Loss of Foreign Governmental Health Plan Coverage/Special Enrollment P

[Guest Carolyn Steinhauer]

Does a foreign governmental health plan qualify as "health insurance coverage" so that loss of such coverage qualifies an individual for a Special Enrollment Period?

To qualify for a Special Enrollment Period, Section 2590.701-6(a)(3) of the HIPAA regs state that the individual had to have been covered under another group health plan or had other insurance coverage at the time the coverage was previously declined.

It is clear that a foreign governmental health plan would not meet the definition of "group health plan" set forth in IRS Code Section 50000(B)(1).

Section 2590.701-2, Definitions, of the HIPAA regs defines "health insurance coverage" as benefits consisting of medical care (provided directly, through medical insurance, reimbursement, or otherwise) under any hospital or medical service policy or certificate, hospital or medical service plan contract, or HMO contract offered by a health insurance issuer.

On the surface, a foreign governmental health plan does not appear to qualify as "health insurance coverage," except perhaps as a medical service plan contract.

If you've had any experience with this issue, please advise!