HIPAA Special Enrollment

Section 125 midyear election changes

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If an employer determines that they are required to permit an individual to enroll in coverage midyear due to a special enrollment right, the employer may also permit the employee to pay for that coverage on a pre-tax basis if the employer has established a Section 125 plan. However, employers are permitted to allow individuals to enroll in or drop coverage on a pre-tax basis for several reasons, of which HIPAA special enrollment events are just one example.

HIPAA Special Enrollment Events

(Group health plan is required to permit enrollment.)

  • Loss of Eligibility for Other Health Coverage
  • Medicaid or CHIP Eligibility
  • Acquisition of new Spouse or Dependent

Section 125 Midyear
Pretax Election Changes

(Employer can determine which to permit, if any.)

 

  • Change in Cost of Benefits
  • Significant Curtailment or Improvement of Coverage
  • Change in Coverage Under Other Employer Plan
  • Loss of Group Health Coverage Sponsored by Governmental or Educational Institution
  • COBRA Qualifying Events
  • Judgments, Decrees, or Orders
  • Medicare or Medicaid Entitlement
  • FMLA
  • HSA
  • Individual Plan Enrollment