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Vegas Law

econdary or incidental to other insurance benefits. 3. The term does not include the following benefits 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: (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 federal regulations adopted pursuant to Public Law 104-191. 4. The term does not include the following benefits 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 such 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: (a) Coverage that is only for a specified disease or illness; and (b) Hospital indemnity or other fixed indemnity insurance. 5. The term does not include any of the following, if offered as a separate policy, certificate or contract of insurance: (a) Medicare supplemental health insurance as defined in section 1882(g)(1) of the Social Security Act, as that section existed on July 16, 1997; (b) Coverage supplemental to the coverage provided pursuant to chapter 55 of Title 10, United States Code (Civilian Health and Medical Program of Uniformed Services (CHAMPUS)); and (c) Similar supplemental coverage provided under a group health plan. (Added to NRS by 1997, 2885) NRS 689A.540 “Health benefit plan” defined. 1. “Health benefit plan” means a policy, contract, certificate or agreement offered by a carrier 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 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) Other similar insurance coverage specified in federal regulations issued pursuant to Public Law 104-191 under which benefits for medical care are secondary or incidental to other insurance benefits; (i) Coverage under a short-term health insurance policy; and (j) Coverage under a blanket student accident and health insurance policy. 3. The term does not include the following benefits 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: (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. The term does not include the following benefits 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: (a) Coverage that is only for a specified disease or illness; and (b) Hospital indemnity or other fixed indemnity insurance. 5. The term does not include any of the following, if offered as a separate policy, certificate or contract of insurance: (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. (Added to NRS by 1997, 2886; A 1999, 2803) NRS 689A.545 “Health status-related factor” defined. “Health status-related factor” means, with regard to a person who is or seeks to be insured: 1. Health status; 2. Any medical conditions, including physical or mental illness, or both; 3. Claims experience; 4. Receipt of health care; 5. Medical history; 6. Genetic information; 7. Evidence of insurability, including conditions arising out of acts of domestic violence; and 8. Disability. (Added to NRS by 1997, 2887) NRS 689A.550 “Individual carrier” defined. “Individual carrier” means any entity subject to the provisions of this title and the regulations adopted pursuant thereto, that contracts or offers to contract to provide for, deliver payment for, arrange for payment of, pay for, or reimburse any cost of health care services, including a sickness and accident health service corporation, and any other entity providing a plan of health insurance, health benefits or health services to individuals and their dependents in this state. (Added to NRS by 1997, 2887) NRS 689A.555 “Individual health benefit plan” defined. “Individual health benefit plan” means: 1. A health benefit plan for individuals and their dependents, other than a converted policy or a plan for coverage of a bona fide association; and 2. A certificate issued to an individual that evidences coverage under a policy or contract issued to a trust or an association or to any other similar group of persons, other than a plan for coverage of a bona fide association, regardless of the situs of delivery of the policy or contract, if the individual pays the premium and is not being covered under the policy or contract pursuant to any provision for the continuation of benefits applicable under federal or state law. (Added to NRS by 1997, 2887) NRS 689A.560 “Individual reinsuring carrier” defined. “Individual reinsuring carrier” means an individual carrier that is eligible to reinsure eligible persons in the Program of Reinsurance established pursuant to NRS 689C.610 to 689C.980, inclusive. (Added to NRS by 1997, 2887) NRS 689A.565 “Individual risk-assuming carrier” defined. “Individual risk-assuming carrier” means an individual carrier that has elected to act as a risk-assuming carrier. (Added to NRS by 1997, 2888) NRS 689A.570 “Plan for coverage of a bona fide association” defined. “Plan for coverage of a bona fide association” means a health benefit plan for the members, and their dependents, of a bona fide association in this state regardless of the situs of delivery of the policy or contract, if the health benefit plan conforms with NRS 689A.725. (Added to NRS by 1997, 2888) NRS 689A.575 “Plan of operation” defined. “Plan of operation” means the plan of operation of the Program of Reinsurance established pursuant to NRS 689C.610 to 689C.980, inclusive. (Added to NRS by 1997, 2888) NRS 689A.580 “Plan sponsor” defined. “Plan sponsor” has the meaning ascribed to it in section 3(16)(B) of the Employe

Vegas Law




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