Nevada Administive Code Chapter 695D - Organizations for Dental Care
Here’s a detailed and organized summary of Nevada Administrative Code Chapter 695D – Organizations for Dental Care, current through May 10, 2025:
📌 1. Scope & Key Definitions
Establishes that this chapter governs “organizations for dental care” (e.g., dental HMOs), laying out rules for licensing, administration, financial responsibility, member complaints, and out-of-state entities (law.cornell.edu).
Defines "dental care" as services by dentists, including appliances, drugs, supplies, prosthetics, orthodontics, etc. (law.justia.com).
🏢 2. Certificate of Authority (Licensing Requirements)
Requires organizations to apply for a Certificate of Authority, including forms with organizational documents, bylaws, leadership structure, dentist contracts, financials, administrative plans, and Nevada agent appointment (doi.nv.gov).
Must also submit policy, marketing strategies, geographic service area, and specified fees (e.g., $2,450 for application and renewal). Annual renewal filings are due by March 1 (doi.nv.gov).
🖋️ 3. Name Restrictions
Organization names cannot use “health” or “medical” unless “dental” is explicitly included, to avoid implication of broader coverage (law.cornell.edu).
🗃️ 4. Administration & Records
Outlines provisions from NAC 695D.120 to 695D.230 covering:
Notification of changes in business details, geographic expansion, and internal administration;
Maintaining proper records and member communications (law.cornell.edu).
💰 5. Financial Requirements
NAC 695D.240 to 695D.300 detail financial rules:
Required capital accounts, bonding or deposits, limits on marketing/admin spending, minimum reserves, and annual reporting including audited financial statements (law.cornell.edu, nevada.public.law).
🌐 6. Out-of-State Organizations
NAC 695D.310–695D.330 applies to organizations licensed out-of-state that seek to offer services in Nevada; they must comply with comparable Nevada rules (law.cornell.edu).
⚖️ 7. Complaints & Discipline
Establishes a Complaint Resolution System for members (NAC 695D.500–695D.540), including Commissioner oversight.
Additional sections cover disciplinary procedures under NAC 695D.300, and compliance with insurance trade practice laws (law.cornell.edu).
✅ 8. Other Key Provisions
Organizations cannot set fees for services not covered by the plan—dentists must not be required to charge approved third-party fees for non-covered services (nevada.public.law).
Advertising and marketing materials must be approved by the Commissioner before use (NAC 695D.230) .
📋 Summary Table
Area
Description
Licensing
Requires Certificate of Authority, detailed application, annual renewals
Name Use
May not imply medical/health unless including “dental”
Administration & Records
Must notify changes, maintain records, log member communications
Finance & Reporting
Capital, bonds, admin expense limits, reserves, filing audited statements
Out-of-State Entities
Must meet equivalent Nevada requirements
Member Complaints
Formal system with Commissioner oversight
Fee Limitations
No mandated fees for non-covered services
Advertising Approval
Required prior Commissioner sign-off
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