NAC695C.215. Cost sharing.

     1. An organization may establish schedules for cost sharing between an enrollee and the organization. For a benefit provided pursuant to a health care plan by a provider who is under contract with the organization to provide services on a preferred basis, commonly referred to as a “preferred” or “in-network” benefit, cost sharing may be not more than 50 percent of the usual and customary charges for providing any single service or supplying an item to an enrollee, but in no case more than 50 percent of the maximum benefits provided by the evidence of coverage for such service or item, after any applicable deductible has been met.

     2. The amount of the cost sharing listed in the schedule given to the enrollee and submitted to the Division for approval must be:

     (a) Stated in dollars; or

     (b) Expressed as a percentage of the cost of the service or the item supplied.

     (Added to NAC by Comm’r of Insurance, eff. 6-11-86; A 5-27-92; R148-99, 1-27-2000; R180-12, 2-20-2013)