Nevada Health Insurance (NV)

Nevada (NV)
Individual Health Insurance Regulations

Learn more about Nevada Individual Health Insurance

The State of Nevada permits individual health insurance policies to be medically underwritten. Policies that are medically underwritten provide the health insurance carrier to review past and current health status and opt to do one of the following: 1) deny coverage 2) provide coverage or 3) provide coverage with specific limitations and or exclusions with regard to pre-existing health conditions. Nevada does not place a limitation on the look back or exclusionary period for pre-existing problems, but does require that credit for prior coverage be given. Health insurance companies may also adjust your monthly premium at time of application approval, but they are limited to a 50% increase over the standard published rate. Once your application has been approved at a standard rate, the insurance company may not re-adjust your rate level for future medical claims. Rates are based on age, gender, geographical location and health status.

Nevada Small Group Health Insurance Regulations

Small group health insurance is available to companies with 2-50 employees. Under Nevada law, small group health insurance must be offered on a guarantee issue basis, which provides that each eligible employee who is offered health insurance may not be declined coverage due to current or past health history. Prior to allowing an employee to join a group health plan, the employer may impose a waiting period from the date of hire. Waiting periods must be the same for all employees. Once eligible, the health insurance company may utilize a 12 month exclusionary period on pre-existing conditions on all applicants not able to provide proof of prior creditable coverage. Nevada small group premium rates may be medically underwritten and may vary plus or minus 25 percent of the indexed rate, depending upon the health status of the group.

Nevada COBRA and Continuation Coverage

As in all states, any Nevada employer with more than 20 employees must abide by federal COBRA regulations. The mini-COBRA law in Nevada applies to businesses with less than 20 employees and provides that any employee suffering a qualifying event must be afforded the opportunity to extend his/her group health plan coverage. To qualify for Nevada mini-COBRA benefits, an employee must have been covered under group plan for at least 12 months prior to the date of termination and accept their COBRA option within 60 days. The period of continued coverage is limited to 18 months for an employee and 36 months for an employee's spouse or dependent child. Any individual who elects to continue coverage under COBRA shall be responsible for the payment of premiums which may not exceed 125% of the premium that was being charged to the employer for that employee's coverage. An employee who voluntarily quits his job is not eligible for mini-COBRA coverage. Once an employee has exhausted their COBRA period, they may receive guarantee issue coverage from individual health insurance companies , all of which are required to provide at least 2 plans in their portfolio to HIPAA eligible individuals.

Additional Nevada Resources

• Nevada Check Up
  Nevada Check Up is a state sponsored program providing low-cost health insurance coverage to low-income, uninsured children through the age of 18.
• Nevada Department of Health and Human Services
  The Department of Health and Human Services promotes the health and well-being of Nevadans by offering helpful information and many useful consumer links. The Division of Health Care Financing manages the Medicaid program.
• Nevada State Health Insurance Advisory Program
  A state sponsored program operated by volunteers who provide seniors with counseling and information pertaining to their Medicare rights and health plan options.

NV Medical Insurance Statistics

Total Population: 2,448,000
With Health Insurance: 2,023,000 / 82.6%
Without Health Insurance: 425,000 / 17.4%
*According to 2005 CPS Reports / U.S. Census Bureau

Note: The percentage of Nevada residents without health insurance has decreased by 1.1% since 2004.

Nevada Division of Insurance
Phone: 775-687-4270
The Nevada Division of Insurance regulates the insurance industry throughout the state and protects the rights of Nevada consumers in their insurance dealings.

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