What Your Qualified Health Plan Covers

Some Nevadans may qualify for a Government subsidy to help them pay for their health insurance. This is buying your health insurance “On Exchange”, meaning, you get your health plan through Nevada Health Link (however it is recommended to have the assistance of a qualified broker). If you currently have Group Coverage “offered” (whether you enroll or not) through an employer, Medicare, Medicaid, VA, Tricare, CHIP, etc., you most likely will not be eligible for a Government subsidy. You are considered covered and won’t be eligible for a subsidy. Rules change all the time, so contact us for eligibility.

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What Are Essential Health Benefits And Who Has To Have Them?

What are “Essential Health Benefits” and who must have them? From 1/1/2014 and forward, all new health insurance plans (insured small group and individual health insurance plans) must cover the 10 bulleted benefits below, called “Essential Heath Care Benefits” in order to qualify as being an ACA plan (Obamacare). Qualified Health Plans MUST cover these 10 items without any lifetime or annual limits on these “Essential Health Benefits.”


Ambulatory patient services  (clinics, doctors office, same-day surgery centers, etc.)

Emergency services

♦ Hospitalization

Maternity and newborn care

Mental health and substance use disorder services, including behavioral health treatment

Prescription drugs

Rehabilitative and habilitative services and devices

♦ Laboratory services

Preventive and wellness services and chronic disease management

♦ Pediatric services, including dental and vision care (see plan details)


ON exchange vision is covered and dental is offered to purchase separately. OFF exchange you’ll have preventive care, however, minor and major restorative is subject to the medical deductible.

Health Insurance - Ten Essential Health Benefits

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Get The Answers You Need From Nevada Insurance Enrollment

Here at Nevada Insurance Enrollment we can assist you with your health insurance coverage enrollment. Please call our licensed health insurance agents to help you with choosing the right plan for you and your family.

Related Articles:

Health Insurance plan “Unaffordable”? Need Exemption?

On-Exchange and Off-Exchange Health Insurance Plans

Health Insurance: What is a Summary of Benefits?

Dental and Vision Insurance in Las Vegas, Nevada


Read More: Health Insurance in Las Vegas, Nevada


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