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Health Benefits Advisor for Employers


Special Enrollment

The opportunity to enroll in a group health plan when certain work or life events occur, regardless of the plan's regular enrollment dates. Generally, if certain conditions are met, special enrollment is available when you, your spouse or your dependents lose other coverage (including exhaustion of COBRA continuation coverage), when you marry or when you have a new child by birth, adoption or placement for adoption. The plan must give you at least 30 days--from the loss of coverage or from the date of the marriage, birth, adoption or placement for adoption--to request special enrollment. The maximum pre-existing condition exclusion that may be applied to a person upon special enrollment is 12 months (reduced by the person's prior creditable coverage). However, if enrolled within 30 days of birth, adoption or placement for adoption, children may be exempt from any pre-existing condition exclusion. A description of a plan's special enrollment rules must be given to the employee on or before the time the employee is offered the opportunity to enroll in the plan.

The Department has developed a model special enrollment notice that may be used by a group health plan or health insurance issuer. Correct use of the model will generally assure compliance with the regulatory requirements.


Complete Glossary of Terms