How Health Care Reform Affects You and Your Family

Guaranteed Issue

Since January 1, 2014, you can no longer be declined coverage or charged more for health insurance because of a health issue you have now or in the past.

No annual or lifetime dollar limits on Essential Health Benefits

The Health Care Reform Law sets as a standard for all plans in the individual and small group market a minimum level of benefits that must be provided. These benefits are referred to as Essential Health Benefits (EHBs). EHBs are a set of health care services that must be covered with no “annual or lifetime dollar limits.” These benefits may still have other limitations, such as a visit limit.

The below list is a general summary with all of the Nevada EHBs available here, including the current benchmark plan.

  • Ambulatory patient services;
  • Emergency services;
  • Hospitalization;
  • Maternity and newborn care;
  • Mental health and substance use disorder services, including behavioral health treatment;
  • Prescription drugs;
  • Rehabilitative and habilitative services and devices;
  • Laboratory services;
  • Preventive and wellness services and chronic disease management; and
  • Pediatric services, including dental and vision care.

Preventive Care Services

Preventive care services must be provided without any cost-sharing to you long as the service is provided by a network provider. This means that a network provider cannot charge copays, deductibles or coinsurance to you or your family. Exhaustive lists of services for women (including pregnant), children and families is available here, with some of the services below:

  • Blood pressure, diabetes and cholesterol tests;
  • Many cancer screenings, including mammograms and colonoscopies;
  • Counseling on such topics as smoking cessation, weight loss, eating healthy, treating depression, and reducing alcohol use;
  • Regular well-baby and well-child visits from birth to age 21;
  • Routine vaccinations against diseases such as measles, polio and meningitis;
  • Counseling, screening and vaccines to ensure healthy pregnancies; and
  • Flu and Pneumonia shots.