Revises provisions relating to insurance for vision care. (BDR 57-983)

Existing law prohibits certain unfair trade practices in the business of insurance. (NRS 686A.010-686A.310) Existing law prohibits an insurer from entering into a contract with a provider of vision care that conditions any rate of reimbursement for vision care on the provider of vision care prescribing certain ophthalmic devices or materials or increases the rate of reimbursement if the provider of vision care prescribes such ophthalmic devices or materials. Existing law also prohibits an insurer from entering into a contract with a provider of vision care that: (1) 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; or (2) requires the provider of vision care to use a specific laboratory as the manufacturer of ophthalmic devices or materials provided to a covered person. Finally, existing law requires a provider of vision care to disclose to any covered person an ownership or pecuniary interest of the provider in a supplier of ophthalmic devices or materials before the covered person authorizes the provider to obtain covered eyewear materials from such a supplier. (NRS 686A.135) Existing law authorizes the Commissioner of Insurance to investigate a violation of and enforce those provisions as an unfair or deceptive trade practice. (NRS 686A.020, 686A.160, 686A.170, 686A.183) Sections 2, 5-7, 9, 11, 13.5, 14, 16, 17, 28, 30, 34.5 and 37 of this bill revise provisions of existing law governing vision care and set forth various definitions, additional requirements and restrictions governing providers of vision insurance. Section 13.5 defines “provider of vision insurance” to mean a person, including, without limitation, an insurer, who creates, promotes, sells, provides, operates, advertises or administers a vision benefit plan or vision benefit discount plan. Section 16 defines “vision benefit plan” to mean a policy, contract, certificate or agreement offered by a provider of vision insurance to provide for, deliver payment for, arrange for the payment of, pay for or reimburse any of the costs of vision care. Section 16 specifies that the term includes a standalone vision benefit plan or a health benefit plan that provides coverage for vision care. Section 14 defines “vision benefit discount plan” to mean a policy, contract, certificate or agreement offered by a provider of vision insurance to an enrollee that solely provides for a discount for covered services or covered materials. Because an insurer that provides a vision benefit plan constitutes a provider of vision insurance, section 37 revises the provisions of existing law setting forth certain prohibitions on insurers with respect to vision care to replace references to an insurer with references to a provider of vision insurance. Section 30 prohibits a provider of vision insurance that offers more than one vision benefit plan or vision benefit discount plan from conditioning the participation of a provider of vision care in one plan on his or her participation in any of the other plans of the provider of vision insurance. Section 34.5 provides that a vision benefit plan, a vision benefit discount plan or a contract between a provider of vision insurance and a provider of vision care that is delivered, issued for delivery or renewed on or after January 1, 2026, has the legal effect of including the provisions required by sections 2-34.5 and 37. Section 28 prohibits certain actions of a provider of vision insurance relating to certain business practices and billing practices. Sections 35, 36 and 38-43 of this bill make provisions of existing law which are generally applicable to certain unfair or deceptive trade practices in the business of insurance specifically applicable to the provisions of sections 2-34.5. Sections 43.5-47 of this bill provide that certain entities that provide coverage for vision care, including local governments and the Public Employees' Benefits Program, are subject to the provisions of sections 2-34.5.