Current through September 16, 2024
An insurance institution, agent or insurance-support
organization shall not disclose personal or privileged information about a
natural person collected or received in connection with an insurance
transaction unless the disclosure is:
1. Authorized in writing by the natural
person and:
(a) If the authorization is
submitted by a person other than an insurance institution, agent or
insurance-support organization, the authorization is:
(1) Dated;
(2) Signed by the natural person;
and
(3) Obtained not more than 1
year before the date a disclosure is sought pursuant to this section.
(b) If the authorization is
submitted by another insurance institution, agent or insurance-support
organization, the authorization meets the requirements of NAC
679B.695.
2. Directed to
a person other than an insurance institution, agent or insurance-support
organization, provided the disclosure is reasonably necessary:
(a) To enable the person to perform a
business, professional or insurance function for the disclosing insurance
institution, agent or insurance-support organization and the person agrees not
to disclose the information further without the natural person's written
authorization unless the further disclosure:
(1) Would otherwise be permitted by this
section if made by an insurance institution, agent or insurance-support
organization; or
(2) Is reasonably
necessary for the person to perform its function for the disclosing insurance
institution, agent or insurance-support organization; or
(b) To enable the person to provide
information to the disclosing insurance institution, agent or insurance-support
organization in order to:
(1) Determine a
natural person's eligibility for an insurance benefit or payment; or
(2) Detect or prevent criminal activity,
fraud, material misrepresentation or material nondisclosure in connection with
an insurance transaction.
3. Directed to an insurance institution,
agent, insurance-support organization, or self-insurer, if the information
disclosed is limited to that which is reasonably necessary:
(a) To detect or prevent criminal activity,
fraud, material misrepresentation or material nondisclosure in connection with
insurance transactions; or
(b) For
the disclosing or receiving insurance institution, agent or insurance-support
organization to perform its function in connection with an insurance
transaction involving the natural person.
4. Directed to a medical care institution or
medical professional to:
(a) Verify insurance
coverage or benefits;
(b) Inform a
natural person of a medical problem of which the natural person may not be
aware; or
(c) Conduct an operations
or services audit to verify the natural persons treated by the medical
professional or at the medical care institution, provided only information
which is reasonably necessary to accomplish the foregoing purposes is
disclosed.
5. Directed
to an insurance regulatory authority.
6. Directed to a law enforcement or other
governmental authority:
(a) To protect the
interest of the insurance institution, agent or insurance-support organization
in preventing or prosecuting the perpetration of fraud upon it; or
(b) If the insurance institution, agent or
insurance-support organization reasonably believes that illegal activities have
been conducted by the natural person.
7. Otherwise permitted or required by
law.
8. In response to a facially
valid administrative or judicial order, including a search warrant or
subpoena.
9. Made to conduct
actuarial or research studies, if:
(a) No
natural person may be identified in any actuarial or research report;
(b) Materials allowing the natural person to
be identified are returned or destroyed as soon as they are no longer needed;
and
(c) The actuarial or research
organization agrees that the information not be disclosed unless the disclosure
would otherwise be permitted by this section if made by an insurance
institution, agent or insurance-support organization.
10. Directed to a party or representative of
a party to a proposed or consummated sale, transfer, merger or consolidation of
all or part of the business of the insurance institution, agent or
insurance-support organization, if:
(a) Before
consummating the sale, transfer, merger or consolidation, only information that
is reasonably necessary to enable the recipient to make business decisions
about the purchase, transfer, merger or consolidation is disclosed;
and
(b) The recipient agrees not to
disclose the information unless the disclosure would otherwise be permitted by
this section if made by an insurance institution, agent or insurance-support
organization.
11.
Directed to a person whose only use of the information will be in connection
with the marketing of a product or service, if:
(a) No medical record information, privileged
information, or personal information relating to a natural person's character,
personal habits, mode of living or general reputation is disclosed, and no
classification derived from the information is disclosed;
(b) The natural person has been given an
opportunity to indicate that he or she does not want personal information
disclosed for marketing purposes and has given no indication that he or she
does not want the information disclosed; and
(c) The person receiving the information
agrees not to use it except in connection with the marketing of a product or
service.
12. Directed to
an affiliate whose only use of the information will be in connection with an
audit of the insurance institution or agent or the marketing of an insurance
product or service, if the affiliate agrees not to disclose the information for
any other purpose or to unaffiliated persons.
13. Made by a consumer reporting agency, if
the disclosure is to a person other than an insurance institution or
agent.
14. Directed to a group
policyholder to report claims experience or conduct an audit of the insurance
institution's or agent's operations or services, if the information disclosed
is reasonably necessary for the group policyholder to conduct the review or
audit.
15. Directed to a
professional peer review organization to review the service or conduct of a
medical care institution or medical professional.
16. Directed to a governmental authority to
determine the natural person's eligibility for health benefits for which the
governmental authority may be liable.
17. Directed to a certificate holder or
policyholder to provide information regarding the status of an insurance
transaction.
18. Directed to a
lienholder, mortgagee, assignee, lessor or other person shown on the records of
an insurance institution or agent as having a legal or beneficial interest in a
policy of insurance, if:
(a) No medical record
information is disclosed unless the disclosure would otherwise be permitted by
this section; and
(b) The
information disclosed is limited to that which is reasonably necessary to
permit the person to protect his or her interests in the policy.
Added to NAC by Comm'r
of Insurance, eff. 10-4-88
NRS
679B.130
