Gov. Brian Sandoval will ultimately decide which of 10 existing health insurance plans now offered in Nevada will be used to determine the essential benefits that will be required in all individual and small group health insurance plans starting on Jan. 1, 2014.
The ACA requires health insurance policies offered in the individual and small group markets, both inside and outside of the Silver State Health Insurance Exchange, to offer a comprehensive package of items and services, known as essential health benefits.
Ten categories of items and services are required for the state’s essential benefits plan: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.
With some variations, the 10 plans available in Nevada now are fairly comparable in what they offer in these required categories, said Adam Plain, insurance regulation liaison for Division of Insurance.
But the plans differ in what additional services and benefits they offer, he said. A plan might cover chiropractic treatments or hearing aids as well, Plain said. Another may not.
So it is important for the public to weigh in on what coverages they think should be part of an essential health benefits plan for Nevada, keeping in mind that the more benefits covered, the higher the cost will be, he said.
“What we’re looking at is: is physical therapy covered,” Plain said. “If it is, what benefits specifically are covered. And are there any limitations like 20 visits per year, or 60 visits per year, or is the benefit unlimited in the number of visits. And so that is what we’re looking at.”
The state must also pick benefits and services as they are offered now in one of the 10 existing plans, he said. So depending on which plan is selected, advocates for some coverages may not get what they want in the essential benefits plan, Plain said.
“Because none of the plans are perfect, and no single plan is the best in terms of coverage, we can’t say, you know, we want everything to be covered, because no plan does that,” he said. “If someone wants coverage for hearing aids, and someone else wants coverage for gastric bypass surgery, and those two benefits aren’t offered under the same plan, someone is not going to walk away happy.”
Cost-sharing issues, including co-pays and deductibles, are not at issue in this provision of the ACA, Plain said.
The 10 existing health plans that can be used to set the benchmark for the items and services included in the essential health benefits package are:
- Health Plan of Nevada Point-of-Service
- Aetna PPO
- Anthem PPO
- Nevada PEBP High-Deductible Health Plan
- Nevada PEBP Health Plan of Nevada HMO
- Nevada PEBP Hometown Health Plan HMO
- Government Employees Health Association
- FEHBP/ Blue Cross-Blue Shield Standard
- FEHBP/ Blue Cross-Blue Shield Basic
- Clark County School District/Health Plan of Nevada HMO
The Nevada Division of Insurance is seeking public comment at meetings being held across the state this week. The meetings will be held in:
- Henderson on Wednesday at 2 p.m. at the Henderson City Council Chambers, 240 Water St.;
- Las Vegas on Wednesday at 6 p.m. at the Charleston Campus of the College of Southern Nevada, 6375 W. Charleston Blvd., Room K-101;
- Reno on Thursday at 6 p.m. at Truckee Meadows Community College, 7000 Dandini Blvd., Room 205 of the Vista Building.
A hearing was also held in Elko last week.
Public comment can also be submitted in writing to the Commissioner of Insurance at 1818 E. College Pkwy., Suite 103, Carson City, NV 89706 or by fax at (775) 687-0788 or by email to Adam Plain at firstname.lastname@example.org. All written public comment must be received by Thursday at 5 p.m.
After the public comment period has closed the NVDOI will make a recommendation to Sandoval regarding which essential health benefits should be required for Nevada based on the range of services offered in the 10 separate plans. Sandoval is required to decide by Sept. 30 which plan will be used to set the essential benefits for the state.
Adam Plain, insurance regulation liaison for the Division of Insurance, says the purpose of the hearings is to determine which benefits should be covered:
Plain says not all benefits will be able to be included in an essential plan: