Individual and Family Plans
Enrollment in and induvial and Family plan can only occur either during the Open Enrollment Period or if you have experienced a Qualifying Life Event.
Open enrollment runs from 11/1 to 12/15 each year. This is the period when you can enroll in QHP - Qualified Health Plan. Plans are effective the following January 1st.
Qualifying Life Events
Outside of the Open Enrollment period an individual will only be able to apply for coverage if they have experienced a qualifying life event (QLE) resulting in the loss of minimum essential coverage (please note voluntarily terminating any health plan will not be considered a loss of MEC), birth, marriage, divorce, permanent relocation, etc.
You will have 60-days from the QLE to apply for coverage. Proof of your QLE will be required upon submittal of an application.
In order to be considered minimum essential coverage, all health plans, regardless of price, insurance company, or metal tier, cover ten essential health benefits.
- Ambulatory patient services (outpatient services)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
How much of these benefits they cover depends on your plan’s actuarial value or the percentage of total average costs for covered benefits your health insurance plan will pay for.
A tax credit you can take in advance to lower your monthly health insurance payment (or “premium”). When you apply for coverage in the Health Insurance Marketplace (in Nevada this is the Health Exchange), you estimate your expected income for the year. If you qualify for a premium tax credit based on your estimate, you can use any amount of the credit in advance to lower your premium. Think of it as an income based plan to help you pay your premiums.
With our help we can guide you through the process of applying through the Silver State Health Exchange (nevadahealthlink.com) The Exchange will use your household and income information to determine how much of an APTC you qualify for. The APTC is paid directly to the insurance company and applied towards your monthly premium. You experience a lower premium, sometimes even paying no premium for your QHP.