Employee Only Coverage & HIPAA Special Enrollment Provision

[PhilB]

I am currently revising my company's SPD for CO-OP students, to whom we offer employee-only medical coverage while they are employed here. I know that I need to keep the HIPAA special enrollment provision in the SPD.

My question: Since the coverage is available only to the CO-OP students (not to the employee's spouse or dependents), can I modify the HIPAA language to take out references to special enrollments for the spouse and dependents? Also, I'm curious what we would be required to do if we received a QMCSO on one of these

CO-OP students - would we be forced to cover one of their dependents?

Any input appreciated.

[papogi]

HIPAA has a provision which allows plans to completely disallow dependents. This way, your plan would not be subject to HIPAA's special enrollment rules concerning dependents. HIPAA is careful to say that its rules apply only to individuals who are eligible under the plan.

[PhilB]

Thanks papogi -

Can you cite something specific so I can find that language in the HIPAA regs?

[papogi]

ERISA Section 701(f)(1) states that for an individual to be considered under the special enrollment provisions, that individual must be eligible under the plan. Further, 701(f)(2)(A)(i) alludes to the possibility that dependents can be written as eligible or ineligible under a plan.

[PhilB]

That's just what I was searching for - Many, many thanks! Do you think the same would apply as far as QMCSOs?

[papogi]

Per 29 CFR Part 2590(4)(B), a plan has the right to turn down a child support order if the plan does not offer family coverage. I guess the named custodian will have to buy an individual policy for the child in that case.