I AM: A Member
Welcome to Health Plan of Nevada. We're glad you're here.
As a member, you either have a Health Maintenance Organization (HMO) plan or a Point-of-Service (POS) plan. What's the difference between the two plans? Let's take a closer look.
Easier on the wallet, HMO plans are designed to save you money on out-of-pocket costs. In exchange, HMO members are required to choose a primary care provider (PCP) and stay within a network of providers, urgent cares, and hospitals to receive coverage under the plan.
To have a specialist visit covered, you must see your primary care provider (PCP) for an initial exam. Then he/she will give you a referral to a specialist for a more thorough diagnosis, if needed.
POS plans are designed to offer the most flexibility. This means you get the choice of how you want to use your plan based on three tiers:
Tier I (HMO): You can visit your PCP to receive an initial exam and a referral to a specialist for a more thorough diagnosis. This option provides the most coverage for the least out-of-pocket cost.
Tier II (PPO): You can bypass your PCP to see a specialist or a doctor in network, but you share more of the cost. This may include copayments or coinsurance for office visits, coinsurance for other covered services and a deductible. This tier also has a preferred provider network.
Tier III (Out of Network): This option allows you to visit any licensed health care provider or hospital. However, you're responsible for paying all costs for care at the time of service, filing claim forms for reimbursement, meeting a deductible, and sharing higher coinsurance.
If you don't select a PCP, we'll match you with a doctor in your service area. You can change your PCP at any time. Simply sign in to the online member center. First time users will have to create an account.
Your PCP will take care of most of your health care needs. Visit your PCP for routine care, yearly checkups and other general health concerns. Each member covered under your plan can select his/her own PCP, or you may all choose the same one. You may also pick a pediatrician for your child. Females over the age of 14 may select an OB/GYN in addition to a PCP.
Save money when you stay within our network. If you see a doctor outside of the Health Plan of Nevada HMO network, it will cost you more. Ask your doctor to use a network lab for any tests or diagnostic imaging services, such as X-rays, MRIs and CT scans.