New Baby

Mary is a current Iowa CoOportunity Health member and has a baby on April 24. When is baby Evan eligible for coverage?

Baby Evan is eligible for coverage on April 24, the day he was born. Mary will need to pay a prorated amount based on Baby Evan's date of birth and the number of days left in his birth month for the first month.

Mary has 60 days to enroll Evan. Since Evan will have claims right away, however, it is best if Mary gets coverage for Evan right away to ensure the claims get paid promptly.

In Nebraska, a state mandate requires carriers to allow the first 31 days free for a newborn. Any days left after the 31 days are prorated until a full month is due.

Adoption

Steve and Megan are Nebraska CoOportunity Health members and adopt a child, Olivia, on May 5. When is Olivia eligible for coverage?

Olivia is eligible for coverage on May 5, the date of her adoption. In Nebraska, a state mandate requires carriers to allow the first 31 days free for a newborn or adopted child, which takes them through June 4. June 5 through June 30 will be prorated. July is the first month in which a full month's premium is due.

Steve and Megan have 60 days to enroll Olivia in coverage. Even if they wait until June 20 to enroll Olivia, the coverage will be effective on May 5 since that is the date of the qualifying event.

Marriage

Jennifer and Jason get married June 21. Jennifer wants to add Jason to her contract. When is Jason eligible for coverage?

Jason is eligible for coverage on July 1, which is the first of the month following the date of the marriage. Jason has 60 days from June 21 to enroll. If Jason wants coverage on July 1, he must notify us by July 1. If Jason waits until August to enroll, his coverage will be effective starting September 1 since that is first of the month following notification or plan selection.

Loses Tax Credit Eligibility

Kate and Ben’s 2013 income qualified them to receive advanced premium tax credits to help them pay for their health insurance purchased on the Marketplace. Kate, who had been unemployed after being laid off, gets a new job in April. Her higher income makes the family ineligible for advanced premium tax credits. What are Kate and Ben’s options?

Kate and Ben can cancel their Marketplace coverage and purchase a new policy through CoOportunity Health by either working with a broker or directly from CoOportunity Health.

Kate and Ben have 60 days to make their change. Their new CoOportunity Health coverage would start on May 1, since the qualifying event occurred in April.

Moves

Tonya decides to pursue her dream of becoming a nurse and moves from Grand Island to Omaha to go back to school in August. What are Tonya’s options for getting coverage?

Tonya has 60 days from her move date to get coverage. Her effective date depends upon when she enrolls. If she enrolls between the 1st and the 15th of the month, coverage will be effective the first of the following month (i.e. applies Aug. 5; coverage starts Sept. 1). If she enrolls between the 16th and the end of the month, coverage will be effective the first of the subsequent month (i.e. applies Aug. 17; coverage starts Oct. 1).

Because the effective date varies, there could be a gap in coverage.

Loses Employer-based Coverage

Laura gets laid off from her job on June 13 and loses her employer-based health insurance on June 30. What are Laura’s options for getting health insurance?

Laura has 30 days from June 30 to enroll in an individual policy. She’ll need to provide her coverage cancellation letter as proof that she had insurance. Her effective date is July 1, the first of the month following the loss of her other coverage.

Turns 26, Loses Mom & Dad’s Coverage

Kevin celebrates his 26th birthday on May 26th and is no longer eligible for coverage under his Dad’s employer-based coverage after May 31st. What are Kevin’s options?

Kevin has 30 days from May 31 to enroll in an individual policy. His effective date is June 1, the first of the month following the loss of his other coverage.