General Provisions

NAC 287.005. Definitions.

NAC 287.0056. “Biennial employee” defined.

NAC 287.011. “Certifying agency” defined.

NAC 287.021. “Continuous employment” defined.

NAC 287.025. “Day” defined.

NAC 287.035. “Dependent” defined.

NAC 287.055. “Health insurance” defined.

NAC 287.059. “Initial date of hire” defined.

NAC 287.065. “Medicare” defined.

NAC 287.085. “Open enrollment” defined.

NAC 287.090. “Opt-out plan” defined.

NAC 287.095. “Participant” defined.

NAC 287.100. “Plan year” defined.

NAC 287.126. “Public employer” defined.

NAC 287.135. “Retired officer or employee” defined.

NAC 287.141. “Subsidy” defined.

NAC 287.143. “Tier of coverage” defined.

NAC 287.145. “Vendor” defined.

NAC 287.150. “Full-time employment” interpreted.

NAC 287.155. Date of receipt of required notices.

NAC 287.160. Determination of late submission of documents or information.

Board of the Public Employees’ Benefits Program

NAC 287.170. Chair: Duty; voting.

NAC 287.172. Vice Chair: Election; duty.

NAC 287.174. Meetings: Agenda.

NAC 287.176. Meetings: Approval of actions; motions; rules of conduct.

NAC 287.178. Meetings: Minutes; transcript.

NAC 287.190. Advisory opinions: Request; action by Executive Officer; appeal.

NAC 287.192. Advisory opinions: Oral opinion prohibited; effect of response by electronic mail or oral response.

NAC 287.194. Petitions for declaratory orders.

NAC 287.196. Petitions for adoption, filing, amendment or repeal of regulations.

Participation in Public Employees’ Benefits Program

NAC 287.310. Prerequisites to participation; fees; establishment of rates; provision to agency of report on history of claims.

NAC 287.3105. Persons eligible to participate in Program.

NAC 287.311. Dependents: Enrollment and disenrollment.

NAC 287.312. Dependents: Eligibility of child of participant, spouse or domestic partner.

NAC 287.3125. Dependents: Terms and conditions of certain changes.

NAC 287.313. Responsibility for final determinations concerning eligibility.

NAC 287.314. Provision of information about Program to participants, representatives of participating public agencies and employees of Program.

NAC 287.317. Participating public agency to notify Program of appointment of persons eligible to participate in Program or of termination of appointment; enrollment.

NAC 287.318. Enrollment forms: Required information.

NAC 287.319. Notification of change of address by participant to Program.

NAC 287.320. Withdrawal from Program: Procedure; termination of coverage; limitation on reentry; eligibility of certain officers and employees after exclusion of group; liability of Program.

Option of Group to Leave Public Employees’ Benefits Program

NAC 287.355. Procedure for applying to leave Program.

NAC 287.357. Application to leave Program: Contents.

NAC 287.359. Application to leave Program: Deadline for submission; duties of Board.

NAC 287.361. Application to leave Program: Considerations for approval or denial; basis for findings by Board.

NAC 287.363. Approval of application by Board: Format and contents of decision; responsibilities of and noncompliance by group.

NAC 287.365. Denial of application by Board: Format and contents of decision.

NAC 287.367. Denial of application by Board: Procedure for reconsideration.

NAC 287.368. Denial of request for reconsideration: Appeal.

NAC 287.369. Effective date of departure from Program; coverage by Program until departure.

NAC 287.371. Eligibility of officer or employee to join opt-out plan; ineligibility of officer or employee to continue participation in opt-out plan.

NAC 287.373. Notification of Program regarding certain changes in status and court orders.

NAC 287.375. Eligibility for coverage under opt-out plan: Administration of requirements by Program; compliance with determinations of Program.

NAC 287.376. Participation in Program by certain persons eligible for coverage under or participating in opt-out plan prohibited; exceptions.

NAC 287.379. Options for coverage under opt-out plan: Annual notification of Program; effective period.

NAC 287.381. Premiums or contributions for participants in opt-out plans: General administrative duties of Program.

NAC 287.383. Premiums or contributions for participants in opt-out plans: Requirements for billing.

NAC 287.385. Premiums or contributions for participants in opt-out plans: Remittance or transfer of payments; nonpayment by participant.

NAC 287.386. Liability of Program and opt-out plan for expense or claim of officer or employee or retired officer or employee, or dependent thereof.

NAC 287.387. Administrative fee: Establishment by Program; calculation; notice.

NAC 287.389. Duties of Program: Accounting for and remittance of payments; monthly reports.

Option of Group to Reenter Public Employees’ Benefits Program

NAC 287.400. Procedure for applying to reenter Program.

Payment of Premiums and Contributions; Coverage

NAC 287.420. Payment of premiums or contributions by public employer: Date due; penalty.

NAC 287.430. Direct payment of premiums or contributions: Date due; cancellation of coverage.

NAC 287.440. Payment of premiums or contributions by retired officers and employees.

NAC 287.450. Employees on leave without pay: Payment of premiums or contributions; eligibility for coverage as dependent of participant; coverage upon return to work.

NAC 287.460. Officers and employees on leave because of injuries in course of employment: Payment of premiums or contributions; reports of change in status; coverage of dependents upon return to work.

NAC 287.470. Overpayment or underpayment of premiums or contributions.

NAC 287.485. Subsidy for retired officer or employee: Report required to obtain subsidy; audit of service credit required; billing; commencement of payment; adjustment of amount of subsidy; assumption of liability for service credit earned.

NAC 287.490. Subsidy for retired officer or employee: Calculation of amount of payment.

NAC 287.500. Coverage of seasonal employees and biennial employees.

NAC 287.510. Coverage of persons returning to work with previous employer within 1 year after leaving employment.

NAC 287.515. Coverage of retired participants upon reemployment.

NAC 287.520. Coverage of person qualified as both employee and dependent; change of status from employee to dependent.

NAC 287.530. Coverage of retired person, spouse, domestic partner or surviving dependent: Generally.

NAC 287.540. Coverage of participating employee of State who reenrolls upon retirement or total disability; coverage of nonparticipating employee of State.

NAC 287.542. Coverage of participating employee of local governmental agency who retires on or before September 1, 2008, and reenrolls upon retirement or total disability.

NAC 287.544. Coverage of nonparticipating employee of local governmental agency who retires on or before September 1, 2008, and enrolls upon retirement or total disability.

NAC 287.546. Coverage of participating employee of local governmental agency who retires after September 1, 2008, and reenrolls upon retirement or total disability.

NAC 287.548. Coverage of nonparticipating employee of local governmental agency who retires after September 1, 2008.

Claims

NAC 287.600. Definitions.

NAC 287.601. “Adverse determination” defined.

NAC 287.602. “Appeals Manager” defined.

NAC 287.603. “Claims Administrator” defined.

NAC 287.608. Claims Administrator or vendor required to be independent contractor.

NAC 287.610. Period for submission.

NAC 287.620. Assumption regarding availability of benefits under Medicare; coordination under Medicare.

NAC 287.660. Notification of adverse determination; grounds for appeal.

NAC 287.670. Appeal of adverse determination: Requirements; duties of Appeals Manager.

NAC 287.680. Appeal of decision of Appeals Manager: Requirements; duties of Executive Officer or designee.

NAC 287.690. Request for external review.

NAC 287.695. Request for expedited review by Claims Administrator.