[Rev. 2/11/2015 11:54:36
AM--2014R2]
CHAPTER 695A - FRATERNAL BENEFIT SOCIETIES
NRS 695A.001 Definitions.
NRS 695A.003 “Benefit
contract” defined.
NRS 695A.004 “Benefit
member” defined.
NRS 695A.006 “Certificate”
defined.
NRS 695A.010 “Fraternal
benefit society” defined.
NRS 695A.014 “Insurer”
defined.
NRS 695A.016 “Laws”
defined.
NRS 695A.018 “Lodge”
defined.
NRS 695A.020 “Lodge
system” defined.
NRS 695A.023 “Medicaid”
defined.
NRS 695A.027 “Order
for medical coverage” defined.
NRS 695A.030 “Premiums”
defined.
NRS 695A.040 “Representative
form of government” defined.
NRS 695A.042 “Rules”
defined.
NRS 695A.044 “Society”
defined.
NRS 695A.050 Organization:
Preparation and contents of articles of incorporation.
NRS 695A.060 Organization:
Filing of documents and bond with Commissioner; preliminary certificate of
authority.
NRS 695A.070 Organization:
Solicitation of members; collection of advance premiums; reports to
Commissioner.
NRS 695A.080 Certificate
of authority: Issuance and renewal; effect; record; copies; fees.
NRS 695A.090 General
powers and duties of society.
NRS 695A.095 Contracts
between society and provider of health care: Prohibiting society from charging
provider of health care fee for inclusion on list of providers given to
insureds; form to obtain information on provider of health care; modification;
schedule of fees.
NRS 695A.110 Unincorporated
or voluntary association prohibited.
NRS 695A.120 Location
of principal office; meetings of supreme governing body; minutes of certain
proceedings; official publications; grievances by benefit members.
NRS 695A.130 Consolidation;
merger.
NRS 695A.140 Conversion
of fraternal benefit society into mutual life insurer.
NRS 695A.150 Qualifications
for and rights and privileges of membership.
NRS 695A.151 Effect
of eligibility for medical assistance under Medicaid on eligibility for
coverage; assignment of rights to state agency.
NRS 695A.152 Society
required to comply with certain provisions concerning portability and
availability of health insurance.
NRS 695A.153 Society
prohibited from asserting certain grounds to deny enrollment of child of
insured pursuant to order.
NRS 695A.155 Certain
accommodations to be made when child is covered under policy of noncustodial
parent.
NRS 695A.157 Society
to authorize enrollment of child of parent who is required by order to provide
medical coverage under certain circumstances; termination of coverage of child.
NRS 695A.159 Society
prohibited from restricting coverage of child based on preexisting condition
when person who is eligible for group coverage adopts or assumes legal
obligation for child.
NRS 695A.160 Amendment
of laws of society.
NRS 695A.180 Scope
of contractual benefits.
NRS 695A.184 Coverage
for prescription drug previously approved for medical condition of insured.
NRS 695A.188 Approval
or denial of claim; interest on unpaid claim; request for additional
information; payment of claim; costs and attorney’s fees.
NRS 695A.195 Society
prohibited from denying coverage solely because person was victim of domestic
violence.
NRS 695A.197 Society
prohibited from denying coverage solely because insured was intoxicated or
under the influence of controlled substance; exceptions.
NRS 695A.200 Nonforfeiture
benefits, cash surrender values, certificate loans and other options.
NRS 695A.210 Beneficiaries;
funeral benefits.
NRS 695A.220 Benefits
not liable to attachment, garnishment or other process.
NRS 695A.230 Terms
and conditions of benefit contracts.
NRS 695A.235 Offering
policy of health insurance for purposes of establishing health savings account.
NRS 695A.240 Approval
and contents of certificates.
NRS 695A.255 Coverage
for prescription drugs: Provision of notice and information regarding use of
formulary.
NRS 695A.270 Waiver
of provisions of society’s laws.
NRS 695A.280 Reinsurance.
NRS 695A.300 Admission
of foreign or alien society.
NRS 695A.310 Injunction
against, liquidation of or appointment of receiver for domestic society.
NRS 695A.320 Suspension,
revocation or refusal of license of foreign or alien society.
NRS 695A.330 Licensing
of insurance agents of society; persons exempt from licensing.
NRS 695A.400 Service
of process on society.
NRS 695A.410 Injunctions
against societies.
NRS 695A.420 Judicial
review of Commissioner’s findings and decisions.
NRS 695A.430 Assets,
funds and accounts of society.
NRS 695A.440 Investments.
NRS 695A.450 Annual
statement of financial condition, transactions and affairs.
NRS 695A.460 Penalties
for failure to file statement properly.
NRS 695A.475 Liability
of directors, officers, employees, members and volunteers; indemnification and
reimbursement of directors, officers, employees and agents.
NRS 695A.490 Standards
of valuation for certificates.
NRS 695A.500 Examination
of societies transacting business in State.
NRS 695A.530 Applicability
of statutory provisions relating to trade practices and frauds.
NRS 695A.550 Exemption
of societies from certain taxes.
NRS 695A.555 Fees:
Applicability of certain provisions.
NRS 695A.560 Exemption
of societies from other insurance laws.
NRS 695A.570 Applicability.
NRS 695A.580 Penalties.
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NRS 695A.001 Definitions. As
used in this chapter, unless the context otherwise requires, the words and
terms defined in NRS 695A.003 to 695A.044, inclusive, have the meanings ascribed to
them in those sections.
(Added to NRS by 1991, 221; A 1995, 2432)
NRS 695A.003 “Benefit contract” defined. “Benefit
contract” means an agreement for the provision of any contractual benefit
authorized by NRS 695A.180.
(Added to NRS by 1991, 221)
NRS 695A.004 “Benefit member” defined. “Benefit
member” means a member of a society who is an adult and who is designated by
the laws or rules of the society to be a benefit member under a benefit
contract.
(Added to NRS by 1991, 221)
NRS 695A.006 “Certificate” defined. “Certificate”
means the document issued as written evidence of the benefit contract.
(Added to NRS by 1991, 221)
NRS 695A.010 “Fraternal benefit society” defined. “Fraternal
benefit society” means any incorporated society, order or supreme lodge,
without capital stock, including one exempted under the provisions of paragraph
(b) of subsection 1 of NRS 695A.570 whether
incorporated or not, which:
1. Is conducted solely for the benefit of
its members and their beneficiaries and not for profit;
2. Operates on a lodge system with
ritualistic form of work;
3. Has a representative form of
government; and
4. Provides benefits in accordance with
this chapter.
(Added to NRS by 1971, 1835; A 1991, 222)
NRS 695A.014 “Insurer” defined. “Insurer”
includes every person engaged as principal and as indemnitor, surety or
contractor in the business of entering into contracts of insurance.
(Added to NRS by 1991, 221)
NRS 695A.016 “Laws” defined. “Laws”
means the articles of incorporation, charter, constitution and bylaws of the
society.
(Added to NRS by 1991, 221)
NRS 695A.018 “Lodge” defined. “Lodge”
means a subordinate unit of a society, and includes a camp, court, council,
branch or any similar entity by whatever name designated.
(Added to NRS by 1991, 221)
NRS 695A.020 “Lodge system” defined. “Lodge
system” means the system under which a society is operating if:
1. The society has a supreme governing
body and subordinate lodges into which members are elected, initiated or
admitted in accordance with its laws, ritual and rules; and
2. The subordinate lodges are required by
the laws of the society to hold regular meetings at least once in each month.
(Added to NRS by 1971, 1835; A 1991, 223)
NRS 695A.023 “Medicaid” defined. “Medicaid”
means a program established in any state pursuant to Title XIX of the Social
Security Act (42 U.S.C. §§ 1396 et seq.) to provide assistance for part or all
of the cost of medical care rendered on behalf of indigent persons.
(Added to NRS by 1995, 2431)
NRS 695A.027 “Order for medical coverage” defined. “Order
for medical coverage” means an order of a court or administrative tribunal to
provide coverage under a certificate for health benefits to a child pursuant to
the provisions of 42 U.S.C. § 1396g-1.
(Added to NRS by 1995, 2431)
NRS 695A.030 “Premiums” defined. “Premiums”
means premiums, rates, dues or other required contributions by whatever name
known, which are payable under the certificate.
(Added to NRS by 1971, 1835; A 1991, 223)
NRS 695A.040 “Representative form of government” defined. “Representative form of government” means that
form of government which a society has when:
1. It has a supreme governing body which
is:
(a) An assembly composed of delegates elected
either directly by the members of the society or at intermediate assemblies or
conventions of members or their representatives, and such other delegates as
prescribed in the laws of the society; or
(b) A board composed of persons elected by the
members of the society, either directly or by their representatives in
intermediate assemblies, and such other persons as prescribed in the laws of
the society.
2. If its supreme governing body is an
assembly:
(a) The elected delegates constitute a majority
in number, have a majority of the votes and have not less than the number of
votes necessary to amend the laws of the society;
(b) The election of delegates is done in person
or by mail, as prescribed in the laws of the society;
(c) The assembly is elected and meets not less
than once every 4 years;
(d) A board of directors is elected by the
assembly to conduct the business of the society in the interim between meetings
of the assembly; and
(e) Vacancies on the board of directors are
filled in the manner prescribed in the laws of the society.
3. If its supreme governing body is a
board:
(a) The persons elected to the board constitute a
majority in number, have a majority of the votes and have not less than the
number of votes necessary to amend the laws of the society;
(b) The election of the members of the board is
done in person or by mail, as prescribed in the laws of the society;
(c) The term of any member of the board does not
exceed 4 years;
(d) The board meets not less than quarterly to
conduct the business of the society;
(e) Vacancies on the board are filled in the
manner prescribed in the laws of the society; and
(f) A person filling the unexpired term of an
elected member of the board is considered to be an elected member.
4. The officers of the society are elected
either by the supreme governing body or by the board of directors.
5. Only benefit members are eligible for
election to the supreme governing body, the board of directors or any
intermediate assembly.
6. Each member who is entitled to vote has
only one vote, and votes are not cast by proxy.
(Added to NRS by 1971, 1836; A 1991, 223)
NRS 695A.042 “Rules” defined. “Rules”
includes all rules, regulations and resolutions adopted by the supreme
governing body or board of directors of a society and which generally apply to
the members of the society.
(Added to NRS by 1991, 221)
NRS 695A.044 “Society” defined. “Society”
means a fraternal benefit society.
(Added to NRS by 1991, 221)
NRS 695A.050 Organization: Preparation and contents of articles of
incorporation. Ten or more
citizens of the United States, a majority of whom are citizens of this state,
who desire to form a fraternal benefit society, may make, sign and acknowledge
before some person competent to take acknowledgment of deeds, articles of
incorporation, in which must be stated:
1. The proposed corporate name of the
society, which must not so closely resemble the name of any society or insurer
as to be misleading or confusing;
2. The purposes for which it is being
formed, which must not include more liberal powers than are granted by this
chapter;
3. The mode in which its corporate powers
are to be exercised; and
4. The names and residences of the
incorporators and the names, residences and official titles of all the
officers, trustees, directors or other persons who are to have and exercise the
general control of the management of the affairs and money of the society for
the first year or until the ensuing election at which all officers must be
elected by the supreme governing body, which election must be held not later
than 1 year after the date of the issuance of the permanent certificate of
authority.
(Added to NRS by 1971, 1836; A 1991, 224)
NRS 695A.060 Organization: Filing of documents and bond with Commissioner;
preliminary certificate of authority.
1. Duly certified copies of the laws and
rules of the society, copies of all proposed forms of certificates,
applications therefor, circulars to be issued by the society and a bond
conditioned upon the return to applicants of the advanced payments if the
organization is not completed within 1 year must be filed with the
Commissioner, who may require such further information as the Commissioner deems
necessary. The bond with sureties approved by the Commissioner must be in such
amount, not less than $300,000 nor more than $1,500,000, as required by the
Commissioner. All documents filed must be in the English language. If the
purposes of the society conform to the requirements of this chapter and all
applicable provisions of the law of this state have been complied with, the
Commissioner shall so certify, retain and file the articles of incorporation
and furnish the incorporators a preliminary certificate of authority for the
society to solicit members as provided in this chapter.
2. No preliminary certificate of authority
granted under the provisions of this section is valid after 1 year from its
date or after such further period, not exceeding 1 year, as may be authorized
by the Commissioner upon cause shown, unless 500 applicants have been secured
and the organization has been completed as provided in this chapter. The
articles of incorporation and all proceedings thereunder are void 1 year after
the date of the preliminary certificate of authority, or at the expiration of
the extended period, unless the society has completed its organization and
received a certificate of authority to do business.
(Added to NRS by 1971, 1837; A 1991, 225)
NRS 695A.070 Organization: Solicitation of members; collection of advance
premiums; reports to Commissioner.
1. Upon receipt of a preliminary
certificate of authority from the Commissioner, the society:
(a) May solicit members for the purpose of
completing its organization;
(b) Shall collect from each applicant the amount
of not less than one regular monthly premium in accordance with its table of
rates; and
(c) Shall issue to each applicant a receipt for
the amount collected.
2. A society shall not incur any liability
other than for the return of an advance premium, or issue any certificate, or
pay, allow, or offer or promise to pay or allow, any death or disability
benefit to any person until:
(a) Actual bona fide applications for benefits
have been secured aggregating at least $500,000 on not less than 500
applicants, and all required evidence of insurability has been furnished to and
approved by the society;
(b) Not less than 10 subordinate lodges have been
established into which the 500 applicants have been admitted;
(c) There has been submitted to the Commissioner,
under oath of the president or secretary, or corresponding officer of the
society, a list of the applicants, giving their names and addresses, the date
each was admitted, the name and number of the subordinate lodge of which each
applicant is a member, the amount of benefits to be granted and the premiums
therefor; and
(d) It has been shown to the Commissioner, by
sworn statement of the treasurer or corresponding officer of the society, that
at least 500 applicants have each paid in cash at least one regular monthly
premium as provided in this chapter, which premiums in the aggregate must
amount to at least $150,000.
3. The advance premiums provided for in
subsection 2 must be held in trust during the period of organization and if the
society has not qualified for a permanent certificate of authority within 1
year, as provided in this chapter, the premiums must be returned to the
applicants.
(Added to NRS by 1971, 1837; A 1991, 225)
NRS 695A.080 Certificate of authority: Issuance and renewal; effect; record;
copies; fees.
1. The Commissioner may make such
examination and require such further information as the Commissioner deems
advisable. Upon presentation of satisfactory evidence that the society has
complied with all applicable provisions of law, the Commissioner shall issue to
the society a certificate of authority indicating that the society may transact
business pursuant to the provisions of this chapter.
2. The certificate of authority is prima
facie evidence of the existence of the society on the date of the certificate.
3. The Commissioner shall cause a record
of the certificate of authority to be made. A certified copy of the record may
be given in evidence with like effect as the original certificate of authority.
4. For the issuance or renewal of a
certificate of authority, a society must pay to the Commissioner:
(a) A fee of $250 if the number of outstanding
benefit contracts within Nevada of the society is 600 or less;
(b) A fee of $500 if the number of outstanding
benefit contracts within Nevada of the society is more than 600 but less than
1,200;
(c) A fee of $2,450 if the number of outstanding
benefit contracts within Nevada of the society is 1,200 or more; and
(d) In addition to any other fee or charge, all
applicable fees required pursuant to NRS
680C.110.
Ê Each such
certificate or renewal expires on March 1 following its issuance.
5. If a society properly applies for the
renewal of its certificate of authority but does not receive approval of its
application by March 1, it may continue to transact business pursuant to this
chapter unless it receives notice that the application for renewal is
specifically denied.
6. A certified copy or duplicate of a
certificate of authority is prima facie evidence that the society may lawfully
transact business in this state pursuant to the provisions of this chapter
during the period stated on the license.
(Added to NRS by 1971, 1838; A 1991, 226, 1633; 1993, 2304; 2009, 1814)
NRS 695A.090 General powers and duties of society. A
society shall operate for the benefit of its members and their beneficiaries by
providing benefits as specified in NRS 695A.180
and may:
1. Operate for any lawful social,
intellectual, educational, charitable, benevolent, moral, fraternal, patriotic
or religious purpose.
2. Carry out its purposes directly or
through subsidiary corporations or affiliated organizations.
3. Create, maintain and operate, or
establish organizations to operate, nonprofit institutions to further the
society’s purposes. Such institutions may charge a reasonable amount for their
services.
4. Organize and operate lodges for
children under the minimum age for adult membership. Membership and initiation
in local lodges must not be required of children, and they must not have a
voice or vote in the management of the society.
5. Adopt laws and rules for the government
of the society, the admission of its members and the management of its affairs.
6. Amend its laws and rules.
7. Exercise any other power which is
necessary and incidental to carrying into effect the objects and purposes of
the society and which is not inconsistent with the provisions of this chapter.
(Added to NRS by 1971, 1838; A 1991, 227)
NRS 695A.095 Contracts between society and provider of health care:
Prohibiting society from charging provider of health care fee for inclusion on
list of providers given to insureds; form to obtain information on provider of
health care; modification; schedule of fees.
1. A society shall not charge a provider
of health care a fee to include the name of the provider on a list of providers
of health care given by the society to its insureds.
2. A society shall not contract with a
provider of health care to provide health care to an insured unless the society
uses the form prescribed by the Commissioner pursuant to NRS 629.095 to obtain any information
related to the credentials of the provider of health care.
3. A contract between a society and a
provider of health care may be modified:
(a) At any time pursuant to a written agreement
executed by both parties.
(b) Except as otherwise provided in this
paragraph, by the society upon giving to the provider 45 days’ written notice
of the modification of the society’s schedule of payments, including any
changes to the fee schedule applicable to the provider’s practice. If the
provider fails to object in writing to the modification within the 45-day
period, the modification becomes effective at the end of that period. If the
provider objects in writing to the modification within the 45-day period, the
modification must not become effective unless agreed to by both parties as
described in paragraph (a).
4. If a society contracts with a provider
of health care to provide health care to an insured, the society shall:
(a) If requested by the provider of health care
at the time the contract is made, submit to the provider of health care the
schedule of payments applicable to the provider of health care; or
(b) If requested by the provider of health care
at any other time, submit to the provider of health care the schedule of
payments, including any changes to the fee schedule applicable to the
provider’s practice, specified in paragraph (a) within 7 days after receiving
the request.
5. As used in this section, “provider of
health care” means a provider of health care who is licensed pursuant to chapter 630, 631,
632 or 633
of NRS.
(Added to NRS by 1999, 1649; A 2001, 2732; 2003, 3362; 2011, 2534)
NRS 695A.110 Unincorporated or voluntary association prohibited. No unincorporated or voluntary association may
transact business in this state as a fraternal benefit society.
(Added to NRS by 1971, 1839; A 1991, 227)
NRS 695A.120 Location of principal office; meetings of supreme governing
body; minutes of certain proceedings; official publications; grievances by
benefit members.
1. The principal office of any domestic
society must be located in this state.
2. The meetings of its supreme governing
body may be held in any state, district, province or territory in which the
society has at least five subordinate lodges, and all business transacted at
those meetings is as valid in all respects as if the meetings were held in this
state.
3. The minutes of the proceedings of the
supreme governing body and the board of directors must be written in the
English language.
4. A society may provide in its laws for
an official publication in which any notice, report or statement which is
required by law to be given to a member, including a notice of election, may be
published. Such a report, notice or statement must be printed conspicuously in
the publication.
5. If the records of a society indicate
that two or more benefit members have the same mailing address, an official
publication mailed to one member shall be deemed to be mailed to all members at
the same address unless a member requests a separate copy.
6. A society may provide in its laws or
rules a procedure by which a benefit member may pursue a grievance or complaint
against the society, its supreme governing body, officers, directors or other
members.
(Added to NRS by 1971, 1839; A 1991, 227)
NRS 695A.130 Consolidation; merger.
1. A domestic society that wishes to
consolidate or merge with any other society must file with the Commissioner:
(a) A certified copy of the written contract
containing in full the terms and conditions of the consolidation or merger;
(b) A sworn statement by the president and
secretary or corresponding officers of each society showing the financial
condition thereof on a date fixed by the Commissioner, but not earlier than
December 31, next preceding the date of the contract;
(c) The certification of such officers, duly
verified by their respective oaths, that the consolidation or merger has been
approved by a two-thirds vote of the supreme governing body of each society at
a regular or special meeting of such bodies or, if permitted by the laws of the
society, by mail; and
(d) Evidence that at least 60 days before the
action of the supreme governing body of each society, the text of the contract
was furnished to all members of each society either by mail or by publication
in full in the official publication of each society.
2. If the Commissioner finds that the
contract containing in full the terms and conditions of the consolidation or
merger is in conformity with the provisions of this section, that the financial
statements are correct and that the consolidation or merger is just and
equitable to the members of each society, the Commissioner shall approve the
contract and issue a certification of that fact.
3. The contract becomes effective upon
approval by the Commissioner unless any society which is a party to the
contract is incorporated under the laws of any other state or territory, in
which case the consolidation or merger does not become effective unless:
(a) It is approved as provided by the laws of the
other state or territory and a certificate of such approval has been filed with
the Commissioner of this state; or
(b) If the laws of the other state or territory
do not provide for such approval, it is approved by the officer responsible for
supervising the business of insurance in the other state or territory and a
certificate of such approval has been filed with the Commissioner of this
state.
4. Upon the consolidation or merger
becoming effective as provided in this chapter, all the rights, franchises and
interests of the consolidated or merged societies in and to every species of
property, real, personal or mixed, and things in action belonging thereto are
vested in the society resulting from or remaining after the consolidation or
merger without any other instrument, except that conveyances of real property
may be evidenced by proper deeds. The title to any real property or interest
therein, vested under the laws of this state in any of the societies
consolidated or merged, does not revert and is not in any way impaired by the
consolidation or merger but vests absolutely in the society resulting from or
remaining after the consolidation or merger.
5. The affidavit of any officer of the
society or of anyone authorized by it to mail any notice or document, stating
that the notice or document has been duly addressed and mailed, is prima facie
evidence that the notice or document has been furnished the addressees.
(Added to NRS by 1971, 1839; A 1991, 228)
NRS 695A.140 Conversion of fraternal benefit society into mutual life
insurer. Any domestic fraternal
benefit society may be converted to and licensed as a mutual life insurer by
compliance with all the applicable requirements of chapter 693A of NRS if a plan of conversion
is:
1. Prepared by the board of directors of
the society in writing setting forth in full the terms and conditions of the
conversion;
2. Approved by the affirmative vote of two-thirds
of all members of the supreme governing body of the society at a regular or
special meeting; and
3. Approved by the Commissioner, who may
give such approval if the Commissioner finds that the proposed change is in
conformity with the laws of this state and not prejudicial to the certificate
holders of the society.
(Added to NRS by 1971, 1840; A 1991, 229)
NRS 695A.150 Qualifications for and rights and privileges of membership.
1. Subject to the limitations set forth in
subsections 2, 3 and 4, a society shall specify in its laws or rules for each
class of membership:
(a) The standards of eligibility and the process
for admission to membership in that class; and
(b) The rights and privileges of membership in
that class, provided that only benefit members may have the right to vote on
the management of the business of the society relating to insurance.
2. If benefits are provided on the lives
of children, the minimum age for membership as an adult must be not less than
15 and not greater than 21 years of age.
3. A society may also admit social
members, who have no voice or vote in the management of its affairs relating to
insurance.
4. Membership rights in the society must
not be assignable.
(Added to NRS by 1971, 1841; A 1973, 1582; 1991, 229)
NRS 695A.151 Effect of eligibility for medical assistance under Medicaid on
eligibility for coverage; assignment of rights to state agency.
1. A society shall not, when considering
eligibility for coverage or making payments under a certificate for health
benefits, consider the availability of, or eligibility of a person for, medical
assistance under Medicaid.
2. To the extent that payment has been
made by Medicaid for health care, a society:
(a) Shall treat Medicaid as having a valid and
enforceable assignment of an insured’s benefits regardless of any exclusion of
Medicaid or the absence of a written assignment; and
(b) May, as otherwise allowed by its certificate
for health benefits, evidence of coverage or contract and applicable law or
regulation concerning subrogation, seek to enforce any reimbursement rights of
a recipient of Medicaid against any other liable party if:
(1) It is so authorized pursuant to a
contract with Medicaid for managed care; or
(2) It has reimbursed Medicaid in full for
the health care provided by Medicaid to its insured.
3. If a state agency is assigned any
rights of a person who is:
(a) Eligible for medical assistance under
Medicaid; and
(b) Covered by a certificate for health benefits,
Ê the society
that issued the health policy shall not impose any requirements upon the state
agency except requirements it imposes upon the agents or assignees of other
persons covered by the certificate.
4. If a state agency is assigned any
rights of an insured who is eligible for medical assistance under Medicaid, a
society that issues a certificate for health benefits, evidence of coverage or
contract shall:
(a) Upon request of the state agency, provide to
the state agency information regarding the insured to determine:
(1) Any period during which the insured, a
spouse or dependent of the insured may be or may have been covered by the
society; and
(2) The nature of the coverage that is or
was provided by the society, including, without limitation, the name and
address of the insured and the identifying number of the certificate for health
benefits, evidence of coverage or contract;
(b) Respond to any inquiry by the state agency
regarding a claim for payment for the provision of any medical item or service
not later than 3 years after the date of the provision of the medical item or
service; and
(c) Agree not to deny a claim submitted by the
state agency solely on the basis of the date of submission of the claim, the
type or format of the claim form or failure to present proper documentation at
the point of sale that is the basis for the claim if:
(1) The claim is submitted by the state
agency not later than 3 years after the date of the provision of the medical
item or service; and
(2) Any action by the state agency to
enforce its rights with respect to such claim is commenced not later than 6
years after the submission of the claim.
(Added to NRS by 1995, 2431; A 2007, 2404)
NRS 695A.152 Society required to comply with certain provisions concerning
portability and availability of health insurance.
1. To the extent reasonably applicable, a
fraternal benefit society shall comply with the provisions of NRS 689B.340 to 689B.580, inclusive, and chapter 689C of NRS relating to the portability
and availability of health insurance offered by the society to its members. If
there is a conflict between the provisions of this chapter and the provisions
of NRS 689B.340 to 689B.580, inclusive, and chapter 689C of NRS, the provisions of NRS 689B.340 to 689B.580, inclusive, and chapter 689C of NRS control.
2. For the purposes of subsection 1,
unless the context requires that a provision apply only to a group health plan
or a carrier that provides coverage under a group health plan, any reference in
those sections to “group health plan” or “carrier” must be replaced by
“fraternal benefit society.”
(Added to NRS by 1997, 2954; A 2001, 1923; 2013, 3636)
NRS 695A.153 Society prohibited from asserting certain grounds to deny
enrollment of child of insured pursuant to order. A
society shall not deny the enrollment of a child pursuant to an order for
medical coverage under a certificate for health benefits pursuant to which a
parent of the child is insured, on the ground that the child:
1. Was born out of wedlock;
2. Has not been claimed as a dependent on
the parent’s federal income tax return; or
3. Does not reside with the parent or
within the society’s geographic area of service.
(Added to NRS by 1995, 2431)
NRS 695A.155 Certain accommodations to be made when child is covered under
policy of noncustodial parent. If
a child has coverage under a certificate for health benefits pursuant to which
a noncustodial parent of the child is insured, the society issuing that
certificate shall:
1. Provide to the custodial parent such
information as necessary for the child to obtain any benefits under that
coverage.
2. Allow the custodial parent or, with the
approval of the custodial parent, a provider of health care to submit claims
for covered services without the approval of the noncustodial parent.
3. Make payments on claims submitted
pursuant to subsection 2 directly to the custodial parent, the provider of
health care or an agency of this or another state responsible for the
administration of Medicaid.
(Added to NRS by 1995, 2432)
NRS 695A.157 Society to authorize enrollment of child of parent who is
required by order to provide medical coverage under certain circumstances;
termination of coverage of child. If
a parent is required by an order for medical coverage to provide coverage under
a certificate for health benefits for a child and the parent is eligible for
coverage of members of the parent’s family under a certificate for health
benefits, the society that issued the certificate:
1. Shall, if the child is otherwise
eligible for that coverage, allow the parent to enroll the child in that
coverage without regard to any restrictions upon periods for enrollment.
2. Shall, if:
(a) The child is otherwise eligible for that
coverage; and
(b) The parent is enrolled in that coverage but
fails to apply for enrollment of the child,
Ê enroll the
child in that coverage upon application by the other parent of the child, or by
an agency of this or another state responsible for the administration of
Medicaid or a state program for the enforcement of child support established
pursuant to 42 U.S.C. §§ 651 et seq., without regard to any restrictions upon
periods for enrollment.
3. Shall not terminate the enrollment of
the child in that coverage or otherwise eliminate that coverage of the child
unless the society has written proof that:
(a) The order for medical coverage is no longer
in effect; or
(b) The child is or will be enrolled in
comparable coverage through another insurer on or before the effective date of
the termination of enrollment or elimination of coverage.
(Added to NRS by 1995, 2432)
NRS 695A.159 Society prohibited from restricting coverage of child based on
preexisting condition when person who is eligible for group coverage adopts or
assumes legal obligation for child.
1. If a person:
(a) Adopts a dependent child; or
(b) Assumes and retains a legal obligation for
the total or partial support of a dependent child in anticipation of adopting
the child,
Ê while the
person is eligible for group coverage under a certificate for health benefits,
the society issuing that certificate shall not restrict the coverage, in
accordance with NRS 689B.340 to 689B.580, inclusive, and chapter 689C of NRS relating to the
portability and availability of health insurance, of the child solely because
of a preexisting condition the child has at the time he or she would otherwise
become eligible for coverage pursuant to that policy.
2. For the purposes of this section,
“child” means a person who is under 18 years of age at the time of his or her
adoption or the assumption of a legal obligation for his or her support in
anticipation of his or her adoption.
(Added to NRS by 1995, 2432; A 1997, 2954; 2013, 3636)
NRS 695A.160 Amendment of laws of society.
1. A domestic society may amend its laws
in accordance with the provisions thereof by action of its supreme governing
body at any regular or special meeting thereof or, if its laws so provide, by
referendum. Such a referendum may be held in accordance with the provisions of
its laws by the vote of the voting members of the society, by the vote of
delegates or representatives of voting members or by the vote of local lodges.
A society may provide for voting by mail. No amendment submitted for adoption
by referendum may be adopted unless, within 6 months after the date of
submission thereof, a majority of all of the voting members of the society have
signified their consent to the amendment by one of the methods specified in
this section.
2. No amendment to the laws of any
domestic society becomes effective unless approved by the Commissioner, who
shall approve the amendment if the Commissioner finds that it has been duly
adopted and is not inconsistent with any requirement of the laws of this state
or with the character, objects and purposes of the society. Unless the
Commissioner disapproves an amendment within 60 days after it is filed, such
amendment shall be deemed approved. The approval or disapproval of the Commissioner
must be in writing and mailed to the secretary or corresponding officer of the
society at its principal office. If the Commissioner disapproves an amendment,
the reasons therefor must be stated in the written notice.
3. Within 90 days after their approval by
the commissioner, all the amendments, or a synopsis thereof, must be furnished
to all members of the society either by mail or by publication in full in the
official publication of the society. The affidavit of any officer of the
society or of anyone authorized by it to mail any amendments or synopsis
thereof, stating facts which show that the amendments or synopsis thereof have
been duly addressed and mailed, is prima facie evidence that the amendments or
synopsis thereof have been furnished the addressee.
4. Every foreign or alien society
authorized to do business in this state shall file with the Commissioner a duly
certified copy of all amendments of, or additions to, its laws within 90 days
after their enactment.
5. Printed copies of the laws as amended,
certified by the secretary or corresponding officer of the society, are prima
facie evidence of the legal adoption thereof.
(Added to NRS by 1971, 1841; A 1991, 230)
NRS 695A.180 Scope of contractual benefits.
1. A society authorized to do business in
this state may provide the following contractual benefits in any form:
(a) Death benefits;
(b) Endowment benefits;
(c) Annuity benefits;
(d) Temporary or permanent disability benefits;
(e) Hospital, medical or nursing benefits;
(f) Monument or tombstone benefits to the memory
of deceased members; and
(g) Any other benefits which life insurance
companies are authorized to pay which are not inconsistent with the provisions
of this chapter.
2. A society shall specify in its laws or
rules those persons who may be issued, or covered by, the contractual benefits
set forth in subsection 1, consistent with the purpose of providing benefits to
members and their dependents. A society may provide benefits on the lives of
children under the minimum age for adult membership upon the application of an
adult.
(Added to NRS by 1971, 1842; A 1991, 231)
NRS 695A.184 Coverage for prescription drug previously approved for medical
condition of insured.
1. Except as otherwise provided in this
section, a benefit contract which provides coverage for prescription drugs must
not limit or exclude coverage for a drug if the drug:
(a) Had previously been approved for coverage by
the society for a medical condition of an insured and the insured’s provider of
health care determines, after conducting a reasonable investigation, that none
of the drugs which are otherwise currently approved for coverage are medically
appropriate for the insured; and
(b) Is appropriately prescribed and considered
safe and effective for treating the medical condition of the insured.
2. The provisions of subsection 1 do not:
(a) Apply to coverage for any drug that is
prescribed for a use that is different from the use for which that drug has
been approved for marketing by the Food and Drug Administration;
(b) Prohibit:
(1) The society from charging a
deductible, copayment or coinsurance for the provision of benefits for
prescription drugs to the insured or from establishing, by contract,
limitations on the maximum coverage for prescription drugs;
(2) A provider of health care from
prescribing another drug covered by the benefit contract that is medically
appropriate for the insured; or
(3) The substitution of another drug
pursuant to NRS 639.23286 or 639.2583 to 639.2597, inclusive; or
(c) Require any coverage for a drug after the
term of the benefit contract.
3. Any provision of a benefit contract
subject to the provisions of this chapter that is delivered, issued for
delivery or renewed on or after October 1, 2001, which is in conflict with this
section is void.
(Added to NRS by 2001, 861; A 2003, 2299)
NRS 695A.188 Approval or denial of claim; interest on unpaid claim; request
for additional information; payment of claim; costs and attorney’s fees.
1. Except as otherwise provided in
subsection 2, a society shall approve or deny a claim relating to a certificate
of health insurance within 30 days after the society receives the claim. If the
claim is approved, the society shall pay the claim within 30 days after it is
approved. If the approved claim is not paid within that period, the society
shall pay interest on the claim at the rate of interest established pursuant to
NRS 99.040 unless a different rate of
interest is established pursuant to an express written contract between the
society and the provider of health care. The interest must be calculated from
30 days after the date on which the claim is approved until the claim is paid.
2. If the society requires additional
information to determine whether to approve or deny the claim, it shall notify
the claimant of its request for the additional information within 20 days after
it receives the claim. The society shall notify the provider of health care of
all the specific reasons for the delay in approving or denying the claim. The
society shall approve or deny the claim within 30 days after receiving the
additional information. If the claim is approved, the society shall pay the
claim within 30 days after it receives the additional information. If the
approved claim is not paid within that period, the society shall pay interest
on the claim in the manner prescribed in subsection 1.
3. A society shall not request a claimant
to resubmit information that the claimant has already provided to the society,
unless the society provides a legitimate reason for the request and the purpose
of the request is not to delay the payment of the claim, harass the claimant or
discourage the filing of claims.
4. A society shall not pay only part of a
claim that has been approved and is fully payable.
5. A court shall award costs and
reasonable attorney’s fees to the prevailing party in an action brought
pursuant to this section.
(Added to NRS by 1991, 1330; A 1999, 1649)
NRS 695A.195 Society prohibited from denying coverage solely because person
was victim of domestic violence. A
society shall not deny a claim, refuse to issue a benefit contract or cancel a
benefit contract solely because the claim involves an act that constitutes
domestic violence pursuant to NRS 33.018,
or because the person applying for or covered by the benefit contract was the
victim of such an act of domestic violence, regardless of whether the insured
or applicant contributed to any loss or injury.
(Added to NRS by 1997, 1096)
NRS 695A.197 Society 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 society that provides health benefits shall not:
(a) Deny a claim under a benefit contract 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 a benefit contract 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 to issue a benefit contract 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 society from enforcing a provision included in a benefit contract
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 a benefit contract solely because of
such a claim; or
(c) Refuse to issue a benefit contract to an
eligible applicant solely because of such a claim.
3. The provisions of this section do not
apply to a society under a benefit contract that provides coverage for
long-term care or disability income.
(Added to NRS by 2005, 2345; A 2007, 85)
NRS 695A.200 Nonforfeiture benefits, cash surrender values, certificate loans
and other options.
1. A society may grant paid-up
nonforfeiture benefits, cash surrender values, certificate loans and such other
options as its laws may permit.
2. In the case of certificates for which
reserves are computed on the Commissioners 1980 Standard Ordinary Mortality
Table or such other table of mortality as may be specified by the society and
approved by the Commissioner, every paid-up nonforfeiture benefit and the
amount of any cash surrender value, loan or other option granted must not be
less than the corresponding amount ascertained in accordance with the
provisions of the laws of this state applicable to life insurance companies
issuing policies containing like insurance benefits based upon those tables.
(Added to NRS by 1971, 1843; A 1985, 1185; 1991, 231)
NRS 695A.210 Beneficiaries; funeral benefits.
1. The owner of a benefit contract has the
right at all times to change any beneficiary in accordance with the laws or
rules of the society, unless the owner waives that right by requesting in
writing that the owner’s designation of a beneficiary be irrevocable. Every
society by its laws or rules may limit the scope of a designation of a beneficiary
and shall provide that a revocable beneficiary does not have or obtain any
vested interest in the proceeds of any certificate until the certificate has
become due and payable in conformity with the provisions of the benefit
contract.
2. A society may provide for the payment
of funeral benefits to the extent of such portion of any payment under a
certificate as might reasonably appear to be due to any person equitably
entitled thereto by reason of having incurred expense occasioned by the burial of
a member, but the portion so paid must not exceed $1,000.
3. If, at the death of any person insured
under a benefit contract, there is no lawful beneficiary to whom the insurance
benefits are payable, the amount of such benefits, except to the extent that
funeral benefits may be paid as provided in subsection 2, are payable:
(a) To the estate of the deceased insured; or
(b) To the owner of the certificate if the owner
is not the person insured under the benefit contract.
(Added to NRS by 1971, 1844; A 1991, 232)
NRS 695A.220 Benefits not liable to attachment, garnishment or other process. No money or other benefit, charity, relief or
aid to be paid, provided or rendered by any society is liable to attachment,
garnishment or other process, or to be seized, taken, appropriated or applied
by any legal or equitable process or operation of law to pay any debt or
liability of a benefit member or beneficiary, or any other person who may have
a right thereunder, either before or after payment by the society.
(Added to NRS by 1971, 1844; A 1991, 233)
NRS 695A.230 Terms and conditions of benefit contracts.
1. Every society authorized to do business
in this state shall issue to each owner of a benefit contract a certificate
specifying the amount of benefits provided thereby. The certificate, together
with any riders or endorsements attached thereto, the laws of the society, the
application for membership, the application for insurance and the declaration
of insurability, if any, signed by the applicant, and all amendments to each
thereof, constitute the agreement, as of the date of issuance, between the
society and the member, and the certificate must so state. A copy of the
application for insurance and the declaration of insurability, if any, must be
endorsed upon or attached to the certificate.
2. All statements on an application for
insurance are representations and not warranties. Any waiver of this provision
is void.
3. Except with regard to contracts
providing benefits payable in variable amounts, any changes, additions or
amendments to the laws of the society duly made or enacted after the issuance
of the certificate bind the owner and the beneficiaries, and govern and control
the benefit contract as though the changes, additions or amendments were in
force at the time of the application for insurance, except that no change,
addition or amendment may destroy or diminish benefits which the society
contracted to give the owner as of the date of issuance.
4. Any person upon whose life a benefit
contract is issued before the person attains the age of majority is bound by
the terms of the application and certificate and by all the laws and rules of
the society as though the age of majority had been attained at the time of
application.
5. Copies of any of the documents
mentioned in this section, certified by the secretary or corresponding officer
of the society, must be received in evidence of the terms and conditions
thereof.
6. Except with regard to contracts
providing benefits payable in variable amounts, a society shall provide in its
laws that if its reserves as to all or any class of certificates become
impaired, its supreme governing body or board of directors may require each
owner of such certificates to pay to the society the amount of the owner’s
equitable proportion of such deficiency as ascertained by its board, and that
if the payment is not made, the owner may elect to:
(a) Let it stand as an indebtedness against the
certificate and draw interest at a rate not to exceed that specified for loans
made pursuant to the certificates; or
(b) In lieu of, or in combination with paragraph
(a), accept a proportionate reduction in benefits under the certificate.
Ê The society
may specify the manner of the election and which alternative is to be presumed
if no election is made by the owner.
(Added to NRS by 1971, 1844; A 1991, 233)
NRS 695A.235 Offering policy of health insurance for purposes of establishing
health savings account. A society
may, subject to regulation by the Commissioner, offer a policy of health
insurance that has a high deductible and is in compliance with 26 U.S.C. § 223
for the purposes of establishing a health savings account.
(Added to NRS by 2005, 2158)
NRS 695A.240 Approval and contents of certificates.
1. No certificate may be delivered or
issued for delivery in this state unless a copy of the form of the certificate
has been filed with and approved by the Commissioner in conformity with the
requirements of NRS 687B.120.
2. The certificate must contain:
(a) A provision stating the amount of premiums
which are payable under the certificate;
(b) A provision setting forth the society’s laws
or rules which, if violated, will result in the termination or reduction of
benefits payable under the certificate;
(c) If the laws of the society provide for the
expulsion or suspension of a member, a provision that any member who is
expelled or suspended, except for nonpayment of a premium or, during the period
of contestability, for material misrepresentation in the application for
membership or insurance, may maintain the certificate in force by continuing
payment of the required premium; and
(d) All standard contractual provisions which are
required by the provisions of chapters 687B,
688A, 688B,
689, 689A
and 689B of NRS to be included in similar
policies issued by life or health insurers in this state, and which are not
inconsistent with the provisions of this chapter.
3. The certificate may contain:
(a) A provision that the member is entitled to a
grace period of 1 month in which the payment of any premium after the first may
be made.
(b) For a benefit contract issued on the life of
a person under the society’s minimum age for membership as an adult, a
provision governing the transfer of ownership to the insured at an age
specified in the certificate. A society may require approval of an application
for membership in order to make the transfer, and may provide for the
regulation, government and control of such a certificate and all rights,
obligations and liabilities incident to the certificate, including rights of ownership
before the transfer.
(c) The terms and conditions governing the
assignability of the benefit contract.
(Added to NRS by 1971, 1845; A 1991, 234)
NRS 695A.255 Coverage for prescription drugs: Provision of notice and
information regarding use of formulary.
1. A society that offers or issues a
benefit contract which provides coverage for prescription drugs shall include
with any certificate for such a contract provided to a benefit member, notice
of whether a formulary is used and, if so, of the opportunity to secure
information regarding the formulary from the society pursuant to subsection 2.
The notice required by this subsection must:
(a) Be in a language that is easily understood
and in a format that is easy to understand;
(b) Include an explanation of what a formulary
is; and
(c) If a formulary is used, include:
(1) An explanation of:
(I) How often the contents of the
formulary are reviewed; and
(II) The procedure and criteria for
determining which prescription drugs are included in and excluded from the
formulary; and
(2) The telephone number of the society
for making a request for information regarding the formulary pursuant to
subsection 2.
2. If a society offers or issues a benefit
contract which provides coverage for prescription drugs and a formulary is
used, the society shall:
(a) Provide to any insured or participating
provider of health care, upon request:
(1) Information regarding whether a
specific drug is included in the formulary.
(2) Access to the most current list of
prescription drugs in the formulary, organized by major therapeutic category,
with an indication of whether any listed drugs are preferred over other listed
drugs. If more than one formulary is maintained, the society shall notify the
requester that a choice of formulary lists is available.
(b) Notify each person who requests information
regarding the formulary, that the inclusion of a drug in the formulary does not
guarantee that a provider of health care will prescribe that drug for a
particular medical condition.
(Added to NRS by 2001, 860)
NRS 695A.270 Waiver of provisions of society’s laws. The
laws of the society may provide that no subordinate body or any of its
subordinate officers or members may waive any of the provisions of the laws of
the society. Such a provision is binding on the society and every member and
beneficiary of a member.
(Added to NRS by 1971, 1849; A 1991, 237)
NRS 695A.280 Reinsurance.
1. Except as otherwise provided in
subsection 3, a domestic society may, by a reinsurance agreement, cede any
individual risk or risks in whole or in part to an insurer, other than another
fraternal benefit society, authorized to provide reinsurance in this state, or
if not so authorized, one which is approved in writing by the Commissioner, but
no such society may reinsure substantially all of its insurance in force
without the written permission of the Commissioner.
2. A society may take credit for the
reserves on such ceded risks to the extent reinsured, but no credit may be
allowed as an admitted asset or as a deduction from liability to a ceding
society for reinsurance made, ceded, renewed or otherwise becoming effective
after July 1, 1963, unless the reinsurance is payable by the assuming insurer
on the basis of the liability of the ceding society under the benefit contract
or contracts reinsured without diminution because of the insolvency of the
ceding society.
3. A society may reinsure the risks of
another society in a consolidation or merger which is approved by the
Commissioner pursuant to NRS 695A.130.
(Added to NRS by 1971, 1849; A 1987, 649; 1991, 237)
NRS 695A.300 Admission of foreign or alien society.
1. A foreign or alien society shall not
transact business in this state without a license issued by the Commissioner.
2. A foreign or alien society may be
licensed to transact business in this state upon a showing that its assets are
invested in accordance with the provisions of this chapter and upon filing with
the Commissioner:
(a) A duly certified copy of its laws, certified
by its secretary or corresponding officer;
(b) A power of attorney to the Commissioner as
prescribed in NRS 695A.400;
(c) A statement of its business under oath of its
president and secretary or corresponding officers in a form prescribed by the
Commissioner, duly verified by an examination made by the supervising insurance
officer of its home state or other state, territory, province or country,
satisfactory to the Commissioner of this state;
(d) Certification from the proper officer of its
home state, territory, province or country that the society is legally
incorporated and licensed to transact business therein;
(e) Copies of its certificate forms; and
(f) Such other information as the Commissioner
may deem necessary.
3. Any foreign or alien society desiring
admission to this state must comply substantially with the requirements and
limitations of this chapter applicable to domestic societies.
(Added to NRS by 1971, 1849; A 1991, 237)
NRS 695A.310 Injunction against, liquidation of or appointment of receiver
for domestic society.
1. When the Commissioner upon
investigation finds that a domestic society:
(a) Has exceeded its powers;
(b) Has failed to comply with any provision of
this chapter;
(c) Is not fulfilling its contracts in good
faith;
(d) Has a membership of less than 400 after an
existence of 1 year or more; or
(e) Is conducting business fraudulently or in a
manner hazardous to its members, creditors, the public or the business,
Ê the
Commissioner shall notify the society of his or her findings, state in writing
the reasons for the Commissioner’s dissatisfaction, and issue a written order
requiring the society to make the necessary corrections. If the Commissioner
finds that the society has failed to comply with the order within 30 days after
receiving it, the Commissioner shall notify the society of his or her finding
of noncompliance and require the society to show cause on a date named why it
should not be enjoined from carrying on any business until the violation
complained of has been corrected, or why an action in quo warranto should not
be commenced against the society.
2. If on that date the society does not
present good and sufficient reasons why it should not be so enjoined or why
such action should not be commenced, the Commissioner may present the facts
relating thereto to the Attorney General, who shall, if he or she deems the
circumstances warrant, commence an action to enjoin the society from
transacting business or an action in quo warranto.
3. The court shall thereupon notify the
officers of the society of a hearing. If, after a full hearing, it appears that
the society should be so enjoined or liquidated or a receiver appointed, the
court shall enter the necessary order.
4. A society that is so enjoined shall not
do business until:
(a) The Commissioner finds that the violation complained
of has been corrected;
(b) The costs of the action have been paid by the
society, if the court finds that the society was in default as charged;
(c) The court has dissolved its injunction; and
(d) The Commissioner has reinstated the
certificate of authority.
5. If the court orders the society
liquidated, it must be enjoined from carrying on any further business,
whereupon the receiver of the society shall proceed at once to take possession
of the books, papers, money and other assets of the society and, under the
direction of the court, proceed forthwith to close the affairs of the society
and to distribute its funds to those entitled thereto.
6. No action under this section may be
recognized in any court of this state unless brought by the Attorney General
upon request of the Commissioner. Whenever a receiver is to be appointed for a
domestic society, the court shall appoint the Commissioner as the receiver.
7. The provisions of this section relating
to hearing by the Commissioner, action by the Attorney General at the request
of the Commissioner, hearing by the court, injunction and receivership apply to
a society which voluntarily determines to discontinue business.
(Added to NRS by 1971, 1850; A 1991, 238)
NRS 695A.320 Suspension, revocation or refusal of license of foreign or alien
society.
1. When the Commissioner upon
investigation finds that a foreign or alien society transacting or applying to
transact business in this state:
(a) Has exceeded its powers;
(b) Has failed to comply with any provision of
this chapter;
(c) Is not fulfilling its contracts in good
faith; or
(d) Is conducting its business fraudulently or in
a manner hazardous to its members or creditors or the public,
Ê the
Commissioner shall notify the society of his or her findings, state in writing
the reasons for the Commissioner’s dissatisfaction and issue a written order
requiring the society to make the necessary corrections. If the Commissioner
finds that the society has failed to comply with the order within 30 days after
receiving it, the Commissioner shall notify the society of his or her finding
of noncompliance and require the society to show cause on a date named why its
license should not be suspended, revoked or refused.
2. If on that date the society does not
present good and sufficient reason why its authority to do business in this
state should not be suspended, revoked or refused, the Commissioner may suspend
or refuse the license of the society to do business in this state until
satisfactory evidence is furnished to the Commissioner that the suspension or
refusal should be withdrawn, or the Commissioner may revoke the authority of
the society to do business in this state.
3. Nothing contained in this section
prevents a society from continuing in good faith all contracts made in this
state during the time the society was legally authorized to transact business
in this state.
(Added to NRS by 1971, 1851; A 1991, 239)
NRS 695A.330 Licensing of insurance agents of society; persons exempt from
licensing.
1. Every insurance agent of a society must
be licensed pursuant to chapter 683A of NRS
and any regulations adopted by the Commissioner which apply to health and life
insurance agents.
2. No written or other examination is
required of a person who held a license as an insurance agent on July 1, 1977,
for renewals of his or her license.
3. No examination or license is required
of:
(a) Any regular salaried officer or employee of a
licensed society who devotes substantially all of his or her services to
activities other than the solicitation of fraternal insurance contracts from
the public, and who does not receive for the solicitation of such contracts any
commission or other compensation directly dependent upon the amount of business
obtained; or
(b) Any member of the society who does not write
insurance contracts, and whose solicitation or negotiation is incidental to
securing new members for the society, and whose only remuneration consists of
prizes in the form of merchandise or payments of a nominal amount of money.
(Added to NRS by 1971, 1851; A 1977, 693; 1991, 239)
NRS 695A.400 Service of process on society.
1. Every society authorized to do business
in this state shall appoint in writing the Commissioner and each successor in
office to be its true and lawful attorney upon whom all lawful process in any
action or proceeding against it must be served, and shall agree in the writing
that any lawful process against it which is served on the Commissioner is of
the same legal force and validity as if served upon the society, and that the
authority continues in force so long as any liability remains outstanding in
this state. A copy of the appointment, certified by the Commissioner,
constitutes sufficient evidence of the appointment and must be admitted in
evidence with the same validity as the original.
2. Service must be made only upon the
Commissioner, or if absent, upon the person in charge of the Office of the
Commissioner. It must be made in duplicate and constitutes sufficient service
upon the society. When legal process against a society is served upon the
Commissioner, the Commissioner shall forthwith forward one of the duplicate
copies by registered mail, prepaid, directed to the secretary or corresponding
officer.
3. No such service may require a society
to file its answer, pleading or defense in less than 30 days from the date of
mailing the copy of the service to a society.
4. Legal process must not be served upon a
society except in the manner provided in this section.
5. At the time of serving any process upon
the Commissioner, the plaintiff or complainant in the action shall pay to the
Commissioner a fee of $5.
6. For the purposes of this section,
“process” includes only the summons or the initial documents served in an
action. The Commissioner is not required to serve any documents after the
initial service of process.
(Added to NRS by 1971, 1854; A 1971, 1956; 1985, 612; 1991, 240)
NRS 695A.410 Injunctions against societies. No
application or petition for injunction against any domestic, foreign or alien
society, or any of its lodges, may be recognized in any court of this state
unless made by the Attorney General upon request of the Commissioner.
(Added to NRS by 1971, 1855; A 1991, 240)
NRS 695A.420 Judicial review of Commissioner’s findings and decisions. All decisions and findings of the Commissioner
made under the provisions of this chapter are subject to review by proper
proceedings in any court of competent jurisdiction in this state.
(Added to NRS by 1971, 1855; A 1991, 241)
NRS 695A.430 Assets, funds and accounts of society.
1. All assets must be held, invested and
disbursed for the use and benefit of the society and no member or beneficiary
may have or acquire individual rights therein or become entitled to any
apportionment or the surrender of any part thereof, except as provided in the
benefit contract.
2. A society may create, maintain, invest,
disburse and apply any special fund necessary to carry out any purpose
permitted by the laws of the society.
3. A society may, pursuant to a resolution
of its supreme governing body and subject to the provisions of NRS 688A.390, establish and operate one
or more separate accounts and issue contracts providing benefits payable in
variable amounts. For the purposes of NRS
688A.390, a society shall be deemed to be a domestic life insurer.
(Added to NRS by 1971, 1855; A 1991, 241)
NRS 695A.440 Investments.
1. A society shall invest its money only
in such investments as are authorized by the laws of this state for the
investment of assets of life insurers and subject to the limitations thereon.
2. Any foreign or alien society permitted
or seeking to do business in this state which invests its money in accordance
with the laws of the state, district, territory, country or province in which
it is incorporated shall be deemed to meet the requirements of this section for
the investment of money.
(Added to NRS by 1971, 1855; A 1991, 241)
NRS 695A.450 Annual statement of financial condition, transactions and affairs.
1. Every society transacting business in
this state shall annually, on or before the first day of March, unless for
cause shown the time has been extended by the Commissioner, file with the
Commissioner a true statement of its financial condition, transactions and
affairs for the preceding calendar year and pay a filing fee of $25. The
statement must be in such general form and context as approved by the National
Association of Insurance Commissioners for fraternal benefit societies and as
supplemented by additional information required by the Commissioner. The
statement must include separately from the society’s admitted assets all real
or personal property owned, held or leased by the society for the purposes of
its nonprofit institutions operated pursuant to NRS
695A.090.
2. A synopsis of its annual statement
providing an explanation of the facts concerning the condition of the society
thereby disclosed must be printed and mailed to each benefit member of the
society not later than June 1 of each year, or, in lieu thereof, the synopsis
may be published in the society’s official publication established pursuant to NRS 695A.120.
3. As a part of the annual statement
required by subsection 1, each society shall, on or before the first day of
March, file with the Commissioner a valuation of its certificates in force on
the preceding December 31. The Commissioner may, in the discretion of the
Commissioner for cause shown, extend the time for filing the valuation for not
more than 2 calendar months. The valuation must be done pursuant to NRS 695A.490. The valuation and supporting data must
be certified by a qualified actuary or, at the expense of the society, verified
by the actuary of the department of insurance of the state in which the society
is domiciled.
(Added to NRS by 1971, 1856; A 1987, 466; 1991, 241)
NRS 695A.460 Penalties for failure to file statement properly. If a society fails to file the annual
statement in the form and within the time provided by NRS
695A.450, it shall pay to the Commissioner $100 for each day that the
statement remains unfiled or deficient, and, upon notice by the Commissioner to
that effect, its authority to do business in this state ceases until the
statement is properly filed.
(Added to NRS by 1971, 1857; A 1991, 242)
NRS 695A.475 Liability of directors, officers, employees, members and
volunteers; indemnification and reimbursement of directors, officers, employees
and agents.
1. The officers and members of the supreme
governing body or any subordinate body of a society are not personally liable
for payment of any benefits provided by the society.
2. A person may be indemnified and
reimbursed by a society for expenses reasonably incurred by, and liabilities
imposed upon, the person in connection with or arising out of any action, suit
or proceeding, whether civil, criminal, administrative or investigative, or
threat thereof, in which the person may be involved because the person is or
was a director, officer, employee or agent of the society or of any firm,
corporation or organization which the person served in any capacity at the
request of the society.
3. A person may not be so indemnified or
reimbursed as to any matter in an action, suit or proceeding, or threat
thereof, in which the person is finally adjudged to be guilty of a breach of a
duty as a director, officer, employee or agent of the society, or which is made
the subject of a compromise settlement, unless:
(a) The person acted in good faith for a purpose
the person reasonably believed to be in the best interests of the society; and
(b) If a criminal action, the person had no
reasonable cause to believe that his or her conduct was unlawful.
4. The determination of whether the
conduct of a person meets the standard required for indemnification and
reimbursement may only be made by:
(a) The supreme governing body or board of
directors by a majority vote of a quorum consisting of persons who were not
parties to the action, suit or proceeding; or
(b) A court of competent jurisdiction.
5. The termination of any action, suit or
proceeding by judgment, order, settlement or conviction, or upon a plea of nolo
contendere, does not create a conclusive presumption that the person does not
meet the standard of conduct required for indemnification and reimbursement.
6. The right of indemnification and
reimbursement does not exclude other rights to which the person may be entitled
as a matter of law, and inures to the benefit of the person’s heirs, executors
and administrators.
7. A society may purchase and maintain
insurance on behalf of any person who is or was a director, officer, employee
or agent of the society, or who is serving or has served at the request of the
society as a director, officer, employee or agent of any other firm,
corporation or organization, against any liability asserted against and
incurred by the person in that capacity or arising out of the status of the
person as such, whether or not the society may indemnify the person against
liability pursuant to this section.
8. A director, officer, employee, member
or volunteer of a society who serves without compensation is not liable, and no
cause of action may be brought for damages resulting from his or her exercise
of judgment or discretion in carrying out his or her duties or responsibilities
on behalf of the society, unless the act or omission involved willful or wanton
misconduct.
(Added to NRS by 1991, 221)
NRS 695A.490 Standards of valuation for certificates.
1. The minimum standards of valuation for
certificates issued before July 1, 1964, are those provided by the law
applicable immediately before July 1, 1963, but not lower than the standards
used in the calculating of rates for those certificates.
2. Except as otherwise provided in
subsection 4, the minimum standard of valuation for certificates issued on or
after July 1, 1964, but before January 1, 1993, is 3.5 percent interest and the
following:
(a) For certificates of life insurance, American
Men Ultimate Table of Mortality, with Bowerman’s or Davis’ Extension thereof or
with the consent of the Commissioner, the Commissioners 1941 Standard Ordinary
Mortality Table, the Commissioners 1941 Standard Industrial Mortality Table or
the Commissioners 1958 Standard Ordinary Mortality Table, using the actual age
of the insured for male risks and an age not more than 3 years younger than the
actual age of the insured for female risks.
(b) For annuity and pure endowment certificates,
excluding any disability and accidental death benefits in those certificates,
the 1937 Standard Annuity Mortality Table or the Annuity Mortality Table for
1949, Ultimate, or any modification of either of these tables approved by the
Commissioner.
(c) For total and permanent disability benefits
in or supplementary to life insurance certificates, Hunter’s Disability Table,
or the Class III Disability Table (1926) modified to conform to the contractual
waiting period, or the tables of Period 2 disablement rates and the 1930 to
1950 termination rates of the 1952 Disability Study of the Society of Actuaries
with due regard to the type of benefit. Any such table must, for active lives,
be combined with a mortality table permitted for calculating the reserves for
life insurance certificates.
(d) For accidental death benefits in or
supplementary to life insurance certificates, the Inter-Company Double
Indemnity Mortality Table or the 1959 Accidental Death Benefits Table. Either
table must be combined with a mortality table permitted for calculating the
reserves for life insurance certificates.
(e) For noncancellable accident and health
benefits, the Class III Disability Table (1926) with conference modifications
or, with the consent of the Commissioner, tables based upon the society’s own
experience.
3. Except as otherwise provided in
subsection 4, the minimum standard of valuation for certificates issued on or
after January 1, 1993, is:
(a) For certificates of life insurance, the
Commissioners 1980 Standard Ordinary Mortality Table or any more recent table
made applicable to life insurance companies; and
(b) For annuity and pure endowment certificates,
total and permanent disability benefits, accidental death benefits and
noncancellable accident and health benefits, such tables as are authorized for
use by life insurance companies in this state.
4. A society may value its certificates in
accordance with the valuation standards used for policies containing comparable
benefits which are issued in this state by life insurance companies.
5. The Commissioner may:
(a) Accept other standards for valuation if the
Commissioner finds that the reserves produced thereby will not be less in the
aggregate than reserves computed in accordance with the minimum valuation
standard prescribed in this section.
(b) Vary the standards of mortality applicable to
all benefit contracts on substandard lives or other extra-hazardous lives by
any society authorized to do business in this state.
6. Any society, with the consent of the
commissioner of insurance of the state of domicile of the society and under
such conditions, if any, as he or she may impose, may establish and maintain
reserves on its certificates in excess of the reserves required thereunder, but
the contractual rights of any benefit member are not affected thereby.
(Added to NRS by 1971, 1858; A 1985, 1186; 1991, 242)
NRS 695A.500 Examination of societies transacting business in State. The Commissioner, or any person the
Commissioner may appoint, may examine any domestic, foreign or alien society
which is transacting business or applying for admission to transact business in
this state in the same manner as authorized for the examination of domestic,
foreign or alien insurers. For the purposes of this section, the provisions of NRS 679B.230 to 679B.300, inclusive, are applicable to
societies.
(Added to NRS by 1971, 1859; A 1991, 244)
NRS 695A.530 Applicability of statutory provisions relating to trade
practices and frauds. A society
authorized to do business in this state and its agents are subject to the
provisions of chapter 686A of NRS relating
to trade practices and frauds, except that nothing in that chapter applies to
or affects:
1. The right of a society to determine its
eligibility requirements for membership; or
2. The offering of benefits exclusively to
members or persons eligible for membership in the society by a subsidiary
corporation or affiliated organization of the society.
(Added to NRS by 1971, 1860; A 1991, 245)
NRS 695A.550 Exemption of societies from certain taxes. Every society organized or licensed under this
chapter is hereby declared to be a charitable and benevolent institution, and
is exempt from every state, county, district, municipal and school tax other
than taxes on real property and office equipment.
(Added to NRS by 1971, 1861; A 1991, 245)
NRS 695A.555 Fees: Applicability of certain provisions. Societies are not exempt from the provisions
of NRS 679B.700. If a society is an
admitted health insurer, as that term is defined in NRS 449.450, it is not exempt from the
fees imposed pursuant to NRS 449.465.
(Added to NRS by 1985, 1071)
NRS 695A.560 Exemption of societies from other insurance laws. Except as otherwise provided in this chapter
or by specific statute, societies are governed by this chapter and are exempt
from all other provisions of the insurance laws of this state.
(Added to NRS by 1971, 1861; A 1991, 246)
NRS 695A.570 Applicability.
1. Nothing contained in this chapter shall
be construed to affect or apply to:
(a) Grand or subordinate lodges of societies,
orders or associations now doing business in this state which provide benefits
exclusively through local or subordinate lodges;
(b) Orders, societies or associations which admit
to membership only persons engaged in one or more crafts or hazardous
occupations, in the same or similar lines of business, insuring only their own
members and their families and the ladies’ societies or ladies’ auxiliaries to
such orders, societies or associations;
(c) Domestic societies which limit their
membership to employees of a particular city or town, designated firm, business
house or corporation which provide for a death benefit of not more than $400 or
disability benefits of not more than $350 to any person in any 1 year, or both;
or
(d) Domestic societies or associations of a
purely religious, charitable or benevolent description, which provide for a
death benefit of not more than $400 or for disability benefits of not more than
$350 to any one person in any 1 year, or both.
2. Any society or association described in
paragraphs (c) or (d) of subsection 1 which provides for death or disability
benefits for which benefit certificates are issued, and any such society or
association included in paragraph (d) of subsection 1 which has more than 1,000
members, shall not be exempted from the provisions of this chapter but shall
comply with all requirements thereof.
3. No society which, by the provisions of
this section, is exempt from the requirements of this chapter, except any
society described in paragraph (b) of subsection 1, shall give or allow, or
promise to give or allow, to any person any compensation for procuring new
members.
4. Every society which provides for
benefits in case of death or disability resulting solely from accident and
which does not obligate itself to pay natural death or sick benefits shall have
all of the privileges and be subject to all the applicable provisions and
regulations of this chapter, except that the provisions thereof relating to
medical examination, valuations of benefit certificates and incontestability
shall not apply to such society.
5. The Commissioner may require from any
society or association, by examination or otherwise, such information as will
enable the Commissioner to determine whether such society or association is
exempt from the provisions of this chapter.
6. Societies, exempted under the
provisions of this section, shall also be exempt from all other provisions of
the insurance laws of this state.
(Added to NRS by 1971, 1861)
NRS 695A.580 Penalties.
1. Any person who makes a false or
fraudulent statement in or relating to an application for membership or for the
purpose of obtaining money from or a benefit in any society is guilty of a
gross misdemeanor.
2. Any person who solicits membership for,
or in any manner assists in procuring membership in, any society not licensed
to do business in this State is subject to an administrative fine, imposed by
the Commissioner, of not less than $25 nor more than $500 for each violation.
In addition if the person is an insurance agent of the society, the
Commissioner may suspend, revoke, limit or refuse to continue his or her
license in the manner provided in NRS
683A.451 and 683A.461.
3. Any person convicted of a willful
violation of, or neglect or refusal to comply with, any provision of this
chapter for which a penalty is not otherwise prescribed shall be punished by a
fine of not more than $1,000 for each violation, and not more than $10,000 for
all related violations.
(Added to NRS by 1971, 1862; A 1977, 695; 1979, 1493; 2001, 2248)
