopting regulations relating to 34
fiscal policy, correspondence with inmates and visitation with 35
inmates of the Department of Corrections. 36
Sec. 334. NRS 239.010 is hereby amended to read as follows: 37
239.010 1. Except as otherwise provided in this section and 38
NRS 1.4683, 1.4687, 1A.110, 3.2203, 41.0397, 41.071, 49.095, 39
49.293, 62D.420, 62D.440, 62E.516, 62E.620, 6 2H.025, 62H.030, 40
62H.170, 62H.220, 62H.320, 75A.100, 75A.150, 76.160, 78.152, 41
80.113, 81.850, 82.183, 86.246, 86.54615, 87.515, 87.5413, 42
87A.200, 87A.580, 87A.640, 88.3355, 88.5927, 88.6067, 88A.345, 43
88A.7345, 89.045, 89.251, 90.730, 91.160, 116.757, 116A. 270, 44
116B.880, 118B.026, 119.260, 119.265, 119.267, 119.280, 45

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119A.280, 119A.653, 119A.677, 119B.370, 119B.382, 120A.640, 1
120A.690, 125.130, 125B.140, 126.141, 126.161, 126.163, 126.730, 2
127.007, 127.057, 127.130, 127.140, 127.2817, 128.090, 130.312, 3
130.712, 136.050, 159.044, 159A.044, 164.041, 172.075, 172.245, 4
176.01334, 176.01385, 176.015, 176.0625, 176.09129, 176.156, 5
176A.630, 178.39801, 178.4715, 178.5691, 178.5717, 179.495, 6
179A.070, 179A.165, 179D.160, 180.600, 200.3771, 200.3772, 7
200.5095, 200.604, 202.3662, 205.4651, 209.392, 209.3923, 8
209.3925, 209.419, 209.429, 209.521, 211A.140, 213.010, 213.040, 9
213.095, 213.131, 217.105, 217.110, 217.464, 217.475, 218A.350, 10
218E.625, 218F.150, 218G.130, 218G.240, 218G.350, 218G.615, 11
224.240, 226.462, 226.796, 228.270, 228.450, 228.495, 228.570, 12
231.069, 231.1285, 231.1473, 232.1369, 233.190, 237.300, 13
239.0105, 239.0113, 239.014, 239B.026, 239B.030, 239B.040, 14
239B.050, 239C.140, 239C.210, 239C.230, 239C.250, 239C.270, 15
239C.420, 240.007, 241.020, 241.030, 241.039 , 242.105, 244.264, 16
244.335, 247.540, 247.545, 247.550, 247.560, 250.087, 250.130, 17
250.140, 250.145, 250.150, 268.095, 268.0978, 268.490, 268.910, 18
269.174, 271A.105, 281.195, 281.805, 281A.350, 281A.680, 19
281A.685, 281A.750, 281A.755, 281A.780, 284.4068, 28 4.4086, 20
286.110, 286.118, 287.0438, 289.025, 289.080, 289.387, 289.830, 21
293.4855, 293.5002, 293.503, 293.504, 293.558, 293.5757, 293.870, 22
293.906, 293.908, 293.909, 293.910, 293B.135, 293D.510, 331.110, 23
332.061, 332.351, 333.333, 333.335, 338.070, 338.1379 , 338.1593, 24
338.1725, 338.1727, 348.420, 349.597, 349.775, 353.205, 25
353A.049, 353A.085, 353A.100, 353C.240, 353D.250, 360.240, 26
360.247, 360.255, 360.755, 361.044, 361.2242, 361.610, 365.138, 27
366.160, 368A.180, 370.257, 370.327, 372A.080, 378.290, 378.300, 28
379.0075, 379.008, 379.1495, 385A.830, 385B.100, 387.626, 29
387.631, 388.1455, 388.259, 388.501, 388.503, 388.513, 388.750, 30
388A.247, 388A.249, 391.033, 391.035, 391.0365, 391.120, 31
391.925, 392.029, 392.147, 392.264, 392.271, 392.315, 392.317, 32
392.325, 392.327, 392.335, 392.850, 393.045, 394.167, 394.16975, 33
394.1698, 394.447, 394.460, 394.465, 396.1415, 396.1425, 396.143, 34
396.159, 396.3295, 396.405, 396.525, 396.535, 396.9685, 35
398A.115, 408.3885, 408.3886, 408.3888, 408.5484, 412.153, 36
414.280, 416.070, 422.27 49, 422.305, 422A.342, 422A.350, 37
425.400, 427A.1236, 427A.872, 427A.940, 432.028, 432.205, 38
432B.175, 432B.280, 432B.290, 432B.4018, 432B.407, 432B.430, 39
432B.560, 432B.5902, 432C.140, 432C.150, 433.534, 433A.360, 40
439.4941, 439.4988, 439.5282, 439.840, 439.9 14, 439A.116, 41
439A.124, 439B.420, 439B.754, 439B.760, 439B.845, 440.170, 42
441A.195, 441A.220, 441A.230, 442.330, 442.395, 442.735, 43
442.774, 445A.665, 445B.570, 445B.7773, 449.209, 449.245, 44
449.4315, 449A.112, 450.140, 450B.188, 450B.805, 453.164, 45

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453.720, 458.055, 458.280, 459.050, 459.3866, 459.555, 459.7056, 1
459.846, 463.120, 463.15993, 463.240, 463.3403, 463.3407, 2
463.790, 467.1005, 480.535, 480.545, 480.935, 480.940, 481.063, 3
481.091, 481.093, 482.170, 482.368, 482.5536, 483.340, 483.363, 4
483.575, 483.65 9, 483.800, 484A.469, 484B.830, 484B.833, 5
484E.070, 485.316, 501.344, 503.452, 522.040, 534A.031, 561.285, 6
571.160, 584.655, 587.877, 598.0964, 598.098, 598A.110, 7
598A.420, 599B.090, 603.070, 603A.210, 604A.303, 604A.710, 8
604D.500, 604D.600, 612.265, 616B. 012, 616B.015, 616B.315, 9
616B.350, 618.341, 618.425, 622.238, 622.310, 623.131, 623A.137, 10
624.110, 624.265, 624.327, 625.425, 625A.185, 628.418, 628B.230, 11
628B.760, 629.043, 629.047, 629.069, 630.133, 630.2671, 12
630.2672, 630.2673, 630.2687, 630.30665, 630. 336, 630A.327, 13
630A.555, 631.332, 631.368, 632.121, 632.125, 632.3415, 14
632.3423, 632.405, 633.283, 633.301, 633.427, 633.4715, 633.4716, 15
633.4717, 633.524, 634.055, 634.1303, 634.214, 634A.169, 16
634A.185, 634B.730, 635.111, 635.158, 636.262, 636.342, 637.085, 17
637.145, 637B.192, 637B.288, 638.087, 638.089, 639.183, 18
639.2485, 639.570, 640.075, 640.152, 640A.185, 640A.220, 19
640B.405, 640B.730, 640C.580, 640C.600, 640C.620, 640C.745, 20
640C.760, 640D.135, 640D.190, 640E.225, 640E.340, 641.090, 21
641.221, 641.2215, 64 1A.191, 641A.217, 641A.262, 641B.170, 22
641B.281, 641B.282, 641C.455, 641C.760, 641D.260, 641D.320, 23
642.524, 643.189, 644A.870, 645.180, 645.625, 645A.050, 24
645A.082, 645B.060, 645B.092, 645C.220, 645C.225, 645D.130, 25
645D.135, 645G.510, 645H.320, 645H.330, 64 7.0945, 647.0947, 26
648.033, 648.197, 649.065, 649.067, 652.126, 652.228, 653.900, 27
654.110, 656.105, 657A.510, 661.115, 665.130, 665.133, 669.275, 28
669.285, 669A.310, 670B.680, 671.365, 671.415, 673.450, 673.480, 29
675.380, 676A.340, 676A.370, 677.243, 678A.470 , 678C.710, 30
678C.800, 679B.122, 679B.124, 679B.152, 679B.159, 679B.190, 31
[679B.285,] 679B.690, 680A.270, 681A.440, 681B.260, 681B.410, 32
681B.540, 683A.0873, 685A.077, 686A.289, 686B.170, 686C.306, 33
687A.060, 687A.115, 687B.404, 687C.010, 688C.230, 688C.480, 34
688C.490, 689A.696, 692A.117, 692C.190, 692C.3507, 692C.3536, 35
692C.3538, 692C.354, 692C.420, 693A.480, 693A.615, 696B.550, 36
696C.120, 703.196, 704B.325, 706.1725, 706A.230, 710.159, 37
711.600, sections 26, 36, 37 and 220 of this act, sections 35, 38 and 38
41 of chapter 478, Statutes of Nevada 2011 and section 2 of chapter 39
391, Statutes of Nevada 2013 and unless otherwise declared by law 40
to be confidential, all public books and public records of a 41
governmental entity must be open at all times during office hours to 42
inspection by any person, and may be fully copied or an abstract or 43
memorandum may be prepared from those public books and public 44
records. Any such copies, abstracts or memoranda may be used to 45

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supply the general public with copies, abstracts or memoranda of the 1
records or may be used in any other way to the advantage of the 2
governmental entity or of the general public. This section does not 3
supersede or in any manner affect the federal laws governing 4
copyrights or enlarge, diminish or affect in any other manner the 5
rights of a person in any written book or record which is 6
copyrighted pursuant to federal law. 7
2. A governmental entity may not reject a book or record 8
which is copyrighted solely because it is copyrighted. 9
3. A governmental entity that has legal custody or control of a 10
public book or record shall not deny a request made pursuant to 11
subsection 1 to inspect or copy or receive a copy of a public book or 12
record on the basis that the requested public book or record contains 13
information that is confidential if the governmental entity can 14
redact, delete, conceal or separate, including, without limitation, 15
electronically, the confidential information from the information 16
included in the public book or record t hat is not otherwise 17
confidential. 18
4. If requested, a governmental entity shall provide a copy of a 19
public record in an electronic format by means of an electronic 20
medium. Nothing in this subsection requires a governmental entity 21
to provide a copy of a p ublic record in an electronic format or by 22
means of an electronic medium if: 23
(a) The public record: 24
(1) Was not created or prepared in an electronic format; and 25
(2) Is not available in an electronic format; or 26
(b) Providing the public record in an electronic format or by 27
means of an electronic medium would: 28
(1) Give access to proprietary software; or 29
(2) Require the production of information that is confidential 30
and that cannot be redacted, deleted, concealed or separated from 31
information that is not otherwise confidential. 32
5. An officer, employee or agent of a governmental entity who 33
has legal custody or control of a public record: 34
(a) Shall not refuse to provide a copy of that public record in the 35
medium that is requested because the officer, employee or agent has 36
already prepared or would prefer to provide the copy in a different 37
medium. 38
(b) Except as otherwise provided in NRS 239.030, shall, upon 39
request, prepare the copy of the public record and shall not require 40
the person who has reques ted the copy to prepare the copy himself 41
or herself. 42
Sec. 335. NRS 289.470 is hereby amended to read as follows: 43
289.470 “Category II peace officer” means: 44

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1. The bailiffs of the district courts, justice courts and 1
municipal courts whose duties require them to carry weapons and 2
make arrests; 3
2. Subject to the provisions of NRS 258.070, constables and 4
their deputies; 5
3. Inspectors employed by the Nevada Transportation 6
Authority who exercise those powers of enforcement conferred by 7
chapters 706 and 712 of NRS; 8
4. Special investigators who are employed full -time by the 9
office of any district attorney or the Attorney General; 10
5. Investigators of arson for fire departments who are specially 11
designated by the appointing authority; 12
6. Investigators for the State Forester Firewarden who are 13
specially designated by the State Forester Firewarden and whose 14
primary duties are related to the investigation of arson; 15
7. Agents of the Nevada Gaming Control Board who exercise 16
the powers of enforcement specified in NRS 289.360, 463.140 or 17
463.1405, except those agents whose duties relate primarily to 18
auditing, accounting, the collection of taxes or license fees, or the 19
investigation of applicants for licenses; 20
8. Investigators and administrators of the Division of 21
Compliance Enforcement of the Department of Motor Vehicles who 22
perform the duties specified in subsection 2 of NRS 481.048; 23
9. Officers and investigators of the Section for the Control of 24
Emissions From Vehicles and the Enforcement of Matters Related 25
to the Use of Special Fuel of the Department of Motor Vehicles who 26
perform the duties specified in subsection 3 of NRS 481.0481; 27
10. Legislative police officers of the State of Nevada; 28
11. Parole counselors of the Div ision of Child and Family 29
Services of the Department of Health and Human Services; 30
12. Criminal investigators who are employed by the Division 31
of Child and Family Services of the Department of Health and 32
Human Services; 33
13. Juvenile probation officers and deputy juvenile probation 34
officers employed by the various judicial districts in the State of 35
Nevada or by a department of juvenile justice services established 36
by ordinance pursuant to NRS 62G.210 whose official duties require 37
them to enforce court orders on juvenile offenders and make arrests; 38
14. Field investigators of the Taxicab Authority; 39
15. Security officers employed full -time by a city or county 40
whose official duties require them to carry weapons and make 41
arrests; 42
16. The chief of a depar tment of alternative sentencing created 43
pursuant to NRS 211A.080 and the assistant alternative sentencing 44
officers employed by that department; 45

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17. Agents of the Cannabis Compliance Board who exercise 1
the powers of enforcement specified in NRS 289.355; 2
18. Criminal investigators who are employed by the Secretary 3
of State; [and] 4
19. The Inspector General of the Department of Corrections 5
and any person employed by the Department as a criminal 6
investigator [.] ; and 7
20. Investigators and administrators of the Division of 8
Insurance of the Department of Business and Industry who 9
perform the duties specified in NRS 679B.600 to 679B.700, 10
inclusive. 11
Sec. 336. NRS 315.725 is hereby amended to read as follows: 12
315.725 1. Except as otherwise provided in subsection 3, any 13
two or more affordable housing entities may establish and 14
participate in a program to jointly self -insure and jointly purchase 15
insurance or reinsurance for coverage under a plan of: 16
(a) Casualty insurance, as that term is defined in NRS 17
681A.020, except for workers’ compensation and employer’s 18
liability coverage; 19
(b) Marine and transportation insurance, as that term is defined 20
in NRS 681A.050; 21
(c) Property insurance, as that term is defined in NRS 681A.060; 22
(d) Surety insurance, as that term is defined in NRS 681A.070; 23
or 24
(e) Insurance for any combination of the kinds of insurance 25
listed in paragraphs (a) to (d), inclusive. 26
2. A program established pursuant to subsection 1 must be 27
administered by an en tity which is organized as a nonprofit 28
corporation, limited-liability company, partnership or trust, whether 29
organized under the laws of this State or another state or operating 30
in another state. A majority of the board of directors or other 31
governing body of the entity administering the program must be 32
affiliated with one or more of the affordable housing entities 33
participating in the program. 34
3. This section does not apply to an affordable housing entity 35
that individually self -insures or participates in a risk pooling 36
arrangement, including a risk retention group or a risk purchasing 37
group, with respect to the kinds of insurance set forth in 38
subsection 1. 39
4. Except as otherwise provided in this section or by specific 40
statute: 41
(a) A program establishe d pursuant to subsection 1 and the 42
entity administering the program: 43
(1) Shall be deemed not to be providing coverage which 44
constitutes insurance; and 45

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(2) Are not subject to the provisions of title 57 of NRS; and 1
(b) The entity administering a program established pursuant to 2
subsection 1 shall be deemed not to be engaging in the transaction 3
of insurance. 4
5. The entity administering a program established pursuant to 5
subsection 1 shall provide any affordable housing entity that seeks 6
to participate in the program with a written notice, in 10 -point type 7
or larger, before the affordable housing entity begins participating in 8
the program, that the program is not regulated by the Commissioner 9
and that, if the program or the entity administering the program is 10
found insolvent, a claim under the program is not covered by the 11
Nevada Insurance Guaranty Association Act. 12
6. The entity administering a program established pursuant to 13
subsection 1 shall submit to the Commissioner: 14
(a) Within 105 days after the end of the program’s fiscal year: 15
(1) An annual financial statement for the program audited by 16
a certified public accountant; and 17
(2) An annual actuarial analysis for the program prepared by 18
an actuary who meets the qualification standards for issuing 19
statements of actuarial opinion in the United States established by 20
the American Academy of Actuaries or its successor organization; 21
and 22
(b) Within 30 days after: 23
(1) Filing with any other regulatory body, a claims audit 24
report relating to the entity or the program, a copy of the claims 25
audit report filed with the other regulatory body; 26
(2) Issuance by any other regulatory body of a report of 27
examination relating to the entity or the program, a copy of the 28
report of examination issued by the other regulatory body; 29
(3) The effective date of a plan of financing, management 30
and operation for the entity or the program or any material change in 31
such a plan, a copy of the plan or material change; and 32
(4) The effective date of any material change in the sco pe of 33
regulation of the entity or the program by any other state in which 34
the entity operates, a statement of the material change. 35
7. The Commissioner may order an examination of a program 36
established pursuant to subsection 1 or the entity administering the 37
program based upon any credible evidence that the program or 38
entity is in violation of this section or is operating or being operated 39
while in an unsafe financial condition. Such an examination must be 40
administered in accordance with [NRS 679B.230 to 6 79B.300,] 41
sections 2 to 41, inclusive, of this act and any regulations adopted 42
pursuant thereto. 43
8. If the Commissioner determines that a program established 44
pursuant to subsection 1 or the entity administering the program is 45

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in violation of this section or is operating or being operated while in 1
an unsafe financial condition, the Commissioner may issue and 2
serve upon the entity administering the program an order to cease 3
and desist from the violation or from administering or in any way 4
operating the program. 5
9. The Commissioner may hold a hearing, without a request by 6
any party, to determine whether a program established pursuant to 7
subsection 1 or the entity administering the program is in violation 8
of this section or is op erating or being operated while in an unsafe 9
financial condition. A person aggrieved by any act or failure of the 10
Commissioner to act, or by any report, rule, regulation or order of 11
the Commissioner relating to this section, may request a hearing. 12
Any hear ing held pursuant to this subsection must be held in 13
accordance with NRS 679B.310 to 679B.370, inclusive, and any 14
regulations adopted pursuant thereto. 15
10. The provisions of this section must be liberally construed 16
to grant affordable housing entities ma ximum flexibility to jointly 17
self-insure and jointly purchase insurance or reinsurance to the 18
extent that a program established pursuant to subsection 1 is being 19
administered and otherwise operated in a safe financial condition 20
and in a sound manner. 21
11. Each entity administering a program established pursuant 22
to subsection 1 shall, on or before January 15 of each odd-numbered 23
year, submit a report to the Director of the Legislative Counsel 24
Bureau for transmittal to the Legislature. The report must includ e, 25
without limitation, a list of the affordable housing entities 26
participating in the program and any other information the Director 27
deems relevant. 28
12. As used in this section: 29
(a) “Affordable housing” means housing projects in which some 30
of the dwelli ng units may be purchased or rented, with or without 31
government assistance, on a basis that is affordable to persons of 32
low income. 33
(b) “Affordable housing entity” means: 34
(1) A housing authority created under the laws of this State 35
or another jurisdicti on and any agency or instrumentality of a 36
housing authority, including, but not limited to, a legal entity created 37
to enter into an agreement which complies with NRS 277.055; 38
(2) A nonprofit corporation organized under the laws of this 39
State or another s tate that is engaged in providing affordable 40
housing; or 41
(3) A general or limited partnership or limited -liability 42
company which is engaged in providing affordable housing and 43
which is affiliated with a housing authority described in 44

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- *AB74*
subparagraph (1) or a nonprofit corporation described in 1
subparagraph (2) if the housing authority or nonprofit corporation: 2
(I) Has, or has the right to acquire, a financial or 3
ownership interest in the partnership or limited-liability company; 4
(II) Has the power to direct the management or policies of 5
the partnership or limited-liability company; or 6
(III) Has entered into a contract to lease, manage or 7
operate the affordable housing owned by the partnership or limited -8
liability company. 9
(c) “Commissioner” means the Commissioner of Insurance. 10
Sec. 337. NRS 439B.727 is hereby amended to read as 11
follows: 12
439B.727 “Provider of health care” has the meaning ascribed 13
to it in NRS [695G.070.] 629.031. 14
Sec. 338. NRS 439B.736 is hereby amended to read as 15
follows: 16
439B.736 1. “Third party” includes, without limitation: 17
(a) The issuer of a health benefit plan, as defined in NRS 18
[695G.019,] 687B.470, which provides coverage for medically 19
necessary emergency services; 20
(b) The Public Employees’ Benefits Program established 21
pursuant to subsection 1 of NRS 287.043; and 22
(c) Any other entity or organization that elects pursuant to NRS 23
439B.757 for the provisions of NRS 439B.700 to 439B.760, 24
inclusive, to apply t o the provision of medically necessary 25
emergency services by out-of-network providers to covered persons. 26
2. The term does not include the State Plan for Medicaid, the 27
Children’s Health Insurance Program or a health maintenance 28
organization, as defined in NRS 695C.030, or managed care 29
organization, as defined in NRS 695G.050, when providing health 30
care services through managed care to recipients of Medicaid under 31
the State Plan for Medicaid or insurance pursuant to the Children’s 32
Health Insurance Program pursuant to a contract with the Division 33
of Health Care Financing and Policy of the Department. 34
Sec. 339. Chapter 452 of NRS is hereby amended by adding 35
thereto a new section to read as follows: 36
The Administrator may adopt such regulations as may be 37
necessary to carry out the purposes and provisions of this section 38
and NRS 452.640 to 452.740, inclusive, which relate to 39
endowment care. 40
Sec. 340. NRS 452.180 is hereby amended to read as follows: 41
452.180 1. It is unlawful for a cemetery authority, its 42
officers, employees or agents, or a seller or agent certified or 43
licensed pursuant to NRS 689.450 to 689.595, inclusive, to 44
represent that an endowment care fund or an y other fund set up for 45

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- *AB74*
maintaining care is perpetual or permanent, or to sell, offer for sale 1
or advertise any plot under representation that the plot is under 2
endowment care, before an endowment care fund has been 3
established for the cemetery in which th e plot is situated. Any 4
person violating any of the provisions of NRS 452.050 to 452.180, 5
inclusive, is personally liable for all damages resulting to any person 6
by reason of such violation, and upon conviction thereof is guilty of 7
a misdemeanor. 8
2. The Administrator, for the purpose of ascertaining the assets, 9
conditions and affairs of any endowment care cemetery, may 10
examine the books, records, documents and assets of any 11
endowment care cemetery operating, or being organized to operate 12
as such a cemetery, in the State of Nevada, and may make whatever 13
other investigations as may be necessary to determine that the 14
cemetery is complying fully with the provisions of NRS 452.050 to 15
452.180, inclusive. 16
3. If, after an examination or investigation, the Admini strator 17
has just cause to believe that a cemetery granted a permit under the 18
provisions of NRS 452.050 to 452.180, inclusive, has failed to 19
comply with the provisions and requirements of NRS 452.050 to 20
452.180, inclusive, and any regulations adopted thereu nder, the 21
Administrator may, after due notice and hearing, if the 22
Administrator finds that the cemetery authority has violated those 23
requirements or regulations, revoke or refuse to renew the permit of 24
that cemetery authority and refer the violation to the Attorney 25
General to determine if further action should be taken under 26
subsection 1. 27
4. The provisions of [NRS 679B.230 to 679B.300, ] sections 2 28
to 41, inclusive, of this act apply to any examination conducted 29
under this section. Unless the context requires that a provision apply 30
only to insurers, any reference in those sections to “insurer” must be 31
replaced by a reference to “cemetery authority” or the person being 32
examined. 33
Sec. 341. NRS 452.640 is hereby amended to read as follows: 34
452.640 As used in NRS 452.640 to 452.740, inclusive, and 35
section 339 of this act, unless the context otherwise requires: 36
1. “Administrator” means the Commissioner of Insurance. 37
2. “Cemetery authority” means a person who owns or controls 38
any real property dedicated for use as a cemetery for pets pursuant 39
to NRS 452.655, and who operates a cemetery for pets on that 40
property. 41
Sec. 342. NRS 452.735 is hereby amended to read as follows: 42
452.735 1. It is unlawful for a cemetery authorit y, its 43
officers, employees or agents, or a seller or agent certified or 44
licensed pursuant to NRS 689.450 to 689.595, inclusive, to: 45

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(a) Represent that a trust fund for the endowment care of the 1
cemetery is perpetual or permanent; or 2
(b) Sell, offer for sale or advertise any plot under representation 3
that the plot is under endowment care, 4
 before a trust fund for the endowment care of the cemetery has 5
been established for the cemetery in which the plot is situated. 6
2. The Administrator, for the purpose of ascertaining the assets, 7
conditions and affairs of a cemetery for pets, may examine the 8
books, records, documents and assets of a cemetery for pets 9
operating, or being organized to operate as such a cemetery, in this 10
state and may make any other invest igations as may be necessary to 11
determine that the cemetery is complying fully with the provisions 12
of NRS 452.705 to 452.740, inclusive. 13
3. The provisions of [NRS 679B.230 to 679B.300, ] sections 2 14
to 41, inclusive, of this act apply to any examination conducted 15
under this section. Unless the context requires that a provision apply 16
only to insurers, any reference in those sections to “insurer” must be 17
replaced by a reference to “cemetery authority” or the person being 18
examined. 19
Sec. 343. NRS 616B.027 is hereby amended to read as 20
follows: 21
616B.027 1. Every insurer shall: 22
(a) Provide an office in this State operated by the insurer or its 23
third-party administrator in which: 24
(1) A complete file, or a reproduction of the complete file, of 25
each claim is accessible, in accordanc e with the provisions of 26
NRS 616B.021; 27
(2) Persons authorized to act for the insurer and, if necessary, 28
licensed pursuant to chapter 683A of NRS, may receive information 29
related to a claim and provide the services to an employer and his or 30
her employees required by chapters 616A to 617, inclusive, of NRS; 31
and 32
(3) An employee or his or her employer, upon request, is 33
provided with information related to a claim filed by the employee 34
or a copy or other reproduction of the information from the file for 35
that claim, in accordance with the provisions of NRS 616B.021. 36
(b) Provide statewide toll -free telephone service to the office 37
maintained pursuant to paragraph (a). 38
2. Each private carrier shall provide: 39
(a) Adequate services to its insured employers in c ontrolling 40
losses; and 41
(b) Adequate information on the prevention of industrial 42
accidents and occupational diseases. 43
3. An employee of a private carrier who is licensed as [a 44
company] an adjuster pursuant to chapter 684A of NRS or a person 45

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who acts as a third-party administrator pursuant to chapters 616A to 1
616D, inclusive, or chapter 617 of NRS for a private carrier who 2
administers a claim arising under chapters 616A to 616D, inclusive, 3
or chapter 617 of NRS from a location outside of this State pursuan t 4
to subsection 1 of NRS 616B.0275 shall make himself or herself 5
available to communicate in real time with the claimant or a 6
representative of the claimant Monday through Friday, 9 a.m. to 5 7
p.m. local time in this State, excluding any day declared to be a 8
legal holiday pursuant to NRS 236.015. 9
Sec. 344. NRS 616B.0275 is hereby amended to read as 10
follows: 11
616B.0275 1. An employee of a private carrier who is 12
licensed as [a company ] an adjuster pursuant to chapter 684A of 13
NRS or a person who acts as a third -party administrator pursuant to 14
chapters 616A to 616D, inclusive, or chapter 617 of NRS for a 15
private carrier may administer claims arising under chapters 616A to 16
616D, inclusive, or chapter 617 of NRS from a location in or outside 17
of this State. All records concerning a claim administered pursuant 18
to this subsection must be maintained at one or more offices located 19
in this State or by computer in a microphotographic, electronic or 20
other similar format that produces an ac curate reproduction of the 21
original. 22
2. An employee of a private carrier who is not licensed as [a 23
company] an adjuster pursuant to chapter 684A of NRS or a person 24
who acts as a third-party administrator pursuant to chapters 616A to 25
616D, inclusive, or c hapter 617 of NRS for a self -insured employer 26
or an association of self -insured public or private employers may 27
administer claims arising under chapters 616A to 616D, inclusive, 28
or chapter 617 of NRS only from one or more offices located in this 29
State. All records concerning a claim administered pursuant to this 30
subsection must be maintained in those offices. 31
3. The Commissioner may: 32
(a) Under exceptional circumstances, waive the requirements of 33
subsections 1 and 2; and 34
(b) Adopt regulations to carry out the provisions of this section. 35
Sec. 345. NRS 616B.303 is hereby amended to read as 36
follows: 37
616B.303 For the purposes of NRS 616B.306, 616B.309 and 38
616B.318, an employer is insolvent if [the] : 39
1. The employer’s assets are less than the employer’s liabilities 40
[.] ; or 41
2. The employer fails to pay its outstanding obligations as 42
they mature in the regular course of its business. 43

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Sec. 346. NRS 616B.395 is hereby amended to read as 1
follows: 2
616B.395 1. The Commissioner may examine the books, 3
records, accounts and assets of an association of self -insured public 4
or private employers as the Commissioner deems necessary to carry 5
out the provisions of NRS 616B.350 to 616B.446, inclusive . The 6
Commissioner shall so examine each association of self -insured 7
public or private employers not less frequently than every 5 years. 8
2. The expense of any examination conducted pursuant to this 9
section must be paid by the association. 10
Sec. 347. NRS 616B.422 is hereby amended to read as 11
follows: 12
616B.422 1. If the assets of an association of self -insured 13
public or private employers are insufficient to make certain the 14
prompt payment of all compensation under chapters 616A to 617, 15
inclusive, of NRS and to maintain the reserves required by NRS 16
616B.419, as described in subsection 4, the association shall 17
immediately notify the Commissioner of the deficiency and: 18
(a) Transfer any surplus acquired from a previou s fund year to 19
the current fund year to make up the deficiency; 20
(b) Transfer money from its administrative account to its claims 21
account; 22
(c) Collect an additional assessment from its members in an 23
amount required to make up the deficiency; or 24
(d) Take any other action to make up the deficiency which is 25
approved by the Commissioner. 26
 Any action taken to address the deficiency must be 27
accompanied by a corrective action plan, filed with the 28
Commissioner and subject to his or her approval, that details how 29
the action will remedy the deficiency and prevent a deficiency 30
from reoccurring. 31
2. If the association wishes to transfer any surplus from one 32
fund year to another, the association must first notify the 33
Commissioner of the transfer. 34
3. The Commissione r shall order the association to make up 35
any deficiency pursuant to subsection 1 if the association fails to do 36
so within 30 days after notifying the Commissioner of the 37
deficiency. The association shall be deemed insolvent if it fails to: 38
(a) Collect an additional assessment from its members within 30 39
days after being ordered to do so by the Commissioner; or 40
(b) Make up the deficiency in any other manner within 60 days 41
after being ordered to do so by the Commissioner. 42
4. For the purposes of this section, the assets of an 43
association are insufficient to maintain the reserves required by 44
NRS 616B.419 if the assets of the association, excluding any 45

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securities posted pursuant to NRS 616B.353, are less than the 1
required reserves. 2
Sec. 348. NRS 616B.428 is hereby amended to read as 3
follows: 4
616B.428 1. The Commissioner may impose an 5
administrative fine for each violation of any provision of NRS 6
616B.350 to 616B.446, inclusive, or any regulation adopted 7
pursuant thereto. Except as otherwise provided in those sections, the 8
amount of the fine may not exceed $1,000 for each violation or an 9
aggregate amount of $10,000. 10
2. The Commissioner may withdraw the certificate of an 11
association of self-insured public or private employers if: 12
(a) The association’s certificate was obtained by fraud; 13
(b) The application for certification contained a material 14
misrepresentation; 15
(c) The association is found to be insolvent; 16
(d) The association fails to have five or more members; 17
(e) The association fails to pay the costs of any examination or 18
any penalty, fee or assessment required by the provisions of chapters 19
616A to 616D, inclusive, or chapter 617 of NRS; 20
(f) The association fails to comply with any of the provisions of 21
this c hapter or chapter 616A, 616C, 616D or 617 of NRS, or any 22
regulation adopted pursuant thereto; 23
(g) The association fails to comply with any order of the 24
Commissioner within the time prescribed by the provisions of 25
chapters 616A to 616D, inclusive, or chapt er 617 of NRS or in the 26
order of the Commissioner; [or] 27
(h) The association or its third -party administrator 28
misappropriates, converts, illegally withholds or refuses to pay any 29
money to which a person is entitled and that was entrusted to the 30
association in its fiduciary capacity [.] ; or 31
(i) The association fails to notify the Commissioner of a 32
deficiency pursuant to subsection 1 of NRS 616B.422. 33
3. If the Commissioner withdraws the certification of an 34
association of self -insured public or private emp loyers, each 35
employer who is a member of the association remains liable for his 36
or her obligations incurred before and after the order of withdrawal. 37
4. Any employer who is a member of an association whose 38
certification is withdrawn shall, on the effecti ve date of the 39
withdrawal, qualify as an employer pursuant to NRS 616B.650. 40
Sec. 349. NRS 631.3458 is hereby amended to read as 41
follows: 42
631.3458 1. A person shall not provide dental services 43
through teledentistry to a patient who is located at an originating site 44
in this State unless the person: 45

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(a) Is licensed to practice dentistry, dental hygiene or dental 1
therapy in this State; and 2
(b) Has complied with subsection 2 of NRS 631.220. 3
2. The provisions of this chapt er and the regulations adopted 4
thereto, including, without limitation, clinical requirements, ethical 5
standards and requirements concerning the confidentiality of 6
information concerning patients, apply to services provided through 7
teledentistry to the same extent as if such services were provided in 8
person or by other means. 9
3. A licensee who provides dental services through 10
teledentistry, including, without limitation, providing consultation 11
and recommendations for treatment, issuing a prescription, 12
diagnosing, correcting the position of teeth and using orthodontic 13
appliances, shall provide such services in accordance with the same 14
standards of care and professional conduct as when providing those 15
services in person or by other means. 16
4. A licensee shall not: 17
(a) Provide treatment for any condition based solely on the 18
results of an online questionnaire; or 19
(b) Engage in activity that is outside his or her scope of practice 20
while providing services through teledentistry. 21
5. Nothing in this section or NRS 631.34581 to 631.34586, 22
inclusive, prohibits an organization for dental care or an 23
administrator of a health benefit plan that provides dental coverage 24
from negotiating rates of reimbursement for services provided 25
through teledentistry with a denti st, dental hygienist or dental 26
therapist. 27
6. As used in this section: 28
(a) “Health benefit plan” has the meaning ascribed to it in NRS 29
[695G.019.] 687B.470. 30
(b) “Organization for dental care” has the meaning ascribed to it 31
in NRS 695D.060. 32
Sec. 350. Any money remaining on July 1, 2025, in the 33
Account for the Regulation and Supervision of Captive Insurers 34
created by NRS 694C.460 remains in the Fund for Insurance 35
Administration and Enforcement created by NRS 680C.100 and 36
may be used for any other purpose for which any money in the Fund 37
may be used. 38
Sec. 351. 1. Any valid license issued before July 1, 2025, 39
that a person holds as a company adjuster or a staff adjuster shall be 40
deemed to be a license as an independent adjuster and remains valid 41
until its date of expiration. 42
2. As used in this section: 43

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(a) “Company adjuster” and “staff adjuster” have the meanings 1
ascribed to them in NRS 684A.030, as that section existed on 2
June 30, 2025. 3
(b) “Independent adjuster” has the meaning ascribed to it in 4
NRS 684A.030, as amended by section 67 of this act. 5
Sec. 352. 1. Any administrative regulations adopted by an 6
officer or an agency whose name has been changed or whose 7
responsibilities have been transferre d pursuant to the provisions of 8
this act to another officer or agency remain in force until amended 9
by the officer or agency to which the responsibility for the adoption 10
of the regulations has been transferred. 11
2. Any contracts or other agreements entere d into by an officer 12
or agency whose name has been changed or whose responsibilities 13
have been transferred pursuant to the provisions of this act to 14
another officer or agency are binding upon the officer or agency to 15
which the responsibility for the admini stration of the provisions of 16
the contract or other agreement has been transferred. Such contracts 17
and other agreements may be enforced by the officer or agency to 18
which the responsibility for the enforcement of the provisions of the 19
contract or other agreement has been transferred. 20
3. Any action taken by an officer or agency whose name has 21
been changed or whose responsibilities have been transferred 22
pursuant to the provisions of this act to another officer or agency 23
remains in effect as if taken by the o fficer or agency to which the 24
responsibility for the enforcement of such actions has been 25
transferred. 26
Sec. 353. The Legislative Counsel shall, in preparing 27
supplements to the Nevada Administrative Code, make such 28
changes as necessary so that references to a “company adjuster” or 29
“staff adjuster” are changed to an “independent adjuster.” 30
Sec. 354. NRS 645.645, 679B.230, 679B.240, 679B.250, 31
679B.260, 679B.270, 679B.280, 679B.282, 679B.285, 679 B.287, 32
679B.290, 679B.300, 689A.413, 689B.068, 689C.196, 689C.320, 33
690B.100, 690B.110, 690B.120, 690B.130, 690B.140, 690B.150, 34
690B.155, 690B.160, 690B.170, 690B.175, 690B.180, 695A.195, 35
695B.316, 695C.203 and 695D.217 are hereby repealed. 36
Sec. 355. 1. This section and sections 1 to 327, inclusive, 37
and 329 to 354, inclusive, of this act become effective on July 1, 38
2025. 39
2. Section 328 of this act becomes effective on January 1, 40
2026. 41

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LEADLINES OF REPEALED SECTIONS

645.645 Additional grounds for disciplinary action:
Unprofessional and improper co nduct relating to sale of
insurance for home protection.
679B.230 Examination of insurers.
679B.240 Examination of holding companies, subsidiaries,
agents, promoters, independent review organizations and
others.
679B.250 Conduct of examination; access to records;
corrections; penalty.
679B.260 Appraisal of asset.
679B.270 Report of examination: Filing; contents;
evidentiary effect in certain proceedings.
679B.280 Report of examination: Delivery of copy and
notice to examinee; right of exami nee to review and respond to
report; entry of order by Commissioner; Commissioner
authorized to order insurer to cure violation.
679B.282 Report of examination: Hearing; filing for public
inspection; forwarding filed report to examinee; distribution
and presentation of report of examination of domestic insurer.
679B.285 Report of examination: Disclosure;
confidentiality.
679B.287 Limitations on actions and liability for
communicating or delivering information or data pursuant to
examination; Commissio ner, representatives and examiners
entitled to attorney’s fees and costs in certain tort actions.
679B.290 Expense of examination; billing for examination;
regulations.
679B.300 Deposit of money; payment of certain expenses.
689A.413 Insurer prohibited from denying coverage solely
because claim involves act that constitutes domestic violence or
applicant or insured was victim of domestic violence.
689B.068 Insurer prohibited from denying coverage solely
because claim involves act that consti tutes domestic violence or
applicant or insured was victim of domestic violence.
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.320 Required notification when carrier discontinues
transacting insurance in this State or particular geographic

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service area of state; restrictions on carrier that discontinues
transacting insurance.
690B.100 Definitions.
690B.110 Applicability of other provisions.
690B.120 Exemption of person selling insurance from
licensing requirements as agent, broker or solicitor.
690B.130 Deposit of securities or surety bond; maintenance
of capital stock or surplus, premium reserves and losses and loss
expense reserves.
690B.140 Investments in tangible personal property:
Limitation; waiver.
690B.150 Filing of annual and quarterly statements.
690B.155 Provision requiring binding arbitration
authorized; procedures for arbitration.
690B.160 Contracts: Specifications; cancellation; renewal.
690B.170 Contracts: Regulations on content.
690B.175 Regulations regarding administrative expenses
for insurers and accounting standards.
690B.180 Prohibited acts.
695A.195 Society prohibited from denyi ng coverage solely
because claim involves act that constitutes domestic violence or
applicant or insured was victim of domestic violence.
695B.316 Corporation prohibited from denying coverage
solely because claim involves act that constitutes domestic
violence or applicant or insured was victim of domestic violence.
695C.203 Health maintenance organization prohibited
from denying coverage solely because claim involves act that
constitutes domestic violence or applicant or insured was victim
of domestic violence.
695D.217 Organization for dental care prohibited from
denying coverage solely because claim involves act that
constitutes domestic violence or applicant or insured was victim
of domestic violence.

H