Certain Events Trigger 30 or 60-Day Special Enrollment Periods
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.
Check out our HIPAA for All Employers section for additional group health plan requirements under HIPAA.
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Please Note: The information and materials herein are provided for general information purposes only and are not intended to constitute legal or other advice or opinions on any specific matters and are not intended to replace the advice of a qualified attorney, plan provider or other professional advisor. This information has been taken from sources which we believe to be reliable, but there is no guarantee as to its accuracy. In accordance with IRS Circular 230, this communication is not intended or written to be used, and cannot be used as or considered a ‘covered opinion’ or other written tax advice and should not be relied upon for any purpose other than its intended purpose.
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