Question: An employee has asked to be added to our medical insurance midyear because his coverage through his wife's plan is changing. His wife’s severance package provided several months of free COBRA coverage, but the subsidy is expiring and they would have to pay the COBRA premiums themselves to continue on her plan. So our employee wants to enroll himself and his wife in our plan. What events allow a midyear enrollment and what is the timeframe for adding the employee once the request is made?
Answer: Under HIPAA special enrollment rights, an employee must be given the opportunity to enroll in the group health plan midyear under certain circumstances. Group health plans are required to provide special enrollment periods during which individuals who previously declined health coverage for themselves or their dependents may be allowed to enroll (without waiting for the next open enrollment period).
Special enrollment rights occur when:
When one of the above events occurs, a special enrollment opportunity may be triggered. The employee requesting special enrollment must have had the other health coverage when he or she previously declined coverage under your plan. Special enrollees must be given at least 30 days from the date of the event to enroll. For events related to Medicaid or CHIP, the minimum special enrollment period is 60 days. Coverage must take effect no later than the first of the month following the date the special enrollment request is made. If the event is birth or adoption of a child, coverage must take effect retroactively on the date of the birth, adoption (or placement for adoption).
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