NAC695F.250. Geographic area of service: Definition.

An organization shall clearly define the geographic area it intends to serve, which:

     1. In a county having a population of 30,000 or more, must have a radius of not more than 25 miles between the subscriber or individual enrollee and the providers used by the organization, unless the organization demonstrates to the satisfaction of the Commissioner that the standards of that community differ from the requirements of this subsection.

     2. In any other county, must be defined by the organization under a plan of operation for the provision of limited health service which is approved in writing by the Commissioner. The plan of operation must:

     (a) Demonstrate the availability and accessibility of services to the organization’s enrollees, including reasonable access to providers and to medically necessary services or services in an emergency;

     (b) Include a statement concerning the standards within that community regarding the availability and accessibility of other limited health services; and

     (c) Demonstrate that the organization will meet the standards of that community for limited health services.

     (Added to NAC by Comm’r of Insurance, eff. 2-3-97)