NRS 695A.151
Effect of eligibility for medical assistance under Medicaid on eligibility for coverage

  • assignment of rights to state agency.

1.

A society shall not, when considering eligibility for coverage or making payments under a certificate for health benefits, consider the availability of, or eligibility of a person for, medical assistance under Medicaid.

2.

To the extent that payment has been made by Medicaid for health care, a society:

(a)

Shall treat Medicaid as having a valid and enforceable assignment of an insured’s benefits regardless of any exclusion of Medicaid or the absence of a written assignment; and

(b)

May, as otherwise allowed by its certificate for health benefits, evidence of coverage or contract and applicable law or regulation concerning subrogation, seek to enforce any reimbursement rights of a recipient of Medicaid against any other liable party if:

(1)

It is so authorized pursuant to a contract with Medicaid for managed care; or

(2)

It has reimbursed Medicaid in full for the health care provided by Medicaid to its insured.

3.

If a state agency is assigned any rights of a person who is:

(a)

Eligible for medical assistance under Medicaid; and

(b)

Covered by a certificate for health benefits,
Ê the society that issued the health policy shall not impose any requirements upon the state agency except requirements it imposes upon the agents or assignees of other persons covered by the certificate.

4.

If a state agency is assigned any rights of an insured who is eligible for medical assistance under Medicaid, a society that issues a certificate for health benefits, evidence of coverage or contract shall:

(a)

Upon request of the state agency, provide to the state agency information regarding the insured to determine:

(1)

Any period during which the insured, a spouse or dependent of the insured may be or may have been covered by the society; and

(2)

The nature of the coverage that is or was provided by the society, including, without limitation, the name and address of the insured and the identifying number of the certificate for health benefits, evidence of coverage or contract;

(b)

Respond to any inquiry by the state agency regarding a claim for payment for the provision of any medical item or service not later than 3 years after the date of the provision of the medical item or service; and

(c)

Agree not to deny a claim submitted by the state agency solely on the basis of the date of submission of the claim, the type or format of the claim form or failure to present proper documentation at the point of sale that is the basis for the claim if:

(1)

The claim is submitted by the state agency not later than 3 years after the date of the provision of the medical item or service; and

(2)

Any action by the state agency to enforce its rights with respect to such claim is commenced not later than 6 years after the submission of the claim.

Source: Section 695A.151 — Effect of eligibility for medical assistance under Medicaid on eligibility for coverage; assignment of rights to state agency., https://www.­leg.­state.­nv.­us/NRS/NRS-695A.­html#NRS695ASec151.

695A.001
Definitions.
695A.003
“Benefit contract” defined.
695A.004
“Benefit member” defined.
695A.006
“Certificate” defined.
695A.010
“Fraternal benefit society” defined.
695A.014
“Insurer” defined.
695A.016
“Laws” defined.
695A.018
“Lodge” defined.
695A.020
“Lodge system” defined.
695A.023
“Medicaid” defined.
695A.027
“Order for medical coverage” defined.
695A.030
“Premiums” defined.
695A.040
“Representative form of government” defined.
695A.042
“Rules” defined.
695A.044
“Society” defined.
695A.050
Organization: Preparation and contents of articles of incorporation.
695A.060
Organization: Filing of documents and bond with Commissioner
695A.070
Organization: Solicitation of members
695A.080
Certificate of authority: Issuance and renewal
695A.090
General powers and duties of society.
695A.095
Contracts between society and provider of health care: Prohibiting society from charging provider of health care fee for inclusion on list of providers given to insureds
695A.110
Unincorporated or voluntary association prohibited.
695A.120
Location of principal office
695A.130
Consolidation
695A.140
Conversion of fraternal benefit society into mutual life insurer.
695A.150
Qualifications for and rights and privileges of membership.
695A.151
Effect of eligibility for medical assistance under Medicaid on eligibility for coverage
695A.152
Society required to comply with certain provisions concerning portability and availability of health insurance.
695A.153
Society prohibited from asserting certain grounds to deny enrollment of child of insured pursuant to order.
695A.155
Certain accommodations to be made when child is covered under policy of noncustodial parent.
695A.157
Society to authorize enrollment of child of parent who is required by order to provide medical coverage under certain circumstances
695A.159
Society prohibited from restricting coverage of child based on preexisting condition when person who is eligible for group coverage adopts or assumes legal obligation for child.
695A.160
Amendment of laws of society.
695A.180
Scope of contractual benefits.
695A.184
Coverage for prescription drug previously approved for medical condition of insured.
695A.188
Approval or denial of claim
695A.195
Society prohibited from denying coverage solely because person was victim of domestic violence.
695A.197
Society prohibited from denying coverage solely because insured was intoxicated or under the influence of controlled substance
695A.200
Nonforfeiture benefits, cash surrender values, certificate loans and other options.
695A.210
Beneficiaries
695A.220
Benefits not liable to attachment, garnishment or other process.
695A.230
Terms and conditions of benefit contracts.
695A.232
Requirements regarding issuance of health benefit plans and adjustment of costs.
695A.235
Offering policy of health insurance for purposes of establishing health savings account.
695A.240
Approval and contents of certificates.
695A.255
Coverage for prescription drugs: Provision of notice and information regarding use of formulary.
695A.265
Coverage for services provided through telehealth.
695A.270
Waiver of provisions of society’s laws.
695A.280
Reinsurance.
695A.300
Admission of foreign or alien society.
695A.310
Injunction against, liquidation of or appointment of receiver for domestic society.
695A.320
Suspension, revocation or refusal of license of foreign or alien society.
695A.330
Licensing of insurance agents of society
695A.400
Service of process on society.
695A.410
Injunctions against societies.
695A.420
Judicial review of Commissioner’s findings and decisions.
695A.430
Assets, funds and accounts of society.
695A.440
Investments.
695A.450
Annual statement of financial condition, transactions and affairs.
695A.460
Penalties for failure to file statement properly.
695A.475
Liability of directors, officers, employees, members and volunteers
695A.490
Standards of valuation for certificates.
695A.500
Examination of societies transacting business in State.
695A.530
Applicability of statutory provisions relating to trade practices and frauds.
695A.550
Exemption of societies from certain taxes.
695A.555
Fees: Applicability of certain provisions.
695A.560
Exemption of societies from other insurance laws.
695A.570
Applicability.
695A.580
Penalties.
695A.1845
Required coverage for certain tests and vaccines relating to human papillomavirus
695A.1855
Coverage for mammograms for certain women
695A.1857
Benefit contract that includes coverage for maternity care must not deny coverage to gestational carrier
695A.1865
Coverage for drug or device for contraception and related health services in certain circumstances
695A.1873
Coverage for management and treatment of sickle cell disease.
695A.1875
Coverage for certain services, screenings and tests relating to wellness
Last Updated

Jun. 24, 2021

§ 695A.151’s source at nv​.us