Network Adequacy (Revised May 8, 2015)

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 (Revisions to filing instructions)

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 ID 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 Nevada Declaration Document, Plans and Benefits Template, ECP Template, Network ID Template, Service Area Template and the Membership Data Call Spreadsheet must be submitted under the “Supporting Documentation” tab in a separate/stand-alone SERFF Filing. The Carrier must select the TOI and Sub-TOI “Network Adequacy”. No filing fee required.

ADDITIONALLY, the “Network Adequacy Template” must be submitted directly to Examination Resources via email to IngridFranklin@examresources.net with copy to HollyBlanchard@examresources.net Please be sure to include the SERFF Tracking Number in the excel file name and include both the Filing Company name and SERFF Tracking Number in the Subject Line of the email.

Due to the size of the data, a follow up email should be sent to Examination Resources asking for confirmation that the file was received. 

 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.