HomeMust ReadWho Is Eligible For Health Insurance

Who Is Eligible For Health Insurance

Option : Work With An Agent Or Broker

Medicaid Eligible? | VA Health Care | Department of Veterans Affairs | theSITREP

An agent or broker can help you find a good policy for you because they have experience evaluating health insurance plans. The federal governments Find Local Help tool can help you locate a marketplace-trained private insurance broker. To learn about the greatest number of options and get the least-biased advice, you may want to work with a broker that sells both marketplace and non-marketplace plans.

Health insurance companies pay brokers when they sell policies. Consumers dont pay a fee to brokers, nor do they pay higher premiums to work with them. Agent usually means someone who only sells policies from one insurance company, while broker means someone who sells policies from multiple insurance companies.

Private insurance brokers may also show you options on private enrollment sites from insurance companies and web brokers. If you want to qualify for subsidies, however, you should apply through Healthcare.gov or your state exchange.

The governments health insurance navigators will only show you marketplace plans available through Healthcare.gov. All of these plans are eligible for subsidies, and a navigators help is free.

Q Are Internationally Adopted Children Exempt From The 3

Effective April 1, 2009, changes were made to Regulation 552 of the Health Insurance Act which provides an exemption from the three-month waiting period for Ontario health insurance coverage for children adopted internationally by Ontario residents.

Exemption from the Waiting Period for OHIP

  • A child under the age of 16, who is adopted outside of Canada by Ontario residents, will be exempt from the three-month waiting period for Ontario health insurance coverage if they meet the following 2 requirements:
    • The child has an OHIP-eligible citizenship/immigration status. OHIP-eligible citizenship/immigration statuses are listed in Regulation 552 of the Health Insurance Act more information can be found on this topic under the fact sheet OHIP Eligibility.
    • The adoptive parents can provide confirmation that they have received director approval, provided by the Ministry of Children and Youth Services, of their international adoption under Ontarios Intercountry Adoption Act.
  • A child under the age of 16, who will be placed for adoption in Ontario from another country, will be exempt from the three-month waiting period for Ontario health insurance coverage if they meet the following 2 requirements:
  • Who Is Eligible Under Family Coverage

    An eligible employee’s dependents are eligible for coverage. Eligible dependents include an employee’s spouse, domestic partner, unmarried children, and children adopted by the employee or the employee’s spouse. Eligibility requirements for a domestic partner are described in the next block.


    An employee’s current or legally separated spouse is eligible for coverage. A divorced spouse is not eligible.


    Coverage can include an employee’s children up to age 26 including, but not limited to, stepchildren and children under the employee’s legal guardianship living at home.

    An employee’s unmarried children of any age incapable of self-support due to a mental or physical disability who were disabled before reaching age 26 can be covered subject to medical documentation as required by the claims administrator.

    Note: The Research Foundation is required by law to permit employees subject to a child medical support order to enroll dependent children in a health care plan without regard to open enrollment restrictions.


    An employee may not be covered both as an employee and as a dependent of another RF employee. If two members of the same family are employed at the Research Foundation, both can have individual coverage or one can have family coverage.

    Don’t Miss: How To Switch Health Insurance

    Eligibility And Summer Only Appointments

    Employees on summer only appointments are not eligible for health insurance coverage. If a summer only employee is subsequently appointed to a regular, eligible position, the time spent in a summer only appointment does not count toward the benefit waiting period .

    If a summer only appointment is later determined to be a regular, eligible appointment, the employee will be eligible for benefit coverage based on eligibility rules for regular employees.

    Refer to Sponsored Program Administration > Personnel Administration > Staffing and Appointments > Description of Assignment Groups on the RF Web site for more information on summer only appointments.

    Who Can Be Added As A Dependent On My Health Insurance Plan

    Who is Eligible for Medicare?

    When you purchase a health insurance plan for yourself, you can get coverage that extends to your dependents likewise, if youre an employer covering your workers, you can provide coverage for any dependents they have. If youre planning on purchasing a family health insurance plan to cover your dependents, its important to make sure you know theyre eligible to join your family health insurance plan before you make your final purchase.

    Also Check: How To Put Someone On Your Health Insurance

    Where Can I Buy Private Health Insurance

    A good place to start looking for coverage is the Health Insurance Marketplace created in 2014 by the ACA. On the marketplace for your state, you can look through the details of private health insurance plans and compare the cost and benefits of each. If your state does not have its own marketplace, use HealthCare.gov.

    Basic Requirements For Coverage


    You must be a resident of Massachusetts to get MassHealth or other health care benefits that are funded by the Commonwealth.

    You meet residency requirements if:

    • You live in Massachusetts and either intend to reside in Massachusetts, with or without a fixed address, or have entered Massachusetts with a job commitment or seeking employment

    You do not meet residency requirements for MassHealth ifyou are visiting Massachusetts:

    • For personal pleasure, such as for vacation, or
    • To receive medical care in a setting other than a nursing facility

    Citizenship or immigration status

    To get the most MassHealth, Health Safety Net, or Children’s Medical Security Plan coverage, your citizenship or satisfactory immigration status must be verified.

    MassHealth may conduct information matches with state and federal agencies. If you do not provide this information, you may be considered for fewer benefits.

    If electronic sources are unable to verify your declared status, documentation may be requested from you.

    Don’t Miss: Do You Need Health Insurance To Go To Planned Parenthood

    Q What If My Photo Health Card Is Lost Stolen Or Damaged

    You can call the ServiceOntario INFOline at 1-866-532-3161. For TTY service, call 1-800-387-5559 to report your lost, stolen or damaged health card.

    If the card is a photo health card you will be sent a new one right away but if there are additional changes to your information, like an address change or name change, then you need to visit a ServiceOntario centre.

    For information regarding ServiceOntario centres in your area call the ServiceOntario INFOline at 1-866-532-3161.

    If you find your reported lost or stolen health card, keep it only until your new photo health card arrives in the mail and then destroy the old health card because it will no longer be valid. Make sure you have your new photo health card before destroying the old health card.

    Request An Eligibility Review For Health Care Coverage

    VA Health Care Eligibility and Priority Groups Explained

    If you are denied coverage, you may request to have your application and documents reviewed.

    As part of the eligibility review, your application along with any new supporting documents you submit will be considered.

    It is your responsibility to demonstrate your eligibility for AHCIP coverage. Make sure you provide sufficient evidence to the AHCIP office.

    Send your appeal letter to the AHCIP office

    To request an eligibility review, write an appeal letter to the AHCIP office. Include the reasons for your request and any additional supporting evidence.

    Mail your letter and supporting documents to:

    Alberta HealthAttention: Alberta Health Care Insurance Plan, Eligibility ReviewPO Box 1360, Station MainEdmonton, Alberta T5J 2N3

    Eligibility review decisions

    When an eligibility review has taken place and a decision has been made to deny or cancel AHCIP coverage, you will be sent a letter outlining the legislative, regulatory and/or policy reasons for the decision.

    If you are not satisfied with the decision from the eligibility review, the letter will also contain information on the process for requesting an administrative review of the decision.

    Recommended Reading: How To Apply For Health Insurance As A College Student

    Eligibility Criteria For Group Health Insurance

    Whether you are an emerging startup, organizations small and large, social/cultural association or a group with a common interest, you are eligible to apply for a Group Health Insurance Plan. Organizations or groups with more than 20 employees can opt for a group health cover. However, the insurance industry regulator, the IRDAI has stated that micro-insurance plans can be availed by groups of less than 5 employees/members.

    Here are some of the guidelines that you must consider before buying a group health insurance scheme:

    Am I Covered For Emergency Care Outside Of Canada

    Doctor Bills Manitoba Health will pay for emergency doctors services outside of Canada at a rate equal to what a Manitoba doctor would receive for a similar service.

    Hospital Bills Emergency hospital care is paid on an average daily rate established by Manitoba Health.

    You may be charged more than the amount paid by Manitoba Health for services provided outside Canada.

    The difference above the covered amount may be substantial and is your responsibility.

    Bring or mail your original bill to the Out-of-Province Claim Section at Manitoba Health within 6 months of receiving care. If you have made payments on your bills, Manitoba Health requires a receipt showing the amount paid. If you do not include your receipt, Manitoba Health will pay the hospital or doctor directly.

    For more information contact:

    Business hours: Monday to Friday 8:30 to 16:30 For more information call: 204-786-7303Toll free: 1-800-392-1207 Ext. 7303TDD/TTY: 204-774-8618

    You May Like: What To Do When You Lose Your Health Insurance

    Eligibility During Inactive Employment Status

    Unpaid Leave of Absence

    An employee enrolled in the health plan who is on an approved leave of absence of up to one year without pay is eligible to continue health insurance coverage during the leave period if he or she pays the employee and employer portion of the insurance premium to the Research Foundation.

    Refer to LOA – Information on Continuation of Group Coverage While on LOA Other Than Family and Medical Leave for additional information. The procedure includes links to an application for continuation of coverage under leaves of absence, and the premium amounts for coverage.


    A disabled employee enrolled in the health plan who is receiving a benefit from New York State Disability insurance or Workers’ Compensation for a total disability is eligible for health insurance coverage continuation at no cost for the length of the disability.

    FMLA Leave

    An employee enrolled in the health plan who takes leave under the Family and Medical Leave Act is eligible for health insurance coverage continuation during the 12 weeks of approved FMLA leave provided that he or she continues to pay the employee portion of the premium.

    Beyond 12 weeks, coverage may be continued under the terms of continuation of coverage for an unpaid leave of absence or disability . Employees who have accrued paid leave may also use this time and would be eligible for coverage as an active employee.

    Am I Eligible For Cobra Health Insurance

    The Right Thing: Special Enrollment (SEP) for Individual Health ...

    Shereen Lehman, MS, is a healthcare journalist and fact checker. She has co-authored two books for the popular Dummies Series .

    If you anticipate a change in your life, planning for health insurance after that change is an important part of maintaining your financial security and your health. A popular way to get health insurance after a major life event is to continue your employer-sponsored health insurance using COBRA continuation coverage.

    This article will explain what you need to know about COBRA eligibility, electing COBRA, and other alternatives that are available to you as well.

    If you get a divorce, become a widow or widower, or lose your job, losing your health insurance can add even more stress when your coping mechanisms are already maxed-out. If youre scrambling to find a new job, move, learn how to live without a partner, or all of those things at once, choosing a new health plan in the individual market can be overwhelming. .

    However, not everyone is allowed to use the COBRA law to continue their health insurance. Understanding whether or not youre eligible for COBRA health insurance will help you plan for a secure future.

    To be eligible for COBRA, you must satisfy all three of the following requirements:

  • Your current health plan must be subject to the COBRA law. Not all health plans are.
  • You must be considered a qualified beneficiary of your current health plan.
  • You May Like: Is It Required By Law To Have Health Insurance

    Who Your Health Insurance Policy Covers

    Your health insurance policy covers you if the policy is in your name.

    Your spouse or partner and children under 19 years old may also be eligible for coverage under your insurance policy. Children over 19 may be eligible for coverage under your policy if they are still in school or if they are disabled.

    I’m New To Manitoba How Do I Apply For Coverage

    If you are eligible , coverage will begin on the first day of the third month after your arrival in Manitoba. For example, if you arrive on April 29, April will count as the first month, with May and June as the following two. Therefore, in this case your coverage would begin July 1.

    When you register, you will need to:

    Provide proof of residence in Manitoba: 6 months in a calendar year.

    How to Prove Your Residence in Manitoba

    Please provide any one of these documents, subject to the documents being acceptable to Health:

    • Signed mortgage agreement
    • Signed long term rental or lease agreement
    • Current Employment Confirmation
    • Notarized letter from the homeowner or leaseholder stating: names of the applicants for Manitoba health coverage living with them in the residence and length of stay
    • Letter from a Resettlement Assistance Program providers/Letter from Sponsorship Agreement Holders, regarding the applicant’s residence in Manitoba

    Any two of these documents, subject to the documents being acceptable to Health:

    • Utility Bill telephone, cable/satellite TV, gas, water/sewer
    • Insurance policy
    • Property Tax Bill
    • Valid Manitoba Driver’s License

    Main floor, 170 Goulet St.Winnipeg MB

    Rural areas: Contact the city or municipal office in your area, or visit the Bilingual Service Centre nearest you:

    51 Rogers St

    Read Also: Where To Buy Health Insurance Online

    Need Of Health Insurance

    Different market studies prove that modern lifestyle is making all of us more prone to illness and as a result of this most of us are leading to unwanted health issues. The consequences of these issues result some serious health problems and for the treatment of the same you would need huge money. Everyone wants to get the best health facility but for a normal Indian its not easy. In such scenario, a health insurance plan acts a real savior. As a result, in the past few years the health insurance industry has become one among the fastest growing segments in India and all the leading insurance companies are offering a number of health insurance plans with extended features like wider coverage and aid-on benefits

    Option : Buy Through A Membership Organization

    Who is eligible for unemployment benefits?

    If you belong to a union, alumni association, professional organization, or any other large group, you may be able to purchase health insurance through it at group rates. Freelancers Union, for example, offers health insurance through its subsidiary, Freelancers Insurance Agency, and through one of its partners, HealthPlanServices.

    When looking for health insurance through an association or membership organization, make sure you will actually be purchasing insurance and not just a health services discount plan. Discount plans might save you money on prescriptions or eyeglasses, but they wont help you if you get cancer. Also be aware that even if the association itself is a not-for-profit organization, it may be tied to or even established by a for-profit insurance agency through which it sells policies to association members.

    Also Check: Can I Add My Husband To My Health Insurance

    Other Individuals In Bc

    Certain other individuals, such as some holders of Study and/or Work Permits, or Work Permits on Working Holiday Programs which are issued under the federal Immigration and Refugee Protection Act and are valid for a period of six or more months may be deemed residents.

    A working holiday is a visa program designed for those between the ages of 18 and 35 who may choose to work while travelling abroad. Learn more about working holiday program eligibility requirements.

    What Is The Affordable Care Act

    The Affordable Care Act provides individuals and families greater access to affordable health insurance options including medical, dental, vision, and other types of health insurance that may not otherwise be available. Under the ACA:

    • You may be able to purchase health care coverage through a state or federal marketplace that offers a choice of plans.

    • Insurers can’t refuse coverage based on gender or a pre-existing condition.

    • There are no lifetime or annual limits on coverage.

    • Young adults can stay on their familys insurance plan until age 26.

    • Seniors who hit the Medicare Prescription Drug Plan coverage gap or “donut hole” can get a discount on medications.

    Read the full text of the ACA and learn more about its provisions and relationship to patients, insurers, businesses, and families.

    Recommended Reading: Do I Need A Health Insurance Broker

    Q What If I Forget To Bring My Health Card When I Go For Health Care

    You may be charged for a health service if you do not have a health card. The ministry requests that the provider reimburse you for the service if it was an OHIP insured service and you can later show that you were covered by OHIP at the time of the service.

    Your health care provider may ask you to fill out a Health Number Release to indicate your consent to the ministry providing your health number to them.

    Popular Articles

    explore more