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SPECIAL ENROLLMENT PERIODS

Group health plans and insurers must offer special enrollment periods during which eligible persons are allowed on the plan without being considered late entrants. Eligible employees or dependents are allowed to enroll within 30 days following:

A loss of coverage under another health plan due to:

separation

divorce

death

termination of employment

reduction in work hours

employer contributions toward coverage have terminated

exhaustion of COBRA continuation or state continuation

A change in family status due to:

marriage

birth of a child

adoption or placement for adoption of a child

Employees or dependent spouses who are otherwise eligible but not enrolled in the plan, can also enroll during the special enrollment period when a change in family status occurs. Persons enrolling under these special enrollment conditions cannot be treated as late entrants.

For persons losing other group coverage, special enrollment requests can be made only after losing eligibility for the other coverage. Special enrollment is not available in the previous coverage loss resulted from fraudulent activity or because the person did not pay premiums.

A group health plan may require an employee to state in writing that coverage is refused because of other health insurance coverage. The employee must be notified if such a statement is required and she/he must also be informed that refusal to provide such a statement could result in a loss of eligibility for coverage.

A group health plan must also provide a description of special enrollment rights to employees before or at the time they are eligible to enroll.

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