logo

Network Adequacy

Carriers choosing to market a network plan in Nevada will be required to submit documentation to the Division for network adequacy determination.  The Federal Plan Management Data Templates will be used to collect the data in a uniform and consistent manner.  The data collected will then be run through a comprehensive comparison program that will identify any outliers or deficiencies for each plan network.

The scope of this review imposes technical and analytical demands upon the Division which requires outside assistance to effectively and efficiently carry out the Division’s duties. NRS 687B.490 provides for the expense of any determination made by the Commissioner to be assessed against the carrier. The Division entered into a contract with Examination Resources to provide this support.

Please refer to Bulletin 14-005 for the standards that will be used to determine adequacy for plan year 2016. Additional guidance will be forthcoming in regulation R049-14 to interpret and clarify the provisions of NRS 687B.490 for plan year 2017.

Health Benefit Plans

Every carrier that chooses to market a health benefit plan (network plan) in Nevada for 2016 will be required to complete and provide a  2016 Nevada  Declaration Document, Plans and Benefits Template, Network Adequacy Template, ECP Template, Network Template, Service Area Template and the Membership Data Call Spreadsheet. This requirement applies to PPO, HMO and POS networks, individual and small groups. The 2016 Declaration Document and Membership Data Call are below. The Templates can be found at www.serff.com/hix.htm and requirements for filing have been added to the Plan Management General Instructions page.

The templates and associated documents must be submitted in a separate binder under the "Supporting Documents" tab in SERFF. One Network Adequacy binder is required for each health carrier.  Carriers must title the binder "Network Adequacy".  Carriers that are NOT participating on the Exchange are NOT required to submit validated templates. This information is due to the Division by May 13, 2015.

NOTE: Nevada requires five (5) additional provider specialty types to the un-validated Network Adequacy Template.  

  • 080-Urgent Care
  • 200-Hematology
  • 201-Licenesed Behavior Analyst (LBA)
  • 202-Licensed Assistant Behavior Analyst (LABA)
  • 203-Certified Autism Behavior Interventionist (CABI)

Dental Plans

For plan year 2016, there are no separate network adequacy filings required for standalone dental plans. Provider networks must have one (1) general dentist, one (1) pediatric dentist, one (1) oral surgeon, and one (1) orthodontist within the travel standards established by the Silver State Health Insurance Exchange.