Nev. Admin. Code § 695C.180 - Coordination of benefits; lien against recovery from third person

1. An organization may coordinate its benefits with any policy of individual or group health insurance offered by an insurance company, trust established by an employer to pay for health care for his or her employees, group contract for hospital, medical or dental service offered by a nonprofit corporation for hospital, medical or dental service, or evidence of coverage offered by another health maintenance organization. Before an organization may seek coordination for the payment of the cost of benefits, it must first provide those benefits to its enrollees. If an organization intends to coordinate its benefits, it shall do so based upon standards filed with and approved by the Division.

2. Except as otherwise provided by specific federal or state statute or regulation, an organization may include in its evidence of coverage a provision for subrogation regarding the right of an enrollee to recover, and the imposition of a lien upon any recovery by an enrollee, from a third person for the cost of the medical benefits which were provided by the organization to the enrollee because of injuries incurred by the enrollee as a result of the actions of the third person. The amount of the lien must not be more than the reasonable value of the services rendered by the organization.

Notes

Nev. Admin. Code § 695C.180

Added to NAC by Comm'r of Insurance, eff. 6-11-86; A 5-27-92; 12-15-94; A by R089-17AP, eff. 5/16/2018

NRS 679B.130, 695C.275