HIPAA -- special enrollments

[Guest Ray Goetz]

I have some questions on the "special enrollment" rules for health plans under HIPAA. [ERISA 701(f); IRC 9801(f)]

1. How are employers dealing with the rule that employees/dependents have a right to special enrollment only if, when they declined enrollment, they stated in writing that they were declining because they had other coverage?

2. How are employers dealing with the related rule that the above condition can only be imposed if the plan provides that such a written statement is required, and only if the employee was notified of that requirement at the time coverage was declined?

-- Are plans even using the "had other coverage" limitation in Rule #1 at all?

-- What language do plans use, if they apply Rule #1 and have people "decline in writing"?

-- Do employers just put the "had other coverage" language in the enrollment forms?

-- What language is used by plans to meet Rule #2 and describe the "decline in writing" requirement?

-- What procedures are used by employers to ensure that employees are properly "notified" of Rule #2?

AND -- How do you deal with persons who declined initial enrollment before HIPAA was enacted (and therefore before the plan would ever have met the requirement in Rule #2, and before any employee would have been notified of the requirement)? Is it just not possible to use Rule #1 and deny special enrollment to such persons?