Nevada EHB Benchmark Requirement List.
The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care. In addition to the basic EHB benefit categories, Colorado has the following state-required benefits:
In addition to the basic EHB benefit categories, Nevada has the following state-required benefits:
- Coverage for hospice
- Coverage for home care or health support services
- Coverage related to complications of pregnancy
- Plan that includes coverage for maternity care and pediatric care; Requirement to allow minimum stay in hospital in connection with childbirth; prohibited acts
- Coverage for treatment of conditions relating to severe mental illness
- Benefits for treatment of abuse of alcohol or drugs
- Coverage for autism spectrum disorders
- Coverage for human papillomavirus vaccine
- Coverage for prostate cancer screening
- Coverage of certain drugs for treatment of cancer
- Coverage for cytologic screening test and mammograms for certain women
- Coverage for drug or devices for contraception and for hormone replacement therapy in certain circumstances; prohibited actions by insurers
- Coverage for outpatient health care services related to contraceptives and hormone replacement therapy in certain circumstances; prohibited actions by insurers; exceptions
- Coverage for screening for colorectal cancer
- Coverage for treatment of temporomandibular joint
- Coverage for treatment received as part of a clinical trial or study
- Coverage for management and treatment of diabetes
- Coverage for treatment of certain inherited metabolic diseases
- Coverage for prescription drug previously approved for medical condition of insured
Certain limitations and exclusions apply.