NRS 689C.193
Carrier prohibited from imposing restriction on participation inconsistent with certain sections

  • restrictions on rules of eligibility that may be established.

1.

A carrier shall not place any restriction on a small employer or an eligible employee or a dependent of the eligible employee as a condition of being a participant in or a beneficiary of a health benefit plan that is inconsistent with NRS 689C.015 to 689C.355, inclusive.

2.

A carrier that offers health insurance coverage to small employers pursuant to this chapter shall not establish rules of eligibility, including, but not limited to, rules which define applicable waiting periods, for the initial or continued enrollment under a health benefit plan offered by the carrier that are based on the following factors relating to the eligible employee or a dependent of the eligible employee:

(a)

Health status.

(b)

Medical condition, including physical and mental illnesses, or both.

(c)

Claims experience.

(d)

Receipt of health care.

(e)

Medical history.

(f)

Genetic information.

(g)

Evidence of insurability, including conditions which arise out of acts of domestic violence.

(h)

Disability.

3.

Except as otherwise provided in NRS 689C.190, the provisions of subsection 1 do not require a carrier to provide particular benefits other than those that would otherwise be provided under the terms of the health benefit plan or coverage.

4.

As a condition of enrollment or continued enrollment under a health benefit plan, a carrier shall not require any person to pay a premium or contribution that is greater than the premium or contribution for a similarly situated person covered by similar coverage on the basis of any factor described in subsection 2 in relation to the person or a dependent of the person.

5.

Nothing in this section:

(a)

Restricts the amount that a small employer may be charged for coverage by a carrier;

(b)

Prevents a carrier from establishing premium discounts or rebates or from modifying otherwise applicable copayments or deductibles in return for adherence by the insured person to programs of health promotion and disease prevention; or

(c)

Precludes a carrier from establishing rules relating to employer contribution or group participation when offering health insurance coverage to small employers in this State.

6.

As used in this section:

(a)

“Contribution” means the minimum employer contribution toward the premium for enrollment of participants and beneficiaries in a health benefit plan.

(b)

“Group participation” means the minimum number of participants or beneficiaries that must be enrolled in a health benefit plan in relation to a specified percentage or number of eligible persons or employees of the employer.

Source: Section 689C.193 — Carrier prohibited from imposing restriction on participation inconsistent with certain sections; restrictions on rules of eligibility that may be established., https://www.­leg.­state.­nv.­us/NRS/NRS-689C.­html#NRS689CSec193.

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.193’s source at nv​.us