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2019 Small Employer Market

As a Nevada small employer with 1-50 full-time equivalent employees, you can purchase major medical coverage for your employees from one of twelve insurance companies selling small employer plans in Nevada.  These small employer plans are required to cover all essential health benefits and must satisfy stringent requirements for rates, provider networks and drug formularies.  The Division of Insurance annually reviews each offering in the Nevada market to ensure compliance with those requirements. Current year plans are displayed on the Division website at http://doi.nv.gov/Health_Insurance_Rates/Rate_Review/. On October 2nd each year we include the upcoming year plans for your future decision making.  

Approved small group filings and market distribution:

2019 SG Market Image
                     Click on the image to expand.

Access to Nevada SERFF filings:

The Nevada Division of Insurance and the National Association of Insurance Commissioners have combined to provide public access to non-proprietary elements of Nevada's Rate, Form/Rate, Form, and ACA Binder filings.  Accessing this information is a simple process for the regular user of this service.  The Division of Insurance, upon completing our review of a filing, will authorize public access to the following items (if included) in each type of submission:

Nevada Rate Filing-

    Rate Data Template
    Redacted Actuarial Memorandum
    Consumer Justification of Rate Change
    Disposition by the Division
    Rate Review Detail

Nevada Form Filing-

    Approved forms including Schedule of Benefits and Evidence of Coverage
    Disposition by the Division

 

Nevada ACA Binder Filing-

    Prescription Drug Template
    Essential Community Providers / Network Adequacy Template

Nevada Form / Rate Filings-

    See list for Form filing
    See list for Rate filing

For interested brokers, employers or consumers who know the SERFF filing number, the process of reaching each filing is as follows:

1.  Follow this link to our SERFF Filing Access page
2.  Click the plum colored "Begin Search" button
3.  Click the "Accept" button below the legalese
4.  Paste the desired SERFF filing number into the space titled "SERFF Tracking Number"

For more general searches yielding a desired parameter of results follow the first three steps above and then limit or expand the search as applicable to the appropriate Search Options.  

In the table at the top of the page we have listed the SERFF tracking numbers for each of the rate and form filings in the small employer market of Nevada for 2019.  Opening the larger version of the above table allows you to simply click on any of the filing numbers to be transferred directly to our SERFF Filing Access page for your convenience.

Association Health Plans

On June 2018, the Department of Labor (“DOL”) issued a new rule that broadened the small employer option to join together and buy large employer plans from an Association Health Plan (“AHP”). However, on March 28, 2019 the U.S. District Court for the District of Columbia ruled that some aspects of the Association Health Plan rule were unlawful and vacated the new rule.

It is important to note that if an employer member purchased an AHP prior to the court’s ruling on March 28, 2019, the DOL will not take any action against such AHPs through the remainder of the applicable plan year or through the contract term. However, any AHPs sold after that date may not be valid depending on the results of the appeal.

Under federal rules, AHPs may be approved under one of two pathways. A Pathway I AHP may provide benefits to employees of employers who have a similar trade, industry or line of business, as approved by the Department of Labor, while a Pathway II AHP’s commonality is based on geography and sole-proprietors. Pathway I AHPs may continue to be sold; however, Pathway II AHPs may not be sold after March 28th 2019.

AHP plans, as with all other large group plans, are subject to fewer state and federal requirements.  Large employer plans are not required to cover the essential health benefits and they do not undergo the Division’s scrutiny regarding the regulation of rates, provider networks or drug formularies. Additionally, while the Division reviews forms for compliance under state and federal requirements applicable to large employer health plans, the DOL is ultimately the regulating agency to determine whether an AHP complies with the federal rules.

Information on fully-insured AHPs that have been submitted to the Division and the US Department of Labor are displayed below; however, unless the DOL has provided a formal opinion to an association or insurance company certifying the AHP is a Pathway I, such plan may not be valid.

Association Health Plans in Nevada

Northern Nevada Dental Society

Submission Date: May 14, 2019
Effective Date: July 1, 2019
Service Area: Churchhill, Douglas, Elko, Eureka, Humboldt, Lander, Lyon, Pershing, Storey and Washoe counties
Carrier(s): Prominence HealthFirst 
                 Prominence Preferred Health Insurance Company, Inc.
Summary Letter from Carrier
M-1 Form   

Washoe County Medical Society Association Health Plan  

Submission Date: May 14, 2019
Effective Date: July 1, 2019
Service Area: Clark, Douglas, Lyon, Nye, Storey and Washoe counties
Carrier(s): Prominence HealthFirst 
                 Prominence Preferred Health Insurance Company, Inc.
Summary Letter from Carrier
M-1 Form   

Nevada Hotel & Lodging Association Health Plan 

Submission Date: May 14, 2019
Effective Date: July 1, 2019
Service Area: Clark, Douglas, Lyon, Nye, Storey and Washoe counties
Carrier(s): Prominence HealthFirst 
                 Prominence Preferred Health Insurance Company, Inc.
Summary Letter from Carrier
M-1 Form   

Southern Nevada Dental Society

Submission Date: April 2, 2019
Effective Date: June 1, 2019
Service Area: Statewide
Carrier(s): Prominence HealthFirst 
                 Prominence Preferred Health Insurance Company, Inc.
Summary Letter from Carrier
M-1 Form   

Carson Valley Chamber of Commerce

Submission Date: March 26, 2019
Effective Date: May 1, 2019
Service Area: PPO plans available statewide
                     HMO plans available in Washoe, Carson, Douglas, Lyon, and Storey counties
Carrier(s): Hometown Health Plan, Inc.
                 Hometown Health Providers Insurance Company
Summary Letter from Carrier
M-1 Form   

Carson City Chamber of Commerce

Submission Date: March 26, 2019
Effective Date: May 1, 2019
Service Area: PPO plans available statewide
                     HMO plans available in Washoe, Carson, Douglas, Lyon, and Storey counties
Carrier(s): Hometown Health Plan, Inc.
                 Hometown Health Providers Insurance Company
Summary Letter from Carrier
M-1 Form   

KG Enterprise, Inc. dba BNI Northern Nevada Health Plan

Submission Date: March 11, 2019
Effective Date: April 1, 2019
Service Area: PPO plans available statewide
                     HMO plans available in Washoe, Carson, Douglas, Lyon, and Storey counties
Carrier(s): Hometown Health Plan, Inc.
                 Hometown Health Providers Insurance Company
Summary Letter from Carrier
M-1 Form   

2018 Association Health Plans Archive