Health maintenance organization prohibited from denying coverage solely because applicant or insured was intoxicated or under the influence of controlled substance; exceptions.

NRS 695C.205 Health maintenance organization prohibited from denying coverage solely because applicant or insured was intoxicated or under the influence of controlled substance; exceptions. 1. Except as otherwise provided in subsection 2, a health maintenance organization shall not: (a) Deny a claim under a health care plan solely because the claim involves an injury sustained by an enrollee 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 enrollee has made a claim involving an injury sustained by the enrollee 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 health maintenance 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 health maintenance organization under a health care plan that provides coverage for long-term care or disability income. (Added to NRS by 2005, 2345; A 2007, 86)