How Can I Backdate a Health Insurance Plan?

What is backdating health insurance? How does it work? Backdating means coverage of your benefits is made retroactively effective by your insurance provider. Wouldn’t it be great if we could all purchase retroactive coverage? As a general practice, it is illegal. A health insurance carrier will only backdate insurance coverage in some scenarios.

When Does Backdating Happen in Health Insurance?

Some clients wonder if there is any grey area on policy start dates. Buying coverage now for a prior illness is a wonderful prospect. But when exactly can you backdate a policy? Over the years, an independent health insurance broker sees all sorts of coverage in all manner of scenarios. There are some cases where health insurance coverage can be backdated. Most clients wonder and ask about backdating during the enrollment process. Let us help with some answers.

Open Enrollment Period

The U.S. federal health insurance marketplace and the state exchanges begin their enrollment period starting November 15th. The goal is to ensure coverage in time for the beginning of the new year. But, some states have a deadline as late as January 15th (or later) for signing up.

Can those people that enroll later have coverage backdated starting January 1st? In most states, getting coverage during open enrollment means you have coverage effective the first of January. There are a few different possible effective dates depending on your state.

January 1 – the effective date for most policies during open enrollmentFebruary 1 – nearly every state has this alternate effective date for a later registrationMarch 1 – some states have some provider exchange options available longer

Special Enrollment Periods

Life happens, and rarely only at the first of the month. There are a few qualifying life events that allow you to sign up with a health insurance broker any time after the deadline for open enrollment.

Loss of health coverageChanges in householdChanges in residenceOther qualifying events such as changes in citizenship or income

These plans are not usually backdated. Most plans offer coverage that starts on the first day of the next month. If you got married on the Fourth of July and bought coverage later that same month, the industry standard is that it would be effective August 1st.

Is Backdating an Insurance Policy Permitted?

In some industries, backdating business deals and start dates is a normal practice. Life insurance and auto insurance policies are often backdated for several months. In most contracts, it is considered fraudulent for an agent to list an incorrect start date on the policy. Most policies have basic terms that prevent backdating.

Waiting Period

Most policies have a waiting period of up to 90 days in order to prevent complicated overlap of benefits. This qualifying period avoids the need for backdating when changing coverage.

Effective Date

As in special enrollment periods and other extenuating circumstances, it is possible to have the date a policy is purchased be different than the day the coverage becomes effective. Even if these two dates aren’t the same, the start date of your policy is more commonly called the “effective date.” Once this is set, no standard benefits are available before the effective date. At the start of your new plan, this will be the agreed-upon day where your insurance company will begin to help pay for your medical expenses.

What Exceptions Allow Me to Backdate Health Insurance?

There are a few conventional situations where backdating is warranted. 

New Family Members

The most typical backdated policy happens when a new baby is born or a new dependent is added to your family. Most plans give 30 days from the event to add family to your policy or to purchase new coverage.

Recission

This is a backdated cancellation of an insurance policy. It is to avoid potential fraud in a contractual agreement and usually happens when incorrect information is provided during the application process.

Other Examples

Some events allow for backdating:

Facing an exceptional circumstance such as a natural disaster or hospitalizationChanging eligibility for Medicaid or CHIPExperiencing other
QLE (qualifying life events)

Should I Contact a Health Insurance Broker about Backdating New Coverage?

Some states and incidents allow for backdating new plans. Life throws a variety of choices our way. You need individual health coverage from agents with knowledge across several insurance companies and products. The integrity of your insurance carrier is important and a reputable broker will always comply with laws and regulations to offer you the best product for your needs.

A conversation with an experienced health insurance broker will clarify whether or not you qualify for coverage and whether it can be backdated. Contact
Sacket & Associates Insurance Services to have a consultation about your coverage options. We are real people with over 40 years of experience in the industry. We value taking care of our clients just as we would our own families. Our team of independent agents specializes in a variety of healthcare plans and insurance groups and will guide you through your best options for health insurance. Let us help answer all your questions today!

Sources: https://www.healthcare.gov/glossary/qualifying-life-event/