HIPAA special enrollment issues

[Guest Gibson]

Facts: covered employee gives birth but fails to enroll dependent with 30 days (special enrollment period).

Issue: Is there an exception, express or implied, to the special enrollment period rule when enrollment of the newborn dependent would not affect the premium paid? In other words, can (or must plan sponsor permit) a covered employee wait until after the 30 day period has expired to enroll the newborn when the enrollment will not affect the premium amount?

Second issue: assume that covered employee in above example receives the required special enrollment rights notice after the birth of the child. Does the 30 day special enrollment period begin on the date he or she receives the notice?

Thanks

[Guest Lisa Nieman]

Per our plan, "...a newborn child will be covered from the moment of birth providing dependent coverage is in effect at that time. If dependent coverage is not in effect, the employee will have (31) days from the date of the birth to make application for dependent coverage and coverage will be retroactive to the date of birth."

The rule exists for a purpose and the employee did not follow the rules. To me, that says that this child will not have coverage until the next open enrollment period. But perhaps you can make an exception this time and back date the application so that this child will have coverage. We've had to do that when the error was not ours but we needed to make the employee happy. Hope this helps.