[Rev. 11/21/2013 1:17:32 PM--2013]

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. [Effective through December 31, 2013.]

NRS 695A.152        Society required to comply with certain provisions concerning portability and availability of health insurance. [Effective January 1, 2014.]

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. [Effective through December 31, 2013.]

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. [Effective January 1, 2014.]

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. [Effective through December 31, 2013.]

      1.  To the extent reasonably applicable, a fraternal benefit society shall comply with the provisions of NRS 689B.340 to 689B.590, 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.590, inclusive, and chapter 689C of NRS, the provisions of NRS 689B.340 to 689B.590, 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)

      NRS 695A.152  Society required to comply with certain provisions concerning portability and availability of health insurance. [Effective January 1, 2014.]

      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, effective January 1, 2014)

      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. [Effective through December 31, 2013.]

      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.590, 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)

      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. [Effective January 1, 2014.]

      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, effective January 1, 2014)

      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)