In 2014 the Affordable Care Act changed how we enroll in health insurance. They no longer base rates on health history. Instead, they now base the rates on your zip code and age. Health history makes no difference. This created a problem. How would you prevent someone from enrolling only when they needed to use the insurance? This would be similar to only buying auto insurance after a car wreck. Or only buying homeowners insurance after your house burnt down. If people only buy health insurance when they’re sick, the monthly cost for everyone would be unbelievably high. Their answer is a Qualified Life Event.
Another part of the Affordable Care Act is the removal of the pre-existing condition exclusion. Insurance cannot increase the rate or deny a plan for a pre-existing condition. They can’t even ask about it.
Therefore this creates the ultimate problem. How do you enroll people who aren’t just buying it for a specific sickness, without excluding people with pre-existing conditions? Their answer is annual Open Enrollment and waiting periods.
This applies to health insurance plans in Nevada. Both major medical health insurance plans and health insurance small business plans.
Open Enrollment
Between November 1st and December 15th is the annual Open Enrollment period. During this time anyone can purchase insurance.* All plans bought during this time start on January 1st. Current members can change insurance companies or insurance plans. Furthermore, this is the time to add and delete family members. In many states, this is the only time these changes can be made (with the exception of Qualified Life Events).
Waiting Periods
In Nevada, you can apply for insurance at any time. If you apply outside of Open Enrollment the insurance company applies a 90 day waiting period. The insurance starts on the first of the following month. For example, for applications submitted in August, without a life event, they would start December 1st.
Exceptions to the Waiting Period (Qualified Life Events)
Specific situations, or “life events” allow you to start insurance the month after applying. This is regardless if you’re in Open Enrollment or not. These are Qualified Life Events. These are things such as getting married, having a baby, getting a divorce, losing coverage through a job and others. In general, if the change involved a loss of insurance, and you didn’t voluntarily terminate the insurance, it’s a Qualified Life Event.
Examples
If you wanted to add your child to your plan, they may ask you for a recent (within 60 days):
- Court order
- Qualified Medical Child Support Order
- Adoption Papers
- Birth Certificate
To prove a move as a life event you could provide a recent (within 60 days)
- Utility bills: Old and new bills for power, sewer or water.
- Drivers license: Old and new
- Mortgage docs: Old and new
To start coverage for yourself, they may ask you for a recent (within 60 days)
- Marriage Certificate
- Notice of Creditable Coverage from a former employer
- New Social Security Number (new citizens)
In general, the insurance company is trying to discover why the person is suddenly uninsured? Getting insurance because you just broke your arm is not a Qualified Life Event. Neither is getting insurance for your child because they have football that requires it. You can still purchase insurance, but the 90 day waiting period would apply.
Please contact us if you have questions about your specific situation.
*There are conditions to applying. You must be a legal resident, you must pay for your plan and so on.
