In most situations, health insurance plans purchased before the 15th of the month will have an effective date starting the first day of the following month. For plans bought after the 15th of the month, the effective date will be the first day of the month following the next whole month.
Example 1: If you purchase a health plan on December 15, your new plan will become effective starting January 1.
Example 2: If you purchase a health plan on December 16, your new plan will become effective starting February 1.
Essential health benefits include:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization
- Maternity and newborn care (care before and after your baby is born)
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including dental and vision care
All of these benefits are included in plans sold on the Exchange.
A Qualifying Life Event (QLE) is an event in life that opens the door to make changes or add a health insurance plan outside of the regular Open Enrollment period. Events that trigger this are:
- Loss of eligibility for other coverage (for example if you quit your job or were laid off or if your hours were reduced, or if you lose student health coverage when you graduate) Note that loss of eligibility for other coverage because you didn’t pay premiums does not trigger a special enrollment opportunity
- Gaining a dependent (for example, if you get married or give birth to or adopt a child). Note that pregnancy does NOT trigger a special enrollment opportunity.
- Loss of coverage due to divorce or legal separation
- Loss of dependent status (for example, “aging off” a parents’ plan when you turn 26)
- Moving to another state or within a state if you move outside of your health plan service area
- Exhaustion of COBRA coverage
- Losing eligibility for Medicaid or the Children’s Health Insurance Program
- For people enrolled in a Marketplace plan, income increases or decreases enough to change your eligibility for subsidies
- Change in immigration status
- Enrollment or eligibility error made by the Marketplace or another government agency or somebody, such as an assister, acting on their behalf.
Note that some events only qualify you for a Special Enrollment Period on the Exchange and not in the open market, such as a change in immigration status.
A Special Enrollment Period is a 60 day window following certain life events that allow you to change or add health insurance coverage without the 90 day waiting period. This can be triggered by a Qualifying Life Event (QLE) such as a birth, death, marriage, or divorce, among other things. Special Enrollment Periods for employer sponsored plans are required to last for only 30 days.
Open Enrollment is a time during the year, usually between November 1 and January 31, in which individuals and families can apply for or change their existing health insurance coverage. This is for plans offered both on and off the Exchange. Outside of Open Enrollment, you are limited to a 90 day waiting period if you want to change your existing coverage unless you qualify for a special enrollment period.
Typically, you are only allowed to change or buy new insurance during open enrollment or a special enrollment period. In the state of Nevada, you can buy or change your insurance at any time if you are willing to wait 90 days for your coverage to take effect. While it is not recommended to change your insurance often, certain situations may offer worthwhile reasons to make a change to your existing coverage.
The Federal Exchange, also known as the Health Insurance Marketplace, is where individuals, families, and businesses can go to shop for a health insurance plan. The Exchange is the only place you can purchase a plan and receive a subsidy to offset your monthly premium payments through the Advance Premium Tax Credit (APTC). Individuals and families with very low incomes will also be able to find out at the Exchange if they are eligible for coverage through CHIP and Medicaid.