HIPAA Special Enrollment Rights

Group health plans often provide eligible employees with two regular opportunities to elect health coverage; an initial enrollment period when an employee first becomes eligible for coverage and an annual open enrollment period before the start of each plan year.

In addition, to make health coverage more portable, the Health Insurance Portability and Accountability Act (HIPAA) requires group health plans to provide special enrollment opportunities outside of the plans’ regular enrollment periods in certain situations.

Special enrollment must be available in these situations:

  • A loss of eligibility for other health coverage;
  • Termination of eligibility for Medicaid or a state Children’s Health Insurance Program (CHIP);
  • The acquisition of a new spouse or dependent by marriage, birth, adoption or placement for adoption; and
  • Becoming eligible for a premium assistance subsidy under Medicaid or a state CHIP.

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Qualifying Event Checklist



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The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.