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.

This Legislative Brief summarizes HIPAA’s special enrollment events. It also discusses the interaction between HIPAA’s special enrollment provisions and the cafeteria plan election change rules.

This article/Legislative Brief is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.


HIPAA Special Enrollment Rights