689B.550 - Carrier prohibited from imposing restriction on participation inconsistent with chapter; restrictions on rules of eligibility that may be established; premiums to be equitable.
689B.550 Carrier prohibited from imposing restriction on participation inconsistent with chapter; restrictions on rules of eligibility that may be established; premiums to be equitable.
1. A carrier shall not place any restriction on a person or a dependent of the person as a condition of being a participant in or a beneficiary of a policy of blanket accident and health insurance or group health insurance that is inconsistent with the provisions of this chapter.
2. A carrier that offers coverage under a policy of blanket accident and health insurance or group health insurance pursuant to this chapter shall not establish rules of eligibility, including rules which define applicable waiting periods, for the initial or continued enrollment under a group health plan offered by the carrier that are based on the following factors relating to the employee or a dependent of the 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 689B.500, the provisions of subsection 1 do not:
(a) Require a carrier to provide particular benefits other than those that would otherwise be provided under the terms of the blanket health and accident insurance or group health insurance or coverage; or
(b) Prevent a carrier from establishing limitations or restrictions on the amount, level, extent or nature of the benefits or coverage for similarly situated persons.
4. As a condition of enrollment or continued enrollment under a policy of blanket accident and health insurance or group health insurance, a carrier shall not require an employee 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 employee or a dependent of the employee.
5. This section does not:
(a) Restrict the amount that an employer or employee may be charged for coverage by a carrier;
(b) Prevent 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) Preclude a carrier from establishing rules relating to employer contribution or group participation when offering health insurance coverage to small employers in this state.
(Added to NRS by 1997, 2908; A 2001, 2227)