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Coverage Under Individual Health Insurance Plans

If you are federally eligible, you are given the option of either a basic or a standardized individual health plan. These will give you the same benefits that are offered by group plans. You can compare the cost or prices when purchasing a standardized plan. You may be offered non-standardized plans also, but may be charged more for them.

The basic plan covers hospital, skilled nursing, rehabilitation, hospice, emergency care, physician services, laboratory and x-ray services and prescription drugs. You must pay a 50 percent coinsurance which means that you must pay half of what the coverage cost is for each service you may receive. Usually basic policies do not cover mental health services, substance abuse or maternity care.

The standard policy is the same as the basic plan, except you will only be charged a 20 percent coinsurance. This plan also covers mental health services, substance abuse services and maternity care. Obviously, the standard policy covers more and charges less coinsurance, although it will be more costly in premium and deductible price.

Other non-standardized options will offer benefits for maternity stays, mammograms, management and treatment of diabetes and treatment relating to severe mental illness, but these will cost much more for the extra benefits.

To find out more about mandated benefits or get a summary of benefits for individual health plan options, you may contact the Nevada Division of Health Insurance.