Nevada Administrative Code
Chapter 287 - Programs for Public Employees
PROVISION OF HEALTH INSURANCE THROUGH PLAN OF SELF-INSURANCE
Section 287.755 - Subrogation to rights of member; lien upon proceeds of recovery
Current through February 27, 2024
1. Except as otherwise provided in subsections 3 and 4, the Board, pursuant to chapter 287 of NRS, including, without limitation, NRS 287.0465, is entitled to be subrogated to the rights of a member with regard to any and all tort, contractual or other legal liability on the part of a person other than the member, including, without limitation, the legal liability of an insurer providing first-party coverage to a member for the cost of medical services of the member that are payable under the plan of self-insurance established by the Board.
2. The Board delegates to the Executive Officer its powers to subrogate to the rights of a member as described in subsection 1, subject to provisions of such plan documents for the plan of self-insurance as may be approved by the Board. The Executive Officer shall:
3. Except as otherwise provided in subsection 5, a subrogation lien of the Executive Officer upon the proceeds of any recovery from an insurer providing first-party coverage to a member must be reduced by the applicable in-network or out-of-network out-of-pocket maximum balance of the member remaining at the time of the incident giving rise to the subrogation lien. If the subrogation lien includes medical claims from medical costs resulting from the incident giving rise to the subrogation lien which occurred over multiple plan years, the out-of-pocket maximum balances for each plan year must be used for purposes of reducing the subrogation lien amount.
4. The Executive Officer may collect less than the total cost of the medical services to which the Board is entitled to be subrogated pursuant to chapter 287 of NRS, including, without limitation, NRS 287.0465, if the Executive Officer negotiated the amount to be collected in good faith with the member, the legal counsel of the member or the insurance carrier of the member or the insurance carrier of a third party.
5. The provisions of subsection 3 do not apply to the coordination of benefits for coverage of the cost of medical services which may be provided under:
6. A decision of the Executive Officer made pursuant to this section is final and not subject to judicial review.
7. As used in this section, "member" has the meaning ascribed to it in NRS 287.0465.
Added to NAC by Bd. of Pub. Employees' Benefits Prog. by R054-17, eff. 12-19-2017
NRS 287.043, 287.0465
REVISER'S NOTE.
The regulation of the Board of the Public Employees' Benefits Program filed with the Secretary of State on December 19, 2017 (LCB File No. R054-17), the source of this section, contains the following provision not included in NAC:
"Sec. 2. 1. The Executive Officer may apply the provisions set forth in section 1 of this regulation [NAC 287.755 ] concerning his or her power to be subrogated to the rights of a member with regard to the legal liability of an insurer providing first-party coverage to the member to medical expenses incurred before the effective date of this regulation [December 19, 2017].
2. A decision of the Executive Officer made pursuant to subsection 1 is final and not subject to judicial review.
3. As used in this section, "member" has the meaning ascribed to it in NRS 287.0465."
