Nevada Health Insurance Guide
Nevada Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
As a resident of Nevada you can choose from a variety of private health insurance plans including individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for Nevada State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA.
Nevada is not a guarantee issue state. That means private insurance companies are not required to sell you an individual health insurance policy if do not meet their underwriting criteria. You can be turned down for any number of reasons including your past or current health. If you are accepted, the insurer has the right to impose unlimited exclusionary periods and 36-month look-back periods. If a condition is deemed to be pre-existing, benefits can be denied. Nevada allows elimination riders and insurers do not have to give credit for prior creditable coverage. Unless you are HIPPA-eligible or buying a conversion policy, Nevada provides you no protection from exclusionary laws and elimination riders. Premiums on individual policies can be quoted based on your age, sex, where you live, the plan you choose and your health, and adjusted when you application is approved (although by no more than 50% of the standard published rate). After you have been approved, your health insurer cannot adjust your rate level because of future claims.
Nevada does require that health insurance companies selling individual policies in the state offer you the choice of a basic or a standard policy without regard to your health status. The basic plan includes 50% co-insurance coverage for hospital stays, skilled nursing, rehabilitation services, hospice care, emergency services, x-rays and prescriptions. The standard plan provides of 80% co-insurance for those services plus maternity, mental health and substance abuse benefits.
Nevada is a guarantee issue state for group health plans issued to small businesses. If your Nevada health insurance is provided through your employer, your coverage cannot be denied because of your past or current health. However, a 12-month exclusionary period and 6-month look-back period for pre-existing conditions can be applied if you don’t have proof of prior creditable coverage. Your employer also has the right to impose a waiting period on new hires, but it must be equally applied to all new hires. Nevada allows group health insurance issuers to medically underwrite policies to determine the premium they will charge the entire group, although the highest premium cannot be more than 25% of the indexed rate.
Nevada is a guaranteed renewal state. As long as your insurer is operating in Nevada and your plan has not been discontinued, your insurer must renew your individual health insurance policy regardless of your health as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status.
Nevada Mandated Health Benefits
Nevada laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism and Drug Abuse Treatment
- Ambulance Services
- Breast Reconstruction
- Cervical Cancer and HPV Screening
- Clinical Trials
- Colorectal Cancer Screening
- Contraceptives
- Dental Anesthesia
- Diabetic Supplies and Self-Management
- Emergency Services
- Home Health Care
- Hospice Care
- HPV Vaccine
- Mammography
- Maternity Stays
- General and Parity Mental Health
- Off-Label Drug Use
- PKU/Formula
- Prostate Cancer Screening
- TMJ Disorder
- Coverage for newborns under parent's policy
- Coverage for adopted children under parent's policy
- Coverage for handicapped dependents under parent's policy
- Coverage for continuation/dependents under their parents’ policy
- Coverage for continuation/employees
- Coverage for conversion to non-group.
Plans Available in Nevada
The following major medical health insurance plans are generally available in Nevada. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Nevada
Nevada Check Up
Nevada Check Up provides comprehensive health coverage to uninsured resident children up to age 18, whose family incomes meet various eligibility requirements including five-year residency. Waiting periods for coverage may apply, although exemptions are available under certain circumstances. Plan options offered depend on location within the state, but care is generally provided under a managed care organization plan. Enrollment is open. Renewals must be reviewed every 12 months. Quarterly premiums depend on family income, size and other factors. There are no co-pays, deductibles or coinsurance required.
Regulating Agency
The Nevada Division of Insurance is responsible for regulating Nevada’s health insurance industry.
Get access to Nevada health insurance quotes from http://www.einsurance.com/health-insurance.
Nevada Division of Insurance
788 Fairview Dr, Ste 300
Carson City, NV 89701
(755) 687-4270
2501 E Sahara Ave, Ste 302
Las Vegas, NV 89104
(702) 486-4009
http://www.doi.nv.gov
Nevada Check Up
Division of Health Care Financing and Policy
Nevada Check Up & Nevada Check Up Plus
1000 E William St, Ste 200
Carson City, Nevada 89701
(775) 684-3777
http://www.nevadacheckup.state.nv.us
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/