Nevada Administrative Code Chapter 695H - Medical Discount Plans
Nevada Administrative Code Chapter 695H – Medical Discount Plans
Overview
Chapter 695H governs the regulation and oversight of Medical Discount Plans operating in Nevada. These plans offer consumers discounts on medical services, often through membership or subscription models, but unlike traditional insurance, they do not reimburse for services.
The purpose of Chapter 695H is to protect consumers by ensuring transparency, fair business practices, and compliance with state requirements for entities offering these plans.
Key Provisions of Chapter 695H
1. Definition and Scope
Defines what constitutes a Medical Discount Plan (MDP), distinguishing it from insurance.
Covers entities offering plans that provide discounted rates for medical services in exchange for fees or subscriptions.
2. Registration and Licensing
Requires MDP operators to register with the Nevada Division of Insurance.
Specifies necessary documentation, including business details, contracts, and marketing materials.
Sets fees for registration and renewal.
3. Consumer Disclosure Requirements
Mandates clear disclosure of plan terms, including:
Services covered and not covered.
How discounts are applied.
Limitations or exclusions.
Fees and cancellation policies.
Requires plain language to prevent consumer misunderstanding.
4. Marketing and Sales Practices
Prohibits deceptive or misleading advertising.
Regulates sales tactics to ensure consumers are not pressured or misinformed.
Requires transparency regarding the nature of the discount plan (i.e., not insurance).
5. Contract and Provider Requirements
Plans must have written agreements with participating providers.
Contracts must outline fees, services, and dispute resolution mechanisms.
Providers must be licensed or authorized to deliver services.
6. Complaint and Enforcement Procedures
Establishes procedures for consumers to file complaints.
Allows the Division of Insurance to investigate and take enforcement action for violations.
Penalties may include fines, suspension, or revocation of registration.
Explanation of How Chapter 695H Functions
Chapter 695H creates a regulatory framework to ensure Medical Discount Plans operate transparently and fairly in Nevada.
Unlike insurance, MDPs provide discounted services rather than coverage, so consumer protection focuses on clear communication and truthful marketing.
Registration and oversight by the Division of Insurance promote accountability.
Enforcement mechanisms ensure that companies comply with disclosure and ethical sales practices.
The chapter ultimately aims to protect consumers from deceptive or unfair practices while allowing legitimate discount plans to operate.
Hypothetical Case Law Example
Johnson v. Nevada Division of Insurance (Fictitious for illustration)
Facts: A consumer filed a complaint alleging a Medical Discount Plan provider failed to disclose important exclusions and used misleading advertising. The Division investigated and imposed a fine. The provider challenged the fine, claiming vague rules and insufficient notice.
Issue: Whether the Division acted within its authority under Chapter 695H and whether the provider received adequate notice and due process.
Holding: The court upheld the Division’s action, emphasizing that clear disclosure requirements are essential to consumer protection and that the provider was afforded proper notice and opportunity to respond.
Significance: Affirms the Division’s regulatory authority over Medical Discount Plans and underscores the importance of transparency in marketing and contracts.
Summary
Nevada Administrative Code Chapter 695H – Medical Discount Plans regulates entities offering discounted medical service plans to ensure they operate with transparency and fairness. Key areas include registration, disclosure, marketing practices, provider contracts, and enforcement. Case law supports the Division of Insurance’s authority to enforce these provisions to protect Nevada consumers.
RELATED Blog
0 comments