What are Special Enrollment Rights and Requirements?
The Health Insurance Portability and Accountability Act (HIPAA) provides two additional opportunities to enroll in a group health plan: (1) if you lose other coverage or (2) experience certain life events. This is known as Special Enrollment Rights.
Under the first opportunity, employees and dependents who decline coverage due to other health coverage and then lose eligibility or lose employer contributions have special enrollment rights. For instance, an employee turns down health benefits for herself and her family because the family already has coverage through her spouse's plan. Coverage under the spouse's plan ceases. That employee then can request enrollment in her plan for herself and her dependents.
Under the second, employees, spouses, and new dependents are permitted to special enroll because of marriage, birth, adoption, or placement for adoption.
For both cases, the employee must request enrollment within 30 days after losing eligibility for coverage or after a marriage, birth, adoption, or placement for adoption.
It is very important that you comply with the 30- day notification rule, as it is a regulatory compliance rule, not one set by the Board of Trustees. Failure to notify the Benefit Fund Office within 30 days will result in a denial of Special Enrollment Rights and you will have to wait for you next Open Enrollment period to add coverage.
Notifying your Employer does not constitute notifying the Benefit Fund Office.
Even if you do not have all the necessary enrollment paperwork during the Special Enrollment Period, you must still notify the Benefit Fund Office to meet the 30-day requirement. For example, it is understandable that you may not have a new child’s birth certificate within 30 days of birth. However, DO NOT wait until you have the Certificate to notify the Benefit Fund Office as it may push you outside the 30-day requirement. Instead, notify the Benefit Fund Office within the 30 days and we will allow you a reasonable amount of time to supply the Birth Certificate.
Unfortunately, the law does not allow for an extension of the 30-day period, so please pay strict attention to the notification requirements.
NOTE: Under Federal Regulations related to the COVID-19 pandemic, you may be eligible for more than 30-days to notify the Benefit Fund Office, but only during the National Emergency period. Please contact the Benefit Fund Office if you have any questions.