Section 287.357 - Application to leave Program: ContentsAn application to leave the Program must include, without limitation:
1. A copy of the plan of benefits to be offered under the proposed opt-out plan, including, without limitation, a description of:(a) The benefits to be provided under the proposed opt-out plan;(b) The manner for determining eligibility for benefits under the proposed opt-out plan; and(c) The circumstances under which any participant in the proposed opt-out plan, including, without limitation, active and retired officers and employees, may lose coverage under the proposed opt-out plan.2. A description of the manner in which initial eligibility for benefits under the proposed opt-out plan will be determined, including, without limitation, whether members of the group will experience any gap in coverage during the period between when the group leaves the Program and coverage is available for the group under the proposed opt-out plan.3. The proposed effective date of the departure of the group from the Program, which must coincide with the start date of a plan year.4. The name of the group.5. A list of the proposed participants in the proposed opt-out plan, including, without limitation, the name, social security number and date of birth of each proposed participant.6. The federal tax identification number of the proposed opt-out plan.7. A copy of the contract pursuant to which the members of the group will receive coverage from the proposed opt-out plan. The contract must include, without limitation, the amount of premiums or contributions that will be required to maintain coverage for the members of the group under the proposed opt-out plan.8. Evidence establishing that the proposed opt-out plan is or will be operated pursuant to such sound accounting and financial management practices as to ensure that the group will continue to receive adequate benefits. Such evidence must include, without limitation: (a) Financial statements;(b) Audits of financial statements of the proposed opt-out plan, if any, for the 2 years immediately preceding the date of application, which must reflect unqualified opinions by the persons who performed the audits of the financial statements concerning the financial soundness of the proposed opt-out plan; and(c) Any other information requested by the Board or determined by the group to be relevant to the evaluation of the: (1) Financial management practices of the proposed opt-out plan; or(2) Financial soundness of the proposed opt-out plan.9. A completed Business Associate Agreement that is consistent with the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, as amended, and is in a form acceptable to the Board, or a certification that the opt-out plan is a covered entity under and complies with all federal privacy regulations.10. If the proposed opt-out plan is secured from an insurer, a copy of the current certificate of authority issued by the Commissioner of Insurance to the insurer which indicates that the insurer is authorized to provide the coverage proposed to be offered under the proposed opt-out plan in this State.11. The name and contact information of a representative of the group who will be available to answer questions from the Board concerning the application.Nev. Admin. Code § 287.357
Added to NAC by Bd. of Pub. Employees' Benefits Prog. by R097-03, eff. 9-24-2003; A by R089-05, 6-28-2006; R002-12, 6-29-2012