Glossary
Special
Enrollment
The opportunity to enroll in a
group health plan when certain work or life events occur, regardless
of the plan’s regular enrollment dates. Generally, if certain conditions
are met, special enrollment is available when you, your spouse or your
dependents lose other coverage (including
exhaustion of COBRA continuation coverage), when you marry or when
you have a new child by birth,
adoption or placement for adoption. The plan must give you at least
30 days--from the loss of coverage or from the date of the marriage,
birth, adoption or placement for adoption--to request special
enrollment. The maximum
pre-existing condition exclusion that may be applied to a person
upon special enrollment is 12 months (reduced by the person's prior
creditable coverage). However, if enrolled within 30 days of birth,
adoption or placement for adoption, children may be exempt from any
pre-existing condition exclusion. A description of a plan's special
enrollment rules must be given to the employee on or before the time the
employee is offered the opportunity to enroll in the plan.
The Department has developed a
model special
enrollment notice that may be used by a
group health plan or health insurance issuer. Correct use of the model will generally assure compliance
with the regulatory requirements.
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