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)
Structure Nevada Revised Statutes
Chapter 695B - Nonprofit Corporations for Hospital, Medical and Dental Service
NRS 695B.040 - Corporations authorized to undertake and operate plans.
NRS 695B.050 - Manner of incorporation.
NRS 695B.060 - Directors: Qualifications.
NRS 695B.070 - Merger and consolidation: Procedure.
NRS 695B.080 - Merger and consolidation: Continuance of contracts and contribution certificates.
NRS 695B.090 - Merger and consolidation: Withdrawal of prior deposit of securities.
NRS 695B.110 - Certificate of authority: Required; fees.
NRS 695B.120 - Certificate of authority: Qualifications.
NRS 695B.130 - Certificate of authority: Application; issuance.
NRS 695B.135 - Certificate of authority: Expiration; renewal.
NRS 695B.165 - Annual statement required to include report of net worth.
NRS 695B.170 - Acquisition costs and administrative expenses; effect of finding of excess costs.
NRS 695B.180 - Required provisions.
NRS 695B.189 - Group contract: Required provision permitting continuation of coverage.
NRS 695B.190 - Family contracts.
NRS 695B.1951 - Reimbursement for treatment by podiatrist.
NRS 695B.1955 - Reimbursement for treatment by licensed clinical alcohol and drug counselor.
NRS 695B.196 - Reimbursement for acupuncture.
NRS 695B.197 - Reimbursement for treatment by licensed psychologist.
NRS 695B.199 - Reimbursement for services provided by certain nurses.
NRS 695B.1995 - Reimbursement to provider of medical transportation.
NRS 695B.200 - Group contracts written under master contract: Conditions required for issuance.
NRS 695B.210 - Group master service contract: Required provisions.
NRS 695B.225 - Policies of group insurance: Order of benefits.
NRS 695B.230 - Filing and approval of forms and schedules of premium rates.
NRS 695B.240 - Provision of group service coverage before approval of forms.
NRS 695B.250 - Extensions of time; automatic approval.
NRS 695B.252 - Conversion privilege available to spouse and children; conditions.
NRS 695B.254 - Choice of types of contracts required to be offered.
NRS 695B.256 - Issuance and effective date of converted contract; premiums; persons covered.
NRS 695B.257 - Notice of conversion privilege.
NRS 695B.2575 - Converted contract delivered outside Nevada: Form.
NRS 695B.258 - Extension of coverage under existing group contract.
NRS 695B.2585 - Provision of group coverage in lieu of converted individual contract.
NRS 695B.259 - Continuation of identical coverage in lieu of converted contract.
NRS 695B.260 - Suspension or revocation of permission to provide coverage before approval of forms.
NRS 695B.270 - Disapproval of forms; issuance unlawful.
NRS 695B.280 - Regulations; limitations.
NRS 695B.285 - Use of Uniform Billing and Claims Forms authorized.
NRS 695B.290 - Agent’s license required.
NRS 695B.320 - Applicability of other provisions.
NRS 695B.380 - Establishment; approval; requirements; examination.