AB448 - Revises provisions relating to insurance for vision care. (BDR 57-983)

- 83rd Session (2025) Assembly Bill No. 448–Assemblymember Koenig CHAPTER.......... AN ACT relating to health care; establishing various requirements relating to providers of vision insurance and providers of vision care; revising provisions relating to certain contracts between a provider of vision insurance and a provider of vision care; prohibiting certain conduct of a provider of vision insurance or provider of vision care which would constitute an unfair or deceptive trade practice in the business of insurance; and providing other matters properly relating thereto. Legislative Counsel’s Digest: 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. – 2 – - 83rd Session (2025) 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. EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 686A of NRS is hereby amended by adding thereto the provisions set forth as sections 2 to 34.5, inclusive, of this act. Sec. 2. As used in NRS 686A.135 and sections 2 to 34.5, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections 3 to 17, inclusive, of this act have the meanings ascribed to them in those sections. Secs. 3 and 4. (Deleted by amendment.) Sec. 5. “Covered material” means any material for which: 1. Reimbursement from a provider of vision insurance is provided to a provider of vision care by a vision benefit plan of an enrollee, or for which a reimbursement would be available but for the application of the contractual limitations on deductibles, copayments or coinsurance applicable for the enrollee, regardless of how the materials are listed or described in the definition of benefits in a vision benefit plan of an enrollee; or 2. A discount is provided by a vision benefit discount plan of an enrollee. Sec. 6. “Covered services” means the professional work performed by a provider of vision care for which: 1. Reimbursement from a provider of vision insurance is provided to a provider of vision care by a vision benefit plan of an enrollee, or for which a reimbursement would be available but for the application of the contractual plan limitations of deductibles, – 3 – - 83rd Session (2025) copayments or coinsurance, regardless of how the services are listed or described in the definition of benefits in a vision benefit plan of an enrollee; or 2. A discount is provided by a vision benefit discount plan of an enrollee. Sec. 7. “Enrollee” means any person participating in or entitled to receive covered services or covered materials through a vision benefit plan or vision benefit discount plan that is purchased by the person or provided to the person by another person or a governmental entity. Sec. 8. (Deleted by amendment.) Sec. 9. “Materials” means ophthalmic devices, including, without limitation, lenses, devices containing lenses, artificial intraocular lenses, ophthalmic frames and other lens mounting apparatuses, prisms, lens treatments and coatings, contact lenses, low vision devices, vision therapy devices and prosthetic devices, used to correct, relieve or treat defects or abnormal conditions of the human eye or its adnexa, or any other material authorized for use in chapter 636 of NRS and any regulations adopted pursuant thereto. Sec. 10. (Deleted by amendment.) Sec. 11. “Provider of vision care” means a physician who provides vision care or an optometrist. Secs. 12 and 13. (Deleted by amendment.) Sec. 13.5. “Provider of vision insurance” means 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. Sec. 14. “Vision benefit discount plan” means 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. Sec. 15. (Deleted by amendment.) Sec. 16. 1. “Vision benefit plan” means 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. 2. The term includes, without limitation: (a) A policy, contract, certificate or agreement which only pays for or reimburses any of the costs of vision care and is offered or issued separately from any health benefit plan, as defined in NRS 695G.019. – 4 – - 83rd Session (2025) (b) A health benefit plan, as defined in NRS 695G.019, that provides coverage for vision care. Sec. 17. “Vision care” means routine ophthalmological evaluation of the eye, including refraction. Secs. 18-27. (Deleted by amendment.) Sec. 28. A provider of vision insurance shall not directly or indirectly: 1. Control or attempt to control the professional judgment, manner of practice or practice of a provider of vision care. 2. Employ a provider of vision care to provide a covered service or covered material. 3. Withhold or recoup payment to a provider of vision care for covered services or covered materials which are provided to an enrollee if the enrollee was shown to be eligible on the date that the covered services or covered materials were provided. 4. Reimburse a provider of vision care a different amount for covered services or covered materials because of the choice of the provider of vision care of the: (a) Optical laboratory. (b) Source of supplier of: (1) Contact lenses; (2) Ophthalmic lenses; (3) Ophthalmic glasses frames; or (4) Covered or non-covered services or materials. (c) Equipment used for patient care. (d) Membership in a professional trade association. (e) Software for management of the practice of the provider of vision care, including, without limitation, for maintenance of electronic health or medical records. (f) Services for billing, filing third-party claims or securely exchanging electronic business documents. Sec. 29. (Deleted by amendment.) Sec. 30. A provider of vision insurance that offers more than one vision benefit plan or vision benefit discount plan shall not require a provider of vision care, as a condition of participation in a vision benefit plan or vision benefit discount plan, to participate in any of the other vision benefit plans or vision benefit discount plans of the provider of vision insurance. Secs. 31-34. (Deleted by amendment.) Sec. 34.5. 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 subject to the provisions of this chapter and that is delivered, issued for delivery or renewed on or – 5 – - 83rd Session (2025) after January 1, 2026, has the legal effect of including the provisions required by NRS 686A.135 and sections 2 to 34.5, inclusive, of this act. Sec. 35. NRS 686A.010 is hereby amended to read as follows: 686A.010 The purpose of NRS 686A.010 to 686A.310, inclusive, and sections 2 to 34.5, inclusive, of this act is to regulate trade practices in the business of insurance in accordance with the intent of Congress as expressed in the Act of Congress approved March 9, 1945, being c. 20, 59 Stat. 33, also designated as 15 U.S.C. §§ 1011 to 1015, inclusive, and Title V of Public Law 106-102, 15 U.S.C. §§ 6801 et seq. Sec. 36. NRS 686A.020 is hereby amended to read as follows: 686A.020 A person shall not engage in this state in any practice which is defined in NRS 686A.010 to 686A.310, inclusive, and sections 2 to 34.5, inclusive, of this act as, or determined pursuant to NRS 686A.170 to be, an unfair method of competition or an unfair or deceptive act or practice in the business of insurance. Sec. 37. NRS 686A.135 is hereby amended to read as follows: 686A.135 1. [An insurer] A provider of vision insurance shall not enter into a contract with a provider of vision care that: (a) Authorizes the [insurer] provider of vision insurance 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] enrollees; 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] provider of vision insurance 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,] a provider of vision insurance, the [insurer] provider of vision insurance 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] A provider of vision insurance shall disclose in any [policy of insurance that covers] vision [care] benefit plan or vision benefit discount plan or any description of benefits covered by such a [policy,] plan, whether written or electronic, any ownership or other pecuniary interest of the [insurer] provider of vision insurance in a supplier of [ophthalmic devices or] materials – 6 – - 83rd Session (2025) or a provider of vision care. The disclosure must appear in a conspicuous and clear manner. 4. [An insurer] A provider of vision insurance that does not provide reimbursement for specific vision care shall not claim in any advertisement or other material that the [insurer] provider of vision benefit insurance 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] an enrollee is typically required to pay for covered services. 5. A provider of vision care shall disclose in writing to any [covered person] enrollee under a [policy of insurance that covers] vision [care] benefit plan or vision benefit discount plan 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] enrollee authorizes the provider of vision care to obtain covered [eyewear] materials from such a suppl [Text truncated for display. Full text available on LegiScan.]