Answer:

The Health Insurance Portability and Accountability Act (HIPAA) has redefined "Special Enrollment Period" for dependants. HIPAA requires group health plans, which have dependant coverage to have a special 30-day enrollment period for dependents, whenever an eligible employee experiences a "Family Status Change" such as a marriage, birth, adoption or placement for adoption. During this special enrollment period an eligible employee may join the heath plan if he/she has not enrolled when initially eligible. At this time the eligible employee may also enroll a previously eligible spouse and/or dependent(s), or a new spouse and/or dependent(s). These enrollments must occur within 30 days following the family status change. If enrolled within the 30-day limit, these special enrollees are considered timely additions to the group and HIPAA's 12-month pre-existing condition limitation applies to them.

Other situations in which a special enrollment period applies are:

  • Subscriber, spouse or dependent moves out of the service area
  • Spouse's employer terminated coverage
  • Spouse terminates employment
  • Spouse passes away
  • Spouse has a change in hours or a change in position (e.g., switching from full-time to part-time)

    • Note: A qualifying event does not allow an already enrolled member to switch plans it only allows them to add to their current plan.