Written notice to insured required to be provided by insurer explaining right to file complaint; written notice to insured required when insurer denies coverage of health care service.
Nev. Rev. Stat. § 695B.400
in effect1. Following approval by the Commissioner, each insurer that issues a contract for hospital or medical services 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 a certificate of coverage or 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 a beneficiary or subscriber, including, without limitation, denying a claim relating to a contract for dental, hospital or medical services pursuant to NRS 695B.2505 , it shall notify the beneficiary or subscriber in writing within:
(a) Twenty-one days after the insurer receives all information necessary to make a determination concerning the claim, if the information is submitted electronically;
(b) Thirty days after the insurer receives all information necessary to make a determination concerning the claim, if the information is not submitted electronically; or
(c) If no claim is received, 10 working days after the insurer denies coverage of the health care service of:
(1) All reasons for denying coverage of the service, including, without limitation, the specific facts and provisions of the contract relied upon by the insurer as a basis to deny coverage for the service;
(2) The criteria by which the insurer determines whether to authorize or deny coverage of the health care service and the manner in which the insurer applied those criteria to the health care service;
(3) A summary of any applicable process established pursuant to NRS 687B.820 for challenging the denial of the claim; and
(4) The right of the beneficiary or subscriber 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.
Source: NV Statutes (Official Site)URL: https://www.leg.state.nv.us/nrs/NRS-695B.htmlFetched: 10/4/2026