Nev. Admin. Code § 689A.605 - Requirements for approval

To obtain approval of a system for resolving complaints of insureds concerning health care services covered by an insurer from the Commissioner as required pursuant to NRS 689A.745, an insurer must:

1. Demonstrate that the system will resolve oral and written complaints concerning:

(a) Payment or reimbursement for covered health care services;

(b) The availability, delivery or quality of covered health care services, including, without limitation, adverse determinations made pursuant to utilization review; and

(c) The terms and conditions of the health care plans of insureds.

2. Submit to the Division:

(a) The name and title of the employee responsible for the system;

(b) A description of the procedure used to notify an insured of the decision regarding his or her complaint; and

(c) A copy of the explanation of rights and procedures which is to be provided to insureds pursuant to NRS 689A.755.

Notes

Nev. Admin. Code § 689A.605

Added to NAC by Comm'r of Insurance by R132-98, eff. 3-30-99

NRS 679B.130, 689A.745