Posted on Thu, Oct 15, 2009
Nevada requires all individual and family health insurance policies to go through medical underwriting process, which reviews the applicant's health history to determine if coverage will be offered and what the premiums will be. There are no limitations regarding the review-period, and the insurer may choose to look back as many years as desired to identify potential pre-existing conditions. The insurer may also choose to deny coverage or offer a health plan with specific exclusions on any condition that is labeled pre-existing. If the applicant received prior coverage through another insurance company, credit must be given for this previous coverage.
Insurers have the right to determine the monthly premium amounts when the application is approved and must keep any increase in rates to no more than 50% over the standard rate of the time. When the insurance provider approves an application, it may not change the rate level based on future claims for medical care. Nevada premium rates are based on factors such as age, sex, health status and geographical location.
Nevada Small Group Health Insurance Regulations
For Nevada companies with two to 50 employees, small group health insurance is available. The law states that small group health coverage is provided on a guarantee issue basis, which means that an employee who is part of the insurance group may not be declined coverage based on current medical conditions or health history. However, the employer may impose a waiting period after the hire date before the employee can be covered under the group plan, as long as the waiting period is the same time frame for all employees in the group.
Once the employee is eligible for the group plan, the insurer can impose a one-year exclusionary period on any pre-existing condition if the applicant is unable to present a proof of previous creditable coverage. Premium rates for a group in Nevada are medically underwritten and can fluctuate 25% plus or minus of the indexed rate.
Understanding Nevada COBRA and Continuation Coverage Issues
When a Nevada employer has more that 20 employees, the group falls under federal COBRA regulations. There is also the Nevada mini-COBRA which applies to companies having fewer than 20 employees. Mini-COBRA states that if an employee experiences a qualifying event, he or she must have the opportunity to continue group health plan coverage.
Qualifications and guidelines for Nevada COBRA and mini-COBRA include:
- Employee received coverage under a group plan for a minimum of one year prior to the termination date.
- Employee verifies in writing the desire to utilize the COBRA option within 60 days of the termination date.
- Continued COBRA coverage is capped out at 18 months for employees, whereas and employee's spouse and dependent children have 36 months of the continued coverage.
- Employees who choose to continue coverage under COBRA are responsible for premium payments, which cannot exceed 125% of premiums charged to the employer for the small group.
- Employees who voluntarily leave the place of employment are ineligible for COBRA and mini-COBRA coverage.
After an employee has used all of the time available for COBRA coverage, they qualify for guarantee issue coverage through other private individual health insurance companies. In Nevada, these insurers are required to offer a minimum of two plans available to people who qualify through HIPPA.
Nevada Medical Insurance Quotes