Health Maintenance Organizations expand benefits for enrollees under new legislation

Nevada's Assembly Bill 522, introduced on March 24, 2025, aims to enhance healthcare access for children and young adults by mandating specific preventive services and protections within health maintenance organizations (HMOs). The bill focuses on ensuring that enrollees under 18 years of age receive essential health benefits without facing financial barriers or discrimination based on their health needs.

Key provisions of AB522 include the requirement for HMOs to provide oral fluoride supplements for young children in areas with insufficient fluoride in drinking water, counseling on minimizing ultraviolet radiation exposure for fair-skinned individuals under 25, and behavioral interventions to prevent tobacco use among minors. Additionally, the bill mandates screenings for amblyopia in preschool-aged children and other health screenings as recommended by the Health Resources and Services Administration.

A significant aspect of the bill is its protective measures against potential discrimination by HMOs. It prohibits these organizations from imposing higher deductibles, copayments, or longer waiting periods for the mandated benefits. Furthermore, HMOs cannot refuse coverage or penalize healthcare providers for offering these essential services, ensuring that children and young adults have equitable access to necessary healthcare.

The introduction of AB522 has sparked discussions among lawmakers and healthcare advocates. Supporters argue that the bill addresses critical public health issues, particularly in preventing conditions like skin cancer and tobacco addiction among youth. Critics, however, express concerns about the financial implications for HMOs and the potential for increased healthcare costs.

The implications of AB522 are far-reaching. By prioritizing preventive care and safeguarding access to essential health services, the bill aims to improve health outcomes for Nevada's youth, potentially reducing long-term healthcare costs associated with untreated conditions. As the legislative process unfolds, stakeholders will be closely monitoring the bill's progress and its potential impact on the state's healthcare landscape.