NAC695B.200. Requirements for approval.

To obtain approval of a system for resolving complaints of insureds concerning health care services covered by an insurer from the Commissioner as required pursuant to NRS 695B.380, an insurer must:

     1. Demonstrate that the system will resolve oral and written complaints concerning:

     (a) Payment or reimbursement for covered health care services;

     (b) The availability, delivery or quality of covered health care services, including, without limitation, an adverse determination made pursuant to utilization review; and

     (c) The terms and conditions of the health care plan of insureds.

     2. Submit to the Division:

     (a) The name and title of the employee responsible for the system;

     (b) A description of the procedure used to notify an insured of the decision regarding his complaint; and

     (c) A copy of the explanation of rights and procedures which is to be provided to insureds pursuant to NRS 695B.400.

     (Added to NAC by Comm’r of Insurance by R132-98, eff. 3-30-99)