While Nevada Health Link offers a wide variety of health insurance plans to choose from, there are a number of required benefits that come with each plan offered on the Exchange. These are known as the 10 Essential Health Benefits.
All Nevada Health Link enrollees should be aware of the value these coverage benefits bring to each health insurance policy. Apart from these benefits, each insurance policy has to follow certain guidelines on deductibles and payments, holding each policy to similar standards. Here is a rundown of the 10 benefits guaranteed by law that are covered by each insurance plan offered at Nevada Health Link. These 10 essential health benefits can improve your health, give you access to new preventative care and wellness services, and greatly reduce the financial burden of an injury, illness, or chronic health condition.
Outpatient Procedures or Tests
This is what is referred to as “ambulatory services and care” in medical lingo, and is covered on all plans offered through Nevada Health Link. These are healthcare services where you are not admitted to the hospital. This category includes hospice or home health services, as well as other common procedures like blood tests, colonoscopies, chemotherapy, ultrasounds, and x-rays. While all of these services are covered under every plan offered through Nevada Health Link, some plans may limit coverage to no more than 45 days (this 45-day limit would most specifically apply to services like hospice or home health).
Emergency care and/or transport by ambulance is covered under every plan offered through Nevada Health Link. Emergency care is defined as any care that could lead to disability or death if not immediately treated. Remember that you cannot be penalized for any emergency service under your plan.
The treatment you receive during hospitalization is covered, including care from doctors, nurses, and other hospital staff. Hospital coverage includes surgeries, transplants, and skilled nursing care. Some plans may limit your coverage to no more than 45 days— check your deductible to calculate how much you would pay out of pocket before coverage kicks in (deductibles differ across plans).
Pregnancy, delivery, and post-delivery care is covered across all plans offered through Nevada Health Link, as well as newborn care.
Mental Health and Substance Abuse
The diagnosis and treatment of a mental health disorder or substance abuse, both inpatient and outpatient, is covered by plans offered through Nevada Health Link. This could include behavioral health treatment, counseling, and psychotherapy. While these services are covered, your specific policy may limit the number of days you are covered for this care.
Your plan must cover at least one medication from each category and classification of federally approved drugs. However, when a cheaper and equally effective medicine is available, your plan may decline coverage. Sometimes only generic drugs are covered, and some prescription drugs may be excluded. Out-of-pocket drug expenses count toward your deductible.
Rehabilitation (Physical Therapy)
Services that help you gain or recover mental and physical skills lost to injury are included with your coverage. This could include services like rehab after a stroke, or speech therapy for children. Plans must provide 30 visits each year for speech therapy and 30 visits for cardiac or pulmonary rehab.
Any testing that is done to help a doctor determine an injury or condition is covered. Some screenings, such as mammograms or prostate exams, are provided free of charge. Plans must pay 100% of the costs of tests if doctors use them to diagnose an illness.
Preventive and Wellness Services and Chronic Disease Support
Immunizations, physicals, cancer screenings, and counseling are covered under your insurance. Chronic disease care — such as treatment for asthma and diabetes — is also fully covered.
Pediatric Services, including dental and vision
Dental and vision services provided to infants and children under 19 years old are covered by insurance. This includes two routine dental exams, one eye exam, and corrective lenses each year.
In addition to all of these health benefits, Covid-19 diagnosis and treatment are free under the plans offered through Nevada Health Link. There is no additional insurance required. Covid-19 vaccines and tests are all covered. This continues to be an important new health benefit offered under each insurance plan — coverage through Nevada Health Link can give enrollees peace of mind that any Covid-19 testing or treatment they need will not impact them financially.
With all of these details in mind, remember that although all plans on Nevada Health Link are required to cover these 10 essential health benefits, there are still significant variations between health plans. Carefully compare deductibles, co-pays, out-of-pocket maximums, and networks to find the plan that best fits you or your family. Work with a certified agent/broker or navigator to get free enrollment assistance when choosing a plan.