Section 686A.135 - Vision care: Prohibited provisions in contract between insurer and provider; insurer required to provide list of reimbursement rates to provider before entering contract; insurer required to disclose in policy pecuniary interest in supplier or provider; prohibited advertisements by insurer related to coverage; provider required to disclose pecuniary interest in supplier; use of in-network source or supplier not prohibited1. An insurer shall not enter into a contract with a provider of vision care that: (a) Authorizes the insurer to set or limit the amount that the provider of vision care may charge for vision care that is not reimbursed under the contract;(b) Requires the provider of vision care to use a specific laboratory as the manufacturer of ophthalmic devices or materials provided to covered persons; or(c) Conditions any rate of reimbursement for vision care on the provider of vision care prescribing ophthalmic devices or materials in which the insurer has an ownership or other pecuniary interest or increases the rate of reimbursement if the provider of vision care prescribes such ophthalmic devices or materials.2. Before entering into a contract with a provider of vision care to include the provider of vision care in the network of an insurer, the insurer must provide to the provider of vision care a list of the rates of reimbursement for each service covered by the contract. 3. An insurer shall disclose in any policy of insurance that covers vision care or any description of benefits covered by such a policy, whether written or electronic, any ownership or other pecuniary interest of the insurer in a supplier of ophthalmic devices or materials or a provider of vision care. The disclosure must appear in a conspicuous and clear manner.4. An insurer that does not provide reimbursement for specific vision care shall not claim in any advertisement or other material that the insurer covers that vision care if such vision care is available at a discount or with a copayment or coinsurance in an amount that is in addition to the copayment or coinsurance that a covered person is typically required to pay for covered services. 5. A provider of vision care shall disclose in writing to any covered person under a policy of insurance that covers vision care any ownership or other pecuniary interest of the provider of vision care in a supplier of ophthalmic devices or materials, including, without limitation, a general disclosure of any rebates or rewards programs, before the covered person authorizes the provider of vision care to obtain covered eyewear materials from such a supplier or laboratory that is not contracted with the insurer providing the policy of insurance that covers vision care. The disclosure must appear in a conspicuous and clear manner. 6. Nothing in this section shall be construed to prohibit a covered person from using an in-network source or supplier of ophthalmic devices or materials as set forth in the covered person's policy of insurance that covers vision care.7. As used in this section: (a) "Provider of vision care" means a physician who provides vision care or an optometrist.(b) "Vision care" means: (1) Routine ophthalmological evaluation of the eye, including refraction.(2) Ophthalmic devices or materials, including, without limitation, lenses, frames, mountings or other specially fabricated ophthalmic devices. The term "vision care" does not include the initiation of treatment or diagnosis pursuant to a program of medical care.
Added to NRS by 2021, 899; A 2023, 2074Amended by 2023, Ch. 381,§1, eff. 10/1/2023.Added by 2021, Ch. 191,§1, eff. 10/1/2021.