Health Plan of Nevada Small Group Plans

Easier on the wallet, HMO plans are designed to save you money on out-of-pocket costs. With this plan type, you are required to choose a primary care provider (PCP) and stay within a network of providers to receive coverage under the plan, except for emergency services and urgent care.

HMO members can see a specialist, but their PCP must give them a referral to the specialist in order to get benefit coverage.

Balancing value with cost. HMO Balance plans provide more first dollar coverage to simplify the health care experience and give members more predictable cost share. With HPN’s HMO Balance Plans, members get:

• Full HMO network
• HPN HMO Balance Pharmacy Network
• And all the great programs and services you’ve come to expect from Health Plan of Nevada

The Cadillac of all plans, a POS plan offers members the most flexibility. It’s an HMO and PPO wrapped into one. This means members dictate how they want to use the plan based on three tiers:

1. Tier I (HMO): Members can visit their PCP to receive an initial exam and a referral to a specialist if needed. This option provides the most coverage for the least out-of-pocket cost.
2. Tier II (PPO): Members can bypass their PCP to see a specialist or a physician in network, but they share more of the cost. This may include copayments or coinsurance for office visits, coinsurance for other covered services and a deductible. POS plans also have a preferred provider network.
3. Tier III (Out-of-Network): This option allows members to visit any licensed health care provider or hospital. However, they are responsible for paying all costs for care at the time of service, filing claim forms for reimbursement, meeting a deductible, and sharing higher coinsurance.

All of our plans are on a calendar year schedule. Calendar year deductibles reset every January 1 and end December 31.