Nevada is rolling the dice on adverse selection. Since January, insurers that sell individual health plans off the state’s public exchange are now required to offer those options year round. However, a 90-day waiting period can be imposed to discourage people from waiting until they get sick or are in desperate need of immediate care to buy a plan.

“No other state allows this, but I think it is a good thing,” says Vickie Mayville, president of the Nevada State Association of Health Underwriters and owner/broker at Mayville Incorporated Health Insurance Agency in the Las Vegas area. She surmises that some states may attempt to follow Nevada’s lead.

Nevada Assembly Bill 425 passed in 2013 with assistance from the Nevada Division of Insurance, which recognized that some consumers may need or want to buy health insurance off the exchange without having had a special qualifying event.

Also see: Critical Checkpoint Approaches for HIX Fix in Massachusetts

It primarily affects fully funded employers that might be considering moving employees to a public exchange, or individuals who are mulling over a change in their coverage or are uninsured, according to Terri Lightfoot, executive director and CEO of the Nevada Business Group on Health, a self-funded employer purchasing cooperative.

From a consumer perspective, she believes the legislation “creates the opportunity for employees who might lose coverage through their employer to research and purchase their benefits through the exchange at a competitive price – whether they need to make that decision today, next month or next year.”

Lightfoot urges Nevada businesses to examine all of their coverage options, adding: “In this time of uncertainty, it is important that employers voice their needs, learn about their options and feel empowered to make the best choices for their most valuable asset – their employees.”

Might the idea of year-round enrollment off the exchanges catch on elsewhere in the U.S.?

Sabrina Corlette, project director at the Georgetown University Center on Health Insurance Reforms, recently told Kaiser Health News: “The assumption is that no insurance company would do that because they’d just open themselves up to too much adverse selection.”

eHealthInsurance has reported that few of the more than 180 insurance carriers that are part of the national online insurance broker’s off-exchange enrollments would accept new applications after the deadline for HIX signups. These flexible arrangements were confined to just 14 states and mostly involved the final two weeks of April. 

Mindful of’s rocky rollout, the March 31 HIX enrollment deadline was extended through April 15 for consumers who would sign up for coverage in the 36 states where it operates federally facilitated exchanges. Many state-run exchanges followed suit for plans offered both on and off the exchanges, with America’s Health Insurance Plans suggesting that any extension be limited to a defined period of time.

In a related development, some state-run HIXs such as Covered California extended a special enrollment period for COBRA-eligible individuals through July – embracing the spirit of a recent U.S. Department of Health and Human Services initiative.

Shutan is a Los Angeles freelance writer.


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