The Health Insurance Portability and Accountability Act (HIPAA) provides a special enrollment period which allows employees who have previously waived health coverage to enroll for coverage outside of the plan’s open enrollment period. This is called special enrollment.
- Employees and dependents who waive coverage due to other group health coverage and then lose that coverage can enroll in their own employer’s group plan coverage.
- Employees, spouses and new dependents can enroll for coverage because of marriage, birth, adoption, or placement for adoption.
Some examples of events that trigger special enrollment include:
- Divorce, which results in the employee losing coverage under a spouse’s group health plan;
- A dependent “aging off” the parent’s group health plan;
- An employee’s spouse dying, leaving the employee without coverage;
- An employee’s spouse losing his/her employment resulting in a loss of group coverage for the employee;
- An employee’s work hours reducing, resulting in a loss of eligibility for the group health plan.
An employee or dependent must request special enrollment within 30 days of one of these triggering events to be enrolled in the employer’s plan.