Nevada Administrative Code Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service
Here’s a polished overview of Nevada Administrative Code – Chapter 695B: Nonprofit Corporations for Hospital, Medical and Dental Service, focusing on administrative regulation—NAC provisions, as distinct from statutes (NRS):
📘 1. General Provisions & Definitions (NAC 695B.002–.006)
NAC 695B.002 defines terms used throughout the chapter, with additional definitions in NAC 695B.004 and NAC 695B.006 (regulations.justia.com).
These provisions ensure consistent interpretation of key terms like “corporation,” “provider,” and “insured.”
🏥 2. Use of Preferred Providers (NAC 695B.010–.020)
NAC 695B.010 – Coinsurance Disclosure
Group contracts offering preferred and non-preferred providers must clearly disclose:
When coinsurance stops for each provider type;
A sample claim calculation using the contract’s chosen method.
The Commissioner will reject any misleading or deceptive disclosure (law.justia.com, law.cornell.edu).
This regulation has been in effect since June 1, 1988, with amendments in June 1990, September 1992, and December 16, 2022 .
NAC 695B.020 – Preferred Provider Program Requirements
Any nonprofit edifice wishing to offer preferred-provider programs under NRS 695B.185 must comply with NAC 689B.120–160 (law.cornell.edu).
These cross-referenced provisions address provider network contracting, marketing, disclosures, claims handling, and oversight.
📝 3. Why These Rules Matter
They ensure transparency in cost-sharing—policyholders see exactly when and how much they owe.
They guard against misleading contract terms by requiring sample calculations and clear cost-sharing thresholds.
They ensure that preferred-provider networks meet uniform regulatory standards for operation and disclosure.
✅ Summary Table
| NAC Section | Subject | Key Takeaways |
|---|---|---|
| 695B.002–.006 | Definitions | Defines key terms consistently across the chapter. |
| 695B.010 | Coinsurance Disclosure | Mandates clear disclosure and sample claim calc; prohibits misleading terms. |
| 695B.020 | Preferred-Provider Programs | Requires compliance with broader network regulations (NAC 689B.120–160). |
📚 Next Steps
Full regulatory text (NAC 695B.002/.010/.020) available via the Nevada Secretary of State or Cornell LII.
If you're drafting or underwriting group contracts with preferred-provider tiers, review NAC 689B.120–160 closely.
For updates, check quarterly notices from the Commissioner of Insurance—rules like NAC 695B.010 are periodically amended.
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