Plan types (indemnity, HMO, PPO, POS, HDHP/HSA), cost sharing and the federal Affordable Care Act rules are covered in the national Medical Plans guide. This guide covers what Nevada adds: its prompt-pay law, required benefits, newborn and adoption rules, the state exchange and who may help people enroll. Citations are to the Nevada Revised Statutes (NRS).

Prompt payment of claims (NRS 689A.410)

• An insurer approves or denies a claim within 21 days if it was filed electronically, or 30 days if not, and pays approved claims within the same period.
• If it needs more information, it says so within 20 working days, stating the specific reasons.
• Late payments carry interest of 10% a year from the date payment was due.

Required benefits

• Preventive and wellness services (NRS 689A.0419), including all vaccinations recommended by the ACIP, smoking cessation for adults (up to two attempts and four counseling sessions a year), and well-woman visits at least once a year starting at age 14.
• Mental health parity: insurers must follow the federal Mental Health Parity and Addiction Equity Act of 2008 (NRS 687B.404).
• Breast reconstruction after mastectomy, including surgery on the other breast for symmetry, prostheses and physical complications. Benefits are those of the policy at the time of the mastectomy if reconstruction starts within three years. Insureds are told about the coverage at enrollment and annually (NRS 689A.041).
• Hospice care and home health care that would have been covered in a facility (NRS 689A.030(8), (10)).
• Telehealth must be covered to the same extent as in-person care, without first requiring an in-person visit (NRS 689A.0463).

Newborns and adopted children (NRS 689A.043; 689B.033)

• A newborn is covered from the moment of birth, and premature births can't be excluded. Coverage includes congenital defects, birth abnormalities and certain transportation costs.
• A child placed for adoption is covered from the moment of placement.
• The policy may require notice and any added premium within 31 days after birth, adoption or placement for coverage to continue past 31 days.

The Silver State Health Insurance Exchange

• Nevada's marketplace is the Silver State Health Insurance Exchange (NRS 695I.200). Its purposes include helping individuals and small employers buy qualified health plans and reducing the number of uninsured Nevadans. It offers only qualified health plans (NRS 695I.210).
• An exchange enrollment facilitator helps people enroll. A facilitator needs to be 18, pass a written exam, complete required training and be fingerprinted (NRS 695J.110). A facilitator may not sell, solicit or negotiate insurance, may not hold a producer, consultant or surplus lines license at the same time, and may not be paid by health insurers (NRS 695J.210).

HMOs

No one may operate an HMO in Nevada without a certificate of authority from the Commissioner of Insurance (NRS 695C.060).

Individual policy free look

Most individual health policies may be returned within 10 days of delivery for a refund, which voids the policy from the start. Nonrenewable accident-only policies and individual credit health policies are excepted (NRS 689A.170).

Common exam traps

• Prompt pay: 21 days electronic, 30 days paper, with 10% annual interest on late payments.
• Newborns and premature births are covered from birth. Notice and premium may be required within 31 days.
• Adopted children are covered from placement, not from the final adoption.
• Enrollment facilitators can't be licensed producers and can't sell insurance.
• Breast reconstruction started within three years is paid under the policy in force at the time of the mastectomy.