NRS 695C.3175
Required contract with insurance company for provision of insurance, indemnity or reimbursement against cost of health care services

required provisions.

1.

A health maintenance organization shall contract with an insurance company licensed in this State or authorized to do business in this State for the provision of insurance, indemnity or reimbursement against the cost of health care services which are provided by the health maintenance organization.

2.

The contract of insurance required by subsection 1 must include a provision that, in the case of the insolvency or impairment of the health maintenance organization, the insurance company will pay all claims made by an enrollee for the period for which a premium has been or will be paid to the health maintenance organization for the enrollee. The contract of insurance required by subsection 1 must specifically provide for the:

(a)

Continuation of benefits to each enrollee for the period for which a premium has been or will be paid to the health maintenance organization for the enrollee until the expiration or termination of the enrollee’s contract with the health maintenance organization;

(b)

Continuation of benefits for each enrollee who is receiving inpatient services in a medical facility or facility for the dependent at the time of the insolvency or impairment of the health maintenance organization until the inpatient services are no longer medically necessary and the enrollee is discharged from the medical facility or facility for the dependent; and

(c)

Payment of a provider of health care not affiliated with the health maintenance organization who provided medically necessary services to an enrollee, as described in the enrollee’s evidence of coverage.

3.

As used in this section:

(a)

“Facility for the dependent” has the meaning ascribed to it in NRS 449.0045.

(b)

“Impairment” means that a health maintenance organization is not insolvent and has been:

(1)

Deemed to be impaired pursuant to NRS 695C.318; or

(2)

Placed under an order of rehabilitation or conservation by a court of competent jurisdiction.

(c)

“Insolvency” or “insolvent” means that a health maintenance organization has been:

(1)

Deemed to be insolvent pursuant to NRS 695C.318;

(2)

Declared insolvent by a court of competent jurisdiction; or

(3)

Placed under an order of liquidation by a court of competent jurisdiction.

(d)

“Medical facility” has the meaning ascribed to it in NRS 449.0151.

(e)

“Medically necessary” has the meaning ascribed to it in NRS 695G.055.

(f)

“Provider of health care” has the meaning ascribed to it in NRS 629.031.

Source: Section 695C.3175 — Required contract with insurance company for provision of insurance, indemnity or reimbursement against cost of health care services; required provisions., https://www.leg.state.nv.us/NRS/NRS-695C.html#NRS695CSec3175.

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NRS 695C.3175 Required contract with insurance company for provision of insurance, indemnity or reimbursement against cost of health care services

1.

2.

(a)

(b)

(c)

3.

(a)

(b)

(1)

(2)

(c)

(1)

(2)

(3)

(d)

(e)

(f)

NRS 695C.3175
Required contract with insurance company for provision of insurance, indemnity or reimbursement against cost of health care services