Health Insurance in Nevada
Having a suitable health insurance can safeguard you and your family against financial catastrophes arising from the occurrence of illness or injury. Indeed, health insurance does not come cheap; therefore it is imperative to assess all the future risks and its influence on your financial standing. In the U.S., approximately 47 million people are uninsured, among whom a majority of working families are exposed to the lack of proper health coverage. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to the medically-uninsurable individuals. According to the United Health Foundation’s 2008 Health Rankings, Nevada stood at 42nd spot in the healthiest state list. The state plunged three places from its 39th position in 2007 and four spots from its 38th position in 2006. Several factors have contributed to the dwindling health care system of Nevada including poor public health funding, high violent crime rate, higher percentage of children in poverty and high geographical disparity. Nevertheless, the state of Nevada, with more than two million residents, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-cost coverage to the uninsurable citizens of Nevada who meet specific eligibility requirements of age and income. The Nevada Division of Insurance manages and administers all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, state has the lowest percentage of citizens without insurance, i.e. approximately 18.4%. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 32.2% of Nevada’s uninsured citizens come under the above 200% FPL category. Health insurance is essential for your peace of mind. Contact a licensed health insurance agent/broker to select a proper health insurance plan with benefits that suit your family. Individual/Family Health Insurance Below is the guidelines for applying for and obtaining individual health insurance in the state of Nevada. These regulations apply to all insurance companies offering individual or family health insurance in Nevada: Medical Underwriting Yes Pre-Existing Condition Exclusion Period No Limit Look Back Period No Limit Look Back Standard Objective Mandatory Benefits Cancer screening for women including breast cancer screening and cervical cancer screening, reconstructive surgery after mastectomy, direct access to OB/GYNs Market Rate Restrictions Yes Guaranteed Issue Options None Small Group Health Insurance Below is the guidelines for small group health insurance in the state of Nevada. These regulations apply to all insurance companies offering small group health insurance in Nevada: Small Group Size 2-50 Employee Qualifications Two employees must be present for half of the preceding calendar quarter and work 20 hrs/week Guaranteed Issue Yes Premium Rating Factors Rate bands Rate Adjustment Factors 25% Look-Back Period 6 months Pre-existing condition exclusionary period 12 months Mandatory Benefits Same as individual State Cobra Variations for Small Groups Below are the COBRA guidelines for small groups in the state of Nevada. For employer groups of more than 20 employees, refer to the federal COBRA guidelines: Mini-Cobra Option Yes Eligible Group Sizes 2-19 Extension of Benefits Period – Standard 18 months Extension of Benefits Period – Disabled 18 months Maximum Premium Increase 125% State Legislation Reference NRS 689B.245 Required provision concerning continuation of coverage, alongside NRS 689B.246 Notice of eligibility or election to continue coverage, and NRS 689B.249 Termination of continued coverage before end of period. Additional Notes The employee should elect the coverage within 60 days of termination. State Sponsored Health Insurance Programs There are several state sponsored health insurance programs in the State of Nevada to assist those without insurance in obtaining adequate coverage. High-Risk Pools Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. However, Nevada does not have a high risk insurance pool for its residents who are unable to obtain private health insurance due to pre-existing medical conditions. Children’s Health Insurance Program Through shared funding from the federal government, the State of Nevada provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below: Program Name Nevada Check Up Website https://www.nevadahealthlink.com Phone Number 877-543-7669, 775-684-3777 Apply Online Yes Age Limits Under 18 Insurance Carrier Health Plan of Nevada, Amerigroup Length of Coverage Periodic Eligibility Review Residency Requirements Nevada resident and U.S. citizen, qualified alien Other Eligibility Requirements To qualify for coverage: The child should be eligible for Medicaid The child should not have health insurance within the last six months The family’s gross annual income should be between 100% and 200% of FPL. Pre-Existing Condition Exclusions None Cost Depending on your family income you could pay a quarterly premium of $25-$80. You are not required to pay co-payments, deductibles, or other charges for covered services Medicaid Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Nevada: Governing Agency Nevada Department of Health and Human Services Website http://dhcfp.state.nv.us/ Phone Number 800-992-0900 ext 2 Residency Requirements Nevada resident and U.S. citizen Federal Poverty Line Income Limits Child to age 5: 133% FPL Child age 6-19: 100% FPL Non-working parents: 27% FPL Working parent: 87% FPL Pregnant woman: 133% FPL Additional Resources Nevada Health Care Options Matrix™ Guide Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Nevada’s public and private health care choices for individuals and groups with various demographic profiles. Family Health Insurance Guide by HealthInsuranceFinders.com The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families. Nevada: At-A-Glance Provides exclusive health data of Nevada. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.