Posts Tagged ‘Division of Insurance’

Nevada Division of Insurance Seeking Public Input on Essential Health Benefits

By Sean Whaley | 1:33 pm September 24th, 2012

CARSON CITY – The Nevada Division of Insurance (NVDOI) is seeking public input on what should be included in Nevada’s essential health benefits plan under the Affordable Care Act (ACA).

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:

  1. Health Plan of Nevada Point-of-Service
  2. Aetna PPO
  3. Anthem PPO
  4. Nevada PEBP High-Deductible Health Plan
  5. Nevada PEBP Health Plan of Nevada HMO
  6. Nevada PEBP Hometown Health Plan HMO
  7. Government Employees Health Association
  8. FEHBP/ Blue Cross-Blue Shield Standard
  9. FEHBP/ Blue Cross-Blue Shield Basic
  10. 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 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.


Audio clips:

Adam Plain, insurance regulation liaison for the Division of Insurance, says the purpose of the hearings is to determine which benefits should be covered:

092412Plain1 :20 we’re looking at.”

Plain says not all benefits will be able to be included in an essential plan:

092412Plain2 :30 walk away happy.”

Consumers Can Review Health Insurance Rates at New State Website

By Anne Knowles | 4:04 pm September 2nd, 2011

Nevada consumers and small businesses can now review and comment on rate hikes in their health insurance policies online.

The Division of Insurance has launched Nevada Health Rate Review in compliance with a provision of the Affordable Care Act (ACA) that went into effect on Sept. 1.

The federal law requires the state to provide a way for individuals and small businesses to comment on proposed rate hikes. All rate changes for individual, small business and HMO policies must be submitted to the division for approval.

Rates are the base price for a policy; an individual policy may cost more due to medical conditions or other factors specific to each policy holder.

When an insurance provider applies for a rate change, the division will post the application and all the supporting documents with a summary of the proposed change. Visitors will have 60 days to review the material and post a comment, either privately or publicly.  Comments will be reviewed daily by a division actuary, according to Jake Sunderland, the division’s public information officer, and included in the final application.

The law does not require the state to analyze the comments, but the division plans to review and factor them into its decisions. This is one way the state plans to go “above and beyond the law,” said Sunderland. Another way is that the state will review any change in rate, even drops, although the law only requires reviews of rate hikes of 10 percent or greater.

The site already has about one year of previously-decided or pending applications posted online and will post three new applications next week on which consumers can review and comment before the state rules.

So far this year, the division has received 87 applications for rate hikes. It has denied 23, modified four to a lower rate, has 25 pending and has approved 35.

Previously, consumers had to make public records requests to gain access to the applications.

“Bringing greater transparency to families and businesses and giving them easy access to information will help them make better decisions about their health insurance options,” said Annette Raveneau, a spokeswoman with Know Your Care, a nonprofit established to educate citizens about the ACA. “Because of the Affordable Care Act, insurance companies will no longer be able to raise rates without explaining their actions. Rate hikes will be posted on public websites and will have to be justified.”

Part of the goal, says Sunderland, is to give individuals and small businesses more power when dealing with insurance providers. Large corporations are not included because they have the clout and expertise to negotiate more favorable rates.

Sunderland said there are 12,508 policies sold to small businesses in the state, insuring 102,728 people. There are currently 57,681 policies sold to individuals covering 87,309 people.

To comply with the federal law, the Nevada Legislature passed a bill during the 2011 legislative session giving the state the authority to collect rate information on health insurance policies held by businesses with between two and 50 employees.

The insurance division plans to soon start running public service announcements to make the public aware of the new website, said Sunderland.

As part of the ACA, the rate review and website has its detractors.

“The reason a website like this has become necessary is that policymakers’ decision to turn the health care industry into a regulated utility will ultimately deprive consumers of alternatives,” says Geoffrey Lawrence, deputy director of policy at Nevada Policy Research Institute in Las Vegas. “On the exchange, prices and products will homogenize, meaning that consumers will have less opportunity to switch providers in the event of a rate increase.”
Lawrence says stricter regulations will also increase the barriers for potential new providers to enter the market.
“With nowhere to turn, consumers can only complain to regulators, as is the case with other regulated utilities,” said Lawrence.
The rate review process is just one provision of the ACA the state is working on to comply. The Nevada Department of Health and Human Services this week requested $2.8 million in a federal grant money from the legislature’s Interim Finance Committee to create the agency and fill four staff positions to run the Silver State Health Exchange, the state exchange for health insurance mandated by the law. The exchange must be up and running in 2014.

Gov. Brian Sandoval’s office said the appointments to a board to oversee the exchange will made by the end of this month.


Pre-Existing Condition Insurance Rates Drop By 37.5 Percent In Nevada

By Sean Whaley | 1:04 pm June 2nd, 2011

CARSON CITY – Insurance Commissioner Brett Barratt said today that rates for the high risk pool in the federal Pre-Existing Condition Insurance Plan (PCIP) for Nevada have been reduced by 37.5 percent by the U.S. Department of Health and Human Services starting July 1.

“This is great news for the thousands of uninsured Nevadans eligible for the PCIP,” Barratt said. “These rate decreases make PCIP more affordable and comparable to the commercial market for individuals.”

The federal Affordable Care Act of 2010 included a provision to create the PCIP as a “bridging” healthcare program to provide pre-existing condition coverage between now and 2014, when insurers will no longer be permitted to decline health coverage to individuals with pre-existing conditions. Coverage through this program will be available until January 2014 when more health insurance coverage options will become available through a Health Insurance Exchange.

PCIP delivers health coverage to consumers who have a pre-existing medical condition, have not had insurance for six months, who are legal residents of Nevada and are U.S. citizens. Starting July 1, people applying for coverage can simply provide a letter from a doctor, physician assistant, or nurse practitioner dated within the past 12 months stating that they have or, at any time in the past, had a medical condition, disability, or illness. Applicants will no longer have to wait on an insurance company to send them a denial letter.

PCIP covers doctor visits, hospitalizations, prescription drugs and preventative care services for consumers who have been denied health insurance coverage. There are no income requirements, and the plan does not charge a higher premium because of a pre-existing condition. Coverage for a pre-existing condition takes effect immediately; there is no waiting period.

To increase the effectiveness of the program, beginning this fall, HHS will begin paying agents and brokers for successfully connecting eligible people with the PCIP program. This step will help reach those who are eligible but unenrolled.

New Nevada State Insurance Commissioner Appointed

By Nevada News Bureau Staff | 6:37 pm July 7th, 2010

CARSON CITY – The director of the Nevada Department of Business and Industry today announced the appointment of Brett Barratt as the new commissioner of the Division of Insurance.

Director Dianne Cornwall appointed Barratt to replace Scott Kipper, who stepped down as commissioner in June.

An attorney, Barratt has extensive experience in insurance regulation. Beginning in February 2005, he served as the insurance counsel/hearing officer for the division. In October 2009, he became the chief insurance assistant for the division, and since June, he has been the acting commissioner of insurance.

A graduate of the Michigan University College of Law, Barratt earned his law degree in 2003. He is a member of the Nevada State Bar Association’s Insurance and Health Law Section.

“Mr. Barratt comes to us with extensive knowledge of insurance regulation as well as strong legislative expertise and legal experience,” Cornwall said. “He has already proven his ability to lead during a transition, and I look forward to his ongoing oversight of this dynamic agency.”

As commissioner, Barratt will oversee the functions of the Nevada Division of Insurance. Under the auspices of Business and Industry, the division is charged with protecting the rights of the consumer and the public’s interest in dealings with the insurance industry.

The division regulates and licenses insurance producers, brokers and other professionals; sets ethical and financial standards for insurance companies; and reviews rates. The division also reviews programs operated by self-insured employers for workers’ compensation, and investigates claims of insurance fraud.

“I am pleased to be appointed permanently to the commissioner position by Director Cornwall,” Barratt said. “Overseeing the division during this transition has been very rewarding, and I look forward to further reinforcing the agency’s regulatory and consumer protection roles.”