Special Events Enrollment Under HIPAA
Effective July 1, 2016
- The 31-day enrollment period extended to 60 calendar days:
Benefits-eligible employees experiencing a special event under the provisions of HIPAA on or after July 1, 2016 may complete their benefits changes within a 60-day enrollment/change period. (60 calendar days)
Benefits election changes are effective the first day of the month after they have been received and approved by the Benefits Department.
Important Note for benefits-eligible employees experiencing a special event under the provisions of HIPAA on or before June 30, 2016:
The 31-day enrollment change period will remain in effect for employees experiencing a special event under the provisions of HIPAA on or before June 30, 2016
Benefits election changes are effective the first day of the month after they have been received and approved by the Benefits Department.
Under the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), there are special events that may allow you to add health insurance coverage if you did not elect health coverage for yourself and/or your dependents during your initial eligibility period or during Open Enrollment:
Loss of Other Coverage
If you are declining enrollment for yourself and/or your dependents (including your spouse) because of other health coverage, you may be able to enroll yourself and/or your dependents if you or your dependents lose eligibility for that coverage, or if the employer stops contributing towards your or your dependent's coverage. To be eligible for this special enrollment opportunity, you must request enrollment within 31 calendar days after your other coverage ends or after the employer stops contributing towards the other coverage. If the 31-day deadline falls on a weekend or holiday, enrollment forms must be received prior to the weekend or holiday.
Proof Documents Submission Requirements
Examples of Required Dependent Proof Documents
New Dependent as a Result of Marriage, Birth, Adoption, or Placement for Adoption
If you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and/or your dependent(s). To be eligible for this special enrollment opportunity you must request enrollment within 31 calendar days after the marriage, birth, adoption, or placement for adoption. If the 31-day deadline falls on a weekend or holiday, enrollment forms must be received prior to the weekend or holiday.
Medicaid Coverage Effective April 1, 2009
Beginning April 1, 2009, The Children's Health Insurance Program Reauthorization Act of 2009 (CHIP) added a special enrollment event under HIPAA. UNM will allow you and/ or your dependent who is eligible (but not enrolled for coverage) to enroll if either of the following events occur:
Termination of Medicaid or CHIP Coverage
If you and/or your dependent are covered under a Medicaid plan or under CHIP, and your coverage and/or your dependent's coverage under such a plan is terminated as a result of loss of eligibility.
Eligibility for Premium Assistance under Medicaid or CHIP
If you and/or your dependent become eligible for premium assistance under Medicaid or CHIP, including under any waiver or demonstration project conducted under or in relation to such a plan. This is usually a program where the state provides employed individuals with premium payment assistance for their employer's group health plan, rather than direct enrollment in a state Medicaid program.
Under CHIP, you have 60 calendar days to enroll in the UNM Medical Plan if you experience either of the above Qualifying Change of Status Events.
If you are adding a dependent to your Medical, Dental, and/or Vision coverage, you are required to submit proof of your dependent's eligibility. Refer to the Eligibility and Enrollment section for this information.