AB 436 — Revises provisions relating to vision insurance. (BDR 57-808)

(ReprintedAssembly withBill amendmentsNo. adopted on April 19, 2021) FIRST REPRINT A.B.

436436–Committee Aon SSEMBLYCommerce Band ILLNLabor O.CHAPTER..........

436–COMMITTEE ON C OMMERCE AND LABOR M ARCH 26, 2021 ____________ Referred to Committee on Commerce and Labor SUMMARY—Revises provisions relating to vision insurance.

(BDR 57-808) FISCAL NOTE:

Effect on Local Government:

May have Fiscal Impact.

Effect on the State:

Yes.

~ EXPLANATION – Matter in bolded italics is new;

matter between brackets [omitted material] is material to be omitted.

Specifically, section 2 authorizes the Commissioner to hold a hearing if he or she has cause to believe that a violation of has occurred and the insurer in violation knew or should have known of thea violation - *AB436_R1* – 2 – violation, section 3 authorizes the Commissioner to impose an administrative penalty or take action against the license of the insurer.

Sections 4-9 of this bill provide that certain entities that provide vision coverage, including local governments and the Public Employees’ Benefits Program, are subject to thelthe provisions of section 1.

EXPLANATION – Matter in bolded italics is new;

matter between brackets [omitted material] is material to be omitted.

An insurer shall not enter into a contract with a provider of vision care that conditions any rate of reimbursement for vision care on the provider of vision care prescribing ophthalmic devices - 81st Session (2021) – 2 – or materials in which the insurer has an ownership or other pecuniary interest or increases the rate of reimbursement if the provider of vision care prescribes such ophthalmic devices or materials.

2.care to include the provider of vision care in the network of an insurer, the insurer must provide to the provider of vision care a list of the rates of reimbursement for each service covered by the contract.

Before entering into a contract with a provider of vision care to include the provider of vision care in the network of an insurer, the insurer must provide to the provider of vision care a list of the rates of reimbursement for each service covered by the contract.

An insurer that does not provide reimbursement for specific vision care shall not claim in any advertisement or other material that the insurer covers that vision care orif that such vision care is available at a discount or with a copayment or coinsurance in an amount that is in addition to the copayment or coinsurance that a covered person is typically required to pay for covered services.

(1) Routine ophthalmological evaluation of the eye, includinginclud(2) refraction.Ophthalmic devices or materials, including, without limitation, lenses, frames, mountings or other specially fabricated ophthalmic devices.

(2) OphthalmicThe devicesterm or“vision materials,care” including,does withoutnot limitation,include lenses,the frames,initiation mountingsof treatment or otherdiagnosis speciallypursuant fabricatedto ophthalmica devices.program of medical care.

- *AB436_R1* – 3 –  The term “vision care” does not include the initiation of treatment or diagnosis pursuant to a program of medical care.

The statement of charges and notice of hearing shall comply with the requirements of - 81st Session (2021) – 3 – NRS 679B.320 and shall be served upon such person directly or by certified or registered mail, return receipt requested.

After the hearing provided for in NRS 686A.160, the Commissioner shall issue an order on hearing pursuant to NRS 679B.360.

(b) Suspension or revocation of the person’s license if the person knew or reasonably should have known that he or she was in violation of NRS 686A.010 to 686A.310, inclusive [.] , and section 1 of this act.

Until the expiration of the time allowed for taking an appeal, pursuant to NRS 679B.370, if no petition for review has been filed within that time, or, if a petition for review has been filed within that time, until the official record in the proceeding has been filed with the court, the Commissioner may, at any time, upon such notice and in such manner as the Commissioner deems proper, modify or set aside, in whole or in part, any order issued by him or her under this section.

After the expiration of the time allowed for taking an appeal, if no petition for review has been filed, the Commissioner may at any time, after notice and opportunity for hearing, reopen and alter, - *AB436_R1* – 4 – modify or set aside, in whole or in part, any order issued by him or her under this section whenever in the opinion of the Commissioner conditions of fact or of law have so changed as to require such action or if the public interest so requires.

- 81st Session (2021) – 4 – 2.

695B.320corporations 1.are subject to the provisions of this chapter, and to the provisions of chapters 679A and 679B of NRS, NRS 686A.010 to 686A.315, inclusive, and section 1 of this act, 687B.010 to 687B.040, inclusive, 687B.070 to 687B.140, inclusive, 687B.150, 687B.160, 687B.180, 687B.200 to 687B.255, inclusive, 687B.270, 687B.310 to 687B.380, inclusive, 687B.410, 687B.420, 687B.430, 687B.500 and chapters 692B, 692C, 693A and 696B of NRS, to the extent applicable and not in conflict with the express provisions of this chapter.

Nonprofit hospital and medical or dental service corporations are subject to the provisions of this chapter, and to the provisions of chapters 679A and 679B of NRS, NRS 686A.010 to 686A.315, inclusive, and section 1 of this act, 687B.010 to 687B.040, inclusive, 687B.070 to 687B.140, inclusive, 687B.150, 687B.160, 687B.180, 687B.200 to 687B.255, inclusive, 687B.270, 687B.310 to 687B.380, inclusive, 687B.410, 687B.420, 687B.430, 687B.500 and chapters 692B, 692C, 693A and 696B of NRS, to the extent applicable and not in conflict with the express provisions of this chapter.

(b) A statement or item of information shall be deemed to be misleading, whether or not it may be literally untrue if, in the total context in which such statement is made or such item of information is communicated, such statement or item of information may be reasonably understood by a reasonable person not possessing special knowledge regarding health care coverage, as indicating any benefit or advantage or the absence of any exclusion, limitation or disadvantage of possible significance to an enrollee of, or person considering enrollment in, a health care plan if such benefit or - *AB436_R1* – 5 – advantage or absence of limitation, exclusion or disadvantage does not in fact exist.

(c) An evidence of coverage shall be deemed to be deceptive if the evidence of coverage taken as a whole, and with consideration given to typography and format as well as language, shall be such as to cause a reasonable person not possessing special knowledge regarding health care plans and evidences of coverage therefor to - 81st Session (2021) – 5 – expect benefits, services, charges or other advantages which the evidence of coverage does not provide or which the health care plan issuing such evidence of coverage does not regularly make available for enrollees covered under such evidence of coverage.

2.act shall be construed to apply to health maintenance organizations, health care plans and evidences of coverage except to the extent that the nature of health maintenance organizations, health care plans and evidences of coverage render the sections therein clearly inappropriate.

NRS 686A.010 to 686A.310, inclusive, and section 1 of this act shall be construed to apply to health maintenance organizations, health care plans and evidences of coverage except to the extent that the nature of health maintenance organizations, health care plans and evidences of coverage render the sections therein clearly inappropriate.

(a) NRS 687B.310 to 687B.420, inclusive, concerning cancellationcan(b) andNRSon nonrenewalan687B.122ewaltof p687B.128, inclusive, concerning readability of policies.

(b) NRS 687B.122 to 687B.128, inclusive, concerning readability of policies.

- *AB436_R1* – 6 – (h) To the extent applicable, the provisions of NRS 689B.340 to 689B.580, inclusive, and chapter 689C of NRS relating to the portability and availability of health insurance.

(j) NRS 680B.025 to 680B.039, inclusive, concerning premium tax, premium tax rate, annual report and estimated quarterly tax - 81st Session (2021) – 6 – payments.

For the purposes of this subsection, unless the context otherwise requires that a section apply only to insurers, any reference in those sections to “insurer” must be replaced by a reference to “prepaid limited health service organization.” (k)(l) ChapterNRS 692C689A.637, of NRS, concerning holdinghealth companies.centers.companies.

(l) NRS 689A.637, concerning health centers.

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