Important information about your plan and your benefits

On this page, you will find detailed information about your rights and responsibilities as a member and what to expect from the Nevada Health CO-OP (NHC). You can also download a copy of member information by clicking here. Click on the titles below for more information.

Member Rights and Responsibilities Statement

The Nevada Health CO-OP respects the rights and supports the responsibilities of its members. The CO-OP has a Member Rights and Responsibilities statement explaining our commitment to you, what to expect from your healthcare services and how you can participate in your healthcare. Working as an active partner with your healthcare provider, we will help you to receive the most from your benefits.

You have the right to:

  • Receive information about the NHC, its services, practitioners and providers and Member Rights and Responsibilities.
  • Be treated with respect at all times and under all circumstances. We recognize your need for privacy and will respect this need at all times.
  • Participate with practitioners in making decisions about your healthcare.
  • Discuss medically necessary treatment options for your conditions regardless of cost or benefit coverage.
  • Voice complaints about the care provided or make appeals to the NHC.
  • Make recommendations regarding the NHC’s Member Rights and Responsibilities policies.

You have a responsibility to:

  • Provide accurate and complete information about present complaints, past illnesses, hospitalizations, medications and other matters relating to your health that the NHC and its practitioners and providers require in order to care for you.
  • Follow the plans and instructions for care that have been provided by your practitioners.
  • Participate in understanding your health conditions and participate in developing treatment goals, where necessary.

If you would like copies of our Member Rights and Responsibilities statement, please contact the CO-OP Care Crew at 702-823-2667 or toll-free at 855-606-2667.

Language Assistance

We have CO-OP Care Crew members that speak more than one language. If our CO-OP Care Crew members can’t speak your preferred language, you can use our language line to assist when you call. Make sure when you, that you ask to speak with someone in your preferred language. This language service is available at no cost to you for any information about your benefits, our plans and services and our Utilization Management program.

Evaluating Advances in Medical Care

The Nevada Health CO-OP has created the New Technology Committee to review new or alternate procedures, medications, treatments and devices. Our providers and members can ask us to cover something new by submitting a written request to the Chief Medical Officer at:

Nevada Health CO-OP
c/o Chief Medical Officer
3900 Meadows Lane, Suite 214
Las Vegas, Nevada 89107

When we receive a request, the New Technology Committee conducts a thorough investigation of the procedure, medication, treatment or device. The committee will research current medical literature and practices and discuss the findings. The committee will then make a decision about coverage before sending you a letter telling you about their decision regarding coverage.

Submitting a Claim for Covered Services

When you receive covered services from providers in our network, you will be asked to pay the co-payments and deductibles. If you receive a bill for covered services or if you have questions about a bill, please send it to us at:

Nevada Health CO-OP
c/o Claims Department
3900 Meadows Lane, Suite 214
Las Vegas, Nevada 89107

Or call our CO-OP Care Crew at 702-823-2667 or toll-free at 855-606-2667.

Qualifications of Practitioners

A practitioner includes:

  • General Practitioner
  • Specialist
  • Family Medicine Practitioner
  • Internal Medicine Specialist
  • Pediatrician
  • Obstetrician/Gynecologist
  • Physician Assistant
  • Nurse Practitioner

Our online searchable provider directory includes information about these practitioners, which includes the name, address, telephone number and specialty of each practitioner in our network. The CO-OP Healthcare Delivery Department can tell you the medical school attended, the residency completed and the board certification status of any of our primary care practitioners and specialists.

If you would like more information about the professional qualifications of our practitioners, please call the Healthcare Delivery Department at 702-823-2667 or toll-free at 855-606-2667.

Primary Care Service

When you enroll with the Nevada Health CO-OP, you can select a Primary Care Practitioner (PCP) from our network of participating providers. A PCP could be:

  • General Practitioner
  • Family Medicine Practitioner
  • Internal Medicine Specialist
  • Pediatrician
  • Obstetrician/Gynecologist
  • Physician Assistant
  • Nurse Practitioner

You can use the online searchable provider directory to find a PCP. The directory tells you information about our PCPs including their addresses and specialty.

Treatment from a Specialist

If you have health problems that need special care, you may need to see a specialist. Specialists and other types of care (such as home healthcare and medical equipment) may need to be referred by your PCP. If you need to see a specialist, you can use the online searchable provider directory.

If you need more information or need helping finding a Primary Care Practitioner (PCP) or a specialist, call the CO-OP Care Crew at 702-823-2667 or toll-free at 855-606-2667.

Behavioral Health Care Services and/or Substance Use Services

If you need mental health or chemical dependency services, you can talk with your PCP or contact Harmony Healthcare, our behavioral health provider toll-free at 855-371-5758. Harmony Healthcare will help you find a practitioner or a facility to meet your needs.

Non Emergent Care after Doctor’s Regular Office Hours

If you need care after normal doctor’s office hours, you can use a contracted urgent care clinic. You can find a list of our contracted urgent care clinics by using our online searchable provider directory.

Telehealth Services are offered through MDLIVE

Nevada Health CO-OP will no longer be offering telehealth services effective October 1, 2015. We apologize for the inconvenience. As you may be aware, the Nevada Health CO-OP will cease operations at the end of 2015 and will not offer coverage in 2016. This change in telehealth services comes as a result of our rehabilitation and conservation efforts through the end of the year. As a CO-OP member you are still entitled to receive health care services in person from participating providers under the terms of your policy. Please contact your primary care doctor or other health care provider if you need medical assistance. Our customer service department is available at 855-606-2667 between 8am and 5pm if you need help in finding a provider or have other questions.

Emergency Care

If you believe your medical or mental condition requires emergency care, call 911 or go to the emergency room. The Nevada Health CO-OP pays for emergency care and services according to your plan benefits. Please provide the emergency room with your Nevada Health CO-OP I.D. card as soon as you are able.

Emergency Room use should be used for emergencies ONLY. If you need help deciding if you should go to the emergency room, please contact us at 702-823- 2667 or toll-free 855-606-2667 and we can help you make that decision.

For NON-emergencies, you can save time and out-of-pocket costs and go to your primary care doctor or urgent care facility for a co-pay fee. Check your plan benefits for primary care doctor and urgent care facility co-pay fees.

Provider care Outside of the Nevada Health CO-OP Network

If you use a provider that is not in our NHC network, keep in mind that you will have to pay more out-of-pocket fees. Make sure you review your plan benefits to determine your out-of-pocket costs. If you have questions, please call the CO-OP Care Crew at 702-823- 2667 or toll-free 855-606-2667.

Care Outside of Your Home Area

If you are out of the Nevada Health CO-OP service area and need emergency care, go to the nearest hospital or call 911. Please provide the emergency room with your Nevada Health CO-OP I.D. card as soon as you are able. We will pay for emergency services and urgent care services per your plan benefits. Please send us copies of all of your receipts including the hospital information to the following address:

Nevada Health CO-OP
c/o Claims Department
3900 Meadows Lane, Suite 214
Las Vegas, Nevada 89107

If you have questions about obtaining care outside of the Nevada Health CO-OP service area, please call the CO-OP Care Crew at 702-823-2667 or toll-free at 855-606-2667 or refer to your Evidence of Coverage (EOC).