reglab/statecodes huggingface dataset:
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.061 - Limitations on deductibles and copayments charged under policy which offers difference of payment between preferred providers of health care and providers who are not preferred.

A policy of group health insurance which offers a difference of payment between preferred providers of health care and providers of health care who are not preferred:
1. May not require an insured, another insurer who issues policies of group health insurance, a nonprofit medical service corporation or a health maintenance organization to pay any amount in excess of the deductible or coinsurance due from the insured based on the rates agreed upon with a provider.
2. Must require that the deductible and payment for coinsurance paid by the insured to a preferred provider of health care be applied to the negotiated reduced rates of that provider.
3. Must provide that if there is a particular service which a preferred provider of health care does not provide and the provider of health care who is treating the insured requests the service and the insurer determines that the use of the service is necessary for the health of the insured, the service shall be deemed to be provided by the preferred provider of health care.
4. Must require the insurer to process a claim of a provider of health care who is not preferred not later than 30 working days after the date on which proof of the claim is received.
(Added to NRS by 1987, 1781; A 1991, 1329; 1995, 1629; 2013, 3619; 2017, 2370)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.063 - Primary and secondary policies: Determination of benefits.

1. When a policy of group insurance is primary, its benefits are determined before those of another policy and the benefits of another policy are not considered. When a policy of group insurance is secondary, its benefits are determined after those of another policy. Secondary benefits may not be reduced because of benefits under the primary policy. When there are more than two policies, a policy may be primary as to one and may be secondary as to another.
2. The benefits payable under a policy of group health insurance may not be reduced because of any benefits payable under health insurance on a franchise plan or first-party coverage under an automobile insurance policy.
3. As used in this section, "a policy of group insurance" includes Medicare.
(Added to NRS by 1987, 848; A 1989, 1250; 1995, 1629; 2013, 3620)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.064 - Primary and secondary policies: Order of benefits.

A policy of group insurance determines its order of benefits using the first of the following which applies:
1. A policy that does not coordinate with other policies is always the primary policy.
2. The benefits of the policy which covers a person as an employee, member or subscriber, other than a dependent, is the primary policy. The policy which covers the person as a dependent is the secondary policy.
3. When more than one policy covers the same child as a dependent of different parents who are not divorced or separated, the primary policy is the policy of the parent whose birthday falls earlier in the year. The secondary policy is the policy of the parent whose birthday falls later in the year. If both parents have the same birthday, the benefits of the policy which covered the parent the longer is the primary policy. The policy which covered the parent the shorter time is the secondary policy.
4. If more than one policy covers a person as a dependent child of divorced or separated parents, benefits for the child are determined in the following order:
(a) First, the policy of the parent with custody of the child;
(b) Second, the policy of the spouse of the parent with custody; and
(c) Third, the policy of the parent without custody of the child,
unless the specific terms of a court decree state that one parent is responsible for the health care expenses of the child, in which case, the policy of that parent is the primary policy. A parent responsible for the health care pursuant to a court decree must notify the insurer of the terms of the decree.
5. The primary policy is the policy which covers a person as an employee who is neither laid off or retired, or that employee’s dependent. The secondary policy is the policy which covers that person as a laid off or retired employee, or that employee’s dependent.
6. If none of the rules in subsections 1 to 5, inclusive, determines the order of benefits, the primary policy is the policy which covered an employee, member or subscriber longer. The secondary policy is the policy which covered that person the shorter time.
When a policy is determined to be a secondary policy it acts to provide benefits in excess of those provided by the primary policy. The secondary policy may not reduce benefits based upon payments by the primary policy, except that this provision does not require duplication of benefits.
(Added to NRS by 1987, 848)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.065 - Policy issued to replace discontinued policy or coverage: Requirements; notice of reduction of benefits; statement of benefits; applicability of section.

1. A policy of group health insurance issued to replace any discontinued policy or coverage for group health insurance must:
(a) Provide coverage for all persons who were covered under the previous policy or coverage on the date it was discontinued; and
(b) Except as otherwise provided in subsection 2, provide benefits which are at least as extensive as the benefits provided by the previous policy or coverage, except that benefits may be reduced or excluded to the extent that such a reduction or exclusion was permissible under the terms of the previous policy or coverage,
if that replacement policy is issued within 60 days after the date on which the previous policy or coverage was discontinued.
2. If an employer obtains a replacement policy pursuant to subsection 1 to cover the employees of the employer, any benefits provided by the previous policy or coverage may be reduced if notice of the reduction is given to the employees of the employer pursuant to NRS 608.1577.
3. Any insurer which issues a replacement policy pursuant to subsection 1 may submit a written request to the insurer who provided the previous policy or coverage for a statement of benefits which were provided under that policy or coverage. Upon receiving such a request, the insurer who provided the previous policy or coverage shall give a written statement to the insurer providing the replacement policy which indicates what benefits were provided and what exclusions or reductions were in effect under the previous policy or coverage.
4. The provisions of this section:
(a) Apply to a self-insured employer who provides health benefits to the employees of the employer and replaces those benefits with a policy of group health insurance.
(b) Do not apply to the Public Employees’ Benefits Program established pursuant to NRS 287.0402 to 287.049, inclusive.
(Added to NRS by 1987, 849; A 1991, 251; 1999, 3042)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.067 - Provision in policy requiring binding arbitration for disputes with insurer authorized; procedure for arbitration; declaratory relief.

1. Except as otherwise provided in NRS 689B.270 and subject to the approval of the Commissioner, a policy of group health insurance may include a provision which requires a member or a dependent of a member of the insured group and the insurer to submit for binding arbitration any dispute between the member or dependent and the insurer concerning any matter directly or indirectly related to, or associated with, the policy. If such a provision is included in the policy:
(a) A member and any dependent of the member must be given the opportunity to decline to participate in binding arbitration at the time they elect to be covered by the policy.
(b) It must clearly state that the insurer and a member or dependent of a member of the insured group who has not declined to participate in binding arbitration agree to forego their right to resolve any such dispute in a court of law or equity.
2. Except as otherwise provided in subsection 3, the arbitration must be conducted pursuant to the rules for commercial arbitration established by the American Arbitration Association. The insurer is responsible for any administrative fees and expenses relating to the arbitration, except that the insurer is not responsible for attorney’s fees and fees for expert witnesses unless those fees are awarded by the arbitrator.
3. If a dispute required to be submitted to binding arbitration requires an immediate resolution to protect the physical health of a member or a dependent of a member, any party to the dispute may waive arbitration and seek declaratory relief in a court of competent jurisdiction.
4. If a provision described in subsection 1 is included in a policy of group health insurance, the provision shall not be deemed unenforceable as an unreasonable contract of adhesion if the provision is included in compliance with the provisions of subsection 1.
(Added to NRS by 1995, 2557)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.0675 - Insurer prohibited from discriminating against person with respect to participation or coverage on basis of gender identity or expression.

An insurer that issues a policy of group health insurance shall not discriminate against any person with respect to participation or coverage under the policy on the basis of actual or perceived gender identity or expression. Prohibited discrimination includes, without limitation:
1. Denying, cancelling, limiting or refusing to issue or renew a policy of group health insurance on the basis of the actual or perceived gender identity or expression of a person or a family member of the person;
2. Imposing a payment or premium that is based on the actual or perceived gender identity or expression of an insured or a family member of the insured;
3. Designating the actual or perceived gender identity or expression of a person or a family member of the person as grounds to deny, cancel or limit participation or coverage; and
4. Denying, cancelling or limiting participation or coverage on the basis of actual or perceived gender identity or expression, including, without limitation, by limiting or denying coverage for health care services that are:
(a) Related to gender transition, provided that there is coverage under the policy for the services when the services are not related to gender transition; or
(b) Ordinarily or exclusively available to persons of any sex.
(Added to NRS by 2023, 2032)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.068 - Insurer prohibited from denying coverage solely because claim involves act that constitutes domestic violence or applicant or insured was victim of domestic violence.

An insurer shall not deny a claim, refuse to issue a policy of group health insurance or cancel a policy of group health insurance solely because the claim involves an act that constitutes domestic violence pursuant to NRS 33.018, or because the person applying for or covered by the policy of group health insurance was the victim of such an act of domestic violence, regardless of whether the insured or applicant contributed to any loss or injury.
(Added to NRS by 1997, 1096)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.069 - Insurer prohibited from requiring or using information concerning genetic testing; exceptions.

1. Except as otherwise provided in subsection 2, an insurer who provides group health insurance shall not:
(a) Require an insured person or any member of the family of the insured person to take a genetic test;
(b) Require an insured person to disclose whether the insured person or any member of the family of the insured person has taken a genetic test or any genetic information of the insured person or a member of the family of the insured person; or
(c) Determine the rates or any other aspect of the coverage or benefits for health care provided to an insured person based on whether the insured person or any member of the family of the insured person has taken a genetic test.
2. The provisions of this section do not apply to an insurer who issues a policy of group health insurance that provides coverage for long-term care or disability income.
3. As used in this section:
(a) "Genetic information" means any information that is obtained from a genetic test.
(b) "Genetic test" means a test, including a laboratory test that uses deoxyribonucleic acid extracted from the cells of a person or a diagnostic test, to determine the presence of abnormalities or deficiencies, including carrier status, that:
(1) Are linked to physical or mental disorders or impairments; or
(2) Indicate a susceptibility to illness, disease, impairment or any other disorder, whether physical or mental.
(Added to NRS by 1997, 1460; A 2019, 299)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.070 - "Blanket accident and health insurance" defined.

"Blanket accident and health insurance" is that form of accident insurance, health insurance, or both, covering groups of persons as enumerated in one of the following subsections under a policy or contract issued to:
1. Any common carrier or to any operator, owner or lessee of a means of transportation, who or which shall be deemed the policyholder, covering a group of persons who may become passengers defined by reference to their travel status on the common carrier or means of transportation.
2. An employer, who shall be deemed the policyholder, covering any group of employees, dependents or guests, defined by reference to specified hazards incident to an activity or activities or operations of the policyholder.
3. A college, school or other institution of learning, a school district or districts, or school jurisdictional unit, or to the head, principal or governing board of any such educational unit, who or which shall be deemed the policyholder, covering students, teachers or employees.
4. A religious, charitable, recreational, educational or civic organization, or branch thereof, which shall be deemed the policyholder, covering any group of members or participants defined by reference to specified hazards incident to an activity or activities or operations sponsored or supervised by the policyholder.
5. A sports team, camp or sponsor thereof, which shall be deemed the policyholder, covering members, campers, employees, officials or supervisors.
6. A volunteer fire department, organization providing first aid, organization for emergency management or other such volunteer organization, which shall be deemed the policyholder, covering any group of members or participants defined by reference to specified hazards incident to an activity or activities or operations sponsored or supervised by the policyholder.
7. A newspaper or other publisher, which shall be deemed the policyholder, covering its carriers.
8. An association, including a labor union, which has a constitution and bylaws and which has been organized and is maintained in good faith for purposes other than that of obtaining insurance, which shall be deemed the policyholder, covering any group of members or participants defined by reference to specified hazards incident to an activity or activities or operations sponsored or supervised by the policyholder.
9. Cover any other risk or class of risks which, in the discretion of the Commissioner, may be properly eligible for blanket accident and health insurance. The discretion of the Commissioner may be exercised on the basis of an individual risk or class of risks, or both.
(Added to NRS by 1971, 1768; A 1983, 177; 2001, 2221)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.090 - Application and certificates.

1. An individual application need not be required from a person covered under a blanket health policy or contract, nor shall it be necessary for the insurer to furnish each person a certificate, if such person does not pay all or part of the premium for such insurance.
2. The Commissioner may, by rule or regulation, require the delivery of an individual certificate or a statement of the coverage to individuals insured under such a blanket policy or contract who are either required to make an individual written application or pay part or all of the premium therefor, and applying to such classes of cases and circumstances, specified in such rule or regulation, as the Commissioner may find such delivery to be reasonably necessary and practicable.
(Added to NRS by 1971, 1770)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.100 - Payment of benefits.

1. Except as provided in subsection 2, all benefits under any blanket health policy or contract must be payable to the person insured, or to the designated beneficiary or beneficiaries of the person insured, or to the estate of the person insured, except that if the person insured is a minor or otherwise not competent to give a valid release, these benefits may be made payable to the parent or guardian of the person insured or to another person actually supporting the person insured.
2. The policy may provide that all or a portion of any indemnities provided by any such policy on account of hospital, nursing, medical or surgical services, home health care or supportive services:
(a) May, at the option of the insurer and unless the insured requests otherwise in writing not later than the time of filing proofs of such loss; or
(b) Must, upon the written request of the insured,
be paid directly to the hospital or person rendering those services. The policy may not require that the service be rendered by a particular hospital or person. Payment so made discharges the obligation of the insurer with respect to the amount of insurance so paid.
3. If the insured assigns his or her benefits pursuant to this section but the insurer after receiving a copy of the assignment pays the benefits to the insured, the insurer shall also pay the benefits to the assignee as soon as the insurer receives the notice of the incorrect payment.
(Added to NRS by 1971, 1771; A 1975, 450; 1983, 880)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.110 - Legal liability of policyholders for death of or injury to insured member unaffected.

Nothing contained in NRS 689B.070 to 689B.100, inclusive, shall be deemed to affect the legal liability of policyholders for death of or injury to any member insured under a blanket insurance policy.
(Added to NRS by 1971, 1771)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.250 - Acceptance of uniform forms for billing and claims.

Every insurer under a group health insurance contract or a blanket accident and health insurance contract and every state agency, for its records shall accept from:
1. A hospital the Uniform Billing and Claims Forms established by the American Hospital Association in lieu of its individual billing and claims forms.
2. An individual who is licensed to practice one of the health professions regulated by title 54 of NRS such uniform health insurance claims forms as the Commissioner shall prescribe, except in those cases where the Commissioner has excused uniform reporting.
(Added to NRS by 1975, 897; A 2001, 2224; 2021, 1651)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.260 - Group health or blanket health policy containing exclusion, reduction or limitation of coverage relating to complications of pregnancy prohibited; exception.

1. No group health or blanket health policy may be delivered or issued for delivery in this state if it contains any exclusion, reduction or other limitation of coverage relating to complications of pregnancy, unless the provision applies generally to all benefits payable under the policy.
2. As used in this section, the term "complications of pregnancy" includes any condition which requires hospital confinement for medical treatment and:
(a) If the pregnancy is not terminated, is caused by an injury or sickness not directly related to the pregnancy or by acute nephritis, nephrosis, cardiac decompensation, missed abortion or similar medically diagnosed conditions; or
(b) If the pregnancy is terminated, results in nonelective cesarean section, ectopic pregnancy or spontaneous termination.
3. A policy subject to the provisions of this chapter which is delivered or issued for delivery on or after July 1, 1977, has the legal effect of including the coverage required by this section, and any provision of the policy which is in conflict with this section is void.
(Added to NRS by 1977, 415)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.265 - Policy covering anatomical gifts, organ transplants or treatments or services related to organ transplants: Prohibited acts by insurer if insured is person with disability.

1. An insurer that offers or issues a policy of group health insurance that includes coverage for anatomical gifts, organ transplants or treatments or services related to an organ transplant shall not:
(a) Deny, limit or seek reimbursement from an insured for care related to an organ transplant because the insured is a person with a disability;
(b) Deny a person with a disability eligibility or continued eligibility to enroll or renew coverage to avoid providing coverage in accordance with this section;
(c) Reduce or limit the reimbursement of or otherwise penalize a provider of medical or related services because the provider of medical or related services acted in accordance with NRS 460.160; or
(d) Provide monetary or nonmonetary incentives for a provider of medical or related services to induce the provider of medical or related services to provide care to an insured in a manner inconsistent with NRS 460.160.
2. As used in this section:
(a) "Anatomical gift" has the meaning ascribed to it in NRS 451.513.
(b) "Disability" has the meaning ascribed to it in 42 U.S.C. § 12102(1).
(c) "Provider of medical or related services" has the meaning ascribed to it in NRS 460.160.
(Added to NRS by 2021, 1171)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.270 - Required procedure for arbitration of disputes concerning independent medical, dental or chiropractic evaluations.

1. Each policy of group or blanket health insurance must include a procedure for binding arbitration to resolve disputes concerning independent medical evaluations pursuant to the rules of the American Arbitration Association.
2. If an insurer, for any final determination of benefits or care, requires an independent evaluation of the medical, dental or chiropractic care of any person for whom such care is covered under the terms of a policy of group or blanket health insurance, only a physician, dentist or chiropractic physician who is certified to practice in the same field of practice as the primary treating physician, dentist or chiropractic physician or who is formally educated in that field may conduct the independent evaluation.
3. The independent evaluation must include a physical examination of the patient, unless the patient is deceased, and a personal review of all X-rays and reports prepared by the primary treating physician, dentist or chiropractic physician. A certified copy of all reports of findings must be sent to the primary treating physician, dentist or chiropractic physician and the insured person within 10 working days after the evaluation. If the insured person disagrees with the finding of the evaluation, the insured person must submit an appeal to the insurer pursuant to the procedure for binding arbitration set forth in the policy of insurance within 30 days after receiving the finding of the evaluation. Upon its receipt of an appeal, the insurer shall so notify in writing the primary treating physician, dentist or chiropractic physician.
4. The insurer shall not limit or deny coverage for care related to a disputed claim while the dispute is in arbitration, except that, if the insurer prevails in the arbitration, the primary treating physician, dentist or chiropractic physician may not recover any payment from either the insurer, insured person or the patient for services that the primary treating physician, dentist or chiropractic physician provided to the patient after receiving written notice from the insurer pursuant to subsection 3 concerning the appeal of the insured person.
(Added to NRS by 1989, 2114; A 2015, 196)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.275 - Contents, approval and provision of summary of coverage; provision of information about guaranteed availability of certain plans for benefits.

1. An insurer shall provide to each policyholder, or producer of insurance acting on behalf of a policyholder, on a form approved by the Commissioner, a summary of the coverage provided by each policy of group or blanket health insurance offered by the insurer. The summary must disclose any:
(a) Significant exception, reduction or limitation that applies to the policy;
(b) Restriction on payment for care in an emergency, including related definitions of emergency and medical necessity;
(c) Right of the insurer to change the rate of premium and the factors, other than claims experienced, which affect changes in rate;
(d) Provisions relating to renewability; and
(e) Other information that the Commissioner finds necessary for full and fair disclosure of the provisions of the policy.
2. The language of the disclosure must be easily understood. The disclosure must state that it is only a summary of the policy and that the policy should be read to ascertain the governing contractual provisions.
3. The Commissioner shall not approve a proposed disclosure that does not satisfy the requirements of this section and of applicable regulations.
4. In addition to the disclosure, the insurer shall provide information about guaranteed availability of basic and standard plans for benefits to an eligible person.
5. The insurer shall provide the summary before the policy is issued.
(Added to NRS by 2001, 2219; A 2019, 300)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.280 - Disclosure of information concerning medication of insured prohibited.

1. Except as otherwise provided in subsection 2, an insurer or any agent or employee of an insurer who delivers or issues for delivery a policy of group health or blanket health insurance in this State shall not disclose to the policyholder or any agent or employee of the policyholder:
(a) The fact that an insured is taking a prescribed drug or medicine; or
(b) The identity of that drug or medicine.
2. The provisions of subsection 1 do not prohibit disclosure to an administrator who acts as an intermediary for claims for insurance coverage.
(Added to NRS by 1989, 1978)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.285 - Offering policy of health insurance for purposes of establishing health savings account.

An insurer may, subject to regulation by the Commissioner, offer a policy of health insurance that has a high deductible and is in compliance with 26 U.S.C. § 223 for the purposes of establishing a health savings account.
(Added to NRS by 2005, 2137)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.287 - Insurer prohibited from denying coverage solely because applicant or insured was intoxicated or under influence of controlled substance; exceptions.

1. Except as otherwise provided in subsection 2, an insurer shall not:
(a) Deny a claim under a policy of group health insurance solely because the claim involves an injury sustained by an insured as a consequence of being intoxicated or under the influence of a controlled substance.
(b) Cancel a policy of group health insurance solely because an insured has made a claim involving an injury sustained by the insured as a consequence of being intoxicated or under the influence of a controlled substance.
(c) Refuse to issue a policy of group health insurance to an eligible applicant solely because the applicant has made a claim involving an injury sustained by the applicant as a consequence of being intoxicated or under the influence of a controlled substance.
2. The provisions of subsection 1 do not prohibit an insurer from enforcing a provision included in a policy of group health insurance to:
(a) Deny a claim which involves an injury to which a contributing cause was the insured’s commission of or attempt to commit a felony;
(b) Cancel a policy of group health insurance solely because of such a claim; or
(c) Refuse to issue a policy of group health insurance to an eligible applicant solely because of such a claim.
3. The provisions of this section do not apply to an insurer under a policy of group health insurance that provides coverage for long-term care or disability income.
(Added to NRS by 2005, 2344; A 2007, 84)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.290 - Definitions.

As used in NRS 689B.290 to 689B.330, inclusive, unless the context otherwise requires:
1. "Medicaid" means a program established in any state pursuant to Title XIX of the Social Security Act (42 U.S.C. §§ 1396 et seq.) to provide assistance for part or all of the cost of medical care rendered on behalf of indigent persons.
2. "Order for medical coverage" means an order of a court or administrative tribunal to provide coverage under a group health policy to a child pursuant to the provisions of 42 U.S.C. § 1396g-1.
(Added to NRS by 1995, 2428)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.310 - Insurer prohibited from asserting certain grounds to deny enrollment of child of insured pursuant to order.

An insurer shall not deny the enrollment of a child pursuant to an order for medical coverage under a group health policy pursuant to which a parent of the child is insured, on the ground that the child:
1. Was born out of wedlock;
2. Has not been claimed as a dependent on the parent’s federal income tax return; or
3. Does not reside with the parent or within the insurer’s geographic area of service.
(Added to NRS by 1995, 2429)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.320 - Certain accommodations required to be made when child is covered under policy of noncustodial parent.

If a child has coverage under a group health policy pursuant to which a noncustodial parent of the child is insured, the health insurer issuing that policy shall:
1. Provide to the custodial parent such information as necessary for the child to obtain any benefits under that coverage.
2. Allow the custodial parent or, with the approval of the custodial parent, a provider of health care to submit claims for covered services without the approval of the noncustodial parent.
3. Make payments on claims submitted pursuant to subsection 2 directly to the custodial parent, the provider of health care or an agency of this or another state responsible for the administration of Medicaid.
(Added to NRS by 1995, 2429)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.330 - Insurer required to authorize enrollment of child of parent who is required by order to provide medical coverage for child in certain circumstances.

If a parent is required by an order for medical coverage to provide coverage under a group health policy for a child and the parent is eligible for coverage of members of his or her family under a group health policy, the insurer that issued the policy:
1. Shall, if the child is otherwise eligible for that coverage, allow the parent to enroll the child in that coverage without regard to any restrictions upon periods for enrollment.
2. Shall, if:
(a) The child is otherwise eligible for that coverage; and
(b) The parent is enrolled in that coverage but fails to apply for enrollment of the child,
enroll the child in that coverage upon application by the other parent of the child, or by an agency of this or another state responsible for the administration of Medicaid or a state program for the enforcement of child support established pursuant to 42 U.S.C. §§ 651 et seq., without regard to any restrictions upon periods for enrollment.
3. Shall not terminate the enrollment of the child in that coverage or otherwise eliminate that coverage of the child unless the insurer has written proof that:
(a) The order for medical coverage is no longer in effect; or
(b) The child is or will be enrolled in comparable coverage through another insurer on or before the effective date of the termination of enrollment or elimination of coverage.
(Added to NRS by 1995, 2429)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.340 - Definitions.

As used in NRS 689B.340 to 689B.580, inclusive, unless the context otherwise requires, the words and terms defined in NRS 689B.350 to 689B.460, inclusive, have the meanings ascribed to them in those sections.
(Added to NRS by 1997, 2900; A 2001, 1923, 2224; 2013, 3620)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.350 - "Affiliation period" defined.

"Affiliation period" means a period not to exceed 60 days for new enrollees and 90 days for late enrollees during which no premiums may be collected from, and coverage issued would not become effective for, an employee or a dependent of the employee, if the affiliation period is applied uniformly and without regard to any health status-related factors.
(Added to NRS by 1997, 2900)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.360 - "Carrier" defined.

"Carrier" means any person who provides health insurance in this state, including a fraternal benefit society, a health maintenance organization, a nonprofit hospital and health service corporation, a health insurance company and any other person providing a plan of health insurance or health benefits subject to this Title.
(Added to NRS by 1997, 2900)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.380 - "Creditable coverage" defined.

"Creditable coverage" means health benefits or coverage provided to a person pursuant to:
1. A group health plan;
2. A health benefit plan;
3. Part A or Part B of Title XVIII of the Social Security Act, 42 U.S.C. §§ 1395c et seq., also known as Medicare;
4. Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et seq., also known as Medicaid, other than coverage consisting solely of benefits under section 1928 of that Title, 42 U.S.C. § 1396s;
5. The Civilian Health and Medical Program of Uniformed Services, CHAMPUS, 10 U.S.C. §§ 1071 et seq.;
6. A medical care program of the Indian Health Service or of a tribal organization;
7. A state health benefit risk pool;
8. A health plan offered pursuant to the Federal Employees Health Benefits Program, FEHBP, 5 U.S.C. §§ 8901 et seq.;
9. A public health plan as defined in 45 C.F.R. § 146.113, authorized by the Public Health Service Act, 42 U.S.C. § 300gg(c)(1)(I);
10. A health benefit plan under section 5(e) of the Peace Corps Act, 22 U.S.C. § 2504(e);
11. The Children’s Health Insurance Program established pursuant to 42 U.S.C. §§ 1397aa to 1397jj, inclusive;
12. A short-term health insurance policy; or
13. A blanket accident and health insurance policy.
(Added to NRS by 1997, 2900; A 1999, 2240, 2806; 2001, 2224)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.390 - "Group health plan" defined.

1. "Group health plan" means an employee welfare benefit plan, as defined in section 3(1) of the Employee Retirement Income Security Act of 1974, as that section existed on July 16, 1997, to the extent that the plan provides medical care to employees or their dependents as defined under the terms of the plan directly, or through insurance, reimbursement or otherwise.
2. The term does not include:
(a) Coverage that is only for accident or disability income insurance, or any combination thereof;
(b) Coverage issued as a supplement to liability insurance;
(c) Liability insurance, including general liability insurance and automobile liability insurance;
(d) Workers’ compensation or similar insurance;
(e) Coverage for medical payments under a policy of automobile insurance;
(f) Credit insurance;
(g) Coverage for on-site medical clinics; and
(h) Other similar insurance coverage specified in federal regulations adopted pursuant to Public Law 104-191 under which benefits for medical care are secondary or incidental to other insurance benefits.
3. The term does not include the following benefits if the benefits are provided under a separate policy, certificate or contract of insurance or are otherwise not an integral part of a health benefit plan:
(a) Limited-scope dental or vision benefits;
(b) Benefits for long-term care, nursing home care, home health care or community-based care, or any combination thereof; and
(c) Such other similar benefits as are specified in any federal regulations adopted pursuant to Public Law 104-191.
4. The term does not include the following benefits if the benefits are provided under a separate policy, certificate or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and such benefits are paid for a claim without regard to whether benefits are provided for such a claim under any group health plan maintained by the same plan sponsor:
(a) Coverage that is only for a specified disease or illness; and
(b) Hospital indemnity or other fixed indemnity insurance.
5. The term does not include any of the following, if offered as a separate policy, certificate or contract of insurance:
(a) Medicare supplemental health insurance as defined in section 1882(g)(1) of the Social Security Act, as that section existed on July 16, 1997;
(b) Coverage supplemental to the coverage provided pursuant to chapter 55 of Title 10, United States Code (Civilian Health and Medical Program of Uniformed Services (CHAMPUS)); and
(c) Similar supplemental coverage provided under a group health plan.
(Added to NRS by 1997, 2900)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.460 - "Waiting period" defined.

"Waiting period" means the period established by a plan of health insurance that must pass before a person who is an eligible participant or beneficiary in a plan is covered for benefits under the terms of the plan. The term includes the period from the date a person submits an application to an individual carrier for coverage under a health benefit plan until the first day of coverage under that health benefit plan.
(Added to NRS by 1997, 2903; A 1999, 2808)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.480 - Determination of applicable creditable coverage of person; determination of period of creditable coverage of person; required statement.

1. In determining the applicable creditable coverage of a person for the purposes of NRS 689B.340 to 689B.580, inclusive, a period of creditable coverage must not be included if, after the expiration of that period but before the enrollment date, there was a 63-day period during all of which the person was not covered under any creditable coverage. To establish a period of creditable coverage, a person must present any certificates of coverage provided to the person in accordance with NRS 689B.490 and such other evidence of coverage as required by regulations adopted by the Commissioner. For the purposes of this subsection, any waiting period for coverage or an affiliation period must not be considered in determining the applicable period of creditable coverage.
2. In determining the period of creditable coverage of a person, a carrier shall include each applicable period of creditable coverage without regard to the specific benefits covered during that period, except that the carrier may elect to include applicable periods of creditable coverage based on coverage of specific benefits as specified in the regulations of the United States Department of Health and Human Services, if such an election is made on a uniform basis for all participants and beneficiaries of the health benefit plan or coverage. Pursuant to such an election, the carrier shall include each applicable period of creditable coverage with respect to any class or category of benefits if any level of benefits is covered within that class or category, as specified by those regulations.
3. Regardless of whether coverage is actually provided, if a carrier elects in accordance with subsection 2 to determine creditable coverage based on specified benefits, a statement that such an election has been made and a description of the effect of the election must be:
(a) Included prominently in any disclosure statement concerning the health benefit plan; and
(b) Provided to each person at the time of enrollment in the health benefit plan.
4. The provisions of this section apply only to grandfathered plans.
(Added to NRS by 1997, 2903; A 2013, 3620)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.490 - Written certification of coverage required for purpose of determining period of creditable coverage accumulated by person.

1. For the purpose of determining the period of creditable coverage of a person accumulated under a health benefit plan, blanket accident and health insurance or group health insurance, the insurer shall provide written certification on a form prescribed by the Commissioner of coverage to the person which certifies the length of:
(a) The period of creditable coverage that the person accumulated under the plan and any coverage under any provision of the Consolidated Omnibus Budget Reconciliation Act of 1985, as that act existed on July 16, 1997, relating to the continuation of coverage; and
(b) Any waiting and affiliation period imposed on the person pursuant to that coverage.
2. The certification of coverage must be provided to the person who was insured:
(a) At the time that the person ceases to be covered under the plan, if the person does not otherwise become covered under any provision of the Consolidated Omnibus Budget Reconciliation Act of 1985, as that act existed on July 16, 1997, relating to the continuation of coverage;
(b) If the person becomes covered under such a provision, at the time that the person ceases to be covered by that provision; and
(c) Upon request, if the request is made not later than 24 months after the date on which the person ceased to be covered as described in paragraphs (a) and (b).
(Added to NRS by 1997, 2904; A 2001, 2225)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.500 - Carrier required to offer and issue plan regardless of health status of members; prohibited acts; authority to include wellness program in plan that offers discounts based on health status under certain circumstances.

1. A carrier shall offer and issue a health benefit plan to any group regardless of the health status of the group, any member of the group or any dependent of a member of the group. Such health status includes, without limitation:
(a) Any preexisting medical condition of a person, including, without limitation, any physical or mental illness;
(b) The claims history of an insured, including, without limitation, any prior health care services received by the insured;
(c) Genetic information relating to the insured; and
(d) Any increased risk for illness, injury or any other medical condition of the insured, including, without limitation, any medical condition caused by an act of domestic violence.
2. A carrier that offers or issues a health benefit plan shall not:
(a) Deny, limit or exclude a covered benefit based on the health status of an insured; or
(b) Require an insured, as a condition of enrollment or renewal, to pay a premium, deductible, copay or coinsurance based on his or her health status which is greater than the premium, deductible, copay or coinsurance charged to a similarly situated insured who does not have such a health status.
3. A carrier that offers or issues a health benefit plan shall not adjust a premium, deductible, copay or coinsurance for any insured on the basis of genetic information relating to the insured or the covered dependent of the insured.
4. A carrier that offers or issues a health benefit plan may include in the plan a wellness program that reduces a premium, deductible or copayment based on health status if:
(a) An insured who is eligible to participate in the wellness program is given the opportunity to qualify for the discount at least once each year;
(b) The amount of all discounts provided pursuant to such a wellness program does not exceed 30 percent, or if the program is designed to prevent or reduce tobacco use, 50 percent, of the cost of coverage for an insured or an insured and his or her dependents, as applicable, under the plan;
(c) The wellness program is reasonably designed to promote health or prevent disease;
(d) The carrier ensures that the full discount under the wellness program is available to all similarly situated insureds by providing a reasonable alternative standard by which an insured may qualify for the discount which, if based on health status, must accommodate the recommendations of the physician of the insured; and
(e) The plan discloses in all plan materials describing the terms of the wellness program, and in any disclosure that an insured did not satisfy the initial standard to be eligible for the discount, the availability of a reasonable alternative standard described in paragraph (d).
5. As used in this section, "health benefit plan" has the meaning ascribed to it in NRS 687B.470.
(Added to NRS by 1997, 2904; A 1999, 2808; 2001, 2225; 2013, 3621; 2019, 300)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.510 - Carrier authorized to modify coverage for insurance product under certain circumstances.

A carrier may modify the health insurance coverage for a product offered pursuant to a group health plan by the carrier at the time of renewal of such coverage if the modification is consistent with the provisions of this chapter.
(Added to NRS by 1997, 2906)
2023 Nevada Revised Statutes › Chapter 689B - Group and Blanket Health Insurance › NRS 689B.530 - Carrier required to permit eligible employee or dependent of employee to enroll for coverage under certain circumstances.

A carrier offering group health insurance shall permit an employee or a dependent of an employee covered by the group health insurance who is eligible, but not enrolled, for coverage in connection with the group health insurance to enroll for coverage under the terms of the group health insurance if:
1. The employee or dependent was covered under a different group health insurance or had other health insurance coverage at the time coverage was previously offered to the employee or dependent;
2. The employee stated in writing at that time that the other coverage was the reason for declining enrollment, but only if the plan sponsor or carrier required such a written statement and informed the employee of that requirement and the consequences of the requirement; and
3. The employee or dependent:
(a) Was covered under any provision of the Consolidated Omnibus Budget Reconciliation Act of 1985 relating to the continuation of coverage and such continuation of coverage was exhausted; or
(b) Was not covered under such a provision and his or her insurance coverage was lost as a result of cessation of contributions by his or her employer, termination of employment or eligibility, reduction in the number of hours of employment, or the death of, or divorce or legal separation from, a covered spouse.
(Added to NRS by 1997, 2907)