NRS695G.405. Managed care organization prohibited from denying coverage solely because insured was intoxicated or under the influence of controlled substance; exceptions.

      1.  Except as otherwise provided in subsection 2, a managed care organization shall not:

      (a) Deny a claim under a health care plan solely because the claim involves an injury sustained by an insured as a consequence of being intoxicated or under the influence of a controlled substance.

      (b) Cancel participation under a health care plan solely because an insured has made a claim involving an injury sustained by the insured as a consequence of being intoxicated or under the influence of a controlled substance.

      (c) Refuse participation under a health care plan to an eligible applicant solely because the applicant has made a claim involving an injury sustained by the applicant as a consequence of being intoxicated or under the influence of a controlled substance.

      2.  The provisions of subsection 1 do not prohibit a managed care organization from enforcing a provision included in a health care plan to:

      (a) Deny a claim which involves an injury to which a contributing cause was the insured’s commission of or attempt to commit a felony;

      (b) Cancel participation under a health care plan solely because of such a claim; or

      (c) Refuse participation under a health care plan to an eligible applicant solely because of such a claim.

      3.  The provisions of this section do not apply to a managed care organization under a health care plan that provides coverage for long-term care or disability income.

      (Added to NRS by 2005, 2347; A 2007, 87)