Health Insurance
Families and Individuals
Create Financial Security
Health insurance is critical to helping you control your health care costs. You pay health care companies a premium – a set amount of money each month - and you get benefits to pay for your eligible health care expenses.
Understanding Your Health Insurance Options
In Nevada you can purchase individual health insurance through the Silver State Health Exchange, commonly referred to as Nevada Healthlink, on your own or we can help you work through your options. Although it’s called individual health insurance, you can also find plans to cover your family. We all know how expensive health care can be. That’s why it is so important to have health insurance so you’re prepared for when you or your family have medical needs. With health insurance you can prepare for the unexpected and access preventive care services – like checkups, which are covered at 100%.
Health Insurance Plans Available through Nevada Healthlink
There are different types of On Exchange health insurance plans designed to meet different needs. Some types of plans restrict your provider choices or encourage you to get care from the plan’s network of doctors, hospitals, pharmacies, and other medical service providers. Others pay a greater share of costs for providers outside the plan’s network. Here is an overview of the types of marketplace plans available to you.
Depending on how many plans are offered in your area, you may find plans of all or any of these types at each metal level – Bronze, Silver, Gold, and Platinum.
Some examples of plan types you’ll find in the Marketplace:
- Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).
- Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. HMOs often provide integrated care and focus on prevention and wellness.
- Point of Service (POS): A type of plan where you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans require you to get a referral from your primary care doctor in order to see a specialist.
- Preferred Provider Organization (PPO): A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.
For more information about the different options visit www.nevadahealthlink.com
There are pro’s and con’s for each option. It’s important to select the right option based on your needs. Contact us for guidance in selecting the right policy for you and your family. There is no cost to you for our help.
Summary of Benefits and Coverage
Under the Affordable Care Act, health insurers and self-funded employers must provide a uniform Summary of Benefits and Coverage (SBC) to people who apply for and enroll in health policies.
Insurance companies and group health coverage must provide you with:
- A short, plain-language Summary of Benefits and Coverage (SBC)
- A Uniform Glossary of terms used in health coverage and medical care
This information allows you to make “apples-to-apples” comparisons when you’re looking at different coverage.
All individual and group health policies must use the same standard form to help you compare policies. The SBC also includes details, called coverage examples, which allow you to see what the policy would cover in two common medical situations: diabetes care and childbirth. The SBC is available for every policy in the Health Insurance Marketplace. You’ll find a link to it on each policy page when you enroll through the website. You can also ask for a copy from your insurance company or group health administrator at any time. All health policies must provide the SBC to you at important points in the enrollment process, like when you apply for or renew your policy. You can also ask for a copy of the Uniform Glossary to help you understand words used in health coverage and medical care.
Understanding the Affordable Care Act
Under the Affordable Care Act (ACA), fully insured small group and individual health plans on and off the Exchange/Marketplace must cover essential health benefits (EHB). Essential health benefits are minimum requirements for all plans in the Marketplace. Plans may offer additional coverage. You will see exactly what each plan offers when you compare them side-by-side in the Marketplace.
Health Insurance for Companies
Aware Benefits is a full service health insurance and employee health benefits agency. We help companies attract and retain quality employees by creating functioning benefits plans that meet the needs of the employees while containing costs.
We also offer a full suite of HR tools including a Living Handbook that stays up to date with changes in the law, a specialist helpline, online learning for employees and a document library filled with state specific docs to keep you compliant. Any company using Aware Benefits as your employee health benefits broker receives the HR suite FOR FREE. We also offer our employers a benefits management tool so that your employees can easily see their available benefits as well as their cost.
We are always willing to meet directly with employees to answer questions,
removing that burden from your business administrator.
Frequently Asked Questions
With the passing of the Affordable Care Act, we elected as a society to eliminate medical underwriting. That is, regardless of your medical condition, you cannot be denied or even charged a higher premium. The natural result of this is Adverse Selection, only people who are sick will buy insurance. To combat Adverse Selection people are given specific enrollment periods so they cannot wait to buy their insurance until after a diagnosis.
People will often assert that preventative medicine is cheaper in the long run and these types of Alternative Medical Practitioners (AMP) help prevent disease rather than treat it. If we accept that that is true, then there is no way to quantify how much money an AMP is worth. It is possible to know how much of a given population is susceptible to a particular illness and how much that illness costs and so mainstream medical procedures and drugs can be quantified.
We know we know, that’s not a question. But we wanted to address this. The reality is that PPO plans are often significantly more expensive to buy and use than an HMO plan. That’s because once again higher medical costs are being passed through the insurance company and on to you. But so many people expect to go see whichever doctor they want because the insurance company will pay at least a portion and not ask for a referral or prior authorization. However, the specialists and surgeons will usually require a referral anyway, so you’ve spent that extra money for nothing.