Prior Authorization

by | June 26, 2023

Prior Authorization You or your provider (doctor) get pre-approval from the insurance company before receiving, or planning to receive, any non-emergency healthcare services, in order for those services to be considered covered services. Essentially you are getting...

Providers

by | June 26, 2023

Providers Any Ambulatory Surgical Facilities, Dentists, Hospitals, Physicians, Skilled Nursing Facilities, Practitioners, Urgent Care Centers, Surgical or Prescription Fulfillment Service, Medical Supplies or Devices, any other person or licensed entity by the State...

Prescription Drug Formulary

by | June 23, 2023

Prescription Drug Formulary Prescription Drug List A drug formulary is a list of the prescription drugs that your health insurance company has agreed to cover so that when you fill your prescription, you don’t pay the full price of the medication. In most cases,...

Network

by | June 23, 2023

Network A Network is a group of providers which could be hospitals, doctors, labs, radiology centers, urgent care’s, etc., that have contracted with an insurance company on many things including pricing. So having a large network, of many choices for “providers” to...

Open Enrollment

by | June 23, 2023

Open Enrollment Each year, you can only buy Health Insurance during “Open Enrollment” which is November 1st through January 15th, unless you have a “Life Event” ie. Marriage, Divorce, Relocation, Birth,...

Qualified Health Insurance

by | June 23, 2023

Qualified Health Insurance All major medical plans that will be sold from 1/1/2014 and on that sell on or off the “Exchange” (Marketplace) and the “SHOP Exchange” or in the private marketplace must comply with all the rules and regulations in order to be a “Qualified...

Health Insurance Subsidy Cliff

by | May 30, 2023

Health Insurance Subsidy Cliff No More Subsidy Cliff for those making over 400% of the Federal Poverty Level. For the first time, many Nevadan’s (those making over 400% of the Federal Poverty Level), may now be eligible for a health insurance subsidy! Plus, for...

On Exchange

by | May 29, 2023

On Exchange Depending on your household income, you may or may not qualify for financial assistance in paying for your health insurance plan. If you qualify for a Government subsidy to help pay for your health insurance, you’ll need to shop “On Exchange” – the...

Modified Adjusted Gross Income (MAGI)

by | May 29, 2023

How To Figure Your MAGI Modified Adjusted Gross Income ​ Calculating “INCOME” When you apply for a “Subsidy” you’ll need to estimate your income (before taxes) for the year in which you’re applying for insurance. If you are not sure, you’ll have to make your best...