HIPAA Special Enrollment Rights

Summary

This practice note guides employer sponsors of group health plans subject to the Employee Retirement Income Security Act of 1974 (ERISA) when complying with ERISA's special enrollment requirements. The Health Insurance Portability and Accountability Act of 1996 (HIPAA), Pub. L. No. 101-191, amended ERISA to require such plan sponsors to allow employees to enroll themselves or their eligible dependents in group health plans upon the occurrence of certain specified events (i.e., outside of the sponsor's open enrollment period). These special enrollment rules operate in conjunction with the rules that permit mid-year changes to an employee's pre-tax cafeteria plan elections under Section 125 of the Internal Revenue Code. This practice note discusses the requirements and conditions necessary for an employee to obtain coverage during a special enrollment period and the information employers must provide to employees notifying them of their HIPAA special enrollment rights.