NAC695F.340. Copayments.

     1. An organization may establish schedules for nominal copayments to be made by an enrollee to a provider. Each schedule of copayments must be given to the enrollee and submitted to the Commissioner for approval.

     2. A copayment may be not more than 20 percent of the total cost of providing the limited health service described in the evidence of coverage, unless the Commissioner approves a greater amount based upon the type of limited health service offered by the organization and the dollar amount of the benefits provided. The amount of each copayment must be stated in dollars and must not be expressed as a percentage of the cost of the service or item supplied.

     3. With each filing of a schedule of copayments, the organization shall submit a:

     (a) Certificate, signed by an officer of the organization, stating that the schedule meets the requirements of this section; and

     (b) Copy of the calculations demonstrating that the schedule meets those requirements.

     4. If the Commissioner fails to notify the organization of the denial of the schedule within 30 days after it has been filed, the schedule shall be deemed to be approved as submitted by the organization.

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