Health Plan of Nevada
Health Plan of Nevada (HPN) is a subsidiary of the United Healthcare Company. The company primarily provides health maintenance organization (HMO) and point of service plans; HMO plans can be provided for groups and individuals. The company also offers options for behavioral healthcare, preventive maintenance, Medicare Advantage, and other specialized programs, such as vision care and breast care.
HPN appears to abide by the specifications of the Affordable Care Act, or ACA. Essentially, this means that the company offers the same level of coverage for mental health services, such as substance use disorder treatment, as it does for primary care services. Each policy must have some essential coverage for substance use disorder treatment, and the coverage must be equivalent to the type of coverage that is offered for primary healthcare services in the policy.
HMO plans provide a specific network of providers for the policyholder to use. One cannot go outside of this network for insurance services without paying significant costs; usually, the individual must cover the entire cost of the service when they go outside the network under an HMO. The network of providers has already agreed to provide coverage at lower costs than are typical for the services being rendered.
Point of service plans allow individuals to choose whether to get treatment by someone within the network or outside of the network. These plans have significantly higher premiums than HMO plans.
According to its website, HPN offers several different plans:
- An HMO plan with a maternity option: There is a $2,000 annual copay maximum, and specific copays for medications and other services, with this plan. Premiums depend on the individual’s age and health.
- An HMO plan without a maternity option: With this plan, there is a $4,000 annual copay with different copays for medications, etc. The premiums again depend on the person’s age and health.
- A Tier I POS plan with no annual copay or coinsurance maximum: There are copays for medications and specific services. Premiums depend on the individual’s health and age.
- A Tier II POS plan with a deductible of $500 and a $2,000 annual co-pay maximum: Additional copays are in effect. Premiums depend on the individual’s age and health.
- A Tier III POS plan with an annual deductible of $500 and a $4,000 annual copay maximum: Other copays also apply depending on the service. Premiums depend on the individual’s age and health.
Individuals who are considering entering into substance use disorder treatment are encouraged to contact their customer representative regarding the exact costs they will incur. The process of securing coverage will go more smoothly if an individual contacts their customer service representative and the potential provider to determine the extent of coverage they will receive for their specific circumstances.
In addition, getting a referral from a physician to a specific treatment provider can help the process. A physician referral may be required in some instances (e.g., for inpatient treatment or for withdrawal management services), and physicians can often phrase the referrals in such a manner that satisfies the requirements of coverage. This particularly applies to the need to demonstrate that treatment is a medical necessity. Treatments that are deemed medically necessary by the insurance company are more readily covered, and there are often fewer complications regarding benefits.