[Rev. 11/22/2013 10:29:58 AM--2013]

[NAC-689C Revised Date: 6-12]

CHAPTER 689C - HEALTH INSURANCE FOR SMALL EMPLOYERS

HEALTH BENEFIT PLANS

689C.100†††††††† ďExisting coverageĒ interpreted.

689C.105†††††††† Uniformity of benefits required.

689C.110†††††††† Adoption of waiting period for new employees not prohibited.

689C.113†††††††† Carrier prohibited from requesting or considering certain information.

689C.117†††††††† Carrier prohibited from requiring purchase of other insurance as prerequisite to purchase or renewal of group health plan.

689C.120†††††††† Compliance required.

689C.130†††††††† Notice of cancellation, nonrenewal or renewal with altered terms.

689C.140†††††††† Minimum care and services required.

689C.150†††††††† Notification of conversion privilege; coverage of eligible dependent.

689C.155†††††††† Evidence of creditable coverage.

689C.160†††††††† Annual report.

689C.170†††††††† Contents of disclosure form.

689C.172†††††††† Disclosures in advertising and sales materials; inclusion of certain information in health benefit plan.

689C.175†††††††† Request for copy of disclosure.

689C.180†††††††† Filing of forms required by NRS 687B.120.

689C.190†††††††† Coverage under different plan constituting passage of fixed period.

689C.195†††††††† Restrictions on rules of eligibility and on contribution rates.

689C.200†††††††† Development of rate manual; calculation of rates.

689C.202†††††††† Limitation on frequency of increases in premium rates; exceptions.

689C.205†††††††† Disclosure of variance in premium rate.

689C.210†††††††† Marketing in established geographic area.

689C.220†††††††† Requirement upon denial of coverage.

689C.230†††††††† Determination of reduction in liability of carrier because of benefits under other group coverage.

689C.250†††††††† Policies for stop-loss insurance.

689C.260†††††††† Prior notification of desire to change status as risk-assuming or reinsuring carrier.

689C.265†††††††† Application for change of status as risk-assuming or reinsuring carrier: Filing; action by Commissioner; confidentiality.

VOLUNTARY PURCHASING GROUPS

689C.300†††††††† Application for registration; submission of proposed material changes to business plan.

689C.310†††††††† Grounds for denial of application or suspension, revocation or refusal to renew certificate.

689C.320†††††††† Annual renewal fee.

689C.330†††††††† Disclosure by carrier.

689C.340†††††††† Accessibility of coverage: Prohibited activity; enrollment of all eligible employees and dependents.

689C.350†††††††† Annual report.

689C.360†††††††† General powers.

689C.370†††††††† Prohibited acts.

689C.380†††††††† Provisions of contract with participating carrier: Payment of premiums.

689C.390†††††††† Provisions of contract with participating small employer: Group as policyholder of record; issuance of certificates of coverage; coverage through group required.

689C.400†††††††† Establishment of standards and guidelines for insurers.

689C.410†††††††† Establishment of marketing standards and approval of marketing materials.

689C.420†††††††† Board of directors and management personnel: Duties.

689C.430†††††††† Board members and management personnel: Prohibited acts.

689C.440†††††††† Report of suspected violation.

689C.450†††††††† Insolvency of voluntary purchasing group: Jurisdiction of Commissioner.

 

 

HEALTH BENEFIT PLANS

††††† NAC 689C.100  ďExisting coverageĒ interpreted. (NRS 679B.130, 689C.190)  For the purposes of subsection 2 of NRS 689C.190, the Commissioner will interpret ďexisting coverageĒ as not including coverage issued as a supplement to liability insurance, workersí compensation or similar insurance, automobile medical payment insurance, accident insurance only policies, credit insurance, plans for dental care, optometric plans, coverage provided as a supplement to Medicare, coverage for long-term care, disability income or specified disease, hospital confinement indemnity, or limited benefit health insurance if the requirements of NRS 689C.105 are satisfied.

†††† (Added to NAC by Commír of Insurance, eff. 3-28-96)

††††† NAC 689C.105  Uniformity of benefits required. (NRS 679B.130, 689C.155, 689C.203)  A carrier serving small employers shall offer the same benefits to all of the small employers it serves regardless of the number of eligible employees employed by the small employer.

†††† (Added to NAC by Commír of Insurance by R224-97, eff. 11-16-98)

††††† NAC 689C.110  Adoption of waiting period for new employees not prohibited. (NRS 679B.130, 689C.190)  The Commissioner will interpret the provisions of NRS 689C.190 as not prohibiting an employer from adopting a waiting period for new employees to become eligible for participation in a plan of health insurance offered by the employer.

†††† (Added to NAC by Commír of Insurance, eff. 3-28-96)

††††† NAC 689C.113  Carrier prohibited from requesting or considering certain information. (NRS 679B.130, 689C.155, 689C.203)  A carrier serving small employers shall not:

†††† 1.  Request information about an employee or dependent who has waived coverage; or

†††† 2.  Consider any information about an employee or dependent who has waived coverage when calculating a premium rate for a small employer.

†††† (Added to NAC by Commír of Insurance by R193-99, eff. 1-27-2000)

††††† NAC 689C.117  Carrier prohibited from requiring purchase of other insurance as prerequisite to purchase or renewal of group health plan. (NRS 679B.130, 689C.155, 689C.203)  A carrier serving small employers shall not require a small employer to purchase a group life insurance policy or any other form of insurance as a prerequisite to the purchase or renewal of a group health plan for small employers.

†††† (Added to NAC by Commír of Insurance by R193-99, eff. 1-27-2000)

††††† NAC 689C.120  Compliance required. (NRS 679B.130, 689C.155)  A carrier that provides health benefit plans to small employers in this State shall comply with the provisions of this chapter and:

†††† 1.  Chapter 689C of NRS;

†††† 2.  NRS 689B.033 and 689B.290 to 689B.330, inclusive, to the extent that those provisions do not conflict with the provisions of chapter 689C of NRS; and

†††† 3.  All other applicable provisions of title 57 of NRS.

†††† (Added to NAC by Commír of Insurance, eff. 3-28-96)

††††† NAC 689C.130  Notice of cancellation, nonrenewal or renewal with altered terms. (NRS 679B.130, 689C.155, 689C.203)  A notice of cancellation, nonrenewal or renewal with altered terms issued by a carrier to a small employer must comply with the provisions of NRS 687B.310 to 687B.420, inclusive, to the extent that those provisions do not conflict with the provisions of chapter 689C of NRS.

†††† (Added to NAC by Commír of Insurance, eff. 3-28-96)

††††† NAC 689C.140  Minimum care and services required. (NRS 679B.130, 689C.115, 689C.155, 689C.203)  A health benefit plan offered pursuant to chapter 689C of NRS must include basic medical and hospital care, including at least:

†††† 1.  Emergency care;

†††† 2.  Inpatient and outpatient hospital services;

†††† 3.  Physiciansí services;

†††† 4.  Outpatient medical services;

†††† 5.  Laboratory services; and

†††† 6.  X-ray services.

†††† (Added to NAC by Commír of Insurance, eff. 3-28-96)

††††† NAC 689C.150  Notification of conversion privilege; coverage of eligible dependent. (NRS 679B.130, 689C.203, 689C.330)

†††† 1.  A certificate of coverage for a health benefit plan must include notification of the conversion privilege provided by NRS 689C.330.

†††† 2.  An eligible dependent is entitled to be covered under a policy of health insurance issued pursuant to NRS 689C.330.

†††† (Added to NAC by Commír of Insurance, eff. 3-28-96)

††††† NAC 689C.155  Evidence of creditable coverage. (NRS 679B.130, 689C.155, 689C.191, 689C.203)  If a person is unable to obtain a certificate of creditable coverage pursuant to NRS 689C.192, a carrier shall accept from the person other evidence of creditable coverage if it determines that the evidence reasonably establishes prior continuous creditable coverage. Such evidence may include, without limitation, a copy of:

†††† 1.  A policy of health insurance or evidence of coverage;

†††† 2.  A billing statement for the payment of premiums;

†††† 3.  A cancelled check evidencing payment for health insurance coverage;

†††† 4.  A proof of insurance card issued by an insurer;

†††† 5.  An explanation of benefits relating to a specific claim for medical services that were provided to the person by an insurer;

†††† 6.  A letter notifying the person that he or she is eligible for coverage pursuant to the Consolidated Omnibus Budget Reconciliation Act of 1985, Public Law 99-272;

†††† 7.  A letter written by the liquidator of an insurer that verifies the dates that the person was covered by the insurer under a policy of health insurance;

†††† 8.  A statement written by the person that includes the name and telephone number of any insurer under which he or she previously received health insurance coverage;

†††† 9.  Evidence of a payroll deduction from the personís salary for health insurance coverage;

†††† 10.  Any record from a provider of medical care that indicates that the person had health insurance coverage; or

†††† 11.  Any combination thereof.

†††† (Added to NAC by Commír of Insurance by R224-97, eff. 11-16-98)

††††† NAC 689C.160  Annual report. (NRS 679B.130, 689C.250)

††††† 1.  A carrier serving small employers that offers a health benefit plan shall, on or before March 1 of each calendar year, file with the Commissioner a report concerning the operation of the carrier during the preceding calendar year. The report must include:

†††† (a) A statement indicating whether the carrier intends to continue to offer health benefit plans;

†††† (b) A list of the health benefit plans offered by the carrier, including the name of each health benefit plan and a name or number of the form filed pursuant to NAC 689C.180 for each health benefit plan;

†††† (c) The total claims incurred in the preceding calendar year for health benefit plans for small employers in this State;

†††† (d) The index rate as of December 31 of the preceding calendar year; and

†††† (e) For each calendar quarter of the preceding calendar year:

††††††††† (1) The total premiums earned from health benefit plans for small employers in this State;

††††††††† (2) The number of health benefit plans that were in effect for small employers in this State;

††††††††† (3) The number of health benefit plans that were in effect for small employers in this State that employed not less than 2 nor more than 10 employees; and

††††††††† (4) The total number of natural persons covered by health benefit plans for small employers in this State.

†††† 2.  The Commissioner will keep confidential the index rate that is submitted pursuant to this section.

†††† 3.  As used in this section, ďindex rateĒ has the meaning ascribed to it in paragraph (b) of subsection 3 of NRS 689C.230.

†††† (Added to NAC by Commír of Insurance, eff. 3-28-96; A by R224-97, 11-16-98)

††††† NAC 689C.170  Contents of disclosure form. (NRS 679B.130, 689C.203, 689C.270)  The disclosure required to be filed with the Commissioner pursuant to NRS 689C.270 must be on a form which is in at least 10-point type and include:

†††† 1.  The name, address and telephone number of the carrier;

†††† 2.  The name, address and telephone number of the agent, broker and administrator, if applicable;

†††† 3.  A statement describing the principal benefits and the type of coverage provided; and

†††† 4.  A description of any provision of the policy which significantly excludes, eliminates, reduces or limits the payment of benefits, including limitations on access to an emergency room, requirements concerning prior authorization, and limitations relating to the use of preferred or other providers.

†††† (Added to NAC by Commír of Insurance, eff. 3-28-96)

††††† NAC 689C.172  Disclosures in advertising and sales materials; inclusion of certain information in health benefit plan. (NRS 679B.130, 689C.203, 689C.270)

†††† 1.  As part of the disclosure required by NRS 689C.270, a carrier serving small employers shall disclose in the advertising and sales materials that the carrier provides to small employers:

†††† (a) The term of the contract applicable to the premium rates;

†††† (b) A general description of the underwriting factors that the carrier used to calculate premiums; and

†††† (c) A description of the class of business in which the small employer is included.

†††† 2.  A carrier serving small employers shall include a copy of the information described in paragraph (c) of subsection 1 in the health benefit plan that the carrier provides to an insured.

†††† (Added to NAC by Commír of Insurance by R009-02, eff. 5-23-2002; A by R009-02, 7-11-2002)

REVISERíS NOTE.

††††† The regulation of the Commissioner of Insurance filed with the Secretary of State on July 11, 2002 (LCB File No. R009-02), the source of this section (section 13 of the regulation), contains the following provision not included in NAC:

††††† ďSec. 20.  Sections 6, 13, 16 and 19 of this regulation [NAC 689B.205, 689C.172, 695B.035 and 695C.295] apply to any disclosures given for health insurance, group contracts for hospital or medical service and group health care plans offered by insurers, nonprofit corporations for hospital, medical or dental services and health maintenance organizations that are offered or issued on or after July 10, 2002.Ē

 

††††† NAC 689C.175  Request for copy of disclosure. (NRS 679B.130, 689C.203)  On behalf of a small employer, a producer may request a copy of the disclosure required to be filed with the Commissioner pursuant to NRS 689C.270.

†††† (Added to NAC by Commír of Insurance by R224-97, eff. 11-16-98)

††††† NAC 689C.180  Filing of forms required by NRS 687B.120. (NRS 679B.130, 687B.120, 689C.203)  A form required to be filed pursuant to NRS 687B.120 for a health benefit plan must:

†††† 1.  Be in a format prescribed by the Commissioner;

†††† 2.  Include an affidavit signed by an officer of the carrier which certifies that the premium rates and forms for the health benefit plan comply with the provisions of chapter 689C of NRS and all other applicable provisions of title 57 of NRS; and

†††† 3.  Include all other reasonable information requested by the Commissioner.

†††† (Added to NAC by Commír of Insurance, eff. 3-28-96)

REVISERíS NOTE.

††††† The regulation of the Commissioner of Insurance filed with the Secretary of State on March 28, 1996 (LCB File No. R179-95), the source of this section, contains the following provision not included in NAC:

††††† ď1.  A carrier serving small employers that offers a health benefit plan shall, with regard to the plan, file a form which complies with the requirements of section 10 of this regulation [NAC 689C.180] before April 1, 1996.

††††† 2.  A form approved by the Commissioner before the effective date of this regulation [March 28, 1996] shall be deemed to conform with the applicable provisions of chapter 689C of NRS and may be used by the carrier until a new form is approved by the Commissioner. Each small employer, covered employee and dependent must be provided with a new form within 30 days after approval of the form by the Commissioner.Ē

 

††††† NAC 689C.190  Coverage under different plan constituting passage of fixed period. (NRS 679B.130, 689C.190, 689C.203)  A carrier serving small employers shall, with regard to employees that had existing coverage continuously under a different health plan in the 90-day period immediately preceding the effective date of the new coverage, deem satisfied any provision in the policy which requires the passage of a fixed period before coverage is provided for a preexisting condition. The previous carrier shall provide information concerning the previous coverage within 10 working days after receipt of a written request by the current carrier.

†††† (Added to NAC by Commír of Insurance, eff. 3-28-96)

††††† NAC 689C.195  Restrictions on rules of eligibility and on contribution rates. (NRS 679B.130, 689C.155, 689C.193, 689C.203)

†††† 1.  A group health plan and a carrier that issues group health insurance pursuant to chapter 689C of NRS shall not include or establish any rule of eligibility, including continued eligibility, for any individual to enroll for benefits under the terms of the group health plan or group health insurance that discriminates based upon any health status-related factor that relates to the individual or a dependent of the individual.

†††† 2.  A group health plan and a carrier that issues group health insurance pursuant to chapter 689C of NRS shall not include or establish any rule of eligibility, or set a premium or contribution rate, for any individual based on whether the individual is:

†††† (a) Confined to a hospital or other health care institution; or

†††† (b) Actively at work, including whether an individual is continuously employed, unless the group health plan or group health insurance treats absence from work because of a health factor as being actively at work.

†††† 3.  As used in this section, ďrule of eligibilityĒ includes, without limitation, any rule of eligibility relating to:

†††† (a) The effective date of coverage;

†††† (b) Waiting or affiliation periods;

†††† (c) Late and special enrollment periods; or

†††† (d) Eligibility for benefit packages, including rules pursuant to which individuals may change their selection among benefit packages.

†††† (Added to NAC by Commír of Insurance by R009-02, eff. 5-23-2002; A by R009-02, 7-11-2002)

††††† NAC 689C.200  Development of rate manual; calculation of rates. (NRS 679B.130, 689C.155, 689C.203)

†††† 1.  A carrier serving small employers shall develop a rate manual for each class of business established by the carrier. Base premium rates and new business premium rates charged to small employers by the carrier must be computed solely from the applicable rate manual. To the extent that a portion of the premium rates charged by a carrier is based on the carrierís discretion, the manual must specify the criteria and factors considered by the carrier in exercising its discretion.

†††† 2.  The rate manual must specify the risk characteristics and rate factors to be applied by the carrier in establishing premium rates for the class of business.

†††† 3.  A carrier shall keep on file for at least 7 years the calculations used to determine the change in base premium rates and new business premium rates for each health benefit plan for each rating period.

†††† (Added to NAC by Commír of Insurance, eff. 3-28-96)

††††† NAC 689C.202  Limitation on frequency of increases in premium rates; exceptions. (NRS 679B.130, 689C.155, 689C.203)

†††† 1.  Except as otherwise provided in this section, a carrier serving small employers shall not increase the premium rates for a group health benefit plan more frequently than every 6 months unless the increase in the premium rates is being made because:

†††† (a) An employer has requested a change in its group health benefit plan;

†††† (b) There has been a change in the number of employees covered by an employer that would affect the insurance premium rate of the employer; or

†††† (c) There has been a change in federal or state law which affects the cost of providing services under the group health benefit plan.

†††† 2.  If a carrier issues a group health benefit plan to a class of employers that consists solely of bona fide associations and uses a common date of renewal for that class, an increase in the premium rates for that class does not violate the provisions of subsection 1 solely because at least one but not all the members of that class will have an increase in premium rates more frequently than every 6 months.

†††† (Added to NAC by Commír of Insurance by R009-02, eff. 5-23-2002; A by R009-02, 7-11-2002)

††††† NAC 689C.205  Disclosure of variance in premium rate. (NRS 679B.130, 689C.155, 689C.203)  If a carrier serving small employers quotes a premium rate for a health benefit plan to a producer or a small employer who seeks health insurance coverage from the carrier, the carrier shall disclose how much the premium rate may vary from the quoted premium rate because of the health status of a person to be covered by the health insurance.

†††† (Added to NAC by Commír of Insurance by R224-97, eff. 11-16-98)

††††† NAC 689C.210  Marketing in established geographic area. (NRS 679B.130, 689C.203)  A carrier serving small employers shall, in accordance with the provisions of NRS 689C.200, take reasonable steps to market its health benefit plans to small employers located in the carrierís established geographic area.

†††† (Added to NAC by Commír of Insurance, eff. 3-28-96)

††††† NAC 689C.220  Requirement upon denial of coverage. (NRS 679B.130, 689C.155, 689C.203)  If a carrier serving small employers denies coverage in a health benefit plan to a small employer on the basis of a risk characteristic, the denial must be in writing and state the reasons for the denial, subject to any restrictions related to confidentiality of medical information.

†††† (Added to NAC by Commír of Insurance, eff. 3-28-96)

††††† NAC 689C.230  Determination of reduction in liability of carrier because of benefits under other group coverage. (NRS 679B.130)  A reduction in the liability of a carrier serving small employers because of benefits under other valid group coverage must be determined in the manner provided in NRS 689B.063 and 689B.064.

†††† (Added to NAC by Commír of Insurance, eff. 12-9-92; A 3-28-96)ó(Substituted in revision for NAC 689C.080)

††††† NAC 689C.250  Policies for stop-loss insurance. (NRS 679B.130, 689C.155, 689C.940)

†††† 1.  An insurer shall not issue a policy for stop-loss insurance that:

†††† (a) Has an annual attachment point for claims incurred per individual that is lower than $10,000;

†††† (b) Has an annual aggregate attachment point for groups of not more than 50 persons that is lower than the greater of:

††††††††† (1) The number of group members times $4,000;

††††††††† (2) One hundred and twenty percent of expected claims; or

††††††††† (3) Ten thousand dollars.

†††† 2.  For the purposes of this section, an insurer shall determine the number of persons in a group on a consistent basis at least annually.

†††† 3.  If a policy for stop-loss insurance does not meet the criteria set forth in this section, the policy will be deemed to be a health benefit plan for the purposes of this chapter and chapter 689C of NRS.

†††† 4.  As used in this section:

†††† (a) ďAttachment pointĒ means the amount of claims incurred by an insured group beyond which an insurer incurs a liability for payment.

†††† (b) ďExpected claimsĒ means the amount of claims that, in the absence of stop-loss insurance or other insurance, are projected to be incurred by an insured group through its health plan.

†††† (c) ďStop-loss insuranceĒ means insurance purchased by an employer to limit exposure to claim expenses under a health benefit plan provided by the employer.

†††† (Added to NAC by Commír of Insurance by R113-00, eff. 3-30-2001)

††††† NAC 689C.260  Prior notification of desire to change status as risk-assuming or reinsuring carrier. (NRS 679B.130, 689C.155, 689C.283)

†††† 1.  If a carrier serving small employers wishes to change its election to operate as a risk-assuming or reinsuring carrier pursuant to NRS 689C.283 at the end of the current period of election, the carrier must notify the Commissioner not later than 30 days before the expiration of the current period of election.

†††† 2.  If no such notice is provided, the carrier shall be deemed to have elected to operate with the same status for the next period of election.

†††† (Added to NAC by Commír of Insurance by R009-02, eff. 5-23-2002; A by R009-02, 7-11-2002)

††††† NAC 689C.265  Application for change of status as risk-assuming or reinsuring carrier: Filing; action by Commissioner; confidentiality. (NRS 679B.130, 689C.155, 689C.283)

†††† 1.  To change its status as a risk-assuming or a reinsuring carrier in accordance with NRS 689C.283, a carrier serving small employers must file an application for a change of status with the Commissioner.

†††† 2.  The Commissioner will approve such an application for a change of status if the carrier provides evidence satisfactory to the Commissioner that the requested change of status is necessary for the carrier to meet its contractual and statutory obligations.

†††† 3.  The Commissioner will notify the carrier in writing of his or her decision to approve or disapprove the application for a change of status within 60 days after receiving the application.

†††† 4.  The carrier may request that the information in its application for a change of status be kept confidential, if disclosure of the information would adversely affect the financial solvency of the carrier or would promote unfair competition among other carriers serving small employers. The Commissioner will notify the carrier in writing of his or her decision to approve or disapprove such a request within 30 days after receiving the request.

†††† (Added to NAC by Commír of Insurance by R009-02, eff. 5-23-2002; A by R009-02, 7-11-2002)

VOLUNTARY PURCHASING GROUPS

††††† NAC 689C.300  Application for registration; submission of proposed material changes to business plan. (NRS 679B.130, 689C.500, 689C.510, 689C.560, 689C.600)

†††† 1.  In addition to the requirements of NRS 689C.500, the application for registration must include:

†††† (a) A statement authorizing the representative of the voluntary purchasing group to complete and file the application;

†††† (b) A business plan, which must be approved by the Commissioner, that:

††††††††† (1) Explains the manner in which the group will reduce the cost of providing health care, increase access to and improve the quality of health care services for those persons eligible for participation in the group; and

††††††††† (2) Demonstrates to the Commissioner that the applicant possesses the technical expertise and physical capacity to serve at least 10 percent of the proposed service area in which small employers are not currently being served by an existing group;

†††† (c) The scope of services to be offered;

†††† (d) A demonstration that the group is an appropriate and effective representative of the interests of small employers in the service area;

†††† (e) Biographical information concerning the principals of the group demonstrating that the principals have sufficient expertise, experience and competence to represent small employers in a fiduciary capacity;

†††† (f) A description of the administrative and accounting procedures established for the operation of the group;

†††† (g) A description of the manner in which the group will offer insurance coverage through marketing to small employers currently not served by a group;

†††† (h) A disclosure of any preexisting oral or written agreements;

†††† (i) Statements and reports that show that the group itself will not bear the financial risk related to coverage;

†††† (j) An application fee of $1,500; and

†††† (k) A bond posted or a certificate of deposit or securities deposited in an amount to be determined by the Commissioner of not less than $100,000. The bond or deposit must be accompanied by an irrevocable power of attorney authorizing the Commissioner to transfer the bond or deposit, or any part thereof, for any purpose within the scope of NRS 689C.360 to 689C.600, inclusive.

†††† 2.  The application is deemed filed when all required information has been received by the Commissioner.

†††† 3.  Any proposed material changes to the operations of the business plan must be submitted to the Commissioner for review and approval.

†††† (Added to NAC by Commír of Insurance, eff. 3-5-96)

††††† NAC 689C.310  Grounds for denial of application or suspension, revocation or refusal to renew certificate. (NRS 679B.130, 689C.600)  The Commissioner may deny the application of a voluntary purchasing group or suspend, revoke or refuse to renew the certificate of registration of a group for the following reasons:

†††† 1.  Failure to comply with any applicable provisions of title 57 of NRS;

†††† 2.  Failure to disclose a preexisting oral or written agreement during the application process;

†††† 3.  Failure to comply with and carry out the approved business plan;

†††† 4.  Failure to follow approved procedures or maintain adequate controls;

†††† 5.  Failure to meet the standards of a financial or performance examination;

†††† 6.  Failure to market health care services actively to small employers not currently served by the group;

†††† 7.  Failure to comply with an order of the Commissioner;

†††† 8.  Commission of an unfair or deceptive act or practice as defined in chapter 686A of NRS or NAC;

†††† 9.  Filing a form with the Commissioner that contains fraudulent information or omissions;

†††† 10.  Misappropriation of, conversion of, illegal withholding of or refusal to pay obligations legally owed from funds entrusted to the group in its fiduciary capacity;

†††† 11.  Failure to offer the services of the group to small employers not currently being served by a group; or

†††† 12.  Failure to supply a business plan for the group that will reduce and continue to reduce the cost of insurance and improve quality and access to affordable health insurance or health care services.

†††† (Added to NAC by Commír of Insurance, eff. 3-5-96)

††††† NAC 689C.320  Annual renewal fee. (NRS 679B.130, 689C.530, 689C.600)  The voluntary purchasing group must pay an annual renewal fee of $1,000 to the Commissioner on or before March 1 of each year.

†††† (Added to NAC by Commír of Insurance, eff. 3-5-96)

††††† NAC 689C.330  Disclosure by carrier. (NRS 679B.130, 689C.440)  In addition to the requirements of NRS 689C.440, the disclosure offered by a carrier must:

†††† 1.  Be printed in at least 10-point type;

†††† 2.  Include the name, address and telephone number of the insurer;

†††† 3.  Include the name, address and telephone number of any agent, broker or administrator which is under contract with the voluntary purchasing group pursuant to NRS 689C.540;

†††† 4.  Include a statement describing the principal benefits and the type of coverage being provided; and

†††† 5.  Include a definition of the term ďusual and customaryĒ or any similar term used in the policy.

†††† (Added to NAC by Commír of Insurance, eff. 3-5-96)

††††† NAC 689C.340  Accessibility of coverage: Prohibited activity; enrollment of all eligible employees and dependents. (NRS 679B.130, 689C.460)

†††† 1.  A participating carrier, agent or broker shall not engage in any activity that would encourage an eligible employee to decline coverage offered by the voluntary purchasing group or to seek coverage from other participating carriers.

†††† 2.  Participating carriers, agents or brokers must enroll all eligible employees and dependents regardless of current health status or history of prior claims.

†††† (Added to NAC by Commír of Insurance, eff. 3-5-96)

††††† NAC 689C.350  Annual report. (NRS 679B.130, 689C.530, 689C.600)  Each voluntary purchasing group shall submit to the Commissioner no later than March 1, 1997, and annually thereafter, a report concerning:

†††† 1.  The progress achieved by the group in providing affordable coverage to eligible small employers within the service area;

†††† 2.  Any proposed financial incentives or other activities designed to increase group participation;

†††† 3.  An evaluation of the effectiveness of purchasing health care coverage exclusively through the group; and

†††† 4.  Any recommended amendments to the law or regulations to improve the cost-effectiveness of the coverage and fair operations of the group.

†††† (Added to NAC by Commír of Insurance, eff. 3-5-96)

††††† NAC 689C.360  General powers. (NRS 679B.130, 689C.600)  A voluntary purchasing group may:

†††† 1.  Offer other benefit plans approved by the Commissioner, such as group coverage for vision care, dental care and other limited contracts for other care;

†††† 2.  Exclude or temporarily suspend the registration of a participating insurance carrier that has failed to achieve established standards for quality, access or the reporting of information as provided in the contract;

†††† 3.  Require a member of the group who is seeking to withdraw from membership to pay the agreed upon membership fee for the balance of the contract period;

†††† 4.  Establish uniform standards for collecting data to evaluate the performance of participating carriers; and

†††† 5.  Negotiate the component for administrative expenses of their premium rates with participating carriers.

†††† (Added to NAC by Commír of Insurance, eff. 3-5-96)

††††† NAC 689C.370  Prohibited acts. (NRS 679B.130, 689C.600)  A voluntary purchasing group shall not:

†††† 1.  Purchase health care services for its enrollees or otherwise assume the related financial risk;

†††† 2.  Exclude any eligible small employer that is willing to accept the rules and bylaws of membership;

†††† 3.  Commit an act that constitutes a rebate as prohibited by NRS 686A.110;

†††† 4.  Charge fees that are not directly related to the operations of the group or for activities that are not related to health care;

†††† 5.  Require small employers to subscribe to a limited benefit insurance or products or services not related to health care; or

†††† 6.  Operate the group in a manner that excludes those small businesses that may have higher than average health care costs.

†††† (Added to NAC by Commír of Insurance, eff. 3-5-96)

††††† NAC 689C.380  Provisions of contract with participating carrier: Payment of premiums. (NRS 679B.130, 689C.600)  Each contract between a voluntary purchasing group and a participating carrier must include a provision which sets forth:

†††† 1.  A statement of how the premiums are to be paid;

†††† 2.  The grace period after the date the payment of premiums becomes due; and

†††† 3.  The specific penalties for late payment.

†††† (Added to NAC by Commír of Insurance, eff. 3-5-96)

††††† NAC 689C.390  Provisions of contract with participating small employer: Group as policyholder of record; issuance of certificates of coverage; coverage through group required. (NRS 679B.130, 689C.600)  Each contract between a voluntary purchasing group and a participating small employer must provide that:

†††† 1.  For administrative purposes, the group is the policyholder of record for health care contracts on behalf of the small employer;

†††† 2.  Participating carriers shall issue certificates of coverage; and

†††† 3.  Eligible employees of small employers who buy coverage through their employer must obtain the coverage through the group.

†††† (Added to NAC by Commír of Insurance, eff. 3-5-96)

††††† NAC 689C.400  Establishment of standards and guidelines for insurers. (NRS 679B.130, 689C.600)  A voluntary purchasing group shall establish standards and guidelines for compliance by insurers which will enable the group to conduct its business, meet its reporting obligations and offer contracts for health care coverage to its members.

†††† (Added to NAC by Commír of Insurance, eff. 3-5-96)

††††† NAC 689C.410  Establishment of marketing standards and approval of marketing materials. (NRS 679B.130, 689C.600)  The voluntary purchasing group shall establish marketing standards for participating carriers and approve all marketing materials before use.

†††† (Added to NAC by Commír of Insurance, eff. 3-5-96)

††††† NAC 689C.420  Board of directors and management personnel: Duties. (NRS 679B.130, 689C.600)  The board of directors and management personnel of a voluntary purchasing group shall:

†††† 1.  Operate the voluntary purchasing group;

†††† 2.  Publish the requirements that carriers must meet to participate in the group;

†††† 3.  Contract with at least three unaffiliated carriers to create a choice of contracts at a range of premiums with a difference of at least 20 percent between the premiums for the most comprehensive plan and the least comprehensive plan. The Commissioner will waive this condition upon demonstration of good cause;

†††† 4.  Develop standard procedures for enrollment;

†††† 5.  Include a provision for the prepayment of premiums;

†††† 6.  Act on all grievances received from small employers, review information and recommendations received from participants and enrollees, and take appropriate actions;

†††† 7.  Establish procedures for billing and collecting premiums from participating small employers;

†††† 8.  Establish procedures for periods of open enrollment during which enrollees may choose any contract available through the group; and

†††† 9.  Offer the same premiums on each contract to all classes of members.

†††† (Added to NAC by Commír of Insurance, eff. 3-5-96)

††††† NAC 689C.430  Board members and management personnel: Prohibited acts. (NRS 679B.130, 689C.600)  No board members or management personnel of the voluntary purchasing group and their immediate families may, in any capacity:

†††† 1.  Receive remuneration of any kind from any carrier;

†††† 2.  Provide representation for any insurance agent, broker or insurance consultant;

†††† 3.  Be licensed as an insurance agent, broker, third-party administrator or insurance consultant; or

†††† 4.  Have a direct or indirect financial interest in any person licensed, certified or registered pursuant to title 57 of NRS.

†††† (Added to NAC by Commír of Insurance, eff. 3-5-96)

††††† NAC 689C.440  Report of suspected violation. (NRS 679B.130, 689C.600)  A voluntary purchasing group shall report to the Commissioner any suspected violation of law or regulation relating to any transaction between the group and insurers who offer policies for group health insurance.

†††† (Added to NAC by Commír of Insurance, eff. 3-5-96)

††††† NAC 689C.450  Insolvency of voluntary purchasing group: Jurisdiction of Commissioner. (NRS 679B.130, 689C.600)  If a voluntary purchasing group becomes insolvent, the Commissioner will maintain jurisdiction over the group to protect the interests of the enrollees in the group.

†††† (Added to NAC by Commír of Insurance, eff. 3-5-96)