Nevada AB 52: Makes various changes to the Open Meeting Law. (BDR 19-416)

Bill Text

- 83rd Session (2025)
Assembly Bill No. 52–Committee
on Commerce and Labor

CHAPTER..........

AN ACT relating to insurance; requiring the Commissioner of
Insurance to establish programs to inform providers of health
care and insureds under health insurance policies
of certain information relating to the payment of claims;
revising provisions governing the payment of claims under
policies of health insurance; establishing certain
administrative penalties; requiring a health carrier to provide
certain information to participating providers of health care
and covered persons; requiring a health carrier to establish
certain procedures for challenging the denial of a claim; and
providing other matters properly relating thereto.
Legislative Counsel’s Digest:
In most cases, existing law requires the administrators of health insurance plans
and certain health insurers to approve or deny a claim within 30 days after the
insurer receives the claim. If the administrator or insurer approves the claim,
existing law requires the administrator or insurer to pay the claim within 30 days
after the claim is approved. If the administrator or insurer requires additional
information to determine whether to approve or deny the claim, existing law
requires the administrator or insurer to notify the claimant of its request for
additional information within 20 days after the administrator or insurer receives the
claim. If the administrator or insurer approves the claim after receiving such
additional information from the claimant, existing law requires the administrator or
insurer to pay the claim within 30 days after receiving such information. Existing
law requires an administrator or insurer that fails to pay a claim within the required
time period to pay interest on the claim at a prescribed rate. (NRS 287.04335,
683A.0879, 689A.410, 689B.255, 689C.335, 695A.188, 695B.2505, 695C.185,
695D.215, 695F.090)
Sections 2, 5, 8-11, 14 and 16 of this bill replace those requirements with
uniform requirements governing the time periods for the payment of health
insurance claims that apply to administrators of health insurance plans and all
private health insurers in this State. Specifically, sections 2, 5, 8-11, 14 and 16
require each such administrator or insurer to approve or deny a claim and, if the
claim is approved, pay the claim within: (1) twenty-one days after receiving
the claim, if the claim is submitted electronically; or (2) thirty days after receiving
the claim, if the claim is not submitted electronically. Sections 2, 5, 8-11, 14 and
16 require an administrator or insurer that needs additional information to
determine whether to approve or deny a claim to request such information within
20 working days after receiving the claim. If, after receiving such additional
information, the administrator or insurer approves the claim, sections 2, 5, 8-11, 14
and 16 require the administrator or insurer, as applicable, to pay the claim within:
(1) twenty-one days after receiving the additional information, if the additional
information is submitted electronically; or (2) thirty days after receiving the
additional information, if the additional information is not submitted electronically.
Sections 2, 5, 8-11, 14 and 16 prohibit an administrator or insurer from denying a
claim without a reasonable basis for doing so. Sections 2, 5, 8-11, 14 and 16
require an administrator or insurer to annually report to the Commissioner of

– 2 –

- 83rd Session (2025)
Insurance certain information relating to compliance with those requirements.
Section 25 of this bill repeals certain provisions applicable to health maintenance
organizations that are no longer necessary because existing law makes the
provisions of section 16 applicable to all managed care organizations, including
health maintenance organizations. (NRS 695C.055) Sections 13 and 18 of this bill
update references to a section repealed by section 25 with a reference to section 16.
Existing law authorizes the Commissioner to: (1) impose an administrative
penalty upon determining that the administrator of a health insurance plan or
certain health insurers are not in substantial compliance with the provisions of
existing law governing the schedule for paying claims; and (2) suspend or revoke
the certificate of registration or authority of such an administrator or insurer upon a
second or subsequent determination that such an administrator or insurer is not in
substantial compliance with those provisions. (NRS 287.04335, 683A.0879,
689A.410, 689B.255, 689C.335, 695B.2505, 695C.185, 695F.090) Sections 10, 14
and 16 of this bill extend those penalties to apply to fraternal benefit societies,
issuers of plans for dental care and managed care organizations. Sections 2, 5, 8-11,
14 and 16 additionally authorize the Commissioner to: (1) impose an
administrative penalty upon determining that the administrator of a health insurance
plan or a health insurer has failed to approve or deny a claim or pay a