Essential Health Benefits

The Affordable Care Act (ACA) lists ten general categories of Essential Health Benefits (EHB) that all individual and small group health plans are required to cover.  States determined the specific services that must be covered under each EHB category by selecting a benchmark plan from among various options allowed by the United States Department of Health and Human Services (HHS).  HHS is providing an opportunity for states to update their EHB benchmark plan selections and the Nevada Division of Insurance (Division) is soliciting comments regarding the possible changes to the existing EHB Benchmark Plan.

The current Nevada EHB Benchmark plan, for plan years 2017 and beyond, was selected by the Division after receipt of public input and is Health Plan of Nevada’s HPN Solutions HMO Platinum plan.  The links below display the details of the plan as well as the Schedule of Benefits and the Evidence of Coverage.    

HHS Approved 2017 - 2025 NV EHB Benchmark Plan  
Schedule of Benefits 
Evidence of Coverage

These documents are indicative of the types of coverage available under all individual and small group plans. Selection of the HPN Solutions HMO Platinum plan in 2017 is not an endorsement by the Division of Insurance of that particular plan or insurer.

Under current HHS rules Nevada may submit an application to modify the EHB benchmark plan for plan year 2026 and beyond.  Nevada is considering updating its EHB benchmark plan to reflect changes in the insurance market and seeks comment on the following:   

  1. Add all FDA-approved drugs to treat opioid use disorder
  2. Add all FDA-approved drugs for testing, treating and preventing human immunodeficiency virus
  3. Add all FDA-approved drugs for testing, treating, and preventing hepatitis B and C

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