Posts Tagged ‘health insurance exchange’

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.”

Nevada Small Business Owners Support Key Aspect Of Obama Health Care Law

By Andrew Doughman | 4:00 am February 28th, 2011

CARSON CITY – A new study shows support for Gov. Brian Sandoval’s plan to implement President Barack Obama’s national health care reform law.

Nevada small businesses prefer a health insurance exchange crafted in Nevada rather than one created and implemented by the federal government, according to a survey from the local branch of the National Federation of Independent Business.

The small business association is the only private organization suing with 26 states, including Nevada, against the Patient Protection and Affordable Care Act, the law sometimes called “Obamacare.”

Nevada’s government has chosen to adhere to the law’s deadlines until a definitive court ruling either upholds or strikes down the law. In doing so, the state government has more say in meeting the law’s mandates.

About 100 businesses responded to the poll’s question: “Should Nevada establish its own health insurance exchange instead of deferring to the federal government?”

A majority, 55 percent, said Nevada should be in charge while 19 percent voted ‘No,’ Nevada should not be in charge.

The remaining 26 percent were undecided, perhaps revealing that the law’s intricacies are still new to some business owners.

Many are familiar with the “individual mandate” that sets a deadline for the imposition of penalties for not having health insurance. This is the aspect of the law most frequently called “unconstitutional” by those like Sandoval and others suing to have the law overturned.

The health care insurance exchange is a less-trumpeted piece of the law that could act like a clearinghouse for first-time individual and small business buyers. It’s supposed to be active by 2014, but the planning has already started.

Nevada has hired a Massachusetts-based contractor to help set up what is essentially a Travelocity or Expedia for health insurance; it would find the best deals for a buyer based the buyer’s preference and other personal criteria.

It’s an important concept for small businesses because the federal law allows businesses with up to 50 employees to purchase “qualified” health insurance plans through the exchange. One question Nevada’s policymakers will have to answer is whether the state’s exchange should have a separate division just for small businesses.

Two public meetings, one in Las Vegas and one in Reno, are slated for this Tuesday and Wednesday to allow public comment regarding Nevada’s exchange.

Some policymakers are also entertaining the idea of establishing such an exchange even if the federal law is ruled unconstitutional.

“Regardless of whether this bill gets repealed or not, I have a feeling that health care exchanges will be part of the future anyway,” said Randi Thompson, the local representative for the National Federation of Independent Business.

As KUNR reported earlier this month, Mike Willden, the director of the state’s Department of Health and Human Services, has also talked with Sandoval about decoupling the federal law’s mandates and Nevada’s health insurance exchange.

“He [Sandoval] thinks there may be some sense in having a health insurance exchange even if the Supreme Court strikes down the law,” Willden said Friday outside of a committee hearing about the federal health care law.

The National Federation of Independent Business conducts a poll annually so that its lobbyists have some direction for their efforts during legislative sessions nationwide.

In Nevada, the poll’s three other questions were not nearly as controversial as the health insurance exchange question. Among respondents, 77 percent said they would favor penalties for businesses hiring illegal immigrants, 72 percent would support tax exemptions or incentives to promote job growth and 75 percent would endorse a 401(k)-style retirement plan for new government workers.

Thompson said she sent the poll to the approximately 2,000 Nevada members of the National Federation of Independent Business, and said that the 100 respondents represented a “broad spectrum of businesses.”