Guest jac Posted July 12, 2012 Report Share Posted July 12, 2012 If a participant sends notice to a plan of the birth of a child and requests enrollment of the child within the special enrollment period, but then fails to send in enrollment form and the required documents to establish the child’s eligibility for coverage, e.g., a copy of the birth certificate, within the special enrollment period, is the plan still required to cover the child back to the date of birth? Here’s an example: June 1 – baby born June 6 – participant notifies plan by letter that child is born and requests enrollment in the plan June 12 – plan sends participant enrollment form and information on documents (birth certificate) that must be submitted to establish child’s eligibility. (Plan has a 30 day special enrollment period.) September 8 – participant sends completed enrollment form and documents (birth certificate) that establish child’s eligibility Is the letter sent by the participant in June sufficient for purposes of the HIPAA special enrollment rules even though the participant did not complete the enrollment form and send in the birth certificate until September (long past the 30 day special enrollment period)? I've looked at the regulations, which provide that"the plan must allow an individual at least 30 days "to request enrollment." Any thoughts would be welcome. Thanks. Link to comment Share on other sites More sharing options...
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