Nevada Individual Open Enrollment

When looking at plans and rates, your monthly premiums will be determined by the following:

• The plan you want to enroll in
• Your age
• The ages of your enrolling dependents
• The county of your home address

HMO is an abbreviation for Health Maintenance Organization. PPO is an abbreviation for Preferred Provider Organization. Even though these terms are both acronyms, their coverages are very different! The main differences when enrolling in an HMO Plan:

• HMO plans require you to establish a Primary Care Physician from their doctors list.
• HMO plans require you to receive a referral from your Primary Care Physician before seeing a Specialist.
• There are no out-of-network benefits on HMO plans; however, out of network benefits on a PPO are nothing to brag about either.

PPO plans will give you access to more doctors which will decrease wait times when trying to use the policy. You will also avoid the referral requirement on a PPO plan which will give you direct access to specialists whenever you need to see one. Simply put, a PPO plan will give you more flexibility and freedom when receiving health care. Because of this extra coverage, PPO plans usually cost about 15% more in monthly premiums.

Some plans are HSA Compatible, but what does that mean? HSA Plans meet very specific requirements set by the government and allow you to contribute money from your employer, pretax, into a Health Savings Accounts. These funds remain tax-free as long as they are used to pay for approved medical expenses. Unfortunately, premiums are not eligible to be paid from your HSA savings account. To learn more about HSA’s click here.

In general, you cannot switch plans mid-year unless you experience a Qualifying Life Event. Qualifying Life Events grant you a Special Enrollment Period so you can get coverage outside of open enrollment. Be careful, these Special Enrollment Periods do not last forever and usually expire after 60 days! To learn more, click here.

Here at Health Benefits Associates, we do not charge fees. As a full service brokerage, we will help you with shopping for plans, enrolling in coverage, claim and benefit questions throughout the year, and the renewal. Best of all, the price you pay for your insurance plan is the exact same. There is no surcharge to use our services! Other brokers in Nevada charge fees and may only help with the initial enrollment. To learn more about our team and what we can do for you, click here.

Some plans may include pediatric dental and vision. Pediatric dental and vision coverages can be used by people under the age of 19. For people over 19, dental and vision coverage is not included in a major medical plan. These policies can be purchased separately. To learn more about dental coverage, click here. To learn more about vision coverage, click here.

Since 2014, major medical plans are required to cover preexisting conditions. Also, applications cannot ask health questions. Many people get solicited by fake insurance companies. One of the easiest ways to tell if you are shopping for a major medical plan is whether or not health questions are included on the application! Our brokers recommend major medical plans, as they include comprehensive coverage for all of your medical needs! To learn more about what is included in major medical plans, click here.

Long wait times are sometimes unavoidable. To make sure you have the shortest wait times it is important to make sure your health plan reimburses providers correctly. Some insurance companies reimburse doctors less compared to others. The insurance companies that pay doctors more usually have larger network lists and shorter wait times. It is very hard to determine which insurance companies pay doctors the most unless you’ve received the volume of feedback we have from our clients. Our brokers can help you understand which carriers to look for while shopping. To learn more, contact us today!

You can start a group health plan at any time throughout the year! There are many advantages to starting group health plans including lower premiums, larger network lists, and the ability to pay premiums pretax! The main requirements to qualify for a small group plan are:

• You need a minimum of 2 enrolled employees (if you enroll with only 2 employees on the plan, the 2 employees cannot be married or domestic partners).
• You must offer the plan to all full time eligible employees. NRS Code defines full time as a minimum of 30 hours per week or 130 hours per month. 1099 employees are not eligible for coverage in most circumstances.
• As an employer, you must contribute at least 50% of the premium for every employee enrolled on the plan.
• Most insurance carriers will require you to enroll a minimum of 50% – 75% of the uninsured full time employees in your business.
• When you enroll, you will need to prove that you are a legitimate business with full time employees on payroll. Insurance carriers will request us to submit a Quarterly Wage Report to prove eligibility.

If you think you qualify for a group health plan or if you have any questions, please let us know!