CurrentSelectHealthPolicy N/A

Nevada — State Required Benefits (Coverage Criteria Index)

Lists health care benefits that Nevada requires insurers to cover and the statutory citations; applies to individual and group market plans as indicated for each benefit.

Policy Summary

PayerSelectHealth

PolicyNevada — State Required Benefits (Coverage Criteria Index)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionCheck the cited Nevada Revised Statutes (NRS) sections for specific documentation and prior authorization requirements applicable to each mandated benefit.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

≈25distinct required benefit lines listed

Before 2012year of enactment for listed provisions

Multiplemarket applicability

Statutorycitations provided

Nevada Required Benefit Mandates

Nevada required benefit categories

Listed Nevada-required benefits (selected examples from document):

Hospice: Coverage for hospice

Market applicability: Individual, group. Citation: NRS 689A.030(10); NRS 689B.030(6); NRS 695B.180(9)

Home care or health support services: Coverage for home care or health support services

Market applicability: Individual, group. Citation: NRS 689A.030(8); NRS 689B.030(4)

Complications of pregnancy: Coverage related to complications of pregnancy

Market applicability: Individual, group. Citation: NRS 689A.042; NRS 698B.260; NRS 695B.192

Policy Summary

PayerSelectHealth

PolicyNevada — State Required Benefits (Coverage Criteria Index)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionCheck the cited Nevada Revised Statutes (NRS) sections for specific documentation and prior authorization requirements applicable to each mandated benefit.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider Responsibilities & Authorization

Note

Provider actions not specified in document

Provider actions are NOT specified in the source document. The document lists Nevada statutory citations that govern required benefits and related provider/coverage obligations, but it does not enumerate specific provider steps (e.g., prior authorization forms, submission portals, required clinical documentation templates) nor does it list CPT/HCPCS codes or explicit prior authorization rules. Providers should consult the cited Nevada Revised Statutes (NRS) for operational requirements and for any insurer-specific procedures.

Prior Authorization

Prior authorization / coding not detailed

Prior authorization: the brief lists mandates and NRS citations but does not enumerate CPT/HCPCS codes or explicit prior authorization rules. Before submitting claims or prior authorization requests, verify SelectHealth-specific prior authorization policies and code lists; consult both insurer operations and the cited statutes for legal requirements.

Statutory citations provided do not replace insurer prior authorization forms or portal requirements.
No CPT/HCPCS lists or code-level guidance present — obtain code lists from SelectHealth.

Step Therapy

Step therapy not described

Step therapy: No step therapy rules are described in this document. If step therapy may apply, providers should reference SelectHealth’s clinical policy library or member-specific benefit documents for any step therapy protocols.

Document contains no step therapy or fail-first protocols.
Check SelectHealth provider portal or clinical policy documents for step therapy details.

Documentation Required

Statutory citations are the operational reference

Use the statutory citations provided in the source as the primary references for mandated benefit scope and insurer obligations. Where the policy text is silent on operational details (authorization procedures, required documentation, coding), providers must rely on the applicable NRS sections and on SelectHealth’s administrative rules for implementation.

Cite the specific NRS section when disputing coverage denials or when requesting exceptions.
Statutes establish required benefits (e.g., hospice, maternity, autism, cancer drug coverage) but do not specify insurer submission workflows.

Note

Provider authorization procedures absent

Provider authorization specifics are not specified in the source document. The document omits explicit provider authorization procedures (who may request authorization, required attester credentials, timeframes for decisions). Providers should consult SelectHealth for insurer-specific authorization workflows and the cited Nevada statutes for legal obligations.

No insurer contact, form, credential, or timing details provided in the brief.
When in doubt, submit complete clinical documentation and reference the applicable NRS citation to support medical necessity.

Policy Background

This document is an index of Nevada statutory mandates that enumerates categories of health benefits insurers are required to offer. It lists approximately 25 distinct required benefit lines (for example: hospice, home care, complications of pregnancy, maternity minimum hospital stay, severe mental illness treatment, autism spectrum disorders, HPV vaccine, cancer screenings, contraception and hormone therapy, diabetes management, clinical trial treatment, and certain prescription and cancer drug coverage) and provides the corresponding NRS citations for each benefit.

The purpose of the index is informational: it identifies benefit categories and the applicable market(s) (individual, group, HMO, small group) and supplies the statutory citation(s) (NRS sections) that mandate coverage. The document does not translate those statutes into clinical medical-necessity criteria, billing code lists, or detailed utilization-management rules.

Named Benefits and Definitions

Hospice

BenefitHospice coverage

Market applicabilityIndividual, group

Statutory citationsNRS 689A.030(10); NRS 689B.030(6); NRS 695B.180(9)

Year enacted (document)Before 2012

Contraceptives / Hormone Replacement Therapy

BenefitCoverage for drugs or devices for contraception and for hormone replacement therapy

Related servicesOutpatient health care services related to contraceptives and hormone replacement therapy

Market applicabilityIndividual, group (document notes prohibited actions by insurers)

Statutory citationsNRS 689A.0415; NRS 689B.0376; NRS 695B.1916; NRS 689A.0417; NRS 689B.0377; NRS 695B.1918

Year enacted (document)Before 2012

Autism Spectrum Disorders

BenefitCoverage for autism spectrum disorders

Market applicabilityIndividual (offer only), group/HMO

Statutory citationsNRS 689A.0435; NRS 689B.0335; NRS 689C.1655; NRS 695C.1717

Year enacted (document)Before 2012

OpenPayer

Nevada — State Required Benefits (Coverage Criteria Index)

Nevada Required Benefit Mandates

Billing Codes and Dates

Provider Responsibilities & Authorization

Policy Background

Named Benefits and Definitions