U.S. Department of Labor
Health Benefits Advisor for Employers
Determining Compliance with the HIPAA Provisions in Part 7 of ERISA
Compliance with the Special Enrollment Provisions - Treatment of Special Enrollees
Does the plan treat special enrollees the same as individuals who enroll when first eligible, for purposes of eligibility for benefit packages and premiums?
If an individual requests enrollment while the individual is entitled to special enrollment, the individual is a special enrollee, even if the request for enrollment coincides with a late enrollment opportunity under the plan. See 29 CFR 2590.701-6(d)(1).
Special enrollees must be offered the same benefit packages available to similarly situated individuals who enroll when first eligible. (Any difference in benefits or cost-sharing requirements for different individuals constitutes a different benefit package.) In addition, a special enrollee cannot be required to pay more for coverage than a similarly situated individual who enrolls in the same coverage when first eligible. See 29 CFR 2590.701-6(d)(2).
