Looking for an Individual & Family Health Insurance Plan but have questions about where to start? Here are some common questions asked about Individual & Family Plans to help you better understand then and help begin your enrollment process.
Q: Can I enroll mid-year if I do not have a Qualifying Life Event?
A: No. If a new enrollee does not have a Qualifying Life Event within the last 60 days they are not able to enroll until the designated open enrollment period, November 1 – December 15.
Q: How do I enroll?
A: If you are working with an insurance broker, they can assist you with enrollment. If not, go to our Individual & Family page where you can get a health insurance quote, compare plans, and find more information. Either way you enroll, you will be asked to create a My Benefits account to complete the enrollment process.
Q: What is a Qualifying Life Event (QLE) and how does that determine when I can enroll?
A: Qualifying Life Events include:
- Involuntary loss of coverage
- Failure to pay premiums that result in a loss of coverage is not considered involuntary
- Permanent legal guardianship of a child
- Move to the geographic service area
When you experience a Qualifying Life Event, the deadline to enroll is the 15th of the month prior to the effective date OR within 60 days of the Qualifying Life Event.
Q: When is payment due for Individual and Family Policies?
A: Payment is due on the 1st of each month with a 30-day grace period.
Q: When I am enrolled with I be able to change plans?
A: Yes, at annual open enrollment (November 1-December 15). Plan changes will be effective on January 1.
Q: If I want to keep my plan, can I?
A: Each year we make adjustments to your plan (premium and benefits). During the open enrollment period (November 1-December 15) you will have the opportunity to change your plan. If you do nothing, your plan will be mapped to the closest plan for the next calendar year.
Q: Who can I call if I have questions?
A: If you work with an insurance broker, we recommend contacting him/her OR you can contact our Customer Service Department 7 days a week from 7 a.m. to 8 p.m. at 775-982-3232.
Individual & Family Plan Facts
Enrolling a New Individual and Family Plan (IFP) Member
- When brokers are working with a client they need to send them the link to view the quotes and enroll from their eQuote portal. This is the only way that we will know the broker should be tied to that member.
- There is also a link that is located on their IFP page too but we have to go in manually and make them the broker. This is done on a monthly basis.
- Members enroll online and receive ALL communication via email. (i.e. payment due & payment reminder, problems with credit cards). No paper bills are generated
- Credit card or debit card with credit feature are accepted for payment or a personal check.
- When enrolling a family on separate plans they cannot share an email address to create their My Benefits Account. There must be a unique email address for each policy. Make sure this is an email that the client will check every month as this is how we correspond with the member.
- When enrolling for a Qualifying Life Event the member must be enrolled and paid no later than the 15th of the month prior to their effective date. (i.e. 3/1/2019 effective date, enrollment and payment must be entered by 2/15/2019). Cannot back date enrollment (unless it’s a newborn or a subscriber that is enrolled with dependents drops coverage and dependents are enrolling with their own policy).
- HMO vs PPO. (HMO only available in N. Nevada) HMO uses a provider network that requires the member to choose a Renown Health Medical Group PCP. There is a few in the Carson City area. HMO also requires the member to see their PCP for specialist care or lab work.
PPO Network does not have a National Provider directory they can use out-of-state. If member goes out of network they are subject to out-of-network rates and the out-of-network deductible and out of pocket max is separate from the in-network deductible and out of pocket max. Out of network is also subject to the member being balance billed for anything the plan doesn’t pay towards the provider’s charges. PHCS Healthy Directions is the network IFP would use outside of Nevada for an emergency or urgent care.
After the Member is sold
- Brokers have access on their portal to terminate policies and add dependents
- To terminate a policy it must be received by the 20th of the month prior to the effective date of the policy. (i.e. Member wants to terminate the policy as of 3/1/2019, member must log in and submit the request no later than 2/20/2019, otherwise the policy would terminate 3/31/2019).
- Brokers can view from their portal if the payment has been received and if the member has setup automatic payment or manual by clicking on their client’s file in Equote and clicking on the Payment Info tab.
- Members will not receive a welcome packet, only their ID card in the mail. All of their documents are available via MyChart. Which is what they registered for when they entered a username and password during enrollment.
- We require a BOR letter from the member to change their broker.
- If a member terms before the Effective date they may receive a refund. The broker should email Enrollment to inform them of such termination so the refund is timely. It takes up to 10 business days to process a refund. The refunded amount will be placed on the credit card that was used. Email for Enrollment is firstname.lastname@example.org
- If a member wants to change plans before their effective date the Broker can do this in eQuote by clicking on the member’s file and click on Status Change. There you will find categories to change plan/add spouse or dependent or terminate the coverage. If the new plan costs more the credit card on file will be charged the difference the next business day. If the plan costs less than the previously chosen plan, the difference will be applied to the next month’s premium.
- Plan changes are not allowed mid-year