SUMMARY--Requires certain policies of health insurance to include coverage for management and treatment of diabetes. (BDR 57-1703)
FISCAL NOTE: Effect on Local Government: Yes.
Effect on the State or on Industrial Insurance: No.
EXPLANATION - Matter in italics is new; matter in brackets [ ] is material to be omitted.
AN ACT relating to health insurance; requiring certain policies of health insurance to include coverage for the management and treatment of diabetes; providing a penalty; and providing other matters properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1 Chapter 689A of NRS is hereby amended by adding thereto a new section to read as follows:
1. No policy of health insurance that provides coverage for hospital, medical or surgical expenses may be delivered or issued for delivery in this state unless the policy includes coverage for the management and treatment of diabetes.
2. An insurer who delivers or issues for delivery a policy specified in subsection 1:
(a) Shall notify each person insured under the policy of the availability of coverage for the management and treatment of diabetes pursuant to this section.
(b) Shall not deny, limit or exclude coverage or increase the amount of a copayment or impose an additional copayment under the policy:
(1) For a preexisting diabetic condition of a person insured under the policy; or
(2) As a result of providing coverage pursuant to this section.
3. A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1997, has the legal effect of including the coverage required by this section, and any provision of the policy that conflicts with this section is void.
4. As used in this section, "coverage for the management and treatment of diabetes" includes coverage for:
(a) Any training or instruction required by the insured person to ensure that he is able to treat his diabetes safely during any period that he is an outpatient after receiving hospital, medical or surgical services pursuant to a policy specified in subsection 1; and
(b) Any monitors, syringes, pumps, medication or any other materials, supplies or equipment required by the insured for the treatment of his diabetes.
Sec. 2 NRS 689A.330 is hereby amended to read as follows:
689A.330If any policy is issued by a domestic insurer for delivery to a person residing in another state, and if the insurance commissioner or corresponding public officer of that other state has informed the commissioner that the policy is not subject to approval or disapproval by that officer, the commissioner may by ruling require that the policy meet the standards set forth in NRS 689A.030 to 689A.320, inclusive [.] , and section 1 of this act.
Sec. 3 Chapter 689B of NRS is hereby amended by adding thereto a new section to read as follows:
1. No group policy of health insurance that provides coverage for hospital, medical or surgical expenses may be delivered or issued for delivery in this state unless the policy includes coverage for the management and treatment of diabetes.
2. An insurer who delivers or issues for delivery a policy specified in subsection 1:
(a) Shall notify each employee or member of the insured group of the availability of coverage for the management and treatment of diabetes pursuant to this section.
(b) Shall not deny, limit or exclude coverage or increase the amount of a copayment or impose an additional copayment under the policy:
(1) For a preexisting diabetic condition of an employee or member of the insured group; or
(2) As a result of providing coverage pursuant to this section.
3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1997, has the legal effect of including the coverage required by this section, and any provision of the policy that conflicts with this section is void.
4. As used in this section, "coverage for the management and treatment of diabetes" includes:
(a) Any training or instruction required by an employee or member of the insured group to ensure that he is able to treat his diabetes safely during any period that he is an outpatient after receiving hospital, medical or surgical services pursuant to a policy specified in subsection 1; and
(b) Any monitors, syringes, pumps, medication or any other materials, supplies or equipment required by the employee or member for the treatment of his diabetes.
Sec. 4 Chapter 695B of NRS is hereby amended by adding thereto a new section to read as follows:
1. No contract for hospital or medical service that provides coverage for hospital, medical or surgical expenses may be delivered or issued for delivery in this state unless the contract includes coverage for the management and treatment of diabetes.
2. An insurer who delivers or issues for delivery a contract specified in subsection 1:
(a) Shall notify each person covered under the contract of the availability of coverage for the management and treatment of diabetes pursuant to this section.
(b) Shall not deny, limit or exclude coverage or increase the amount of a copayment or impose an additional copayment under the contract:
(1) For a preexisting diabetic condition of a person covered under the contract; or
(2) As a result of providing coverage pursuant to this section.
3. A contract for hospital or medical service subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1997, has the legal effect of including the coverage required by this section, and any provision of the contract that conflicts with this section is void.
4. As used in this section, "coverage for the management and treatment of diabetes" includes coverage for:
(a) Any training or instruction required by a person covered under the contract to ensure that he is able to treat his diabetes safely during any period that he is an outpatient after receiving hospital, medical or surgical services pursuant to the contract; and
(b) Any monitors, syringes, pumps, medication or any other materials, supplies or equipment required by the person for the treatment of his diabetes.
Sec. 5 Chapter 695C of NRS is hereby amended by adding thereto a new section to read as follows:
1. No evidence of coverage that provides coverage for hospital, medical or surgical expenses may be delivered or issued for delivery in this state unless the evidence of coverage includes coverage for the management and treatment of diabetes.
2. An insurer who delivers or issues for delivery an evidence of coverage specified in subsection 1:
(a) Shall notify each enrollee of the availability of coverage for the management and treatment of diabetes pursuant to this section.
(b) Shall not deny, limit or exclude coverage or increase the amount of a copayment or impose an additional copayment under the evidence of coverage:
(1) For a preexisting diabetic condition of an enrollee; or
(2) As a result of providing coverage pursuant to this section.
3. Evidence of coverage subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1997, has the legal effect of including the coverage required by this section, and any provision of the evidence of coverage that conflicts with this section is void.
4. As used in this section, "coverage for the management and treatment of diabetes" includes coverage for:
(a) Any training or instruction required by an enrollee to ensure that he is able to treat his diabetes safely during any period that he is an outpatient after receiving hospital, medical or surgical services pursuant to an evidence of coverage specified in subsection 1; and
(b) Any monitors, syringes, pumps, medication or any other materials, supplies or equipment required by the enrollee for the treatment of his diabetes.
Sec. 6 NRS 695C.330 is hereby amended to read as follows:
695C.3301. The commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization [under] pursuant to the provisions of this chapter if he finds that any of the following conditions exist:
(a) The health maintenance organization is operating significantly in contravention of its basic organizational document, its health care plan or in a manner contrary to that described in and reasonably inferred from any other information submitted [under] pursuant to NRS 695C.060, 695C.070 and 695C.140, unless any amendments to those submissions have been filed with and approved by the commissioner;
(b) The health maintenance organization issues evidence of coverage or uses a schedule of charges for health care services which do not comply with the requirements of NRS 695C.170 to 695C.200, inclusive [;] , or section 5 of this act;
(c) The health care plan does not furnish comprehensive health care services as provided for in subsection 2 of NRS 695C.030;
(d) The state board of health certifies to the commissioner that:
(1) The health maintenance organization does not meet the requirements of subsection 2 of NRS 695C.080; or
(2) The health maintenance organization is unable to fulfill its obligations to furnish health care services as required under its health care plan;
(e) The health maintenance organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees;
(f) The health maintenance organization has failed to put into effect a mechanism affording the enrollees an opportunity to participate in matters relating to the content of programs [under] pursuant to NRS 695C.110;
(g) The health maintenance organization has failed to put into effect the system for complaints required by NRS 695C.260 in a manner reasonably to dispose of valid complaints;
(h) The health maintenance organization or any person on its behalf has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive or unfair manner;
(i) The continued operation of the health maintenance organization would be hazardous to its enrollees; or
(j) The health maintenance organization has otherwise failed to [substantially] comply substantially with the provisions of this chapter.
2. A certificate of authority must be suspended or revoked only after compliance with the requirements of NRS 695C.340.
3. [When] If the certificate of authority of a health maintenance organization is suspended, the health maintenance organization shall not, during the period of that suspension, enroll any additional groups or new individual contracts, unless those groups or persons were contracted for before the date of suspension.
4. [When] If the certificate of authority of a health maintenance organization is revoked, the organization shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs and shall conduct no further business except as may be essential to the orderly conclusion of the affairs of the organization. It shall engage in no further advertising or solicitation [whatsoever.] of any kind. The commissioner may by written order permit such further operation of the organization as he may find to be in the best interest of enrollees to the end that enrollees [will be] are afforded the greatest practical opportunity to obtain continuing coverage for health care.
Sec. 7 The provisions of subsection 1 of NRS 354.599 do not apply to any additional expenses of a local government that are related to the provisions of this act.