1. Following approval by the Commissioner, each insurer that issues a policy of health
insurance in this State shall provide written notice to an insured, in clear and comprehensible
language that is understandable to an ordinary layperson, explaining the right of
the insured to file a written complaint. Such notice must be provided to an insured:
(a) At the time the insured receives his or her evidence of coverage;
(b) Any time that the insurer denies coverage of a health care service or limits coverage
of a health care service to an insured; and
(c) Any other time deemed necessary by the Commissioner.
2. Any time that an insurer denies coverage of a health care service to an insured,
including, without limitation, denying a claim relating to a policy of health insurance
pursuant to NRS 689A.410, it shall notify the insured in writing within 10 working days after it denies coverage
of the health care service of:
(a) The reason for denying coverage of the service;
(b) The criteria by which the insurer determines whether to authorize or deny coverage
of the health care service; and
(c) The right of the insured to file a written complaint and the procedure for filing
such a complaint.
3. A written notice which is approved by the Commissioner shall be deemed to be in
clear and comprehensible language that is understandable to an ordinary layperson.
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