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Special Enrollment Rights


There is no requirement under ERISA to offer an open enrollment period; however, this is a common practice since coverage options and employee contributions typically change from year to year. It also satisfies an employer's requirement to offer coverage if they are subject to the employer mandate (please also refer to the Employer Mandate page to read more about open enrollment). Plans that are subject to HIPPA's special enrollment requirements are required to allow enrollment opportunities outside of the open enrollment period if an individual experiences a special enrollment event.

 

There are two types of special enrollment events- those based on certain life events or upon loss of eligibility for other coverage. For both types, enrollment must be requested within 30 days of the triggering event. Triggering events include but are not limited to the following:

 

  • The loss of eligibility for coverage under a State CHIP or Medicaid program or the determination of eligibility for premium assistance under those programs. In this case an employee or dependent must request enrollment within 60 days.
  • Divorce or legal separation;
  • A dependent is no longer considered a dependent under the plan;
  • Death of the employee covered by the plan;
  • Termination of employment;
  • Reduction in the number of hours of employment;
  • The plan decides to no longer offer any benefits to a class of similarly situated individuals;
  • Termination of employer contributions under the other group health plan;
  • An individual in an HMO or other arrangement no longer resides, lives, or works in the service area.
  • Acquiring a newly eligible dependent through marriage, birth, or adoption
  • An employee may also be able to add a child during the plan year due to a Qualified Medical Child Support Order.

Employers are required to provide their eligible employees with a notice of special enrollment rights when they are given the opportunity to enroll in coverage, which can be included on the plan's enrollment forms. Our enrollment form contains this notice, but some clients may wish to use their own form that does not include this language. In this case, they should be reminded that not including the special enrollment rights is fine, but they will need to provide the notice separately to avoid being out of compliance.

 

The content described on this page is current as of 2018 and is not intended to be legal or tax advice and should not be construed as such. The intent is to provide information only. Meritain encourages plans to consult with their own legal counsel and tax experts for legal and tax advice.