Can I use my health insurance as soon as I get it?

A lot of people that enroll in a health insurance plan have this question. As soon as a person completes the enrolment and pays the premium, s/he should be covered right away. Not really! The date when your health insurance coverage starts paying for your medical expenses is called your plan’s effective date. Not always, this date isn’t the date of your enrollment. The effective date depends on when you buy your health insurance—the first half of the month or the second half! The article will discuss your plan’s coverage commencement date in detail and cover some more relevant aspects as well.

How does coverage start date or the effective date works?

In most states, if you enroll in a plan during an open enrolment period within the first fifteen days of the month (b/w 1st and 15th or the first half of the month) and you pay the required premium by the due date, your plan coverage or effective date would be the first day of the next month.    

Similarly, if you buy a plan in the second half of the month (b/w 16th to the end of the month), your coverage will start from the first day of the month after the next month, which means the second following month. 

Let’s understand this with an example. Assume that you buy your plan on Jan 10, 2022, your coverage will start from Feb 1, 2022, since you purchased your plan in the first half of the month. However, if you enroll in a plan on March 17, 2022, your coverage will start from May 1, 2022. 

The calculation remains the same even if you qualify for a special enrolment period outside of open enrolment. However, you can buy a health insurance plan even after an open enrollment period ends if you have a qualifying event such as moving to another state or a divorce. 

So, you do not get any coverage within 30 to 90 days of purchase of your health insurance plan in case of any type of hospitalization. This is called the initial waiting period and it may vary from insurer to insurer. Usually, this waiting period is a minimum of 30 days. This waiting period is removed only in accidental cases. 

Exceptions in coverage date

Yes, there are exceptions in effective dates too! 

• First exception: If you have a newborn baby either by birth or adoption, your plan’s effective date would be the first day of the month following the date of birth of your baby or the first day of the month following the date of the child’s adoption or legal guardianship.
• Second exception: If you have switched your insurance plan because you lost your job or you got married, your health insurance company will provide coverage from the first day of the next month, regardless of the day of your sign-up.  

What you need to know?

If you wish to start getting coverage at the earliest, ensure buying your health insurance plan in the first half of the month (as explained earlier). Remember the following: 

• To kick-start, your insurance benefits, complete your enrolment, and pay your first month’s premium
• Call your insurance company to know the exact effective date. It will clear out all your confusion regarding your coverage and you would know that everything is in order. 

It’s always a good idea to know all the details of your health insurance plan. Either go through all the plan documents or directly call your insurer to understand all the coverage-related details.