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HIPAA "special enrollment rights"


Guest mls
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Our company has always followed the regs for "family status changes" and allowed changes to our pre-tax medical and dental plans consistent with a family status change. Recent, I heard about new "HIPAA special enrollment rights" and thought they were the same as family status changes. Then, I got an e-mail from someone who indicated that for marriage, birth and adoptions, if an employee wants to add a dependent not consistent with the family status change, they could - due to the new HIPAA regs. For example, if I get married, under our current policy, I could add my spouse but not another dependent. Now with these regs, it seems I could add other dependents. Any info out there on this? Also, do we have to allow an employee who is about to have a baby, elect medical insurance? Since the employee is not on insurance now, we wouldn't allow her to elect even though she is having a baby.

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Guest Hillary P

The HIPAA special enrollment rules aren't really new anymore; the statute was passed in Aug. 1996 and the regs implementing it generally became effective for the first plan year that began on or after July 1, 1997.

HIPAA created several types of special enrollment rights, but this question involves those relating to new dependents. Basically, HIPAA requires a group plan that provides dependent coverage to offer special enrollment (i.e., apart from regular enrollment periods) to employees AND their dependents when an employee acquires a new dependent through marriage, birth, adoption, or placement for adoption.

In your second example, the hypothetical pregnant employee must be allowed to elect insurance coverage for herself and/or the new baby within a certain period after the birth -- it doesn't matter that she was not covered before (at least assuming that the lack of coverage was due to the employee declining it and not because she was ineligibile under the terms of the plan). This is one type of situation that the HIPAA special enrollment rights were created to address.

Note: plans and/or employers also have certain disclosure obligations under HIPAA, including a duty to notify participants about their special enrollment rights.

Regs containing the special enrollment rules can be found at 29 CFR sect. 2590.701-6, and for further general information on HIPAA, see the web site of the Pension and Welfare Benefits Administration (www.dol.gov/dol/pwba). Good luck.

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