Provision in policy requiring binding arbitration for disputes with insurer authorized; procedure for arbitration; declaratory relief.
1. Except as otherwise provided in NRS 689B.270 and subject to the approval of the Commissioner, a policy of group health insurance may include a provision which requires a member or a dependent of a member of the insured group and the insurer to submit for binding arbitration any dispute between the member or dependent and the insurer concerning any matter directly or indirectly related to, or associated with, the policy. If such a provision is included in the policy:
(a) A member and any dependent of the member must be given the opportunity to decline to participate in binding arbitration at the time they elect to be covered by the policy.
(b) It must clearly state that the insurer and a member or dependent of a member of the insured group who has not declined to participate in binding arbitration agree to forego their right to resolve any such dispute in a court of law or equity.
2. Except as otherwise provided in subsection 3, the arbitration must be conducted pursuant to the rules for commercial arbitration established by the American Arbitration Association. The insurer is responsible for any administrative fees and expenses relating to the arbitration, except that the insurer is not responsible for attorney’s fees and fees for expert witnesses unless those fees are awarded by the arbitrator.
3. If a dispute required to be submitted to binding arbitration requires an immediate resolution to protect the physical health of a member or a dependent of a member, any party to the dispute may waive arbitration and seek declaratory relief in a court of competent jurisdiction.
4. If a provision described in subsection 1 is included in a policy of group health insurance, the provision shall not be deemed unenforceable as an unreasonable contract of adhesion if the provision is included in compliance with the provisions of subsection 1.
Last modified: February 27, 2006