NAC689B.020. Request for approval of policy.

An insurer requesting approval of a policy for group insurance to be issued and delivered to an association shall submit to the Division:

     1. A copy of each insurance policy, certificate, rider, endorsement and application used for the association.

     2. A statement illustrating that the benefits payable are reasonable in relation to the premiums charged.

     3. The name and address of the administrator if an administrator is to pay the claims or collect the premiums.

     4. The name and address of the trustee of the association and the name of the trust.

     5. Copies of all agreements or contracts for the administration of claims and collection of premiums as well as any information relating to utilization reviews, quality assurance programs and the marketing of the insurance policy, including copies of any advertising or brochures to be used.

     6. For health insurance benefits:

     (a) A description of the methodology used to determine the usual and customary fees charged for services rendered by providers; and

     (b) A statement verifying that the insurer has adopted at least three practices in administering benefits that control or reduce the cost of health care, and a brief description of those practices. The statement must list those sections of the policy or certificate where the practices are described.

     7. The appropriate filing fees and forms prescribed by the Commissioner.

     (Added to NAC by Comm’r of Insurance, eff. 10-12-88; A 5-27-92)