NAC695C.270. Reports and financial statements.

     1. As a condition of doing business in this State, each health maintenance organization must file with the Commissioner an annual report required by NRS 695C.210 that:

     (a) Conforms to the format prescribed by the National Association of Insurance Commissioners in the Annual Statement Instructions for Health and the Accounting Practices and Procedures Manual, which have been adopted by reference in NAC 679B.033;

     (b) Contains exhibits and schedules that follow the specifications developed by the National Association of Insurance Commissioners; and

     (c) Contains any other information relating to the organization required by the Commissioner.

     2. Information from the annual report of the organization must be filed:

     (a) Pursuant to the specifications adopted by the National Association of Insurance Commissioners for filing information in an electronic format;

     (b) At the central office of the National Association of Insurance Commissioners, 2301 McGee Street, Suite 800, Kansas City, Missouri 64108-2662; and

     (c) On or before March 1 of each year.

     3. If a foreign or alien health maintenance organization files a report in an electronic format with the National Association of Insurance Commissioners, that report will be deemed to have been filed with the Commissioner if:

     (a) The foreign or alien health maintenance organization submits an affidavit, a jurat page or a copy of the jurat page to the Commissioner indicating that the report has been so filed. If the organization submits a jurat page, the jurat page must:

          (1) Conform to the format prescribed by the National Association of Insurance Commissioners in the Annual Statement Instructions for Health, which has been adopted by reference in NAC 679B.033; and

          (2) Be executed by a notarial officer pursuant to NRS 240.1655 and 240.167.

     (b) The affidavit, jurat page or copy of the jurat page is accompanied by the applicable fees set forth in NRS 680B.010.

     4. An annual report required by NRS 695C.210 to be filed with the Commissioner by an organization must be on the current version of the Annual Statement Blanks for Health adopted by the National Association of Insurance Commissioners, which has been adopted by reference in NAC 679B.033. Each organization shall, in preparing the report, follow the Annual Statement Instructions for Health adopted by the National Association of Insurance Commissioners, which accompanies the Annual Statement Blanks for Health.

     5. Each organization shall include in its annual report the number and amount of claims of malpractice initiated against it during that year. The report must include claims made with or without legal process and the disposition, if any, of each claim.

     6. Each organization shall furnish a copy of any annual report it distributes to its enrollees to the Division 30 days before that distribution with a notice of its intent to distribute it.

     7. If an organization is required by federal law to submit quarterly reports to the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services, it shall submit copies of those reports to the Division.

     8. If necessary to determine the financial condition of a foreign or alien health maintenance organization or the fulfillment of contractual obligations or compliance with law by a foreign or alien health maintenance organization, the Commissioner may require the foreign or alien health maintenance organization to file a financial report more frequently than annually. Such a report must be:

     (a) Filed on the current form adopted by the National Association of Insurance Commissioners for the type of organization filing;

     (b) Completed in accordance with the current instruction manual for the type of organization filing; and

     (c) Filed with the National Association of Insurance Commissioners in an electronic format.

     9. Each domestic health maintenance organization shall file a quarterly report with the Commissioner. A quarterly report must be:

     (a) Filed on the current form adopted by the National Association of Insurance Commissioners for the type of organization filing;

     (b) Completed in accordance with the current instruction manual for the type of organization filing; and

     (c) Filed with the National Association of Insurance Commissioners in an electronic format.

     10. For a health maintenance organization, the audited financial statement of the organization filed pursuant to subsection 3 of NRS 695C.210 is a separate document from the annual statement required to be filed pursuant to paragraph (a) of subsection 2 of NRS 695C.210. For a provider-sponsored organization, the audited financial statement of the organization filed pursuant to subsection 3 of NAC 695C.360 is a separate document from the annual statement required to be filed pursuant to paragraph (a) of subsection 2 of NAC 695C.360. The audited financial statement filed pursuant to subsection 3 of NRS 695C.210 or subsection 3 of NAC 695C.360 must be:

     (a) Filed for each individual organization within 120 days after the end of its fiscal year; and

     (b) Filed pursuant to the specifications and instructions adopted by the National Association of Insurance Commissioners which are included in the Annual Statement Instructions for Health, which have been adopted by reference in NAC 679B.033.

Ê Consolidated statements for organizations that are members of an insurance holding company system are not acceptable.

     11. The Commissioner will, if appropriate, take disciplinary action pursuant to NRS 695C.340 or 695C.350 or NAC 695C.1286 or 695C.1288 against an organization which fails to file its annual financial reports or statements on the prescribed forms, in the prescribed format or by the prescribed date.

     12. The Commissioner will grant, for good cause and upon advance written request, an extension for filing an annual report or statement.

     13. As used in this section, “jurat page” means a written declaration by a notarial officer that the signer of a document signed the document in the presence of the notarial officer and swore to or affirmed that the statements in the document are true.

     (Added to NAC by Comm’r of Insurance, eff. 6-11-86; A 12-9-91; 5-27-92; R148-99, 1-27-2000; R248-03, 11-12-2004)