A Few Terms to Know

Before you apply for coverage, it is good to have a basic vocabulary and general knowledge of health insurance. This way you can make good decisions about plans and providers. Some of the terms you will see written out and some you will find as acronyms or abbreviations. There are so many words, but some are much more common and more crucial to the insurance purchasing process or consumer needs. There are specific laws and guidelines between states, so Nevada will have additional terms related to their specific laws or legislation, as other states will have their own terms. Most health insurance terms, however, are broad and universal.

An Affiliation Period is like a waiting period. It is why, in many cases, people need COBRA or conversion policies. This is the amount of time an HMO can make you wait before giving you coverage. Even if you have been accepted and you have a plan, it may not start covering you right away. During the affilitation period you are not charged premiums, and you cannot be given an exclusion period for pre-existing conditions.

COBRA is short for the Consolidated Omnibus Budget Reconciliation Act of 1986. It is a regulation that says you may keep the insurance of your employer even after you lose or quit your job. If it is a large employer with more than 20 employees, you may be able to get COBRA continuation coverage which is available to your family members and can last 18 to 36 months, based on number of dependents and other factors.

Continuous Coverage is a term to describe ongoing health insurance. Usually, if you go without insurance for more than 63 days in a row, you no longer have continuous coverage. In Nevada, you can be without insurance for up to 90 days and still have continuous coverage. HMO affiliation periods as mentioned above are not included in the calculation of days without insurance.

Conversion is a term that means you are changing from one plan to another. In Nevada, it is required by law that group insurers must offer conversion policies to members of the group plan. This means that if you leave your job and your group plan ends, you are able to enroll for individual health coverage. You must be under the group plan for 3 months for this to apply, and you can use the conversion policy simultaneously with COBRA if you so choose.

Creditable coverage is insurance coverage under one of many different assistance programs or alternative insurance providers, and means you can apply it like regular insurance to your healthcare needs.

An Elimination Rider is an amendment that says you may be permanently denied coverage for a specific health condition, even if you are covered for all other healthcare under an individual plan. This only applies to individual plans.

The Enrollment Period is the time when employees and their dependents can sign up for the group plan. Most employers will do this once each year, for new employers to sign up and old ones to change or renew coverage.