HIPAA Special Enrollment Rights Overview
HIPAA Special Enrollment
HIPAA Special Enrollment Overview
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HIPAA provides special enrollment rights for individuals, who are otherwise eligible, attempting to enroll in a group health plan upon the occurrence of the following events:
Losing Eligibility for Other Health Coverage
Becoming Eligible for a State Premium Assistance Subsidy
(Medicaid or CHIP)
Acquiring a New Spouse or Dependent
(marriage, birth, adoption, or placement for adoption)
2
Reduction of hours of the covered employee’s employment
3
Divorce or legal separation of the covered employee from the employee’s spouse
4
Death of the covered employee
5
A dependent child ceases to be a dependent under the generally applicable requirements of the plan
6
A covered employee becomes entitled to benefits under Medicare
7
An employer’s bankruptcy, but only with respect to health coverage for retirees and their families
Losing Eligibility for Other Health Coverage
2
Reduction of hours of the covered employee’s employment
3
Divorce or legal separation of the covered employee from the employee’s spouse
4
Death of the covered employee
5
A dependent child ceases to be a dependent under the generally applicable requirements of the plan
6
A covered employee becomes entitled to benefits under Medicare
7
An employer’s bankruptcy, but only with respect to health coverage for retirees and their families
COBRA coverage offered should be identical to what was in place when the qualifying event occurred, and all individuals covered as of the qualifying event generally has an individual right to elect COBRA. COBRA participants may be required to pay up to 102% of the premium cost. Because COBRA participants must be treated like other similarly situated active participants, they must be given open enrollment and HIPAA special enrollment rights just like other active employees.