Nevada Administive Code Chapter 695D - Organizations for Dental Care
Nevada Administrative Code – Chapter 695D: Organizations for Dental Care
1. General Overview
Chapter 695D regulates organizations that provide dental care plans in Nevada. It sets rules for formation, operation, management, finances, and oversight by the Nevada Division of Insurance.
2. Key Sections
a. General Provisions
Defines important terms:
Commissioner: Commissioner of Insurance
Division: Nevada Division of Insurance
Member: person receiving dental care under the organization’s plan
Organization: entity offering dental care plans
Plan: dental care plan offered by the organization
b. Application for Certificate of Authority
Organizations must apply to the Commissioner to operate.
Application must include:
List of participating providers
Geographic coverage area
Financial statements
Emergency care access
Incomplete applications may be rejected.
c. Administration & Records
Organization name must include “dental” and avoid implying other types of health coverage.
Maintain principal office and records, with specified retention periods.
Qualified individuals must operate the organization.
Certain actions (like acquiring property) require Commissioner approval.
d. Accessibility of Services
Dental services must be reasonably accessible to members.
In areas with ≥30,000 residents, provider locations must be convenient for members.
e. Provider Contracts & Notifications
Contracts with dentists must meet regulatory requirements.
Organizations must notify the Division if a provider leaves the network.
f. Coverage Summary & Advertising
Must file a summary of coverage with the Commissioner.
Members must receive a copy of the coverage summary.
Advertising rules apply; door-to-door solicitation is prohibited.
g. Finances
Organizations must maintain reserves and financial security.
Investments must be in allowable types.
Must file regular and audited financial reports.
Assets are considered for determining financial condition.
h. Out-of-State Organizations
Must provide proof of licensure in other states.
Notify Nevada of any disciplinary actions in other states.
Notify before using out-of-state providers to serve Nevada members.
i. Miscellaneous Provisions
Certification of rate information.
Contracts for administrative services.
Administrative hearings and examinations.
j. Complaint Resolution System
Organizations must have a system for handling member complaints:
Initial investigation of complaints
Review board and appeal procedures
Annual reporting on complaints
3. Key Points
Certificate of Authority is required to operate.
Names must indicate dental coverage only.
Members must get plan summaries.
Records, finances, and complaint procedures are strictly regulated.
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