reglab/statecodes huggingface dataset:
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.1918 - Required provision in contract covering outpatient care concerning coverage of health care services related to hormone replacement therapy; prohibited acts.

1. An insurer that offers or issues a contract for hospital or medical service which provides coverage for outpatient care shall include in the contract coverage for any health care service related to hormone replacement therapy.
2. An insurer that offers or issues a contract for hospital or medical service that provides coverage for outpatient care shall not:
(a) Require an insured to pay a higher deductible, any copayment or coinsurance or require a longer waiting period or other condition for coverage for outpatient care related to hormone replacement therapy;
(b) Refuse to issue a contract for hospital or medical service or cancel a contract for hospital or medical service solely because the person applying for or covered by the contract uses or may use in the future hormone replacement therapy;
(c) Offer or pay any type of material inducement or financial incentive to an insured to discourage the insured from accessing hormone replacement therapy;
(d) Penalize a provider of health care who provides hormone replacement therapy to an insured, including, without limitation, reducing the reimbursement of the provider of health care; or
(e) Offer or pay any type of material inducement, bonus or other financial incentive to a provider of health care to deny, reduce, withhold, limit or delay hormone replacement therapy to an insured.
3. A contract for hospital or medical service subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after October 1, 1999, has the legal effect of including the coverage required by subsection 1, and any provision of the contract or the renewal which is in conflict with this section is void.
4. As used in this section, "provider of health care" has the meaning ascribed to it in NRS 629.031.
(Added to NRS by 1999, 2000; A 2017, 1840, 3950)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.192 - Contract containing exclusion, reduction or limitation of coverage relating to complications of pregnancy prohibited; exception.

1. No hospital, medical or dental service contract issued by a corporation pursuant to the provisions of this chapter may contain any exclusion, reduction or other limitation of coverage relating to complications of pregnancy, unless the provision applies generally to all benefits payable under the contract and complies with the provisions of NRS 689B.340 to 689B.580, inclusive, and chapter 689C of NRS relating to the portability and availability of health insurance.
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 contract subject to the provisions of this chapter which is issued or delivered on or after July 1, 1977, has the legal effect of including the coverage required by this section, and any provision of the contract which is in conflict with this section is void.
(Added to NRS by 1977, 416; A 1997, 2955; 2013, 3637)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.1923 - Required provision concerning coverage for treatment of certain inherited metabolic diseases.

1. A contract for hospital or medical service must provide coverage for:
(a) Enteral formulas for use at home that are prescribed or ordered by a physician as medically necessary for the treatment of inherited metabolic diseases characterized by deficient metabolism, or malabsorption originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate or fat; and
(b) At least $2,500 per year for special food products which are prescribed or ordered by a physician as medically necessary for the treatment of a person described in paragraph (a).
2. The coverage required by subsection 1 must be provided whether or not the condition existed when the contract was purchased.
3. A contract subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after July 1, 2021, has the legal effect of including the coverage required by this section, and any provision of the contract or the renewal which is in conflict with this section is void.
4. As used in this section:
(a) "Enteral formula" includes, without limitation, a formula that is ingested orally.
(b) "Inherited metabolic disease" means a disease caused by an inherited abnormality of the body chemistry of a person.
(c) "Special food product" means a food product that is specially formulated to have less than one gram of protein per serving and is intended to be consumed under the direction of a physician for the dietary treatment of an inherited metabolic disease. The term does not include a food that is naturally low in protein.
(Added to NRS by 1997, 1527; A 2021, 3624)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.1926 - Required provision concerning coverage for testing, treatment and prevention of sexually transmitted diseases; required provision concerning coverage for condoms for certain insureds.

1. A hospital or medical services corporation that offers or issues a policy of health insurance shall include in the policy:
(a) Coverage of testing for and the treatment and prevention of sexually transmitted diseases, including, without limitation,
Chlamydia trachomatis
, gonorrhea, syphilis, human immunodeficiency virus and hepatitis B and C, for all insureds, regardless of age. Such coverage must include, without limitation, the coverage required by NRS 695B.1913 and 695B.1924.
(b) Unrestricted coverage of condoms for insureds who are 13 years of age or older.
2. A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 2024, has the legal effect of including the coverage required by subsection 1, and any provision of the policy that conflicts with the provisions of this section is void.
(Added to NRS by 2023, 3522)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.1927 - Required provision in contract covering hospital, medical or surgical expenses concerning coverage for management and treatment of diabetes.

1. No contract for hospital or medical service that provides coverage for hospital, medical or surgical expenses may be delivered or issued for delivery in this state unless the contract includes coverage for the management and treatment of diabetes, including, without limitation, coverage for the self-management of diabetes.
2. An insurer who delivers or issues for delivery a contract specified in subsection 1:
(a) Shall include in any disclosure of the coverage provided by the contract notice to each policyholder or subscriber covered under the contract of the availability of the benefits required by this section.
(b) Shall provide the coverage required by this section subject to the same deductible, copayment, coinsurance and other such conditions for coverage that are required under the contract.
3. A contract for hospital or medical service subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 1998, has the legal effect of including the coverage required by this section, and any provision of the contract that conflicts with this section is void.
4. As used in this section:
(a) "Coverage for the management and treatment of diabetes" includes coverage for medication, equipment, supplies and appliances that are medically necessary for the treatment of diabetes.
(b) "Coverage for the self-management of diabetes" includes:
(1) The training and education provided to a person covered under the contract after the person is initially diagnosed with diabetes which is medically necessary for the care and management of diabetes, including, without limitation, counseling in nutrition and the proper use of equipment and supplies for the treatment of diabetes;
(2) Training and education which is medically necessary as a result of a subsequent diagnosis that indicates a significant change in the symptoms or condition of the person covered under the contract and which requires modification of the person’s program of self-management of diabetes; and
(3) Training and education which is medically necessary because of the development of new techniques and treatment for diabetes.
(c) "Diabetes" includes type I, type II and gestational diabetes.
(Added to NRS by 1997, 744; A 2017, 2389)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.1929 - Required provision of coverage for management and treatment of sickle cell disease and its variants; policy covering prescription drugs required to provide coverage for medically necessary prescription drugs to treat sickle cell disease and its variants.

1. A hospital or medical service corporation that issues a policy of health insurance shall include in the policy coverage for:
(a) Necessary case management services for an insured who has been diagnosed with sickle cell disease and its variants; and
(b) Medically necessary care for an insured who has been diagnosed with sickle cell disease and its variants.
2. A hospital or medical service corporation that issues a policy of health insurance which provides coverage for prescription drugs shall include in the policy coverage for medically necessary prescription drugs to treat sickle cell disease and its variants.
3. A hospital or medical service corporation may use medical management techniques, including, without limitation, any available clinical evidence, to determine the frequency of or treatment relating to any benefit required by this section or the type of provider of health care to use for such treatment.
4. As used in this section:
(a) "Case management services" means medical or other health care management services to assist patients and providers of health care, including, without limitation, identifying and facilitating additional resources and treatments, providing information about treatment options and facilitating communication between providers of services to a patient.
(b) "Medical management technique" means a practice which is used to control the cost or utilization of health care services. The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.
(c) "Medically necessary" has the meaning ascribed to it in NRS 695G.055.
(d) "Sickle cell disease and its variants" has the meaning ascribed to it in NRS 439.4927.
(Added to NRS by 2019, 2172)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.193 - Contract covering family member of subscriber required to include certain coverage for subscriber’s newly born and adopted children and children placed with subscriber for adoption.

1. All individual and group service or indemnity-type contracts issued by a nonprofit corporation which provide coverage for a family member of the subscriber must as to such coverage provide that the health benefits applicable for children are payable with respect to:
(a) A newly born child of the subscriber from the moment of birth;
(b) An adopted child from the date the adoption becomes effective, if the child was not placed in the home before adoption; and
(c) A child placed with the subscriber for the purpose of adoption from the moment of placement as certified by the public or private agency making the placement. The coverage of such a child ceases if the adoption proceedings are terminated as certified by the public or private agency making the placement.
The contracts must provide the coverage specified in subsection 3, and must not exclude premature births.
2. The contract may require that notification of:
(a) The birth of a newly born child;
(b) The effective date of adoption of a child; or
(c) The date of placement of a child for adoption,
and payments of the required fees, if any, must be furnished to the nonprofit service corporation within 31 days after the date of birth, adoption or placement for adoption in order to have the coverage continue beyond the 31-day period.
3. The coverage for newly born and adopted children and children placed for adoption consists of coverage of injury or sickness, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities and, within the limits of the policy, necessary transportation costs from place of birth to the nearest specialized treatment center under major medical policies, and with respect to basic policies to the extent such costs are charged by the treatment center.
4. For covered services provided to the child, the corporation shall reimburse noncontracted providers of health care to an amount equal to the average amount of payment for which the organization has agreements, contracts or arrangements for those covered services.
(Added to NRS by 1975, 1110; A 1989, 741; 1995, 2434; 1997, 2956; 2019, 306)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.1931 - Contract prohibited from excluding coverage relating to treatment of temporomandibular joint; exception.

1. Except as otherwise provided in this section, no contract for hospital or medical service may be delivered or issued for delivery in this state if it contains an exclusion of coverage of the treatment of the temporomandibular joint whether by specific language in the contract or by a claims settlement practice. A contract for hospital or medical service may exclude coverage of those methods of treatment which are recognized as dental procedures, including, but not limited to, the extraction of teeth and the application of orthodontic devices and splints.
2. Pursuant to a contract for hospital or medical service, a corporation may limit its liability on the treatment of the temporomandibular joint to:
(a) No more than 50 percent of the usual and customary charges for such treatment actually received by a subscriber, but in no case more than 50 percent of the maximum benefits provided by the contract for such treatment; and
(b) Treatment which is medically necessary.
3. Any provision of a contract subject to the provisions of this chapter and issued or delivered on or after January 1, 1990, which is in conflict with this section is void.
(Added to NRS by 1989, 2138)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.1932 - Policy covering prescription drugs: Denial of coverage prohibited for early refills of otherwise covered topical ophthalmic products.

1. A hospital or medical service corporation which offers or issues a policy of health insurance that provides coverage for prescription drugs shall not deny coverage for a topical ophthalmic product which is otherwise approved for coverage by the hospital or medical service corporation when the insured, pursuant to NRS 639.2395, receives a refill of the product:
(a) After 21 days or more but before 30 days after receiving any 30-day supply of the product;
(b) After 42 days or more but before 60 days after receiving any 60-day supply of the product; or
(c) After 63 days or more but before 90 days after receiving any 90-day supply of the product.
2. The provisions of this section do not affect any deductibles, copayments or coinsurance authorized or required pursuant to the policy of health insurance.
3. A policy of health insurance subject to the provisions of this chapter which provides coverage for prescription drugs and that is delivered, issued for delivery or renewed on or after January 1, 2016, has the legal effect of including the coverage required by this section, and any provision of the policy or renewal which is in conflict with this section is void.
4. As used in this section, "topical ophthalmic product" means a liquid prescription drug which is applied directly to the eye from a bottle or by means of a dropper.
(Added to NRS by 2015, 207)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.1942 - Required provision in contract covering treatment of prostate cancer concerning coverage for prostate cancer screening; prohibited act.

1. A policy of health insurance issued by a hospital or medical service corporation that provides coverage for the treatment of prostate cancer must provide coverage for prostate cancer screening in accordance with:
(a) The guidelines concerning prostate cancer screening which are published by the American Cancer Society; or
(b) Other guidelines or reports concerning prostate cancer screening which are published by nationally recognized professional organizations and which include current or prevailing supporting scientific data.
2. A policy of health insurance issued by a hospital or medical service corporation that provides coverage for the treatment of prostate cancer must not require an insured to obtain prior authorization for any service provided pursuant to subsection 1.
3. A policy of health insurance issued by a hospital or medical service corporation that provides coverage for the treatment of prostate cancer which is delivered, issued for delivery or renewed on or after July 1, 2007, has the legal effect of including the coverage required by subsection 1, and any provision of the policy or the renewal which is in conflict with subsection 1 is void.
(Added to NRS by 2007, 3238)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.1944 - Required provision in certain group contracts concerning continuing coverage for employee or member on leave without pay as result of total disability.

1. As used in this section, "total disability" and "totally disabled" mean the continuing inability of the employee or member, because of an injury or illness, to perform substantially the duties related to his or her employment for which the employee or member is otherwise qualified.
2. No group subscriber contract for hospital, medical or dental service may be delivered or issued for delivery in this state unless it provides continuing coverage for an employee or member and dependents of the employee or member who are otherwise covered by the policy while the employee or member is on leave without pay as a result of a total disability. The coverage must be for any injury or illness suffered by the employee or member which is not related to the total disability or for any injury or illness suffered by a dependent of the employee or member. The coverage for such injury or illness must be equal to or greater than the coverage otherwise provided by the policy.
3. The coverage required pursuant to subsection 2 must continue until:
(a) The date on which the employment of the employee or member is terminated;
(b) The date on which the employee or member obtains another policy of health insurance;
(c) The date on which the group subscriber contract is terminated; or
(d) After a period of 12 months in which benefits under such coverage are provided to the employee or member,
whichever occurs first.
(Added to NRS by 1989, 1251)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.1948 - Contract covering maternity care: Prohibited acts by insurer if insured is acting as gestational carrier; child deemed child of intended parent for purposes of contract.

1. An insurer that offers or issues a contract for hospital or medical services that includes coverage for maternity care shall not deny, limit or seek reimbursement for maternity care because the insured is acting as a gestational carrier.
2. If an insured acts as a gestational carrier, the child shall be deemed to be a child of the intended parent, as defined in NRS 126.590, for purposes related to the contract for hospital or medical services.
3. As used in this section, "gestational carrier" has the meaning ascribed to it in NRS 126.580.
(Added to NRS by 2019, 1006)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.1949 - Contract 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 contract for hospital or medical services 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, 1172)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.1951 - Reimbursement for treatment by podiatrist.

1. If any contract for hospital or medical services provides coverage for treatment of an illness which is within the authorized scope of practice of a qualified podiatrist, the insured is entitled to reimbursement for treatments by a podiatrist who is licensed pursuant to chapter 635 of NRS.
2. The terms of the policy must not limit:
(a) Coverage for treatments by a podiatrist to a number less than for treatments by other physicians.
(b) Reimbursement for treatments by a podiatrist to an amount less than that reimbursed for similar treatments by other physicians.
(Added to NRS by 2007, 1046)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.1955 - Reimbursement for treatment by licensed clinical alcohol and drug counselor.

If any contract for hospital or medical service provides coverage for treatment of an illness which is within the authorized scope of practice of a licensed clinical alcohol and drug counselor, the insured is entitled to reimbursement for treatment by a clinical alcohol and drug counselor who is licensed pursuant to chapter 641C of NRS unless the clinical alcohol and drug counselor must be directly reimbursed pursuant to:
1. An assignment of benefits described in NRS 687B.409; or
2. Any other applicable assignment of benefits.
(Added to NRS by 2007, 3094; A 2017, 2210)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.196 - Reimbursement for acupuncture.

If any contract for hospital or medical services provides coverage for acupuncture performed by a physician, the insured is entitled to reimbursement for acupuncture performed by a person who is licensed pursuant to chapter 634A of NRS.
(Added to NRS by 1991, 1134)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.197 - Reimbursement for treatment by licensed psychologist.

If any contract for hospital or medical service provides coverage for treatment of an illness which is within the authorized scope of the practice of a qualified psychologist, the insured is entitled to reimbursement for treatments by a licensed psychologist.
(Added to NRS by 1981, 576; A 1989, 1553; 2017, 935)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.1973 - Reimbursement for treatment by licensed marriage and family therapist or licensed clinical professional counselor.

If any contract for hospital or medical service provides coverage for treatment of an illness which is within the authorized scope of practice of a licensed marriage and family therapist or licensed clinical professional counselor, the insured is entitled to reimbursement for treatment by a marriage and family therapist or clinical professional counselor who is licensed pursuant to chapter 641A of NRS.
(Added to NRS by 1987, 2133; A 2007, 3094)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.1975 - Reimbursement for treatment by licensed associate in social work, social worker, master social worker, independent social worker or clinical social worker.

If any contract for hospital or medical service provides coverage for treatment of an illness which is within the authorized scope of the practice of a licensed associate in social work, social worker, master social worker, independent social worker or clinical social worker, the insured is entitled to reimbursement for treatment by an associate in social work, social worker, master social worker, independent social worker or clinical social worker who is licensed pursuant to chapter 641B of NRS.
(Added to NRS by 1987, 1123; A 2021, 3508)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.198 - Reimbursement for treatment by chiropractic physician.

1. If any contract for hospital or medical service provides coverage for treatment of an illness which is within the authorized scope of practice of a qualified chiropractic physician, the insured is entitled to reimbursement for treatments by a chiropractic physician who is licensed pursuant to chapter 634 of NRS.
2. The terms of the policy must not limit:
(a) Coverage for treatments by a chiropractic physician to a number less than for treatments by other physicians.
(b) Reimbursement for treatments by a chiropractic physician to an amount less than that charged for similar treatments by other physicians.
(Added to NRS by 1981, 930; A 1983, 328)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.199 - Reimbursement for services provided by certain nurses.

1. If any contract for medical service provides coverage for services which are within the authorized scope of practice of a registered nurse who is authorized pursuant to chapter 632 of NRS to perform additional acts in an emergency or under other special conditions as prescribed by the State Board of Nursing, and which are reimbursed when provided by another provider of health care, the insured is entitled to reimbursement for services provided by such a registered nurse.
2. The terms of the contract must not limit:
(a) Coverage for services provided by such a registered nurse to a number of occasions less than for services provided by another provider of health care.
(b) Reimbursement for services provided by such a registered nurse to an amount less than that reimbursed for similar services provided by another provider of health care.
3. An insurer is not required to pay for services provided by such a registered nurse which duplicate services provided by another provider of health care.
(Added to NRS by 1985, 1447)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.1995 - Reimbursement to provider of medical transportation.

1. Except as otherwise provided in subsection 3, every contract for medical service amended, delivered or issued for delivery in this State after October 1, 1989, that provides coverage for medical transportation, must contain a provision for the direct reimbursement of a provider of medical transportation for covered services if that provider does not receive reimbursement from any other source.
2. The subscriber or the provider may submit the claim for reimbursement. The provider shall not demand payment from the subscriber until after that reimbursement has been granted or denied.
3. Subsection 1 does not apply to any agreement between a corporation for medical service and a provider of medical transportation for the direct payment by the corporation for the provider’s services.
(Added to NRS by 1989, 1274)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.200 - Group contracts written under master contract: Conditions required for issuance.

Group hospital or group medical or dental service contracts written under a master hospital or medical or dental service contract may be issued to cover groups of two or more persons, formed for a purpose other than of obtaining insurance.
(Added to NRS by 1971, 1871)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.210 - Group master service contract: Required provisions.

Every group master hospital or group medical or dental service contract issued shall contain the following provisions:
1. A provision that the contract, the application of the employer, or executive officer or trustee of any association or trustees, and the individual applications, if any, of the employees or members covered shall constitute the entire contract between the parties, and that all statements made by the employer, or the executive officer, or trustee or trustees, or by the individual employee or member shall, in the absence of fraud, be deemed representations and not warranties, and that no such statement shall be used in defense to a claim under the contract, unless it is contained in a written application.
2. A provision that the corporation will issue to the employer or to the executive officer or trustee of the association or to the trustees, for delivery to each of the employees or members who are covered under such contract, an individual certificate setting forth a statement as to the hospital or medical or dental service to which he or she is entitled.
3. A provision that to the group or class thereof originally covered shall be added from time to time all new employees of the employer or members of the association eligible to and applying for coverage in such group or class.
4. A statement that such contract is not in lieu of workers’ compensation insurance.
5. Such provisions as may be promulgated by the Commissioner from time to time.
(Added to NRS by 1971, 1871)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.220 - Blanket service contracts: Issuance to college, school or school personnel; pupils not to be compelled to accept service.

Blanket hospital or blanket medical or dental service contracts may be issued to a college or school or to the head or principal thereof or to the governing board of any school district providing for services to pupils of such schools when such services are required as the result of accident or motor vehicle crash to such pupils while they are required to be in or on buildings or other premises of the school or district during the time they are required to be therein or thereon by reason of their attendance upon a college or regular day school or any regular day school of a school district or while being transported to and from school or other place of instruction. No pupil shall be compelled to accept such service without the consent of a parent or guardian of the pupil.
(Added to NRS by 1971, 1871; A 2015, 1697)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.225 - Policies of group insurance: 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 shall 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 nor 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 1989, 514)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.230 - Filing and approval of forms and schedules of premium rates.

If more than one class of risk is included:
1. A hospital or medical or dental service contract or evidence of coverage under a group or nongroup contract must not be issued or delivered in this state until a copy of the form of the contract is filed with the Commissioner and either:
(a) Thirty days expires without notice from the Commissioner after the copy is filed; or
(b) The Commissioner gives written approval before that time.
2. A schedule of premium rates to be paid by subscribers under either a group or nongroup contract must not be issued, delivered or used by any nonprofit hospital, medical or dental service corporation until that corporation files with the Commissioner a copy of the schedule together with any supplementary information required by the Commissioner and either:
(a) Thirty days expires without notice from the Commissioner after the copy is filed; or
(b) The Commissioner gives written approval before that time.
(Added to NRS by 1971, 1872; A 1989, 517)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.240 - Provision of group service coverage before approval of forms.

1. A corporation subject to the provisions of this chapter is permitted to provide group hospital or group medical or dental service coverage prior to the approval of the form of the contract or certificate if all the conditions of subsection 2 of this section are met prior thereto and if thereafter it acts as required by subsection 3.
2. The conditions referred to in subsection 1 are that:
(a) The group is one eligible for coverage pursuant to the provisions of this chapter.
(b) An executed memorandum has been or is concurrently delivered to the subscriber containing a provision that unless a group hospital or group medical or dental service certificate, the form of which has been approved by the Commissioner, which is issued under a group hospital or group medical or dental service contract the form of which has been approved by the Commissioner, and which embodies the coverage, has been issued and delivered to the subscriber within 90 days after the date on which the coverage is provided or agreed to be provided, the coverage provided pursuant to such memorandum terminates 120 days after such date. The memorandum shall contain a specification in either complete or summary form of:
(1) The class or classes of employees eligible for coverage.
(2) The benefits to be provided.
(3) The exceptions and reductions to such benefits, if any.
3. A corporation subject to the provisions of this chapter providing coverage pursuant to this section shall:
(a) Within 60 days after the date on which the coverage is provided or agreed to be provided, submit to the Commissioner for approval a form of a group hospital or group medical or dental service contract, and a form of a certificate of individual coverage, drafted to provide the coverage provided by such memorandum and to meet all requirements of law.
(b) Make such revisions in the contract and certificate submitted as the Commissioner may lawfully require.
(c) Terminate such coverage in accordance with the provisions of paragraph (b) of subsection 2 of this section if approval of such contract and certificate is not secured within the time specified therein.
(Added to NRS by 1971, 1872)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.250 - Extensions of time; automatic approval.

1. Upon written request from the corporation subject to the provisions of this chapter filed within 50 days after the date on which the coverage is provided or agreed to be provided and upon proof satisfactory to the Commissioner that the corporation is acting with due diligence and that hardship will result unless an extension is granted, the Commissioner may extend the time set forth in paragraph (a) of subsection 3 of NRS 695B.240 for a period of not to exceed 30 days. Upon such extension, the corporation with the consent of the subscriber may amend the memorandum referred to in paragraph (b) of subsection 2 of NRS 695B.240 to extend the time within which the certificate must be issued and delivered to the subscriber to 30 days after the date to which the Commissioner has extended the time within which a form of contract and certificate must be submitted to the Commissioner for approval and to extend the date for termination of coverage to 30 days thereafter.
2. A contract and certificate submitted to the Commissioner with a letter from the corporation stating that coverage has been provided in accordance with this section shall be automatically approved unless the Commissioner disapproves the same within 30 days of the date of its submission to the Commissioner.
(Added to NRS by 1971, 1873)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.251 - Group subscriber contracts required to contain provision for conversion to individual contracts; exceptions.

1. Except as otherwise provided in the provisions of this section, NRS 689B.340 to 689B.580, inclusive, and chapter 689C of NRS relating to the portability and availability of health insurance, all group subscriber contracts delivered or issued for delivery in this state providing for hospital, surgical or major medical coverage, or any combination of these coverages, on a service basis or an expense-incurred basis, or both, must contain a provision that the employee or member is entitled to have issued to him or her a subscriber contract of health coverage when the employee or member is no longer covered by the group subscriber contract.
2. The requirement in subsection 1 does not apply to contracts providing benefits only for specific diseases or accidental injuries.
3. If an employee or member was a recipient of benefits under the coverage provided pursuant to NRS 695B.1944, the employee or member is not entitled to have issued to him or her by a replacement insurer a subscriber contract of health coverage unless the employee or member has reported for his or her normal employment for a period of 90 consecutive days after last being eligible to receive any benefits under the coverage provided pursuant to NRS 695B.1944.
(Added to NRS by 1979, 1087; A 1989, 1252; 1997, 2956; 2013, 3637)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.252 - Conversion privilege available to spouse and children; conditions.

Subject to the conditions set forth in NRS 695B.251 to 695B.259, inclusive, the conversion privilege must also be made available:
1. To the surviving spouse, if any, upon the death of the employee or member, with respect to the spouse and any child whose coverage under the group contract is terminated by reason of such death, or if there is no surviving spouse, to each surviving child whose coverage under the group contract terminates by reason of such death, or, if the group contract provides for continuation of dependents’ coverage following the employee’s or member’s death, at the end of the continued coverage;
2. To the spouse of the employee or member upon termination of coverage of the spouse while the employee or member remains covered under the group contract, if the spouse ceases to be a dependent as defined by the group contract, and to any child whose coverage under the group contract terminates at the same time; or
3. To a child solely with respect to himself or herself upon termination of his or her coverage because the child ceases to be a dependent as defined by the group contract, if a conversion privilege is not otherwise provided with respect to the termination.
(Added to NRS by 1979, 1089)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.253 - Denial of converted contract because of overinsurance; notice concerning cancellation of other coverage.

1. The medical service corporation is not required to issue a converted contract to any person who:
(a) Is covered for similar benefits by another hospital, surgical, medical or major medical expense insurance policy, a hospital or medical service subscriber contract, a medical practice or other prepayment plan, or by any other kind of plan or program;
(b) Is eligible to be covered for similar benefits under any arrangement of coverage for individuals in a group, whether on an insured or uninsured basis; or
(c) Has similar benefits provided for or available under the requirements of any state or federal law,
if any benefits provided under the sources listed in this subsection, together with the benefits to be provided by the converted contract, would result in overinsurance according to the medical service corporation’s standards.
2. Before denying a converted contract to an applicant because the applicant has coverage as described in paragraph (a) of subsection 1, the medical service corporation shall notify the applicant that the converted contract will be issued only if the other coverage is cancelled.
(Added to NRS by 1979, 1087)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.254 - Choice of types of contracts required to be offered.

1. A person who is entitled to a converted contract must be given a choice of at least three types of contracts offering benefits on a service basis or an expense-incurred basis, or both.
2. The converted contract may include major medical or catastrophic benefits if they were provided under the group contract.
3. For those subscribers eligible for Medicare, the medical service corporation may provide for a supplement to Medicare as part of the conversion privilege.
(Added to NRS by 1979, 1088)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.255 - Benefits exceeding those provided under group contract not required; exclusions and limitations.

A medical service corporation is not required to issue a converted contract which provides benefits in excess of those provided under the group contract from which conversion is made, and a converted contract may contain any exclusion or benefit limitation contained in the group contract.
(Added to NRS by 1979, 1088)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.2555 - Benefits payable under converted contract authorized to be reduced by amount payable under group contract; limitation.

A converted contract may provide that any hospital, surgical or medical benefits payable under it may be reduced by the amount of any benefits payable under the group contract after his or her termination. A converted contract may provide that during the first contract year the benefits payable under it, together with the benefits payable under the group contract, must not exceed those that would have been payable if the subscriber’s coverage under the group contract had remained in effect.
(Added to NRS by 1979, 1088; A 2019, 307)
2023 Nevada Revised Statutes › Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service › NRS 695B.256 - Issuance and effective date of converted contract; premiums; persons covered.

The medical service corporation shall:
1. Issue the converted contract without evidence of insurability;
2. Base the premium on the converted policies for the first 12 months, and subsequent renewals, upon the medical service corporation’s table of premium rates applicable to the age and class of risk of each person to be covered under the contract and to the type and amount of coverage provided. The frequency of premium payments must be the same as is customarily required by the medical service corporation for the contract form and plan selected except that premium payments must not be required more often than quarterly;
3. Provide that the effective date of the converted contract is 12:01 a.m. on the day after the termination of coverage under the group contract; and
4. Provide that the converted contract covers the employee or member and dependents of the employee or member who were covered by the group contract on the date of his or her termination. At the option of the insurer, a separate converted contract may be issued to cover any dependent.
(Added to NRS by 1979, 1087)