The HIPAA law requires a group health plan to provide special mid-year enrollment opportunities to certain employees and/or their dependents in three circumstances: 1) loss of other employer sponsored coverage, 2) loss of Medicaid or CHIP coverage, or 3) acquisition of a new dependent. If you seek to enroll under these special enrollment rules, you will not be considered a late enrollee and thus would not be subject to the late enrollment penalties as prescribed by HIPAA or have to waive until the next Open Enrollment period.
Other Group Coverage
If you are covered under another employer sponsored group health plan and involuntarily lose that coverage (due to expiration of COBRA or loss of eligibility under the other group plan), you or your dependents may enter the plan under the special mid-year enrollment rights. You must request enrollment in writing within 30 days after the loss of the other coverage or the other employer’s cessation of contributions for such other coverage. Coverage will begin on the first day of the month after the plan receives the enrollment form.
If you or any eligible dependents are covered under Medicaid or CHIP coverage and you lose eligibility under one of those programs or you become eligible for the state’s premium assistance program, you and your eligible dependents may enter the plan under the special mid-year enrollment rights. You must request enrollment in writing within 60 days after the Medicaid/CHIP event. If you request this change, coverage will be effective the first of the month following your request for enrollment. Specific restrictions may apply, depending on federal and state law.
Acquire New Dependent
If you as an employee acquire a new dependent -- by marriage, birth, adoption, or placement for adoption -- you have a right to enroll yourself and the new dependent in the group health plan. You must request enrollment in writing within 60 days of the marriage, birth, adoption, or placement for adoption. Coverage applied for as a result of one of these HIPAA special enrollment events will become effective as outlined in your plan certificate. Please refer to your Certificate of Coverage for specifics.