Key Takeaways
- Nevada operates its own state-based health exchange called Nevada Health Link (Silver State Health Insurance Exchange)
- The Nevada Division of Insurance (DOI) regulates health insurance
- Pre-existing condition exclusions are prohibited under ACA-compliant plans
- Nevada has mental health parity requirements
- Nevada offers Battle Born State Plans (BBSPs) starting in 2026
Nevada Health Insurance Policy Requirements
Nevada has health insurance regulations that work alongside federal requirements under Title 57 of the Nevada Revised Statutes, particularly Chapters 689A through 695G.
Regulatory Structure
Nevada health coverage is regulated by the Nevada Division of Insurance (DOI):
| Agency | Role |
|---|---|
| Nevada Division of Insurance (DOI) | Regulates all health insurance, reviews rates and forms |
| Silver State Health Insurance Exchange | Operates the state-based health exchange (Nevada Health Link) |
Health Insurance Marketplace
Nevada operates its own state-based exchange called Nevada Health Link:
- Silver State Health Insurance Exchange manages the marketplace
- Fully operational State Based Exchange (SBE)
- Nevadans enroll at NevadaHealthLink.com, not HealthCare.gov
- Provides access to qualified health plans (QHPs)
- Premium tax credits available for eligible residents
- Open enrollment and special enrollment periods apply
- Free assistance from licensed enrollment professionals available
Battle Born State Plans (BBSPs) - New in 2026
Starting in 2026, Nevada Health Link offers Battle Born State Plans:
- Same benefits and rules as other Marketplace plans
- Designed to lower monthly costs
- Makes health insurance more affordable for Nevadans
Nevada Reinsurance Program
Nevada has implemented a reinsurance program starting 2026:
- Helps keep unsubsidized premiums lower
- Stabilizes the individual market
- Reduces costs for insurers and consumers
Metal Tier Plans
| Tier | Actuarial Value | Cost Sharing |
|---|---|---|
| Bronze | 60% | Higher out-of-pocket costs |
| Silver | 70% | Moderate cost sharing |
| Gold | 80% | Lower out-of-pocket costs |
| Platinum | 90% | Lowest out-of-pocket costs |
Pre-Existing Condition Protections
Nevada prohibits pre-existing condition exclusions in ACA-compliant plans:
| Market Segment | Pre-Existing Condition Exclusions |
|---|---|
| Individual | Prohibited |
| Small Group | Prohibited |
| Large Group | Limited by federal law |
Guaranteed Issue and Renewal
Nevada requires:
Guaranteed Issue
- Insurers must accept all applicants for ACA-compliant plans
- Cannot deny coverage based on health status
- Applies to individual and small group markets
Guaranteed Renewal
- Insurers cannot cancel coverage except for:
- Non-payment of premium
- Fraud or misrepresentation
- Plan discontinuation (with proper notice)
Mental Health Parity
Nevada requires mental health parity:
Coverage Requirements
Nevada law requires health plans to cover:
- Mental health conditions
- Substance use disorders
- Behavioral health services
Federal MHPAEA Compliance
Nevada requires compliance with the federal Mental Health Parity and Addiction Equity Act (MHPAEA):
- Financial requirements must be comparable to medical/surgical
- Treatment limitations must be comparable
- Prior authorization requirements must be comparable
- Out-of-pocket costs must be comparable
Exam Tip: Nevada operates its own state-based exchange (Nevada Health Link) rather than using HealthCare.gov.
Essential Health Benefits
All individual and small group plans must cover:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorders
- Prescription drugs
- Rehabilitative services
- Laboratory services
- Preventive and wellness services
- Pediatric services (including dental and vision)
Medical Loss Ratio (MLR)
Nevada ensures carriers in individual and small group markets:
- Must spend at least 80 cents of every premium dollar on medical care
- Prohibits annual and lifetime dollar limits on essential health benefits
External Review
Nevada provides external review rights:
- Consumers can appeal denied claims
- Independent external review available
- Binding decision on insurer
Consumer Resources
Nevada Health Link provides consumer assistance:
- Phone: (800) 547-2927
- Website: NevadaHealthLink.com
- Free assistance from licensed enrollment professionals
Small Group Health Insurance
Nevada regulates small group health insurance under NRS Chapter 689C:
Small Group Market Definition
| Definition | Requirement |
|---|---|
| Employer Size | 1-50 employees (fully insured) |
| Rating Factors | Age, tobacco use, geography, family composition |
| Prohibited Factors | Health status, claims history, industry |
Small Group Requirements
| Requirement | Detail |
|---|---|
| Guaranteed Issue | Must accept all eligible small groups |
| Guaranteed Renewal | Cannot refuse renewal except for fraud or non-payment |
| Essential Health Benefits | Must cover all 10 EHB categories |
| Rate Restrictions | Community rating with permitted adjustments |
Individual Health Insurance
Nevada regulates individual health insurance under NRS Chapter 689A:
Individual Market Protections
| Protection | Requirement |
|---|---|
| Guaranteed Issue | Must accept all applicants |
| No Pre-existing Exclusions | Cannot exclude pre-existing conditions |
| Community Rating | Rates based on age, tobacco, geography |
| Essential Health Benefits | All ACA-required benefits |
Short-Term Limited Duration Insurance
Nevada regulates short-term health insurance:
| Requirement | Nevada Rule |
|---|---|
| Maximum Duration | Check current regulations |
| Renewability | May have restrictions |
| Disclosures | Must clearly state limitations |
| Not ACA-Compliant | Does not satisfy coverage requirements |
Important: Short-term plans do not cover pre-existing conditions and are not ACA-compliant. Producers must clearly disclose these limitations.
Health Insurance Rate Review
Nevada DOI reviews health insurance rates:
| Review Type | Threshold |
|---|---|
| Effective Rate Review | All rate filings reviewed |
| Public Comment | Available for significant increases |
| Justification Required | Insurers must justify rate changes |
What is the name of Nevada's state-based health insurance exchange?
What new plan type is Nevada Health Link offering starting in 2026?
Which agency regulates health insurance in Nevada?
Can Nevada health insurers deny coverage based on pre-existing conditions?
What minimum percentage of premiums must Nevada health insurers spend on medical care?