§ 695C.1701 — Health maintenance organization required to offer and issue plan regardless of health status of persons; prohibited acts; authority to include wellness program in plan that offers discounts based on health status under certain circumstances

Nevada § 695C.1701

• Jurisdiction: Nevada
• Title 57: INSURANCE
• Ch. 695C: Health

Text

1. A health maintenance organization shall offer and issue a health benefit plan to any person regardless of the health status of the person or any dependent of the person. Such health status includes, without limitation:
(a) Any preexisting medical condition of the person, including, without limitation, any physical or mental illness;
(b) The claims history of the person, including, without limitation, any prior health care services received by the person;
(c) Genetic information relating to the person; and
(d) Any increased risk for illness, injury or any other medical condition of the person, including, without limitation, any medical condition caused by an act of domestic violence.
2. A health maintenance organization that offers or issues a health benefit plan shall not:
(a) Deny, limit or exclude a covered benefit based on the health status of an enrollee; or
(b) Require an enrollee, as a condition of enrollment or renewal, to pay a premium, deductible, copay or coinsurance based on his or her health status which is greater than the premium, deductible, copay or coinsurance charged to a similarly situated enrollee who does not have such a health status.
3. A health maintenance organization that offers or issues a health benefit plan shall not adjust a premium, deductible, copay or coinsurance for any enrollee on the basis of genetic information relating to the enrollee or the covered dependent of the enrollee.
4. A health maintenance organization that offers or issues a health benefit plan may include in the plan a wellness program that reduces a premium, deductible or copayment based on health status if:
(a) An enrollee who is eligible to participate in the wellness program is given the opportunity to qualify for the discount at least once each year;
(b) The amount of all discounts provided pursuant to such a wellness program does not exceed 30 percent, or if the program is designed to prevent or reduce tobacco use, 50 percent, of the cost of coverage for an enrollee or an enrollee and his or her dependents, as applicable, under the plan;
(c) The wellness program is reasonably designed to promote health or prevent disease;
(d) The health maintenance organization ensures that the full discount under the wellness program is available to all similarly situated enrollees by providing a reasonable alternative standard by which an enrollee may qualify for the discount which, if based on health status, must accommodate the recommendations of the physician of the enrollee; and
(e) The plan discloses in all plan materials describing the terms of the wellness program, and in any disclosure that an enrollee did not satisfy the initial standard to be eligible for the discount, the availability of a reasonable alternative standard described in paragraph (d).
5. As used in this section, “health benefit plan” has the meaning ascribed to it in NRS 687B.470 .

Legislative History

(Added to NRS by 2019, 308 )