Under HIPAA, certain events that happen to employees or their dependents trigger a right to “special enroll” in a group health plan. Special enrollment allows individuals who previously declined health coverage to enroll in coverage outside of a plan’s open enrollment period.
An employee and his or her dependents must be provided at least 30 days to request special enrollment in a group health plan because of:
- Loss of eligibility for other coverage, such as coverage from a spouse’s employer;
- Termination of employer contributions toward other health coverage; or
- Certain life events, including marriage, birth, adoption, or placement for adoption.
An employee and his or her dependents must be provided at least 60 days to request special enrollment in a group health plan because of:
- Loss of coverage under a state Children’s Health Insurance Program (CHIP) or Medicaid; or
- Determination of eligibility for premium assistance under CHIP or Medicaid.
Group health plans must make all employees eligible to enroll in the employer’s group health plan aware of their special enrollment rights at or before the time an employee is initially offered the opportunity to enroll in the plan by distributing a Notice of Special Enrollment Rights. A downloadable model notice from the U.S. Department of Labor (DOL) is available here (scroll to page 2 of the PDF—marked as page 138). Please note that the DOL’s model notice does not discuss the 60-day special enrollment period requirement mentioned above.
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