requires two-thirds majority vote (§§ 13, 33, 38)
A.B. 425
Assembly Bill No. 425–Assemblywoman Angle
March 19, 2001
____________
Referred to Committee on Commerce and Labor
SUMMARY—Revises provisions governing health insurance. (BDR 57‑1295)
FISCAL NOTE: Effect on Local Government: Yes.
~
EXPLANATION
– Matter in bolded italics is new; matter
between brackets [omitted material] is material to be omitted.
Green numbers along left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).
AN ACT relating to insurance; authorizing a chamber of commerce to engage in the business of insurance under certain circumstances; revising the provisions governing certain policies of health insurance that provide coverage for a child or a parent or spouse of a parent of a policyholder; providing a penalty; and providing other matters properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
1-1 Section 1. Title 57 of NRS is hereby amended by adding thereto a
1-2 new chapter to consist of the provisions set forth as sections 2 to 44,
1-3 inclusive, of this act.
1-4 Sec. 2. As used in this chapter, unless the context otherwise
1-5 requires, the words and terms defined in sections 3 to 12, inclusive, of
1-6 this act have the meanings ascribed to them in those sections.
1-7 Sec. 3. “Benefit contract” means an agreement for the provision of
1-8 any contractual benefit authorized by section 25 of this act.
1-9 Sec. 4. “Benefit member” means a member of a chamber of
1-10 commerce who is an adult and who is designated by the laws or rules of
1-11 the chamber of commerce to be a benefit member under a benefit
1-12 contract.
1-13 Sec. 5. “Certificate for health benefits” means a certificate issued as
1-14 written evidence of the benefit contract.
1-15 Sec. 6. “Certificate of authority” means a certificate issued by the
1-16 commissioner to a chamber of commerce authorizing it to engage in the
1-17 business of insurance, including the issuance of certificates for health
1-18 benefits, in accordance with the provisions of this chapter.
1-19 Sec. 7. “Chamber of commerce” means any association or
1-20 organization formed in accordance with the laws of this state:
1-21 1. To promote the commercial interests of a county, city, town or
1-22 other area of this state; and
2-1 2. Whose membership consists of owners or operators of businesses,
2-2 persons who are self-employed or any other person admitted as a member
2-3 in accordance with the laws or rules of the association or organization.
2-4 Sec. 8. “Laws” means the articles of incorporation, charter,
2-5 constitution and bylaws of a chamber of commerce.
2-6 Sec. 9. “Medicaid” means a program established in any state
2-7 pursuant to Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 et
2-8 seq., to provide assistance for part or all of the cost of medical care
2-9 rendered on behalf of indigent persons.
2-10 Sec. 10. “Order for medical coverage” means an order of a court or
2-11 administrative tribunal to provide coverage under a certificate for health
2-12 benefits to a child pursuant to the provisions of 42 U.S.C. § 1396g-1.
2-13 Sec. 11. “Premiums” means premiums, rates, dues or other required
2-14 contributions that are payable under a certificate for health benefits.
2-15 Sec. 12. “Rules” includes all rules, regulations and resolutions
2-16 which have been adopted by the governing body of a chamber of
2-17 commerce and which apply to the members of a chamber of commerce.
2-18 Sec. 13. 1. A chamber of commerce may, in accordance with
2-19 regulations adopted by the commissioner, apply to the commissioner for
2-20 the issuance of a certificate of authority. A single application may be
2-21 submitted by one or more chambers of commerce who have joined
2-22 together to apply for a certificate of authority to issue certificates for
2-23 health benefits in accordance with the provisions of this chapter. The
2-24 application must be submitted on a form approved by the commissioner
2-25 and include such information as required by him.
2-26 2. Upon presentation of satisfactory evidence that the chamber of
2-27 commerce has complied with the provisions of this chapter and
2-28 regulations adopted pursuant to this chapter, the commissioner shall
2-29 issue to the chamber of commerce a certificate of authority indicating
2-30 that the chamber of commerce may engage in the business of insurance
2-31 and issue certificates for health benefits pursuant to the provisions of this
2-32 chapter.
2-33 3. The certificate of authority is prima facie evidence of the existence
2-34 of the chamber of commerce on the date of the certificate.
2-35 4. The commissioner shall cause a record of the certificate of
2-36 authority to be made. A certified copy of the record may be given in
2-37 evidence with the same effect as the original certificate of authority.
2-38 5. For the issuance or renewal of a certificate of authority, a
2-39 chamber of commerce must pay to the commissioner:
2-40 (a) A fee of $250, if the number of outstanding benefit contracts of the
2-41 chamber of commerce is 600 or less;
2-42 (b) A fee of $500, if the number of outstanding benefit contracts of the
2-43 chamber of commerce is more than 600 but less than 1,200; and
2-44 (c) A fee of $2,450, if the number of outstanding benefit contracts of
2-45 the chamber of commerce is 1,200 or more.
2-46 Each such certificate or renewal expires on March 1 after it is issued or
2-47 renewed.
2-48 6. If a chamber of commerce applies for the renewal of its certificate
2-49 of authority but does not receive approval of its application by March 1,
3-1 it may continue to transact business pursuant to this chapter unless it
3-2 receives notice that the application for renewal is denied.
3-3 7. A certified copy or duplicate of a certificate of authority is prima
3-4 facie evidence that the chamber of commerce may lawfully transact
3-5 business pursuant to the provisions of this chapter during the period
3-6 specified on the certificate of authority.
3-7 Sec. 14. A chamber of commerce or a group of chambers of
3-8 commerce may engage in the business of insurance for the benefit of its
3-9 members, the employees of its members and the dependents of those
3-10 members and employees by providing benefits as specified in section 25
3-11 of this act and may:
3-12 1. Adopt and amend laws and rules for the government of the
3-13 chamber of commerce, the admission of its members and the
3-14 management of its affairs;
3-15 2. Carry out its purposes directly or through a subsidiary or affiliated
3-16 chamber of commerce;
3-17 3. Create, maintain and operate, or establish organizations to
3-18 operate, nonprofit institutions to further the purposes of the chamber of
3-19 commerce; and
3-20 4. Exercise any other power which is necessary and incidental to
3-21 carrying out the purposes of the chamber of commerce and which is not
3-22 inconsistent with the provisions of this chapter.
3-23 Sec. 15. A chamber of commerce may charge a provider of health
3-24 care a fee to include the name of the provider on a list of providers of
3-25 health care given by the chamber of commerce to its benefit members.
3-26 The amount of the fee must be reasonable and not exceed an amount
3-27 that is directly related to the administrative costs of the chamber of
3-28 commerce to include the provider on the list.
3-29 Sec. 16. 1. A chamber of commerce may provide in its laws for an
3-30 official publication in which any notice, report or statement required by
3-31 law to be provided to a member may be published.
3-32 2. If the records of a chamber of commerce indicate that two or more
3-33 benefit members have the same mailing address, an official publication
3-34 of the chamber of commerce mailed to one member shall be deemed to be
3-35 mailed to all members at the same address unless a member requests a
3-36 separate copy.
3-37 3. A chamber of commerce may provide in its laws or rules a
3-38 procedure by which a benefit member may bring a grievance or
3-39 complaint against the chamber of commerce, or its governing body,
3-40 officers, directors, employees or other members.
3-41 4. Membership rights in a chamber of commerce may not be
3-42 assigned.
3-43 Sec. 17. 1. A chamber of commerce that wishes to consolidate or
3-44 merge with any other chamber of commerce must file with the
3-45 commissioner:
3-46 (a) A certified copy of the written contract setting forth in full the
3-47 terms and conditions of the consolidation or merger;
3-48 (b) A sworn statement by the president and secretary or corresponding
3-49 officers of each chamber of commerce showing the financial condition
4-1 thereof on a date fixed by the commissioner, but not earlier than
4-2 December 31 immediately preceding the date of the contract;
4-3 (c) The certification of such officers, verified by their respective oaths,
4-4 that the consolidation or merger has been approved by a two-thirds vote
4-5 of the governing body of each chamber of commerce at a regular or
4-6 special meeting of those bodies or, if authorized by the laws of the
4-7 chamber of commerce, by mail; and
4-8 (d) Evidence that at least 60 days before the action of the governing
4-9 body of each chamber of commerce, the text of the contract was provided
4-10 to all members of each chamber of commerce by mail or by publication
4-11 in full in the official publication of each chamber of commerce.
4-12 2. If the commissioner finds that the contract setting forth in full the
4-13 terms and conditions of the consolidation or merger is in conformity with
4-14 the provisions of this section, that the financial statements are correct
4-15 and that the consolidation or merger is just and equitable to the members
4-16 of each chamber of commerce, he shall approve the contract and issue a
4-17 certification indicating that fact.
4-18 3. The contract becomes effective upon approval by the
4-19 commissioner unless any chamber of commerce that is a party to the
4-20 contract is incorporated under the laws of any other state or territory, in
4-21 which case the consolidation or merger does not become effective unless:
4-22 (a) It is approved as provided by the laws of the other state or territory
4-23 and a certificate of such approval has been filed with the commissioner
4-24 of this state; or
4-25 (b) If the laws of the other state or territory do not provide for such
4-26 approval, it is approved by the officer responsible for supervising the
4-27 business of insurance in the other state or territory and a certificate of
4-28 such approval has been filed with the commissioner of this state.
4-29 4. Upon the consolidation or merger becoming effective as provided
4-30 in this chapter, all the rights, franchises and interests of the consolidated
4-31 or merged chambers of commerce in and to every species of property,
4-32 real, personal or mixed, and things in action belonging thereto are vested
4-33 in the chamber of commerce resulting from or remaining after the
4-34 consolidation or merger without any other instrument, except that
4-35 conveyances of real property may be evidenced by deeds. The title to any
4-36 real property or interest therein, vested under the laws of this state in any
4-37 of the chambers of commerce consolidated or merged, does not revert
4-38 and is not impaired by the consolidation or merger but vests absolutely in
4-39 the chamber of commerce resulting from or remaining after the
4-40 consolidation or merger.
4-41 5. The affidavit of any officer of the chamber of commerce or of a
4-42 person authorized by it to mail any notice or document, stating that the
4-43 notice or document has been addressed and mailed, is prima facie
4-44 evidence that the notice or document has been provided to the addressees.
4-45 Sec. 18. 1. A chamber of commerce shall not, when considering
4-46 eligibility for coverage or making payments or paying premiums under a
4-47 certificate for health benefits, consider the availability of, or eligibility of
4-48 a person for, medical assistance under Medicaid.
5-1 2. To the extent that payment has been made by Medicaid for health
5-2 care, a chamber of commerce:
5-3 (a) Shall treat Medicaid as having a valid and enforceable assignment
5-4 of an insured’s benefits regardless of any exclusion of Medicaid or the
5-5 absence of a written assignment; and
5-6 (b) May, as otherwise authorized by its certificate for health benefits,
5-7 evidence of coverage or contract and applicable law or regulation
5-8 concerning subrogation, seek to enforce any reimbursement rights of a
5-9 recipient of Medicaid against any other liable party if:
5-10 (1) It is so authorized pursuant to a contract with Medicaid for
5-11 managed care; or
5-12 (2) It has reimbursed Medicaid in full for the health care provided
5-13 by Medicaid to its insured.
5-14 3. If a state agency is assigned any rights of a person who is:
5-15 (a) Eligible for medical assistance under Medicaid; and
5-16 (b) Covered by a certificate for health benefits,
5-17 the chamber of commerce that issued the health policy shall not impose
5-18 any requirements upon the state agency except requirements it imposes
5-19 upon the agents or assignees of other persons covered by the certificate
5-20 for health benefits.
5-21 Sec. 19. 1. To the extent reasonably applicable, a chamber of
5-22 commerce shall comply with the provisions of NRS 689B.340 to
5-23 689B.590, inclusive, and chapter 689C of NRS relating to the portability
5-24 and availability of health insurance offered by the chamber of commerce
5-25 to its benefit members. If there is a conflict between the provisions of this
5-26 chapter and the provisions of NRS 689B.340 to 689B.590, inclusive, and
5-27 chapter 689C of NRS, the provisions of NRS 689B.340 to 689B.590,
5-28 inclusive, and chapter 689C of NRS control.
5-29 2. For the purposes of subsection 1, unless the context requires that
5-30 a provision apply only to a group health plan or a carrier that provides
5-31 coverage under a group health plan, any reference in those sections to
5-32 “group health plan” or “carrier” must be replaced by “chamber of
5-33 commerce.”
5-34 Sec. 20. A chamber of commerce shall not deny the enrollment of a
5-35 child pursuant to an order for medical coverage under a certificate for
5-36 health benefits pursuant to which a parent of the child is insured on the
5-37 ground that the child:
5-38 1. Was born out of wedlock;
5-39 2. Has not been claimed as a dependent on the parent’s federal
5-40 income tax return; or
5-41 3. Does not reside with the parent or within the geographic area of
5-42 service of the chamber of commerce.
5-43 Sec. 21. If a child has coverage under a certificate for health
5-44 benefits pursuant to which a noncustodial parent of the child is insured,
5-45 the chamber of commerce issuing that certificate for health benefits
5-46 shall:
5-47 1. Provide to the custodial parent such information as is necessary
5-48 for the child to obtain any benefits under that coverage.
6-1 2. Allow the custodial parent or, with the approval of the custodial
6-2 parent, a provider of health care to submit claims for covered services
6-3 without the approval of the noncustodial parent.
6-4 3. Make payments on claims submitted pursuant to subsection 2
6-5 directly to the custodial parent, the provider of health care, or an agency
6-6 of this or another state responsible for the administration of Medicaid.
6-7 Sec. 22. If a parent is required by an order for medical coverage to
6-8 provide coverage under a certificate for health benefits for a child and
6-9 the parent is eligible for coverage of the members of his family under a
6-10 certificate for health benefits, the chamber of commerce that issued the
6-11 certificate:
6-12 1. Shall, if the child is otherwise eligible for that coverage, allow the
6-13 parent to enroll the child in that coverage without regard to any
6-14 restrictions upon periods for enrollment.
6-15 2. Shall, if:
6-16 (a) The child is otherwise eligible for that coverage; and
6-17 (b) The parent is enrolled in that coverage but fails to apply for
6-18 enrollment of the child,
6-19 enroll the child in that coverage upon application by the other parent of
6-20 the child, or by an agency of this or another state responsible for the
6-21 administration of Medicaid or a state program for the enforcement of
6-22 child support established pursuant to 42 U.S.C. §§ 651 et seq., without
6-23 regard to any restrictions upon periods for enrollment.
6-24 3. Shall not terminate the enrollment of the child in that coverage or
6-25 otherwise eliminate that coverage of the child unless the chamber of
6-26 commerce has written proof that:
6-27 (a) The order for medical coverage is no longer in effect; or
6-28 (b) The child is or will be enrolled in comparable coverage through
6-29 another insurer on or before the effective date of the termination of
6-30 enrollment or elimination of coverage.
6-31 Sec. 23. 1. If a person:
6-32 (a) Adopts a dependent child; or
6-33 (b) Assumes and retains a legal obligation for the total or partial
6-34 support of a dependent child in anticipation of adopting the
child,
6-35 while the person is eligible for group coverage under a certificate for
6-36 health benefits, the chamber of commerce issuing that certificate shall
6-37 not restrict the coverage, in accordance with NRS 689B.340 to 689B.590,
6-38 inclusive, and chapter 689C of NRS relating to the portability and
6-39 availability of health insurance, of the child solely because of a
6-40 preexisting condition the child has at the time he would otherwise
6-41 become eligible for coverage pursuant to that certificate.
6-42 2. As used in this section, “child” means a person who is under 18
6-43 years of age at the time of his adoption or the assumption of a legal
6-44 obligation for his support in anticipation of his adoption.
6-45 Sec. 24. 1. A chamber of commerce may amend its laws in
6-46 accordance with the provisions of those laws by action of its governing
6-47 body at any regular or special meeting thereof or, if its laws so provide,
6-48 by referendum. Such a referendum may be held in accordance with the
7-1 provisions of its laws by the vote of the members of the chamber of
7-2 commerce or by the vote of delegates or representatives of those
7-3 members. A chamber of commerce may provide for voting by mail. An
7-4 amendment submitted for adoption by referendum must not be adopted
7-5 unless, within 6 months after the date of submission thereof, a majority
7-6 of all the members of the chamber of commerce have signified their
7-7 consent to the amendment by one of the methods specified in this section.
7-8 2. An amendment to the laws of a chamber of commerce does not
7-9 become effective unless approved by the commissioner, who shall
7-10 approve the amendment if he finds that it has been adopted and is not
7-11 inconsistent with any requirement of the laws of this state or with the
7-12 character, objects and purposes of the chamber of commerce. Unless the
7-13 commissioner disapproves an amendment within 60 days after it is filed,
7-14 the amendment shall be deemed approved. The approval or disapproval
7-15 of the commissioner must be in writing and mailed to the secretary or
7-16 corresponding officer of the chamber of commerce. If the commissioner
7-17 disapproves an amendment, the reasons for the disapproval must be
7-18 specified in the written notice.
7-19 3. Within 90 days after their approval by the commissioner, all the
7-20 amendments, or a synopsis thereof, must be furnished to all members of
7-21 the chamber of commerce by mail or by publication in full in the official
7-22 publication of the chamber of commerce, if any. The affidavit of any
7-23 officer of the chamber of commerce or of a person authorized by it to
7-24 mail any amendments or synopsis thereof, stating facts which indicate
7-25 that the amendments or synopsis thereof have been addressed and
7-26 mailed, is prima facie evidence that the amendments or synopsis thereof
7-27 have been furnished the addressee.
7-28 4. Printed copies of the laws as amended, certified by the secretary or
7-29 corresponding officer of the chamber of commerce, are prima facie
7-30 evidence of the legal adoption thereof.
7-31 Sec. 25. 1. A chamber of commerce that is issued a certificate of
7-32 authority may provide hospital, medical or nursing benefits in any form.
7-33 2. A chamber of commerce shall specify in its laws or rules those
7-34 persons who may be issued, or covered by, the benefits set forth in
7-35 subsection 1, consistent with the purpose of providing benefits to its
7-36 members, the employees of its members, and the dependents of those
7-37 members and employees. A chamber of commerce may provide additional
7-38 benefits upon the application of a member of the chamber of commerce.
7-39 Sec. 26. 1. Except as otherwise provided in subsection 2, a
7-40 chamber of commerce shall approve or deny a claim relating to a
7-41 certificate for health benefits within 30 days after the chamber of
7-42 commerce receives the claim. If the claim is approved, the chamber of
7-43 commerce shall pay the claim within 30 days after it is approved. If the
7-44 approved claim is not paid within that period, the chamber of commerce
7-45 shall pay interest on the claim at the rate of interest established pursuant
7-46 to NRS 99.040 unless a different rate of interest is established pursuant
7-47 to an express written contract between the chamber of commerce and the
7-48 provider of health care. The interest must be calculated from 30 days
7-49 after the date on which the claim is approved until the claim is paid.
8-1 2. If the chamber of commerce requires additional information to
8-2 determine whether to approve or deny the claim, it shall notify the
8-3 claimant of its request for the additional information within 20 days after
8-4 it receives the claim. The chamber of commerce shall notify the provider
8-5 of health care of each reason for the delay in approving or denying the
8-6 claim. The chamber of commerce shall approve or deny the claim within
8-7 30 days after receiving the additional information. If the claim is
8-8 approved, the chamber of commerce shall pay the claim within 30 days
8-9 after it receives the additional information. If the approved claim is not
8-10 paid within that period, the chamber of commerce shall pay interest on
8-11 the claim in the manner prescribed in subsection 1.
8-12 3. A chamber of commerce shall not request a claimant to resubmit
8-13 information that the claimant has provided to the chamber of commerce,
8-14 unless the chamber of commerce provides a legitimate reason for the
8-15 request and the purpose of the request is not to delay the payment of the
8-16 claim, harass the claimant or discourage the filing of claims.
8-17 4. A chamber of commerce shall not pay only part of a claim that has
8-18 been approved and is fully payable.
8-19 5. A court shall award costs and reasonable attorney’s fees to the
8-20 prevailing party in an action brought pursuant to this section.
8-21 Sec. 27. A chamber of commerce shall not deny a claim, refuse to
8-22 issue a benefit contract or cancel a benefit contract solely because the
8-23 claim involves an act that constitutes domestic violence pursuant to NRS
8-24 33.018, or because the person applying for or covered by the benefit
8-25 contract was the victim of such an act of domestic violence, regardless of
8-26 whether the insured or applicant contributed to any loss or injury.
8-27 Sec. 28. No money or other benefit, charity, relief or aid to be paid,
8-28 provided or rendered by any chamber of commerce is liable to
8-29 attachment, garnishment or other process, or to be seized, taken,
8-30 appropriated or applied by any legal or equitable process or operation of
8-31 law to pay any debt or liability of a benefit member or beneficiary, or any
8-32 other person who may have a right thereunder, before or after payment
8-33 by the chamber of commerce.
8-34 Sec. 29. 1. Each chamber of commerce shall issue to each owner
8-35 of a benefit contract a certificate for health benefits specifying the
8-36 amount of benefits provided thereby. The certificate for health benefits,
8-37 together with any riders or endorsements attached thereto, the laws of the
8-38 chamber of commerce, the application for membership, the application
8-39 for insurance and the declaration of insurability, if any, signed by the
8-40 applicant, and all amendments to each thereof, constitute the agreement,
8-41 as of the date of issuance, between the chamber of commerce and the
8-42 member, and the certificate must so state. A copy of the application for
8-43 insurance and the declaration of insurability, if any, must be endorsed
8-44 upon or attached to the certificate for health benefits.
8-45 2. All statements on an application for insurance are representations
8-46 and not warranties. Any waiver of this provision is void.
8-47 3. Except with regard to contracts providing benefits payable in
8-48 variable amounts, any changes, additions or amendments to the laws of
8-49 the chamber of commerce made or enacted after the issuance of the
9-1 certificate for health benefits are binding on the owner and the
9-2 beneficiaries, and govern and control the benefit contract as if the
9-3 changes, additions or amendments were in force at the time of the
9-4 application for insurance, except that no change, addition or amendment
9-5 may destroy or diminish benefits that the chamber of commerce
9-6 contracted to give the owner as of the date of issuance.
9-7 4. Copies of any documents specified in this section, certified by the
9-8 secretary or corresponding officer of the chamber of commerce, must be
9-9 received in evidence of the terms and conditions thereof.
9-10 5. Except with regard to benefit contracts providing benefits payable
9-11 in variable amounts, a chamber of commerce shall provide in its laws
9-12 that if its reserves as to all or any class of certificates for health benefits
9-13 become impaired, its governing body may require each owner of those
9-14 certificates for health benefits to pay to the chamber of commerce the
9-15 amount of his equitable proportion of such deficiency as determined by
9-16 its governing body, and that if the payment is not made, the owner may
9-17 elect to:
9-18 (a) Let it remain as an indebtedness against the certificate for health
9-19 benefits and draw interest at a rate not to exceed that specified for loans
9-20 made pursuant to the certificates for health benefits; or
9-21 (b) In lieu of, or in combination with paragraph (a), accept a
9-22 proportionate reduction in benefits under the certificate for health
9-23 benefits.
9-24 The chamber of commerce may specify the manner of the election and
9-25 which alternative is to be presumed if no election is made by the owner.
9-26 Sec. 30. 1. No certificate for health benefits may be delivered or
9-27 issued for delivery in this state unless a copy of the form of the certificate
9-28 for health benefits has been filed with and approved by the commissioner
9-29 in compliance with the requirements of NRS 687B.120.
9-30 2. The certificate for health benefits must include:
9-31 (a) A provision specifying the amount of premiums that are payable
9-32 under the certificate for health benefits;
9-33 (b) A provision setting forth the laws or rules that, if violated, will
9-34 result in the termination or reduction of benefits payable under the
9-35 certificate for health benefits;
9-36 (c) If the laws of the chamber of commerce provide for the expulsion
9-37 or suspension of a member, a provision that any member who is expelled
9-38 or suspended, except for nonpayment of a premium or, during the period
9-39 of contestability, for material misrepresentation in the application for
9-40 membership or insurance, may maintain the certificate for health
9-41 benefits in force by continuing payment of the required premium; and
9-42 (d) All standard contractual provisions which are required by the
9-43 provisions of chapters 687B, 689A and 689B of NRS to be included in
9-44 similar policies issued by health insurers in this state, and which are not
9-45 inconsistent with the provisions of this chapter.
9-46 3. The certificate for health benefits may contain:
9-47 (a) A provision that the member is entitled to a grace period of 1
9-48 month in which the payment of any premium after the first may be made.
10-1 (b) The terms and conditions governing the assignability of the benefit
10-2 contract.
10-3 Sec. 31. 1. If the commissioner upon investigation finds that a
10-4 chamber of commerce:
10-5 (a) Has exceeded its powers;
10-6 (b) Has failed to comply with any provision of this chapter;
10-7 (c) Is not fulfilling its contracts in good faith; or
10-8 (d) Is conducting business fraudulently or in a manner hazardous to
10-9 its members, creditors, the public or the business,
10-10 he shall notify the chamber of commerce of his findings, state in writing
10-11 the reasons for his dissatisfaction and issue a written order requiring the
10-12 chamber of commerce to make the necessary corrections. If the
10-13 commissioner finds that the chamber of commerce has failed to comply
10-14 with the order within 30 days after receiving it, he shall notify the
10-15 chamber of commerce of his finding of noncompliance and require the
10-16 chamber of commerce to show cause on a date specified in the notice
10-17 why the chamber of commerce should not be enjoined from transacting
10-18 any business until the violation complained of has been corrected, or why
10-19 an action in quo warranto should not be commenced against the
10-20 chamber of commerce.
10-21 2. If on that date the chamber of commerce does not present good
10-22 and sufficient reasons why it should not be so enjoined or why such an
10-23 action should not be commenced, the commissioner may present the facts
10-24 relating thereto to the attorney general, who shall, if he deems the
10-25 circumstances warrant, commence an action to enjoin the chamber of
10-26 commerce from transacting business or an action in quo warranto.
10-27 3. The court shall thereupon notify the officers of the chamber of
10-28 commerce of a hearing. If, after a full hearing, it appears that the
10-29 chamber of commerce should be enjoined or liquidated or a receiver
10-30 appointed, the court shall enter the necessary order.
10-31 4. A chamber of commerce that is so enjoined shall not do business
10-32 until:
10-33 (a) The commissioner finds that the violation complained of has been
10-34 corrected;
10-35 (b) The costs of the action have been paid by the chamber of
10-36 commerce, if the court finds that the chamber of commerce was in
10-37 default as charged;
10-38 (c) The court has dissolved its injunction; and
10-39 (d) The commissioner has reinstated the certificate of authority.
10-40 5. If the court orders the chamber of commerce to be liquidated, it
10-41 must be enjoined from carrying on any further business, whereupon the
10-42 receiver of the chamber of commerce shall proceed at once to take
10-43 possession of the books, papers, money and other assets of the chamber
10-44 of commerce and, under the direction of the court, proceed forthwith to
10-45 close the affairs of the chamber of commerce and to distribute its funds
10-46 to those entitled thereto.
10-47 6. No action taken under this section may be recognized in any court
10-48 of this state unless brought by the attorney general upon request of the
11-1 commissioner. If a receiver is to be appointed for a chamber of
11-2 commerce, the court shall appoint the commissioner as the receiver.
11-3 7. The provisions of this section relating to a hearing by the
11-4 commissioner, action by the attorney general at the request of the
11-5 commissioner, a hearing by the court, injunction and receivership apply
11-6 to a chamber of commerce that voluntarily determines to discontinue
11-7 business.
11-8 Sec. 32. 1. Each insurance agent of a chamber of commerce must
11-9 be licensed pursuant to chapter 683A of NRS and any regulations
11-10 adopted by the commissioner that apply to health insurance agents.
11-11 2. No written or other examination is required of a person who held
11-12 a license as an insurance agent on January 1, 2002, for renewals of his
11-13 license.
11-14 3. No examination or license is required of:
11-15 (a) Any regular salaried officer or employee of a chamber of
11-16 commerce who devotes substantially all his services to activities other
11-17 than the solicitation of benefit contracts from the public, and who does
11-18 not receive for the solicitation of those contracts any commission or other
11-19 compensation directly dependent upon the amount of business obtained;
11-20 or
11-21 (b) Any member of the chamber of commerce who does not write
11-22 benefit contracts, and whose solicitation or negotiation is incidental to
11-23 securing new members for the chamber of commerce, and whose only
11-24 remuneration consists of prizes in the form of merchandise or payments
11-25 of a nominal amount of money.
11-26 Sec. 33. 1. Each chamber of commerce that is issued a certificate
11-27 of authority shall appoint in writing the commissioner and each
11-28 successor in office to be its true and lawful attorney upon whom all
11-29 lawful process in any action or proceeding against it must be served, and
11-30 shall agree in the writing that any lawful process against it which is
11-31 served on the commissioner is of the same legal force and validity as if
11-32 served upon the chamber of commerce, and that the authority continues
11-33 in force as long as any liability remains outstanding. A copy of the
11-34 appointment, certified by the commissioner, constitutes sufficient
11-35 evidence of the appointment and must be admitted in evidence with the
11-36 same validity as the original.
11-37 2. Service must be made only upon the commissioner, or if absent,
11-38 upon the person in charge of his office. Service must be made in
11-39 duplicate and constitutes sufficient service upon the chamber of
11-40 commerce. If legal process against a chamber of commerce is served
11-41 upon the commissioner, he shall immediately forward one of the
11-42 duplicate copies by registered mail, prepaid, directed to the secretary or
11-43 corresponding officer.
11-44 3. No such service may require a chamber of commerce to file its
11-45 answer, pleading or defense in less than 30 days after the date of mailing
11-46 the copy of the service to a chamber of commerce.
11-47 4. Legal process must not be served upon a chamber of commerce
11-48 except in the manner provided in this section.
12-1 5. At the time of serving any process upon the commissioner, the
12-2 plaintiff or complainant in the action shall pay to the commissioner a fee
12-3 of $5.
12-4 6. As used in this section, “process” includes only the summons or
12-5 the initial documents served in an action. The commissioner is not
12-6 required to serve any documents after the initial service of process.
12-7 Sec. 34. No application or petition for an injunction against any
12-8 chamber of commerce may be recognized in any court of this state unless
12-9 made by the attorney general upon request of the commissioner.
12-10 Sec. 35. All decisions and findings of the commissioner made
12-11 pursuant to the provisions of this chapter are subject to review by proper
12-12 proceedings in any court of competent jurisdiction in this state.
12-13 Sec. 36. 1. All assets must be held, invested and disbursed for the
12-14 use and benefit of the chamber of commerce, and a member or
12-15 beneficiary must not have or acquire individual rights therein or become
12-16 entitled to any apportionment or the surrender of any part thereof, except
12-17 as otherwise provided in the benefit contract.
12-18 2. A chamber of commerce may create, maintain, invest, disburse
12-19 and apply any special fund necessary to carry out any purpose authorized
12-20 by the laws of the chamber of commerce.
12-21 Sec. 37. A chamber of commerce shall invest its money only in such
12-22 investments as are authorized by the laws of this state for the investment
12-23 of assets of life insurers and subject to the limitations thereon.
12-24 Sec. 38. 1. Each chamber of commerce that is issued a certificate
12-25 of authority shall annually, on or before the first day of March, unless
12-26 for cause shown the time is extended by the commissioner, file with the
12-27 commissioner an accurate statement of its financial condition,
12-28 transactions and affairs for the preceding calendar year and pay a filing
12-29 fee of $25. The statement must be in such a form and context as
12-30 approved by the commissioner.
12-31 2. A synopsis of its annual statement providing an explanation of the
12-32 facts concerning the condition of the chamber of commerce thereby
12-33 disclosed must be printed and mailed to each benefit member of the
12-34 chamber of commerce not later than June 1 of each year, or, in lieu
12-35 thereof, the synopsis may be published in any official publication of the
12-36 chamber of commerce.
12-37 3. As a part of the annual statement required by subsection 1, each
12-38 chamber of commerce shall, on or before the first day of March, file with
12-39 the commissioner a valuation of its certificates for health benefits in
12-40 force on the preceding December 31. The commissioner may, for cause
12-41 shown, extend the period for filing the valuation for not more than 60
12-42 days. The valuation and supporting data must be certified by a qualified
12-43 actuary.
12-44 Sec. 39. If a chamber of commerce fails to file the annual statement
12-45 in the form and within the period specified in section 38 of this act, it
12-46 shall pay to the commissioner $100 for each day that the statement
12-47 remains unfiled or deficient, and upon notice by the commissioner to that
12-48 effect, its authority to do business in this state ceases until the statement
12-49 is filed.
13-1 Sec. 40. 1. The officers and members of the governing body of a
13-2 chamber of commerce are not personally liable for payment of any
13-3 benefits provided by the chamber of commerce.
13-4 2. A person may be indemnified and reimbursed by a chamber of
13-5 commerce for expenses reasonably incurred by, and liabilities imposed
13-6 upon, him in connection with or arising out of any action, suit or
13-7 proceeding, whether civil, criminal, administrative or investigative, or
13-8 threat thereof, in which the person may be involved because he is or was
13-9 a director, officer, employee or agent of the chamber of commerce or of
13-10 any firm, corporation or organization which he served in any capacity at
13-11 the request of the chamber of commerce.
13-12 3. A person may not be so indemnified or reimbursed concerning any
13-13 matter in an action, suit or proceeding, or threat thereof, in which he is
13-14 finally adjudged to be guilty of a breach of a duty as a director, officer,
13-15 employee or agent of the chamber of commerce, or which is made the
13-16 subject of a compromise settlement, unless:
13-17 (a) He acted in good faith for a purpose he reasonably believed to be
13-18 in the best interests of the chamber of commerce; and
13-19 (b) If a criminal action, he had no reasonable cause to believe that his
13-20 conduct was unlawful.
13-21 4. The determination of whether the conduct of a person meets the
13-22 standard required for indemnification and reimbursement may only be
13-23 made by:
13-24 (a) The governing body by a majority vote of a quorum consisting of
13-25 persons who were not parties to the action, suit or proceeding; or
13-26 (b) A court of competent jurisdiction.
13-27 5. The termination of any action, suit or proceeding by judgment,
13-28 order, settlement or conviction, or upon a plea of nolo contendere, does
13-29 not create a conclusive presumption that the person does not meet the
13-30 standard of conduct required for indemnification and reimbursement.
13-31 6. The right of indemnification and reimbursement does not exclude
13-32 other rights to which the person may be entitled as a matter of law, and
13-33 inures to the benefit of his heirs, executors and administrators.
13-34 7. A chamber of commerce may purchase and maintain insurance
13-35 on behalf of any person who is or was a director, officer, employee or
13-36 agent of the chamber of commerce, or who is serving or has served at the
13-37 request of the chamber of commerce as a director, officer, employee or
13-38 agent of any other firm, corporation or organization, against any liability
13-39 asserted against and incurred by him in that capacity or arising out of his
13-40 status as such, regardless of whether the chamber of commerce
13-41 indemnifies the person against liability pursuant to this section.
13-42 8. A director, officer, employee, member or volunteer of a chamber
13-43 of commerce who serves without compensation is not liable, and no
13-44 cause of action may be brought for, damages resulting from his exercise
13-45 of judgment or discretion in carrying out his duties or responsibilities on
13-46 behalf of the chamber of commerce, unless the act or omission involved
13-47 willful or wanton misconduct.
13-48 Sec. 41. The commissioner, or any person he may appoint, may
13-49 examine any chamber of commerce that is engaging in the business of
14-1 insurance or applying for a certificate of authority in the same manner
14-2 as authorized for the examination of domestic, foreign or alien insurers.
14-3 For the purposes of this section, the provisions of NRS 679B.230 to
14-4 679B.300, inclusive, are applicable to a chamber of commerce.
14-5 Sec. 42. A chamber of commerce is not exempt from the provisions
14-6 of NRS 679B.158. If a chamber of commerce is an admitted health
14-7 insurer, as that term is defined in NRS 449.450, it is not exempt from the
14-8 fees imposed pursuant to NRS 449.465.
14-9 Sec. 43. Except as otherwise provided in this chapter or by a specific
14-10 statute, a chamber of commerce that is issued a certificate of authority is
14-11 governed by this chapter and is exempt from all other provisions of the
14-12 insurance laws of this state.
14-13 Sec. 44. 1. Any person who makes a false or fraudulent statement
14-14 in or relating to an application for membership or for the purpose of
14-15 obtaining money from or a benefit in any chamber of commerce is guilty
14-16 of a gross misdemeanor.
14-17 2. Any person convicted of a willful violation of, or neglect or refusal
14-18 to comply with, any provision of this chapter for which a penalty is not
14-19 otherwise prescribed shall be punished by a fine of not more than $1,000
14-20 for each violation, and not more than $10,000 for all related violations.
14-21 Sec. 45. NRS 689A.030 is hereby amended to read as follows:
14-22 689A.030 A policy of health insurance must not be delivered or issued
14-23 for delivery to any person in this state unless it otherwise complies with
14-24 this code, and complies with the following:
14-25 1. The entire money and other considerations for the policy must be
14-26 expressed therein.
14-27 2. The time when the insurance takes effect and terminates must be
14-28 expressed therein.
14-29 3. It must purport to insure only one person, except that a policy may
14-30 insure, originally or by subsequent amendment, upon the application of an
14-31 adult member of a family[,] who shall be deemed the policyholder, any
14-32 [two or more] eligible members of that family, including [the husband,
14-33 wife,] :
14-34 (a) The spouse;
14-35 (b) The dependent children, from the time of birth, adoption or
14-36 placement for the purpose of adoption as provided in NRS 689A.043, or
14-37 any children under a specified age which must not exceed 19 years except
14-38 as otherwise provided in NRS 689A.045[, and any] ;
14-39 (c) Any child under 30 years of age whose annual income, at the time
14-40 of application by the policyholder, is at or below the federally designated
14-41 level signifying poverty;
14-42 (d) Any parent of the policyholder or the spouse of that parent if, at
14-43 the time of application by the policyholder, the parent or spouse resides
14-44 with the policyholder and has an annual income at or below the federally
14-45 designated level signifying poverty; and
14-46 (e) Any other person dependent upon the policyholder.
14-47 4. The style, arrangement and overall appearance of the policy must
14-48 not give undue prominence to any portion of the text, and every printed
14-49 portion of the text of the policy and of any endorsements or attached papers
15-1 must be plainly printed in light-faced type of a style in general use, the size
15-2 of which must be uniform and not less than 10 points with a lower case
15-3 unspaced alphabet length not less than 120 points. “Text” includes all
15-4 printed matter except the name and address of the insurer, the name or the
15-5 title of the policy, [the] a brief description, if any, and captions and
15-6 subcaptions.
15-7 5. The exceptions and reductions of indemnity must be set forth in the
15-8 policy and, other than those contained in NRS 689A.050 to 689A.290,
15-9 inclusive, must be printed, at the insurer’s option, with the benefit
15-10 provision to which they apply or under an appropriate caption such as
15-11 “Exceptions” or “Exceptions and Reductions,” except that if an exception
15-12 or reduction specifically applies only to a particular benefit of the policy, a
15-13 statement of that exception or reduction must be included with the benefit
15-14 provision to which it applies.
15-15 6. Each such form, including riders and endorsements, must be
15-16 identified by a number in the lower left-hand corner of the first page
15-17 thereof.
15-18 7. The policy must not contain any provision purporting to make any
15-19 portion of the charter, rules, constitution or bylaws of the insurer a part of
15-20 the policy unless that portion is set forth in full in the policy, except in the
15-21 case of the incorporation of or reference to a statement of rates or
15-22 classification of risks, or short-rate table filed with the commissioner.
15-23 8. The policy must provide benefits for [expense] expenses arising
15-24 from care at home or health supportive services if that care or service was
15-25 prescribed by a physician and would have been covered by the policy if
15-26 performed in a medical facility or facility for the dependent as defined in
15-27 chapter 449 of NRS.
15-28 9. The policy must provide, at the option of the applicant, benefits for
15-29 expenses incurred for the treatment of abuse of alcohol or drugs, unless the
15-30 policy provides coverage only for a specified disease or provides for the
15-31 payment of a specific amount of money if the insured is hospitalized or
15-32 receiving health care in his home.
15-33 10. The policy must provide benefits for [expense] expenses arising
15-34 from hospice care.
15-35 Sec. 46. NRS 689B.030 is hereby amended to read as follows:
15-36 689B.030 Each group health insurance policy must contain in
15-37 substance the following provisions:
15-38 1. A provision that, in the absence of fraud, all statements made by
15-39 applicants or the policyholders or by an insured person are representations
15-40 and not warranties, and that no statement made for the purpose of effecting
15-41 insurance voids the insurance or reduces its benefits unless the statement is
15-42 contained in a written instrument signed by the policyholder or the insured
15-43 person, a copy of which has been furnished to him or his beneficiary.
15-44 2. A provision that the insurer will furnish to the policyholder for
15-45 delivery to each employee or member of the insured group a statement in
15-46 summary form of the essential features of the insurance coverage of that
15-47 employee or member and to whom benefits thereunder are payable. If
15-48 dependents are included in the coverage, only one statement need be issued
15-49 for each family.
16-1 3. A provision that to the group originally insured may be added from
16-2 time to time eligible new employees or members or dependents, as the case
16-3 may be, in accordance with the terms of the policy.
16-4 4. A provision for benefits for [expense] expenses arising from care at
16-5 home or health supportive services if the care or service was prescribed by
16-6 a physician and would have been covered by the policy if performed in a
16-7 medical facility or facility for the dependent as defined in chapter 449 of
16-8 NRS.
16-9 5. A provision for benefits payable for expenses incurred for the
16-10 treatment of the abuse of alcohol or drugs, as provided in NRS 689B.036.
16-11 6. A provision for benefits for expenses arising from hospice care.
16-12 7. A provision that the policy may insure any eligible members of the
16-13 family of an insured under the policy, including, without limitation:
16-14 (a) Any child under 30 years of age whose annual income, at the time
16-15 of application by the policyholder, is at or below the federally designated
16-16 level signifying poverty; and
16-17 (b) Any parent of the policyholder or the spouse of that parent if, at
16-18 the time of application by the policyholder, the parent or spouse resides
16-19 with the policyholder and has an annual income at or below the federally
16-20 designated level signifying poverty.
16-21 Sec. 47. NRS 689C.055 is hereby amended to read as follows:
16-22 689C.055 “Dependent” means a spouse or:
16-23 1. A family member who the parent claimed as his dependent on the
16-24 form for income tax returns that he filed with the Internal Revenue
16-25 Service for the previous fiscal year, including:
16-26 (a) An unmarried child under 19 years of age;
16-27 [2.] (b) An unmarried child who is a full-time student under 24 years of
16-28 age and who is financially dependent upon the parent; or
16-29 [3.] (c) An unmarried child of any age who is medically certified as
16-30 disabled and dependent upon the parent[,
16-31 who the parent claimed as his dependent on the form for income tax returns
16-32 which he filed with the Internal Revenue Service for the previous fiscal
16-33 year.] ;
16-34 2. Any child under 30 years of age whose annual income, at the time
16-35 of application by the policyholder, is at or below the federally designated
16-36 level signifying poverty; or
16-37 3. Any parent of the policyholder or the spouse of that parent if, at
16-38 the time of application by the policyholder, the parent or spouse resides
16-39 with the policyholder and has an annual income at or below the federally
16-40 designated level signifying poverty.
16-41 Sec. 48. NRS 695B.190 is hereby amended to read as follows:
16-42 695B.190 1. Family hospital or family medical or dental service
16-43 contracts may be issued to a family consisting of an individual and one or
16-44 more persons dependent upon him, or of one or more persons dependent
16-45 upon an individual, and may include [his] :
16-46 (a) His spouse, whether or not dependent upon him[. Such contracts
16-47 shall contain] ;
17-1 (b) Any child under 30 years of age whose annual income, at the time
17-2 of application by the individual, is at or below the federally designated
17-3 level signifying poverty; and
17-4 (c) Any parent of the policyholder or the spouse of that parent if, at
17-5 the time of application by the individual, the parent or spouse resides
17-6 with the individual and has an annual income at or below the federally
17-7 designated level signifying poverty.
17-8 2. A contract specified in subsection 1 must include a provision to the
17-9 effect that to the family originally covered may be added from time to time
17-10 all new members of the family group eligible for coverage and that the
17-11 head of the family shall give the corporation notice of the addition to the
17-12 family of any person eligible for coverage under the [contracts.] contract.
17-13 Sec. 49. NRS 695C.030 is hereby amended to read as follows:
17-14 695C.030 As used in this chapter, unless the context otherwise
17-15 requires:
17-16 1. “Comprehensive health care services” means medical services,
17-17 dentistry, drugs, psychiatric and optometric and all other care necessary for
17-18 the delivery of services to the consumer.
17-19 2. “Enrollee” means a natural person who has been voluntarily
17-20 enrolled in a health care plan.
17-21 3. “Evidence of coverage” means any certificate, agreement or contract
17-22 issued to an enrollee setting forth the coverage to which he is entitled.
17-23 4. “Family member” includes, without limitation:
17-24 (a) Any child under 30 years of age whose annual income, at the time
17-25 of application for coverage by the enrollee, is at or below the federally
17-26 designated level signifying poverty; and
17-27 (b) Any parent of the enrollee or the spouse of that parent if, at the
17-28 time of application for coverage by the enrollee, the parent or spouse
17-29 resides with the enrollee and has an annual income at or below the
17-30 federally designated level signifying poverty.
17-31 5. “Health care plan” means any arrangement whereby any person
17-32 undertakes to provide, arrange for, pay for or reimburse any part of the cost
17-33 of any health care services and at least part of the arrangement consists of
17-34 arranging for or the provision of health care services paid for by or on
17-35 behalf of the enrollee on a periodic prepaid basis.
17-36 [5.] 6. “Health care services” means any services included in the
17-37 furnishing to any natural person of medical or dental care or hospitalization
17-38 , or incident to the furnishing of such care or hospitalization, as well as the
17-39 furnishing to any person of any other services for the purpose of
17-40 preventing, alleviating, curing or healing human illness or injury.
17-41 [6.] 7. “Health maintenance organization” means any person which
17-42 provides or arranges for provision of a health care service or services and is
17-43 responsible for the availability and accessibility of such service or services
17-44 to its enrollees, which services are paid for or on behalf of the enrollees on
17-45 a periodic prepaid basis without regard to the dates health services are
17-46 rendered and without regard to the extent of services actually furnished to
17-47 the enrollees, except that supplementing the fixed prepayments by nominal
17-48 additional payments for services in accordance with regulations adopted by
17-49 the commissioner shall not be deemed to render the arrangement not to be
18-1 on a prepaid basis. A health maintenance organization, in addition to
18-2 offering health care services, may offer indemnity or service benefits
18-3 provided through insurers or otherwise.
18-4 [7.] 8. “Provider” means any physician, hospital or other person who
18-5 is licensed or otherwise authorized in this state to furnish health care
18-6 services.
18-7 Sec. 50. NRS 695F.090 is hereby amended to read as follows:
18-8 695F.090 Prepaid limited health service organizations are subject to
18-9 the provisions of this chapter and to the following provisions, to the extent
18-10 reasonably applicable:
18-11 1. NRS 687B.310 to 687B.420, inclusive, concerning cancellation and
18-12 nonrenewal of policies.
18-13 2. NRS 687B.122 to 687B.128, inclusive, concerning readability of
18-14 policies.
18-15 3. The requirements of NRS 679B.152.
18-16 4. The fees imposed pursuant to NRS 449.465.
18-17 5. NRS 686A.010 to 686A.310, inclusive, concerning trade practices
18-18 and frauds.
18-19 6. The assessment imposed pursuant to subsection 3 of NRS
18-20 679B.158.
18-21 7. Chapter 683A of NRS.
18-22 8. [To the extent applicable, the] The provisions of NRS 689B.340 to
18-23 [689B.600,] 689B.590, inclusive, and chapter 689C of NRS relating to the
18-24 portability and availability of health insurance.
18-25 9. Subsection 3 of NRS 689A.030 relating to the provision of
18-26 coverage to an eligible member of the family of a policyholder specified
18-27 in paragraph (c) or (d) of that subsection.
18-28 10. NRS 689A.035, 689A.410 and 689A.413.
18-29 [10.] 11. NRS 680B.025 to 680B.039, inclusive, concerning premium
18-30 tax, premium tax rate, annual report and estimated quarterly tax payments.
18-31 For the purposes of this subsection, unless the context otherwise requires
18-32 that a section apply only to insurers, any reference in those sections to
18-33 “insurer” must be replaced by a reference to “prepaid limited health service
18-34 organization.”
18-35 [11.] 12. Chapter 692C of NRS, concerning holding companies.
18-36 Sec. 51. The amendatory provisions of this act do not apply to
18-37 offenses committed before January 1, 2002.
18-38 Sec. 52. This act becomes effective upon passage and approval for the
18-39 purpose of adopting
regulations by the commissioner of insurance to
carry out the provisions of sections 2 to 44, inclusive, of this act and on
18-40 January 1, 2002, for all other purposes.
18-41 H