Access to services and contractual discounts of a provider of health care: Inapplicability of provisions. [Effective January 1, 2020.]

Checkout our iOS App for a better way to browser and research.

NRS 687B.693 to 687B.697, inclusive, do not apply:

1. To provider network contracts for health care services provided to covered persons under Medicare or the State Plan for Medicaid, or the Children’s Health Insurance Program.

2. In circumstances where access to the provider network contract is granted to an entity operating under the same brand license program as the contracting entity.

3. To a health benefit plan which provides:

(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) Coverage for on-site medical clinics.

(d) Coverage under a blanket student accident and health insurance policy.

(e) Other similar insurance coverage specified pursuant to the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, under which benefits for medical care are secondary or incidental to other insurance benefits.

4. To credit insurance.

5. To 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 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.

6. To the following benefits if the benefits are provided under a separate policy, certificate or contract, there is no coordination between the provisions 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.

7. To 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, TRICARE, 10 U.S.C. §§ 1071 et seq.; and

(c) Similar supplemental coverage provided under a group health plan.

(Added to NRS by 2019, 1602, effective January 1, 2020)


Download our app to see the most-to-date content.