695A.Sec. 4 - NEW

695A.Sec. 4. NEW

1. A society that issues a benefit contract shall not require an insured to pay a higher deductible or any copayment, coinsurance or other form of cost-sharing for or use any medical management technique to restrict access by an insured to:

(a) A visit to the office of a provider of health care, an urgent care center, an independent center for emergency medical care, the emergency room of a hospital or a COVID-19 screening or testing site, if the purpose of the visit is to determine whether the insured has COVID-19;

(b) A test to determine whether the insured has COVID-19 if the attending provider of health care determines, in accordance with generally accepted medical standards, that the test is appropriate; or

(c) A vaccine to prevent the insured from contracting COVID-19.

2. A society that issues a benefit contract shall provide information concerning available benefits, options for medical advice and treatment through telehealth and preventative measures related to COVID-19 to each insured and provider of health care that participates in the network plan of the society.

3. A society that issues a benefit contract that provides coverage for prescription drugs and uses a formulary shall cover a prescription drug that is not included in the formulary at no additional cost to the insured if:

(a) No prescription drug that is effective in treating the insured and included in the formulary is available; and

(b) The prescription drug is not available because of a disruption in the supply of those drugs.

4. As used in this section:

(a) "Hospital" has the meaning ascribed to it in NRS 449.012.

(b) "Independent center for emergency medical care" has the meaning ascribed to it in NRS 449.013.

(c) "Medical management technique" means a practice which is used to control the cost or utilization of health care services. The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.

(d) "Network plan" means a benefit contract offered by a society under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the society. The term does not include an arrangement for the financing of premiums.

(e) "Provider of health care" has the meaning ascribed to it in NRS 629.031.

(f) "Telehealth" has the meaning ascribed to it in NRS 629.515.

Added to NAC by Comm'r of Insurance by R054-20A, eff. 7-2-2020

NRS 414.070, 679B.120 and 679B.130

The following state regulations pages link to this page.