AB 170 — Revises provisions relating to health insurance coverage. (BDR 57-278)

and (4) The average period between when a covered person reports difficulty accessing health care services to the resolution of the case by a navigator, case manager or facilitator.

Sec.Sections 5 and 6.

5.

6.

(Deleted by amendment.) Sec.

- *AB170_R2* – 4 – Sec.

2.purposes of the network plan between a participating provider ofr the health care and the health carrier complies with the requirements set forth in NRS 687B.600 to 687B.850, inclusive [;] , and section 4.5 of this act;

As applicable, ensure that each contract entered into for the purposes of the network plan between a participating provider of health care and the health carrier complies with the requirements set forth in NRS 687B.600 to 687B.850, inclusive [;] , and section 4.5 of this act;

- 80th Session (2019) – 4 – 2.

At the time a participating provider of health care signs a contract described in subsection 1, the health carrier and, if applicable, the intermediary shall notify the participating provider of health care of all provisions of the contract and all documents inc3.porWhile a contract described in subsection 1 is in force, the health carrier shall provide timely notice to the participating contract or the documents incorporated by reference in the contract that would result in a material change in the contract.

4.3.

ForWhile a contract described in subsection 1 is in force, the health carrier shall provide timely notice to the participating provider of health care of any changes to the provisions of the contract or the documents incorporated by reference in the contract tha4.wouFor the purposes of subsection 3, the contract must define what is to be considered timely notice and what is to be considered a material change.

and - *AB170_R2* – 5 – (d) Any increased risk for illness, injury or any other medical condition of the person, including, without limitation, any medical condition caused by an act of domestic violence.

(a) Deny, limit or exclude a covered benefit based on the health status of an insured;

or covered benefit based on the (b) Require an insured, as a condition of enrollment or renewal, to pay a premium, deductible, copay or coinsurance based on his or her health status which is greater than the premium, deductible, copay or coinsurance charged to a similarly situated insured who does not have such a health status.

- 80th Session (2019) – 5 – Sec.

689A.330 If 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 7 of this act.

689A.417Sec. NR1.

Except9. as otherwise provided in subsection 2, an insurer who provides health insurance shall not:

(a)NRS Require689A.417 anis insuredhereby personamended or any member of the family of the insured person to takeread aas geneticfollows: test;

an insurer who provides health insurance shall not:subsection 2, (a) Require an insured person or any member of the family of the insured person to take a genetic test;

The provisions of this section do not apply to an insurer who issues a policy of health insurance that provides coverage for long-long-term term care or disability income.

- *AB170_R2* – 6 – (a) “Genetic information” means any information that is obtained from a genetic test.

(b) “Genetic test” means a test, including a laboratory test that uses deoxyribonucleic acid extracted from the cells of a person or a diagnostic test, to determine the presence of abnormalities or deficiencies, including carrier status, that:

- 80th Session (2019) – 6 – (b) Require an insured person to disclose whether the insured person or any member of the family of the insured person has taken a genetic test or any genetic information of the insured person or a member of the family of the insured person;

or member(2) ofAny thegenetic familyinformation of the insured person.]ured person or any 2.mem2.

The provisions of this section do not apply to an insurer who long-termissues carea orpolicy disabilityof income.rancegroup health insurance that provides coverage for 3.long-term care or disability income.

3.

An insurer shall provide to each policyholder, or producer of insurance acting on behalf of a policyholder, on a form approved by the Commissioner, a summary of the coverage provided by each policy of group or blanket health insurance offered by (a) Significant exception, reduction or limitation that applies to the insurer.policy;

The summary must disclose any:

- *AB170_R2* – 7 – (a) Significant exception, reduction or limitation that applies to the policy;

The disclosure must state that it is only a summary of the policy and - 80th Session (2019) – 7 – that the policy should be read to ascertain the governing contractual provisions.

The insurer shall provide the summary before the policy is issued.issSec.

Sec.

689B.500 [A carrier that issues a group health plan or coverage under blanket accident and health insurance or group healthoveragehealth insurance shall not deny, exclude or limit a benefit for a preexisting con1.tioAcondition.] carrier1. shall offer and issue a health benefit plan to any group regardless of the health status of the group, any member of the group or any dependent of a member of the group.

A carrier shall offer and issue a health benefit plan to any group regardless of the health status of the group, any member of the group or any dependent of a member of the group.

(a) Deny, limit or exclude a covered benefit based on the health status of an insured;

or covered benefit based on the (b) Require an insured, as a condition of enrollment or renewal, to pay a premium, deductible, copay or coinsurance - *AB170_R2* – 8 – based on his or her health status which is greater than the premium, deductible, copay or coinsurance charged to a similarly situated insured who does not have such a health status.

- 80th Session (2019) – 8 – (a) An insured who is eligible to participate in the wellness program is given the opportunity to qualify for the discount at least once each year;

(c) The wellness program is reasonably designed to promote hea(d) The carrier ensures that the full discount under the wellness program is available to all similarly situated insureds by providing a reasonable alternative standard by which an insured may qualify for the discount which, if based on health orstatus, preventmust disease;accommodate the recommendations of the physician of the insured;

(d)and (e) The carrierplan ensuresdiscloses thatin theall fullplan discountmaterials underdescribing the terms of the wellness programprogram, isand availablein toany alldisclosure similarlythat situatedan insuredsinsured bydid providingnot asatisfy reasonablethe alternativeinitial standard byto whichbe aneligible insuredfor accommodatethe discount, the recommendationsavailability of thea physicianreasonable ofalternative thestatus,standard mustdescribed insured;in paragraph (d).

and terms of the wellness program, and in any disclosure that anhe insured did not satisfy the initial standard to be eligible for the discount, the availability of a reasonable alternative standard described in paragraph (d).

2.accident and health insurance or group health insurance pursuant to this chapter shall not establish rules of eligibility [,] which conflict with the provisions of NRS 689B.500, including rules which define applicable waiting periods, for the initial or continued enrollment under a group health plan offered by the carrier that are based on the following factors relating to the employee or a dependent of the employee:

A carrier that offers coverage under a policy of blanket accident and health insurance or group health insurance pursuant to this chapter shall not establish rules of eligibility [,] which conflict with the provisions of NRS 689B.500, including rules which define applicable waiting periods, for the initial or continued enrollment under a group health plan offered by the carrier that are based on the - *AB170_R2* – 9 – following factors relating to the employee or a dependent of the employee:

- 80th Session (2019) – 9 – (f) Genetic information.

(a) Require a carrier to provide particular benefits other than those that would otherwise be provided under the terms of the blanket health and accident insurance or group health insurance or coverage;cov(b) Prevent a carrier from establishing limitations or restrictions on the amount, level, extent or nature of the benefits or coverage for similarly situated persons.

or (b) Prevent a carrier from establishing limitations or restrictions on the amount, level, extent or nature of the benefits or coverage for similarly situated persons.

[As a condition of enrollment or continued enrollment under a policy of blanket accident and health insurance or group health insurance, a carrier shall not require an employee to pay a premium or contribution that is greater than the premium or contribution for a similarly situated person covered by similar coverage on the basis of dependentany offactor thedescribed employee.bsectionin subsection 2 in relation to the employee or a 5.]dependent Thisof sectionthe doesemployee. not:

5.] This section does not:

or (c) Preclude a carrier from establishing rules relating to employer contribution or group participation when offering health insuranceinsSec. coverage to small employers in this state.

Sec.

- *AB170_R2* – 10 – Sec.

- 80th Session (2019) – 10 – (a) Any preexisting medical condition of an insured, including, without limitation, any physical or mental illness;

A carrier that offers or issues a health benefit plan shall not:not(a) Deny, limit or exclude a covered benefit based on the health status of an insured;

(a)or Deny,(b) limitRequire an insured, as a condition of enrollment or excluderenewal, to pay a coveredpremium, benefitdeductible, copay or coinsurance based on thehis or her health status ofwhich anis insured;greater than the premium, deductible, copay or coinsurance charged to a similarly situated insured who does not have such a health status.

or3. (b) Require an insured, as a condition of enrollment or renewal, to pay a premium, deductible, copay or coinsurance based on his or her health status which is greater than the premium, deductible, copay or coinsurance charged to a similarly sit3.tedA carrier that offers or issues a health benefit plan shall not adjust a premium, deductible, copay or coinsurance for any or the covered dependent of the insured.ion relating to the insured 4.

A carrier that offers or issues a health benefit plan shall not adjust a premium, deductible, copay or coinsurance for any insured on the basis of genetic information relating to the insured or the covered dependent of the insured.

4.

(b) The amount of all discounts provided pursuant to such a wellness program does not exceed 30 percent, or if the program is designed to prevent or reduce tobacco use, 50 percent, of the cost of coverage for an insured or an insured and his or herherof the cost dependents, as applicable, under the plan;

(d) The carrier ensures that the full discount under the wellness program is available to all similarly situated insureds by providing a reasonable alternative standard by which an insured may qualify for the discount which, if based on health status, must - *AB170_R2* – 11 – accommodate the recommendations of the physician of the insured;

and (e) The plan discloses in all plan materials describing the terms of the wellness program, and in any disclosure that an insured did not satisfy the initial standard to be eligible for the - 80th Session (2019) – 11 – discount, the availability of a reasonable alternative standard described in paragraph (d).

A carrier that offers health insurance coverage to small employers pursuant to this chapter shall not establish rules of eligibility [,] which conflict with the provisions of NRS 689B.550, including, but not limited to, rules which define applicable waiting periods, for the initial or continued enrollment under a health benefit plan offered by the carrier that are based on the following factors relating to the eligible employee or a dependent of the eligible employee:

(b) Medical condition, including physical and mental illnesses, or (c)both. Claims experience.

(c) Claims experience.

(e) Medical history.

Except as otherwise provided in NRS 689C.190, the provisions of subsection 1 do not require a carrier to provide particular benefits other than those that would otherwise be provided underund4. the terms of the health benefit plan or coverage.

4.th[As a condition of enrollment or continued enrollment under a health benefit plan, a carrier shall not require any person to pay a premium or contribution that is greater than the premium or contribution for a similarly situated person covered by similar coverage on the basis of any factor described in subsection 2 in relation to the person or a dependent of the person.

[As a condition of enrollment or continued enrollment under a health benefit plan, a carrier shall not require any person to pay a premium or contribution that is greater than the premium or contribution for a similarly situated person covered by similar coverage on the basis of any factor described in subsection 2 in relation to the person or a dependent of the person.

- *AB170_R2* – 12 – (b) Prevents a carrier from establishing premium discounts or rebates or from modifying otherwise applicable copayments or deductibles in return for adherence by the insured person to programs of health promotion and disease prevention;

or - 80th Session (2019) – 12 – (c) Precludes a carrier from establishing rules relating to employer contribution or group participation when offering health insurance coverage to small employers in this State.

(b) “Group participation” means the minimum number of participants or beneficiaries that must be enrolled in a health benefit planpersons inor relationemployees toof athe specifiedemployer.ntage percentage or number of eligible personsSec. or employees of the employer.

Sec.

(b) Require an insured person to disclose whether the insured person or any member of the family of the insured person has taken a genetic test or any genetic information of the insured person or a mem(c)member Determineof the ratesfamily or any other aspect of the coverage or benefits for health care provided to an insured personperson; based on [:

or (c) Determine the familyrates or any other aspect of the insuredcoverage personor hasbenefits takenfor ahealth geneticcare testprovided .to an insured person based on [:

(1) Whether] whether the insured person or any member of the family of the insured person has taken a genetic test .

3.

As used in this section:

- *AB170_R2* – 13 – Sec.

689C.220 A carrier serving small employers shall not charge adjustments in rates for [claim experience, health status and] - 80th Session (2019) – 13 – duration of coverage or any reason prohibited by NRS 689C.190 to individual employees or dependents.

Such health status includes, without limitation:lim(a) Any preexisting medical condition of the person, including, without limitation, any physical or mental illness;

(a) Any preexisting medical condition of the person, including, without limitation, any physical or mental illness;

(a) Deny, limit or exclude a covered benefit based on the health status of an insured;

or covered benefit based on the (b) Require an insured, as a condition of enrollment or renewal, to pay a premium, deductible, copay or coinsurance based on his or her health status which is greater than the premium, deductible, copay or coinsurance charged to a similarly situated insured who does not have such a health status.

A society that offers or issues a health benefit plan shall not adjust a premium, deductible, copay or coinsurance for any insuredor on the basiscovered dependent of geneticthe informationinsured.ion relating to the insured or4. the covered dependent of the insured.

4.

- *AB170_R2* – 14 – (b) The claims history of the person, including, without limitation, any prior health care services received by the person;

- 80th Session (2019) – 14 – (c) Genetic information relating to the person;

or (b) Require an insured, as a condition of enrollment or renewal, to pay a premium, deductible, copay or coinsurance based on his or her health status which is greater than the premium, deductible, copay or coinsurance charged to a similarly situated insured who does not have such a health status.

(a) An insured who is eligible to participate in the wellness leastprogram onceis eachgiven year;opportunitythe opportunity to qualify for the discount at (b)least Theonce amounteach ofyear; all discounts provided pursuant to such a designed to prevent or reduce tobacco use, 50 percent, of the cost of coverage for an insured or an insured and his or her dependents, as applicable, under the plan;

(c)(b) The amount of all discounts provided pursuant to such a wellness program isdoes reasonablynot exceed 30 percent, or if the program is designed to promoteprevent healthor reduce tobacco use, 50 percent, of the cost of coverage for an insured or preventan disease;insured and his or her dependents, as applicable, under the plan;

(d)(c) The wellness program is reasonably designed to promote hea(d) The insurer ensures that the full discount under the wellness program is available to all similarly situated insureds by providing a reasonable alternative standard by which an insured may qualify for the discount which, if based on health status, must accommodate the recommendations of the physician of the insured;

- *AB170_R2*80th Session (2019) – 15 – Sec.

(b) An adopted child from the date the adoption becomes effective,andective, if the child was not placed in the home before adoption;

and (c) A child placed with the subscriber for the purpose of adoption from the moment of placement as certified by the public or private agency making the placement.

or (c) The date of placement of a child for adoption,  and payments of the required fees, if any, must be furnished to the nonprofit service corporation within 31 days after the date of birth, adoption or placement for adoption in order to have theethe of coverage continue beyond the 31-day period.

children3. placed for adoption consists of coverage of injury or sickness, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities and, within the limits of the policy, necessary transportation costs from place of birth to the nearest specialized treatment center under major medical policies, and with respect to basic policies to the extent such costs are charged by the treatment center.

The coverage for newly born and adopted children and children placed for adoption consists of coverage of injury or sickness, including the necessary care and treatment of medically limits of the policy, necessary transportation costs from place ofhe birth to the nearest specialized treatment center under major medical policies, and with respect to basic policies to the extent such costs are charged by the treatment center.

5.] For covered services provided to the child, the corporation shall reimburse noncontracted providers of health care to an amount equal to the average amount of payment for which the organization - 80th Session (2019) – 16 – has agreements, contracts or arrangements for those covered services.

- *AB170_R2* – 16 – Sec.

695B.2555 A converted contract [must not exclude a preexisting condition not excluded by the group contract, but a converted contract] may provide that any hospital, surgical or medical benefits payable under it may be reduced by the amount of any benefits payable under the group contract after his or her termination.contract year the benefits payable under it, together with the benefits payable under the group contract, must not exceed those that would have been payable if the subscriber’s coverage under the group contract had remained in effect.

A converted contract may provide that during the first contract year the benefits payable under it, together with the benefits payable under the group contract, must not exceed those that would have been payable if the subscriber’s coverage under the group contract had remained in effect.

(1) Whether] whether the insured person or any member of the family of the insured person has taken a genetic test .

or (2) Any genetic information of the insured person or any mem2.member of the family of the insured person.] that issues a policy of health insurance that provides coverage for long-term care or disability income.

The provisions of this section do not apply to a corporation that issues a policy of health insurance that provides coverage for long-term care or disability income.

- 80th Session (2019) – 17 – Sec.

A health maintenance organization shall offer and issue a health benefit plan to any person regardless of the health status of - *AB170_R2* – 17 – the person or any dependent of the person.

(b) The claims history of the person, including, without limitation,lim(c) anyGenetic priorinformation healthrelating careto services received by the person;

(c)and Genetic information relating to the person;

and (d) Any increased risk for illness, injury or any other medical condition of the person, including, without limitation, any medical condition caused by an act of domestic violence.

A health maintenance organization that offers or issues a health benefit plan shall not adjust a premium, deductible, copay or coinsurance for any enrollee on the basis of genetic information relating to the enrollee or the covered dependent of the4.nroA health maintenance organization that offers or issues a health benefit plan may include in the planenrollee. a wellness program status if:es a premium, deductible or copayment based on health (a) An enrollee who is eligible to participate in the wellness program is given the opportunity to qualify for the discount at least once each year;

4.

A health maintenance organization that offers or issues a that reduces a premium, deductible or copayment based on health status if:

(a) An enrollee who is eligible to participate in the wellness program is given the opportunity to qualify for the discount at least once each year;

- 80th Session (2019) – 18 – (d) The health maintenance organization ensures that the full discount under the wellness program is available to all similarly situated enrollees by providing a reasonable alternative standard by which an enrollee may qualify for the discount which, if based on health status, must accommodate the recommendations of the physician of the enrollee;

and - *AB170_R2* – 18 – (e) The plan discloses in all plan materials describing the terms of the wellness program, and in any disclosure that an enrollee did not satisfy the initial standard to be eligible for the discount,described thein availabilityparagraph of(d).of a reasonable alternative standard described5. in paragraph (d).

5.

The provisions of NRS 695C.110, 695C.125, 695C.1691, 695C.173,, 69inclusive,5C695C.1733,C.17695C.17335,0969inclusive,5C.695C.1733,.1705695C.17335, to 695C.1734, 695C.1751, 695C.1755, 695C.176 to 695C.200, inclusive, and 695C.265 do not apply to a health maintenance organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Children’s Health Insurance Program pursuant to a contract with the Division of Health Care Financing and Policy of the Department of Health and Human Services.

The provisions of NRS 695C.1694 to 695C.1698, inclusive, 695C.1708, 695C.1731, 695C.17345, 695C.1735, 695C.1745 and 695C.1757 and section 24 of this act apply to a health maintenance - 80th Session (2019) – 19 – organization that provides health care services through managed care to recipients of Medicaid under the State Plan for Medicaid.

- *AB170_R2* – 19 – (b) An adopted child from the date the adoption becomes effective,andective, if the child was not placed in the home before adoption;

and (c) A child placed with the enrollee for the purpose of adoption from the moment of placement as certified by the public or private agency making the placement.

The coverage for newly born and adopted children and children placed for adoption consists of preventive health care services as well as coverage of injury or sickness, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities and, within the limits of the policy, necessary transportation costs from place of birth to the nearest specialized treatment center under major medical policies, and with respect to basic policies to the extent such costs are charged by the tre4.men[Atreatment healthcenter. maintenance organization shall not restrict the coverage of a dependent child adopted or placed for adoption solely because of a preexisting condition the child has at the time the child would otherwise become eligible for coverage pursuant to that plan.

4.

[A health maintenance organization shall not restrict the coverage of a dependent child adopted or placed for adoption solely because of a preexisting condition the child has at the time the child would otherwise become eligible for coverage pursuant to that plan.

5.] For covered services provided to the child, the health maintenance organization shall reimburse noncontracted providers - 80th Session (2019) – 20 – of health care to an amount equal to the average amount of payment for which the organization has agreements, contracts or arrangements for those covered services.

(b) Require an enrollee to disclose whether the enrollee or any member of the family of the enrollee has taken a genetic test or the - *AB170_R2* – 20 – genetic information of the enrollee or a member of the family of the enrollee;

orrmation of the enrollee or a member of the family of the (c) Determine the rates or any other aspect of the coverage or benefits for health care provided to an enrollee based on [:

695C.330certificate 1.of authority issued to a health maintenance organization pursuant to the provisions of this chapter if the Commissioner finds that any of the following conditions exist:

(a) The Commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization pursuantis tooperating thesignificantly provisionsin contravention of thisits chapterbasic iforganizational thedocument, Commissionerits findshealth tha(a)care Thefplan thhealthowmaintenanceonsor organizationin isa operatingmanner significantlycontrary into contraventionthat ofdescribed itsin basicand organizational document, reasonably inferred from any other information submitted pursuant and 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 - 80th Session (2019) – 21 – which do not comply with the requirements of NRS 695C.1691 to 695C.200, inclusive, and section 24 of this act, or 695C.207;

or (2) Is unable to fulfill its obligations to furnish health care servicesser(e) asThe requiredhealth undermaintenance organization is no longer financially responsible and may reasonably be expected to be unable to meet its healthobligations careto plan;enrollees or prospective enrollees;

- *AB170_R2* – 21 – (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;

(i) The continued operation of the health maintenance organization would be hazardous to its enrollees or creditors or to the(j) The health maintenance organization fails to provide the generalcoverage public;required by NRS 695C.1691;

(j)or (k) The health maintenance organization failshas otherwise failed to providecomply thesubstantially coveragewith requiredthe byprovisions NRSof 695C.1691;this chapter.

or2. (k) The health maintenance organization has otherwise failed to com2.y sA certificate of authority must be suspended or revoked only after compliance with the requirements of NRS 695C.340.

organizationA iscertificate suspended, the health maintenance organization shall not, during the period of thatauthority suspension,must enrollbe anysuspended additional groups or newrevoked individualonly contracts,after unlesscompliance thosewith groups or persons were contracted for before the daterequirements of suspension.NRS 695C.340.

3.

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.

If the certificate of authority of a health maintenance organization is revoked, the organization shall proceed, immediately - 80th Session (2019) – 22 – 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.

-thereto *AB170_R2*a –new 22section –to Sec.read as follows:

29.amended by adding 1.

Chapter 695F of NRS is hereby amended by adding thereto a new section to read as follows:

1.

or (b) Require an enrollee, as a condition of enrollment or renewal, to pay a premium, deductible, copay or coinsurance based on his or her health status which is greater than the premium, deductible, copay or coinsurance charged to a similarly situated enrollee who does not have such a health status.

issues3. a health benefit plan shall not adjust a premium, deductible, copay or coinsurance for any enrollee on the basis of genetic the enrollee.elating to the enrollee or the covered dependent of 4.

A prepaid limited health service organization that offers or issues a health benefit plan shall not adjust a premium, deductible, copay or coinsurance for any enrollee on the basis of genetic information relating to the enrollee or the covered dependent of the enrollee.

4.

- 80th Session (2019) – 23 – (a) An enrollee who is eligible to participate in the wellness program is given the opportunity to qualify for the discount at least once each year;

(c) The wellness program is reasonably designed to promote hea(d) The prepaid limited health orservice preventorganization disease;ensures that the full discount under the wellness program is available to all similarly situated enrollees by providing a reasonable alternative standard by which an enrollee may qualify for the discount which, if based on health status, must accommodate the recommendations of the physician of the enrollee;

(d) The prepaid limited health service organization ensures that the full discount under the wellness program is available to all similarly situated enrollees by providing a reasonable - *AB170_R2* – 23 – alternative standard by which an enrollee may qualify for the discount which, if based on health status, must accommodate the recommendations of the physician of the enrollee;

(a)without Anylimitation, preexistingany medicalphysical conditionor mental illness;son, including, (b) The claims history of the person, including, without limitation, any physicalprior orhealth mentalcare illness;services received by the person;

(b) The claims history of the person, including, without limitation, any prior health care services received by the person;

and (d) Any increased risk for illness, injury or any other medical condition of the person, including, without limitation, any medical con2.tioAcondition managedcaused careby organizationan thatact offersof ordomestic issuesviolence. a health benefit plan shall not:

health2. status of an insured;

orA coveredmanaged benefitcare basedorganization onthat theoffers (b) Require an insured, as a condition of enrollment or renewal,issues to pay a premium, deductible, copay or coinsurance based on his or her health statusbenefit whichplan isshall greaternot: than the premium, deductible, copay or coinsurance charged to a similarly situated insured who does not have such a health status.

(a) Deny, limit or exclude a covered benefit based on the health status of an insured;

or (b) Require an insured, as a condition of enrollment or renewal, to pay a premium, deductible, copay or coinsurance - 80th Session (2019) – 24 – based on his or her health status which is greater than the premium, deductible, copay or coinsurance charged to a similarly situated insured who does not have such a health status.

A managed care organization that offers or issues a health benefit plan may include in the plan a wellness program that reducesstatus aif:premium, premium, deductible or copayment based on health status(a) if:An insured who is eligible to participate in the wellness program is given the opportunity to qualify for the discount at least once each year;

(a)(b) AnThe insuredamount whoof isall eligiblediscounts toprovided participatepursuant into thesuch a wellness program isdoes givennot exceed 30 percent, or if the opportunityprogram is designed to qualifyprevent foror reduce tobacco use, 50 percent, of the discountcost atof leastcoverage oncefor eachan year;insured or an insured and his or her dependents, as applicable, under the plan;

- *AB170_R2* – 24 – (b) The amount of all discounts provided pursuant to such a wellness program does not exceed 30 percent, or if the program is designed to prevent or reduce tobacco use, 50 percent, of the cost of coverage for an insured or an insured and his or her dependents, as applicable, under the plan;

and (e) The plan discloses in all plan materials describing the terms of the wellness program, and in any disclosure that an insured did not satisfy the initial standard to be eligible for the discount, the availability of a reasonable alternative standard the described in paragraph (d).

(a) Respond to written and telephonic inquiries received from related to health care and workers’ compensation;s and problems (b) Assist consumers and injured employees inregarding understandingconcerns withoutand limitation,problems therelated Publicto Employees’health Benefitscare Program,and anduding,workers’ policiescompensation; of industrial insurance;

(c)(b) IdentifyAssist and investigate complaints of consumers and injured employees regardingin understanding their rights and responsibilities under health care plans, including, without limitation, the Public Employees’ Benefits Program, and policies of industrial insuranceinsurance; and assist those consumers and injured employees to resolve their complaints, including, without limitation:

- 80th Session (2019) – 25 – (c) Identify and investigate complaints of consumers and injured employees regarding their health care plans, including, without limitation, the Public Employees’ Benefits Program, and policies of industrial insurance and assist those consumers and injured employees to resolve their complaints, including, without limitation:

and (2) Providing counseling and assistance to consumers and injured employees concerning health care plans, including, without limitation, the Public Employees’ Benefits Program, and policies of industrial insurance;

(d) Provide information to consumers and injured employees concerning health care plans, including, without limitation, the - *AB170_R2* – 25 – Public Employees’ Benefits Program, and policies of industrial insurance in this State;

(i) Establish(1) andInformation maintainconcerning anpurchasing Internetprescription websitedrugss: which includes:

(1) Information concerning purchasing prescription drugs from Canadian pharmacies that have been recommended by the State Board of Pharmacy for inclusion on the Internet website pursuant to subsection 4 of NRS 639.2328;

and (3) A link to the website established and maintained pursuant to NRS 439A.270 which provides information to the general public concerning the charges imposed and the quality of the servicesicservices provided by the hospitals and surgical centers for ambulatory pat(j)patients Assistin consumersthis withState; accessing a navigator, case manager or facilitator to help the consumer obtain health care services;

[and] - 80th Session (2019) – 26 – (j) Assist consumers with accessing a navigator, case manager or facilitator to help the consumer obtain health care services;

As used in this paragraph, “health care facility” has the meaning ascribed to it in NRS 162A.740.]162(m) ;Assist consumers with filing complaints with the Commissioner of Insurance against issuers of health care plans;

(m)and Assist(n) consumersOn withor filingbefore complaintsJanuary with31 of each year, compile a report of aggregated information submitted to the CommissionerOffice for Consumer Health Assistance pursuant to section 4.5 of Insurancethis againstact, issuersaggregated for each type of provider of health care plans;for which such information is provided and submit the report to the Director of the Legislative Counsel Bureau for transmittal to:

and (n) On or before January 31 of each year, compile a report of aggregated information submitted to the Office for Consumer Health Assistance pursuant to section 4.5 of this act, aggregated for each type of provider of health care for which such - *AB170_R2* – 26 – information is provided and submit the report to the Director of the Legislative Counsel Bureau for transmittal to:

(b) “Navigator, case manager or facilitator” has the meaning ascribedascSec. to it in section 4.5 of this act.

Sec.

(a) Adopt and carry into effect a system of group life, accident or health insurance, or any combination thereof, for the benefit of its officers and employees, and the dependents of officers and employees who elect to accept the insurance and who, where necessary, have authorized the governing body to make deductions from their compensation for the payment of premiums on the insurance.

compensation- for80th theSession payment(2019) of– premiums27 on– the (b) Purchase group policies of life, accident or health insurance, or any combination thereof, for the benefit of such officers and employees, and the dependents of such officers and employees, as have authorized the purchase, from insurance companies authorized to transact the business of such insurance in the State of Nevada, and, where necessary, deduct from the compensation of officers and employees the premiums upon insurance and pay the deductions upon the premiums.

(c) Provide group life, accident or health coverage through a self-insurance reserve fund and, where necessary, deduct contributions to the maintenance of the fund from the compensationcompensationt of officers and employees and pay the deductions into the fund.

Any contract - *AB170_R2* – 27 – with an independent administrator must be approved by the Commissioner of Insurance as to the reasonableness of administrative charges in relation to contributions collected and benefits provided.

(d) Defray part or all of the cost of maintenance of a self- insurance fund or of the premiums upon insurance.

In any county in which a legal services organization exists, the governing body of the county, or of any school district, - 80th Session (2019) – 28 – municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada in theionthe or county, may enter into a contract with the legal services organization pursuant to which the officers and employees of the legal services organization, and the dependents of those officers and employees, are eligible for any life, accident or health insurance provided pursuant to this section to the officers and employees, and the dependents of the officers and employees, of the county, school district, municipal corporation, political subdivision, public corporationcor4.ratIf ora othercontract localis governmentalentered agency.into pursuant to subsection 3, the officers and employees of the legal services organization:

4.

If a contract is entered into pursuant to subsection 3, the officers and employees of the legal services organization:

- *AB170_R2* – 28 – (a) Must be submitted to the Commissioner of Insurance for approval not less than 30 days before the date on which the contract is to become effective.

As used in this section, “legal services organization” means an organization that operates a program for legal aid and receives money pursuant to NRS 19.031.

a program for legal aid and receives Sec.

A public officer or employee of any county, school district, municipal corporation, political subdivision, public corporation or other local governmental agency of the State of Nevada who has retired pursuant to NRS 1A.350 or 1A.480, or 286.510 or 286.620, or is enrolled in a retirement program provided pursuant to NRS 286.802, or the surviving spouse of such a retired public officer or employee who is deceased, may, except as otherwise provided in NRS 287.0475, in any even-numbered year, reinstate any insurance, except life insurance, that, at the time of reinstatement, is provided by the last public employer of the retired - 80th Session (2019) – 29 – public officer or employee to the active officers and employees and the(a)their Pursuantdependents to NRS 287.010, 287.015, 287.020 or paragraph (b), (c) or (d) of subsectionthat 1public ofemployer: NRS 287.025;

or(a) publicPursuant employerto ofNRS the287.010, retired287.015, officer287.020 or employeeparagraph participates(b), in(c) theor Public(d) Employees’ Benefits Program pursuant to paragraph (a) of subsection 1 of NRS 287.025.287.025;

or (b) Under the Public Employees’ Benefits Program, if the last public employer of the retired officer or employee participates in the Public Employees’ Benefits Program pursuant to paragraph (a) of subsection 1 of NRS 287.025.

Reinstatement pursuant to paragraph (a) of subsection 1 mustmus(a) beGiving requestedwritten by:notice of the intent of the public officer or employee or surviving spouse to reinstate the insurance to the last public employer of the public officer or employee not later than January 31 of an even-numbered year;

(a) Giving written notice of the intent of the public officer or employee or surviving spouse to reinstate the insurance to the last public employer of the public officer or employee not later than January 31 of an even-numbered year;

and (c) Except as otherwise provided in paragraph (b) of subsection 4 of NRS 287.023, paying any portion of the premiums or contributions of the public employer’s program or plan of insurance, in the manner set forth in NRS 1A.470 or 286.615, which is due from the date of reinstatement and not paid by the public employer.

 The last public employer shall give the insurer notice of the reinstatement not later than March 31 of the year in which the public - *AB170_R2* – 29 – officer or employee or surviving spouse gives notice of the intent to reinstate the insurance.

[If a plan is considered grandfathered under the Patient Protection and Affordable Care Act, Public Law 111-148, reinstatement of insurance pursuant to subsection 1 may exclude claims for expenses for any condition for which medical advice, treatment or consultation was rendered within 12 months before reinstatement unless the reinstated insurance has been in effect more than 12 consecutive months.] If a plan provides coverage only to retired public officers and employees and dependents thereof, reinstatement of insurance pursuant to subsection 1 may exclude claims for expenses related to any condition for which medical advice, treatment or consultation was rendered within 12 months before the reinstatement.

The last public employer of a retired officer or employee who reinstates insurance, except life insurance, which was provided to the retired officer or employee and the retired officer’s or employee’s dependents at the time of retirement pursuant to - 80th Session (2019) – 30 – NRS 287.010, 287.015, 287.020 or paragraph (b), (c) or (d) of subsection 1 of NRS 287.025 shall, for the purpose of establishing actuarial data to determine rates and coverage for such persons, commingle the claims experience of such persons with the claims experience of active and retired officers and employees and their dependents whofwho participate in that group insurance, plan of benefits or medical and hosSec.hospital service.

Sec.

287.04335 If the Board provides health insurance through a plan of self-insurance, it shall comply with the provisions of NRS 687B.409, 689B.255, 695G.150, 695G.160, 695G.162, 695G.164, 695G.1645, 695G.1665, 695G.167, 695G.170 to 695G.173, inclusive, 695G.177, 695G.200 to 695G.230, inclusive, 695G.241 to 695G.310, inclusive, and 695G.405, and section 30 of this act in the same manner as an insurer that is licensed pursuant to title 57 of NRS is required to comply with those provisions.

Section 4.5 of this act becomes effective on [the date on which the provisions of the Patient Protection and - *AB170_R2* – 30 – Affordable Care Act, Public Law 111-148, cease to allow a grandfathered health plan to exclude claims for preexisting medical conditions.] January 1, 2020.

The provisions of sections 7, 12, 15, 19, 20, 24, 29 and 30 of this act apply to any contract, agreement, network plan, policy of health insurance, policy of group health insurance, health benefit plan, benefit contract, contract for hospital or medical service and health care plan that is delivered, issued for delivery or renewed on or after January 1, 2020.

and - 80th Session (2019) – 31 – 2.

LEADLINES~~~~~ OF19 REPEALED- SECTIONS80th 689A.523Session “Exclusion(2019) for a preexisting condition” defined.

689A.585 “Preexisting condition” defined.

689B.450 “Preexisting condition” defined.

689C.082 “Preexisting condition” defined.

695A.159 Society prohibited from restricting coverage of child based on preexisting condition when person who is eligible for group coverage adopts or assumes legal obligation for child.

695F.480 Organization prohibited from restricting coverage of child based on preexisting condition if person who is eligible for group coverage adopts or assumes legal obligation for child.

H - *AB170_R2*