USA Statutes : nevada
Title : Title 57 - INSURANCE
Chapter : CHAPTER 695H - MEDICAL DISCOUNT PLANS
As used in this chapter, unless the
context otherwise requires, the words and terms defined in NRS 695H.020
to 695H.060 , inclusive, have the meanings ascribed to
them in those sections.
(Added to NRS by 2005, 2101 )
“Administrator” means a
person authorized pursuant to NRS 683A.0805 to 683A.0893 , inclusive, to conduct business in this
State as an administrator.
(Added to NRS by 2005, 2101 )
“Affiliate of an
insurer” means a person who directly, or indirectly through one or more
intermediaries, controls, is controlled by or is under common control
with an insurer.
(Added to NRS by 2005, 2101 )
“Insurer” means any insurer,
fraternal benefit society, nonprofit corporation for hospital, medical
and dental services, organization for dental care, health maintenance
organization or prepaid limited health service organization authorized
pursuant to this title to conduct business in this State.
(Added to NRS by 2005, 2101 )
“Medical discount
plan” means a business arrangement or program evidenced by a membership
agreement, contract, card, certificate, device or mechanism in which a
person, in exchange for fees, dues, charges or any other form of
consideration, offers to provide or provides health care or medical
services at a discount from providers of health care who are
participating in the business arrangement or program or whom the person
advertises as or claims to be participating in the business arrangement
or program.
(Added to NRS by 2005, 2101 )
“Provider of
health care” has the meaning ascribed to it in NRS 629.031 .
(Added to NRS by 2005, 2101 )
Notwithstanding any other provision of law, the
Commissioner has exclusive jurisdiction to regulate medical discount
plans in this State.
(Added to NRS by 2005, 2101 )
1. Except as otherwise provided in this section, it is unlawful
for any person to offer, market, sell or engage in business as a medical
discount plan in this State without first registering the medical
discount plan pursuant to the provisions of this chapter.
2. An insurer is not required to register any medical discount
plan pursuant to the provisions of this chapter unless the insurer
offers, markets or sells the medical discount plan in this State for
separate consideration.
3. If an affiliate of an insurer offers, markets, sells or engages
in business as a medical discount plan in this State, the affiliate is
required to register the medical discount plan pursuant to the provisions
of this chapter.
4. The provisions of this chapter do not apply to any medical
discount plan that offers or provides discounts only on prescriptions.
(Added to NRS by 2005, 2101 )
1. An application for registration to engage in business as a
medical discount plan must be submitted on a form prescribed by the
Commissioner. The form must be signed by an officer or an authorized
representative of the applicant. Except as otherwise provided in this
section, the application must be accompanied by:
(a) A registration fee of $500.
(b) A copy of the organizational documents of the applicant, if any.
(c) A list of names, addresses, positions of employment and
biographical information of each person who is responsible for conducting
the business activities of the medical discount plan of the applicant,
including, but not limited to, all members of the board of directors,
board of trustees, officers and managers. The list must set forth the
extent and nature of any contracts or other agreements between any person
who is responsible for conducting the business activities of the
applicant and the medical discount plan, including disclosure of any
possible conflicts of interest.
(d) A complete biographical statement, on a form prescribed by the
Commissioner, describing the facilities, employees and services that will
be offered by the applicant.
(e) A copy of all forms used for contracts between the applicant
and networks of providers of health care regarding the provision of
health care or medical services to members.
(f) A copy of the most recent financial statements of the
applicant, audited by an independent certified public accountant.
(g) A description of the method of marketing proposed by the
applicant.
(h) A description of the procedures for making a complaint to be
established and maintained by the applicant.
(i) Any other information required by the Commissioner.
2. Each person who registers a medical discount plan must renew
the registration annually before the registration expires. Except as
otherwise provided in this section, an application to renew the
registration must include:
(a) An annual renewal fee of $500; and
(b) Any information set forth in subsection 1 that the Commissioner
requires to be included in the application.
3. An administrator or insurer that registers a medical discount
plan is not required to pay the fees for registering or renewing the
registration of the medical discount plan pursuant to this section.
4. The Commissioner shall, by regulation, designate the provisions
of subsection 1 that shall be deemed satisfied by an administrator,
insurer or affiliate of an insurer that has complied with substantially
similar requirements pursuant to other provisions of this title.
(Added to NRS by 2005, 2101 )
A
person who is responsible for conducting the business activities of a
medical discount plan may not:
1. Use the word “insurance” or “enrollment” in any advertising or
marketing material, brochures or discount cards for the medical discount
plan unless approved by the Commissioner;
2. Use in any advertising or marketing material, brochures or
discount cards for the medical discount plan the terms “coverage,”
“copay,” “preexisting conditions,” “guaranteed issue,” “PPO,” “preferred
provider organization” or any other term that could reasonably mislead a
person into believing the medical discount plan is a policy of health
insurance;
3. Pay a provider of health care any fee for providing any health
care or medical services; or
4. Collect or accept money from a member of the medical discount
plan for payment to a provider of health care for specific health care or
medical services that the provider has provided or will provide to the
member unless the registration for the medical discount plan is held by
an administrator or insurer.
(Added to NRS by 2005, 2102 )
1. The following disclosures must be made in writing to any
prospective member of a medical discount plan and must be in clear
language and prominently displayed in any advertisements, marketing
materials and brochures relating to a medical discount plan:
(a) That the medical discount plan is not a policy of health
insurance;
(b) That the medical discount plan provides discounts from
providers of health care who provide health care or medical services to
members;
(c) That the medical discount plan does not make payments directly
to the providers of health care;
(d) That the member will be required to pay for all health care or
medical services but will receive a discount from those providers of
health care who have contracted with the medical discount plan;
(e) The corporate name of the person offering the medical discount
plan and the location and address of each office for the medical discount
plan; and
(f) A telephone number where the member may obtain information and
answers to questions or complaints.
2. The disclosures required pursuant to this section may be
provided orally or electronically if written disclosures are provided not
later than the earlier of:
(a) Ten business days after the prospective member elects to accept
the medical discount plan; or
(b) The date on which any other written material is provided by the
medical discount plan to the member.
(Added to NRS by 2005, 2103 )
The disclosures required
by this chapter must be printed in type that is not smaller than 12-point
type.
(Added to NRS by 2005, 2103 )
1. Each medical discount plan must at all times maintain a net
worth of $100,000.
2. The Commissioner shall not issue a registration or renewal of a
registration for a medical discount plan unless the person registering or
renewing the registration certifies that the medical discount plan has a
net worth of at least $100,000.
(Added to NRS by 2005, 2103 )
1. Except as otherwise provided in this subsection, the
Commissioner may conduct examinations to enforce the provisions of this
chapter pursuant to the provisions of NRS 679B.230 to 679B.300 , inclusive, at such times as he deems
necessary. For the purposes of this chapter, the Commissioner is not
required to comply with the requirement in NRS 679B.230 that insurers be examined not less
frequently than every 5 years.
2. A person who is responsible for conducting the business
activities of a medical discount plan shall, upon the request of the
Commissioner, make available to the Commissioner for inspection any
accounts, books and records concerning the medical discount plan which
are reasonably necessary to enable the Commissioner to determine whether
the medical discount plan is in compliance with the provisions of this
chapter.
(Added to NRS by 2005, 2104 )
1. A medical discount plan must maintain records of the
transactions governed by this chapter. The records must include:
(a) A copy of each type of contract that the medical discount plan
issues, sells or offers for sale;
(b) The name and address of each member of the medical discount
plan;
(c) A copy of each contract that the medical discount plan enters
into with providers of health care for purposes of providing members with
health care or medical services at a discount; and
(d) A copy of the annual certification of net worth and supporting
documentation.
2. Except as otherwise provided in this subsection, each medical
discount plan must retain all records for at least 7 years. A medical
discount plan which intends to discontinue doing business in this State
must provide the Commissioner with satisfactory proof that it has
discharged its duties to the members in this State and must not destroy
its records without the prior approval of the Commissioner.
3. The records required to be maintained pursuant to this section
may be stored on a computer disc or other storage device for a computer
from which the records may be readily printed.
(Added to NRS by 2005, 2104 )
The Commissioner may adopt regulations
to carry out the provisions of this chapter.
(Added to NRS by 2005, 2105 )
A person is subject to the imposition of an administrative penalty
pursuant to this chapter if, in the course of the business of the person,
the person:
1. Solicits, markets, advertises, promotes or sells to a person in
this State a medical discount plan or a membership in connection with a
medical discount plan unless the medical discount plan is registered
pursuant to this chapter.
2. Fails to provide any disclosure required pursuant to NRS
695H.110 .
3. Fails to make available to an applicant for membership or to a
member, through a toll-free telephone number, upon the request of the
applicant or member, a complete and accurate list of all participating
providers of health care who have contracted with the medical discount
plan and who are located in the applicant’s or member’s local area, or
within a radius of 50 miles, and a list of the health care or medical
services for which the discounts are applicable. The list must be made
available, upon the request of the applicant, at the time the applicant
purchases a membership and must be updated not less than once every 6
months.
4. Violates subsection 1 or 2 of NRS 695H.100 or otherwise uses advertising or marketing
material, brochures or discount cards that are misleading, deceptive or
fraudulent.
5. Offers discounted products or services to the applicant or
member that are not authorized by a contract with each provider of health
care listed in conjunction with the medical discount plan.
6. Fails to allow the applicant or member to cancel the membership
in the medical discount plan.
7. If appropriate, fails to refund any required portion of
membership fees paid to the medical discount plan by the applicant or
member within 30 days after the applicant or member provides timely
notification of the cancellation of the membership to the person
administering the medical discount plan.
(Added to NRS by 2005, 2103 )
A person who violates any provision of
this chapter or an order or regulation of the Commissioner issued or
adopted pursuant thereto may be assessed an administrative penalty by the
Commissioner of not more than $2,000 for each act or violation, not to
exceed an aggregate amount of $10,000 for violations of a similar nature.
For the purposes of this section, violations shall be deemed to be of a
similar nature if the violations consist of the same or similar conduct,
regardless of the number of times the conduct occurred.
(Added to NRS by 2005, 2104 )
