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U.S. Department of Labor Seal U.S. Department of Labor

Health Benefits Advisor

Group Health Plan through My Job

This section of the Health Benefits Advisor assumes you are losing coverage under your former spouse's group health plan. If certain conditions are met, you (as the former spouse) and your dependent children may have the opportunity for special enrollment as well as other enrollment opportunities in a group health plan offered by your employer, employee organization (such as a union), or both, even if you were not previously enrolled in the plan and regardless of when the plan otherwise permits enrollment.

Please Note: A child of divorcing parents who is losing coverage under a parent's group health plan due to the parents' divorce may have the opportunity for special enrollment as well as other enrollment opportunities in a group health plan offered through the child's job, the other parent's job or the child's spouse's job.

Qualifications for Special Enrollment

You may qualify for special enrollment in your group health plan if:

  1. You are otherwise eligible for coverage under your plan;
  2. You were covered under your spouse's plan when enrollment in your plan was previously offered and declined; and
  3. You became ineligible for coverage under your spouse's plan because of the legal separation or divorce.

You may also qualify for special enrollment in your group health plan if you enroll with your dependent children who have a special enrollment right.

Your dependent children may also qualify for special enrollment in your group health plan if:

  1. Your children are otherwise eligible for coverage under your plan;
  2. Your children were covered under your spouse's plan when enrollment in your plan was previously offered and declined;
  3. Your children became ineligible for coverage under your spouse's plan because of the legal separation or divorce; and
  4. You are already enrolled in your plan or you special enroll in the plan with your children.

Your dependent children may also qualify for special enrollment in your group health plan if they enroll with you and you have a special enrollment right.

Time Frame for Special Enrollment

In order to special enroll in your group health plan, you must request the enrollment in your plan within 30 days after termination of coverage under your spouse's group health plan. If special enrollment is properly requested, the plan must make the enrollment effective no later than the first day of the first month after the plan receives the request.

Additional Enrollment Rights

In addition to the special enrollment rights just described, you and your children may have other rights to enroll in your group health plan. Additional rights to enroll may exist under the terms of your group health plan or under state law.

To find out more about enrollment rights in your plan:

  1. Read the notice of special enrollment rules that the plan was required to give you when you were offered the opportunity to enroll in the plan
  2. Review the SPD (Summary Plan Description) of your plan for information about enrollment rights; and
  3. Contact your state insurance department to find out if state law gives you or other family members additional enrollment rights.

How to Choose Among Health Coverage Options

Depending on your circumstances, you and your dependent children may have health coverage options available besides your group health plan. Before making any decisions, you should carefully consider information on other kinds of coverage for which you and your children may qualify.

In choosing among the options available to you, you should review the SPD (Summary Plan Description) for each available group health plan to determine which plan best meets your needs. You should also review and compare the information on the other coverages for which you are eligible. In making your decision, you may want to consider such things as:

  1. Any waiting period (or affiliation period) imposed under the plans;
  2. Types of benefits offered (Is dependent coverage available? Do the benefits cover your family's medical needs?);
  3. Cost of coverage (premiums, co-payments and deductibles for prescription drugs and doctor visits);
  4. Limitations on coverage; and
  5. Any exclusions from coverage (treatments, procedures, conditions or prescription drugs).

To find out about other kinds of health coverage for which you and your family members may qualify, return to the Legal Separation/Divorce Page and select another option.

UNITED STATES
DEPARTMENT OF LABOR