NRS 689C.075
“Health benefit plan” defined.


1.

“Health benefit plan” means a policy, contract, certificate or agreement to provide for, deliver payment for, arrange for the payment of, pay for or reimburse any of the costs of health care services. Except as otherwise provided in this section, the term includes short-term and catastrophic health insurance policies and a policy that pays on a cost-incurred basis.

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;

(h)

Coverage under a short-term health insurance policy;

(i)

Coverage under a blanket student accident and health insurance policy; and

(j)

Other similar insurance coverage specified in federal regulations issued pursuant to the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, under which benefits for medical care are secondary or incidental to other insurance benefits.

3.

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, the term does not include the following benefits:

(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 the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191.

4.

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 the 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, the term does not include:

(a)

Coverage that is only for a specified disease or illness; and

(b)

Hospital indemnity or other fixed indemnity insurance.

5.

If offered as a separate policy, certificate or contract of insurance, the term does not include:

(a)

Medicare supplemental health insurance as defined in section 1882(g)(1) of the Social Security Act, 42 U.S.C. § 1395ss, as that section existed on July 16, 1997;

(b)

Coverage supplemental to the coverage provided pursuant to the Civilian Health and Medical Program of Uniformed Services, CHAMPUS, 10 U.S.C. §§ 1071 et seq.; and

(c)

Similar supplemental coverage provided under a group health plan.

Source: Section 689C.075 — “Health benefit plan” defined., https://www.­leg.­state.­nv.­us/NRS/NRS-689C.­html#NRS689CSec075.

689C.015
Definitions.
689C.017
“Affiliated” defined.
689C.019
“Affiliation period” defined.
689C.023
“Bona fide association” defined.
689C.025
“Carrier” defined.
689C.045
“Class of business” defined.
689C.047
“Control” defined.
689C.053
“Creditable coverage” defined.
689C.055
“Dependent” defined.
689C.065
“Eligible employee” defined.
689C.066
“Employee leasing company” defined.
689C.071
“Geographic rating area” defined.
689C.072
“Geographic service area” defined.
689C.073
“Group health plan” defined.
689C.075
“Health benefit plan” defined.
689C.077
“Network plan” defined.
689C.078
“Open enrollment” defined.
689C.079
“Plan for coverage of a bona fide association” defined.
689C.081
“Plan sponsor” defined.
689C.082
“Preexisting condition” defined.
689C.083
“Producer” defined.
689C.085
“Rating period” defined.
689C.095
“Small employer” defined.
689C.106
“Waiting period” defined.
689C.109
Certain plan, fund or program to be treated as employee welfare benefit plan which is group health plan
689C.111
Employee leasing company deemed large employer in certain circumstances.
689C.113
Requirements for employee welfare benefit plan for providing benefits for employees of more than one employer.
689C.115
Mandatory and optional coverage.
689C.125
Rating factors for determining premiums.
689C.135
Effect of provision in health benefit plan for restricted network on determination of rates.
689C.143
Offering of policy of health insurance for purposes of establishing health savings account.
689C.155
Regulations.
689C.156
Each health benefit plan marketed in this State required to be offered to small employers.
689C.158
Producer may only sign up small employers and eligible employees in bona fide associations if employers and employees are actively engaged in or related to bona fide association.
689C.159
Certain provisions inapplicable to plan that carrier makes available only through bona fide association.
689C.160
Carrier must uniformly apply requirements to determine whether to provide coverage.
689C.165
Carrier prohibited from modifying plan to restrict or exclude coverage for certain services.
689C.166
Coverage for alcohol or substance use disorder: Required.
689C.167
Coverage for alcohol or substance use disorders: Benefits.
689C.168
Coverage for prescription drug previously approved for medical condition of insured.
689C.169
Coverage for severe mental illness.
689C.170
Authorized variation of minimum participation and contributions
689C.180
Carrier to offer same coverage to all eligible employees
689C.183
Plan and carrier required to permit employee or dependent of employee to enroll for coverage under certain circumstances.
689C.187
Manner and period for enrolling dependent of covered employee
689C.190
Requirements regarding issuance of health benefit plans and adjustment of costs.
689C.191
Determination of applicable creditable coverage of person
689C.192
Written certification of coverage required for purpose of determining period of creditable coverage accumulated by person.
689C.193
Carrier prohibited from imposing restriction on participation inconsistent with certain sections
689C.194
Plan that includes coverage for maternity and pediatric care: Required to allow minimum stay in hospital in connection with childbirth
689C.195
Coverage for services provided through telehealth.
689C.196
Insurer prohibited from denying coverage solely because person was victim of domestic violence.
689C.197
Carrier prohibited from denying coverage because insured was intoxicated or under influence of controlled substance
689C.198
Insurer prohibited from requiring or using information concerning genetic testing
689C.200
When carrier is not required to offer coverage.
689C.203
Denial of application for coverage from small employer
689C.207
Regulations concerning reissuance of health benefit plan.
689C.220
Adjustment in rates to be applied uniformly.
689C.265
Carrier authorized to modify coverage for insurance product under certain circumstances.
689C.270
Regulations concerning disclosures by carrier to small employer
689C.280
Carrier to provide required disclosures to small employer before issuing policy of insurance.
689C.281
Coverage for prescription drugs: Provision of notice and information regarding use of formulary.
689C.310
Renewal of health benefit plan
689C.320
Required notification when carrier discontinues transacting insurance in this State
689C.325
Coverage offered through network plan not required to be offered to eligible employee who does not reside or work in geographic service area or if carrier lacks capacity to deliver adequate service to additional employers and employees.
689C.330
When insurer is required to allow employee to continue coverage after employee is no longer covered by health benefit plan.
689C.350
Health benefit plan with preferred providers of health care: Deductible
689C.355
Prohibited acts of carrier or producer
689C.1065
Applicability.
689C.1565
Coverage to small employers not required under certain circumstances
689C.1655
Coverage for autism spectrum disorders.
689C.1672
Coverage for certain tests and vaccines relating to human papillomavirus
689C.1674
Coverage for mammograms for certain women
689C.1676
Coverage for drug or device for contraception and related health services
689C.1678
Coverage for certain services, screenings and tests relating to wellness
689C.1683
Coverage for prescription drugs irregularly dispensed for purpose of synchronization of chronic medications.
689C.1685
Coverage for early refills of topical ophthalmic products.
689C.1687
Coverage for management and treatment of sickle cell disease.
689C.1945
Plan that includes coverage for maternity care must not deny coverage to gestational carrier
Last Updated

Jun. 24, 2021

§ 689C.075’s source at nv​.us