Private Health Insurance
When an individual or family shops and selects their own health insurance policy, whether the coverage has a Government subsidy or not, this is a private health insurance plan. A major medical plan will cover your medical bills, hospitals, surgery, doctors, labs, prescriptions, mental health, maternity, preventative visits, etc.
If your plan pays only a certain dollar amount, like $1,000 for emergency room, it may be a “limited liability” health coverage plan. This is NOT a qualified health plan. A major medical plan will cover all the above-mentioned items and more, without a cap. You will have a “maximum out of pocket” limit, which means, once you meet your out of pocket max, the insurance company will pay for everything else up to no limits.
It’s wise to request the help of a licensed health insurance agent/broker so they can explain how the plan works. Brokers/agents are free to the individual, because the insurance company pays them to assist you. Currently, all (ACA compliant) private health insurance plans whether they have a Government subsidy or not, may not “underwrite” you (they can’t look at your health history, height and weight, etc.) before they enroll you. Other plans that are not (ACA compliant) can underwrite you based on your health history, height and weight, etc., like “short term” health insurance plans can. These plans generally will not cover free preventative, mental health, maternity, and the prescription plans they offer may be limited.
Group Health Insurance
Group insurance is something you become eligible for with employment, either through your employer or a spouses or parents employer. Your employer will pay a percentage of your premiums for you, and sometimes they’ll help pay for spouse and dependents, but they are not required to do that. The group insurance plan, however, has to offer it to the spouse and dependents, but isn’t required to pay for them. They may offer to do so, but are not required to.
An employer can offer 1 plan or several plans, and sometimes they’ll offer a group dental and vision plan too. The employer selects the plan they offer the group, not the employees. Once a year the insurance will renew the policy, and the group will have “Open Enrollment” for their employees which will happen 1 month before the group insurance plan renews. This is a critical time for the employee to make decisions whether they want to participate in the group insurance or not. If the employee misses out, they may not have insurance until the next “Open Enrollment” for the group. If the employee misses their open enrollment period at work, they can opt to enroll into a private insurance plan in Nevada. Luckily, in Nevada, we currently can enroll year-round. If you don’t have a “life event” like losing your coverage through an employer, moving to Nevada, getting a divorce, etc., you may have a 90+ day waiting period before your insurance plan begins.