1. Except as otherwise provided in subsection 2, a health maintenance organization shall not:
(a) Deny a claim under a health care plan solely because the claim involves an injury sustained by an enrollee as a consequence of being intoxicated or under the influence of a controlled substance.
(b) Cancel participation under a health care plan solely because an enrollee has made a claim involving an injury sustained by the enrollee as a consequence of being intoxicated or under the influence of a controlled substance.
(c) Refuse participation under a health care plan 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 a health maintenance organization from enforcing a provision included in a health care plan 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 participation under a health care plan solely because of such a claim; or
(c) Refuse participation under a health care plan to an eligible applicant solely because of such a claim.
3. The provisions of this section do not apply to a health maintenance organization under a health care plan that provides coverage for long-term care or disability income.
(Added to NRS by 2005, 2345; A 2007, 86)
Structure Nevada Revised Statutes
Chapter 695C - Health Maintenance Organizations
NRS 695C.020 - Legislative declaration.
NRS 695C.050 - Applicability of certain provisions.
NRS 695C.055 - Applicability of certain other provisions.
NRS 695C.060 - Establishment of health maintenance organization.
NRS 695C.070 - Certificate of authority: Application.
NRS 695C.080 - Certificate of authority: Evaluation of application.
NRS 695C.090 - Certificate of authority: Issuance.
NRS 695C.100 - Certificate of authority: Denial.
NRS 695C.110 - Governing body: Composition; participation by enrollees.
NRS 695C.120 - Powers of health maintenance organization.
NRS 695C.123 - Contracts with certain federally qualified health centers.
NRS 695C.130 - Notice and approval required for exercise of powers; rules or regulations.
NRS 695C.140 - Notice and approval required for modification of operations; regulations.
NRS 695C.150 - Fiduciary responsibilities.
NRS 695C.170 - Evidence of coverage: Issuance; form and contents.
NRS 695C.176 - Required provision concerning coverage for hospice care.
NRS 695C.1765 - Reimbursement for acupuncture.
NRS 695C.177 - Reimbursement for treatments by licensed psychologist.
NRS 695C.1783 - Reimbursement for treatment by podiatrist.
NRS 695C.1789 - Reimbursement for treatment by licensed clinical alcohol and drug counselor.
NRS 695C.179 - Reimbursement for services provided by certain nurses.
NRS 695C.1795 - Reimbursement to provider of medical transportation.
NRS 695C.200 - Approval of forms and schedules.
NRS 695C.215 - Financial statement required to include report of net worth.
NRS 695C.220 - Applications, filings and reports open to public inspection; exception.
NRS 695C.230 - Fees; forwarding of premium tax.
NRS 695C.240 - Information required to be available for inspection.
NRS 695C.270 - Surety bond or deposit required; waiver.
NRS 695C.280 - Commissioner authorized to adopt regulations for licensing of agents or brokers.
NRS 695C.300 - Prohibited practices.
NRS 695C.315 - Financial examination: Payment of expense.
NRS 695C.317 - Procedures required for examination and hearing.
NRS 695C.320 - Rehabilitation, liquidation or conservation: Conduct.
NRS 695C.330 - Disciplinary proceedings: Grounds; effect of suspension or revocation.
NRS 695C.340 - Disciplinary proceedings: Notice; hearing; judicial review.