Prohibited acts; denial of application for coverage; regulations; violation may constitute unfair trade practice; applicability of section.
1. Except as otherwise provided in this section, an individual carrier or a producer shall not, directly or indirectly:
(a) Encourage or direct an eligible person to refrain from filing an application for coverage with an individual carrier because of the health status, claims experience, industry, occupation or geographic location of the eligible person.
(b) Encourage or direct an eligible person to seek coverage from another carrier because of the health status, claims experience, industry, occupation or geographic location of the eligible person.
2. The provisions of subsection 1 do not apply to information provided to an eligible person by an individual carrier or a producer relating to the established geographic service area or a provision for a restricted network of the individual carrier.
3. Except as otherwise provided in this subsection, an individual carrier shall not, directly or indirectly, enter into any contract, agreement or arrangement with a producer if the contract, agreement or arrangement provides for or results in a variation to the compensation paid to a producer for the sale of a health benefit plan because of the health status, claims experience, industry, occupation or geographic location of the individual at the time that the health benefit plan is issued to or renewed by the individual. The provisions of this subsection do not apply to any arrangement for compensation that provides payment to a producer on the basis of a percentage of premiums, except that the percentage may not vary because of the health status, claims experience, industry, occupation or geographic area of the individual.
4. An individual carrier shall not terminate, fail to renew, or limit its contract or agreement of representation with a producer for any reason related to the health status, claims experience, industry, occupation or geographic location of an individual at the time that the health benefit plan is issued to or renewed by the individual placed by the producer with the individual carrier.
5. A denial by an individual carrier of an application for coverage from an eligible person must be in writing and must state the reason for the denial.
6. The Commissioner may adopt regulations that set forth additional standards to provide for the fair marketing and broad availability of health benefit plans to eligible persons in this state.
7. A violation of any provision of this section by an individual carrier may constitute an unfair trade practice for the purposes of chapter 686A of NRS.
8. The provisions of this section apply to a third-party administrator if the third-party administrator enters into a contract, agreement or other arrangement with an individual carrier to provide administrative, marketing or other services related to the offering of a health benefit plan to eligible persons in this state.
9. Nothing in this section interferes with the right and responsibility of a broker to advise and represent the best interests of an eligible person who is seeking health insurance coverage from an individual carrier.
Last modified: February 27, 2006