Q.- An employee’s child had individual health coverage that was not provided by an employer. That coverage terminated. Can we allow the child to come onto our plan mid-year?
A.- Probably yes. HIPAA requires group health plans to allow individuals a special enrollment right due to loss of “other” coverage. The other coverage must be group health coverage or health insurance coverage.
Group Health Coverage is defined as coverage under a plan maintained by an employer providing health care.
Health Insurance Coverage is defined a benefit consisting of medical care offered by a health insurance issuer. It includes group health insurance, individual health insurance coverage, and short-term limited duration insurance. The following types of insurance will not be considered to provide medical care: coverage for accident only or disability income; supplemental liability insurance; liability insurance; worker's comp insurance; auto insurance; credit only insurance; onsite medical clinic insurance; or other secondary/incidental medical care coverage.
The coverage must be lost due to one of the following triggers, in order for the HIPAA special enrollment rights to apply:
1. The coverage was provided under COBRA and the COBRA period was exhausted;
2. The coverage was non-COBRA coverage and the coverage ended because of loss of eligibility for the coverage; or
3. The coverage was non-COBRA coverage and employer contributions terminated.
