1.  As used in this section, ‘total disability’ and ‘totally disabled’ mean the continuing inability of the enrollee, because of an injury or illness, to perform substantially the duties related to his or her employment for which the enrollee is otherwise qualified.

Terms Used In Nevada Revised Statutes 695C.1709

  • Dependent: A person dependent for support upon another.
  • Enrollee: means a natural person who has been voluntarily enrolled in a health care plan. See Nevada Revised Statutes 695C.030
  • Health care plan: means any arrangement whereby any person undertakes to provide, arrange for, pay for or reimburse any part of the cost of any health care services and at least part of the arrangement consists of arranging for or the provision of health care services paid for by or on behalf of the enrollee on a periodic prepaid basis. See Nevada Revised Statutes 695C.030
  • Health maintenance organization: means any person which provides or arranges for provision of a health care service or services and is responsible for the availability and accessibility of such service or services to its enrollees, which services are paid for or on behalf of the enrollees on a periodic prepaid basis without regard to the dates health services are rendered and without regard to the extent of services actually furnished to the enrollees, except that supplementing the fixed prepayments by nominal additional payments for services in accordance with regulations adopted by the Commissioner shall not be deemed to render the arrangement not to be on a prepaid basis. See Nevada Revised Statutes 695C.030

2.  No policy of group insurance to which an enrollee is entitled under a health care plan provided by a health maintenance organization may be delivered or issued for delivery in this state unless it provides continuing coverage for an enrollee and dependents of the enrollee who are otherwise covered by the policy while the enrollee is on leave without pay as a result of a total disability. The coverage must be for any injury or illness suffered by the enrollee which is not related to the total disability or for any injury or illness suffered by a dependent of the enrollee. The coverage must be equal to or greater than the coverage otherwise provided by the policy.

3.  The coverage required pursuant to subsection 2 must continue until:

(a) The date on which the employment of the enrollee is terminated;

(b) The date on which the enrollee obtains another policy of health insurance;

(c) The date on which the policy of group insurance is terminated; or

(d) After a period of 12 months in which benefits under such coverage are provided to the enrollee, whichever occurs first.

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