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HIPAA Notice of Special Enrollment Rights

Explains midyear enrollment rights after loss of coverage, marriage, birth, adoption, or Medicaid/CHIP events. Provide to all new enrollees at or before enrollment.

Companies Eligible

Every group health plan, any size, insured or self-funded.

There is no size or funding exception. Any plan that offers enrollment must describe the special enrollment rights.

What it is

The notice explains the mid-year enrollment rights HIPAA guarantees: 30 days after loss of other coverage, marriage, birth, adoption or placement for adoption; 60 days after losing Medicaid or CHIP coverage, or becoming eligible for state premium assistance.

What needs to be done

  • When: At or before the time an employee is first offered the chance to enroll — with the enrollment packet. Most plans also repeat it in OE materials each year and in the SPD.
  • To whom: Every employee offered enrollment, whether or not they enroll.
  • Who performs: HR, through the enrollment materials; carriers include it in insured plan materials.
  • Customize: Plan name and the contact for enrollment requests.
  • Deliver: With the enrollment packet. Paper by hand or first-class mail to the home always works. Electronic delivery meets the DOL safe harbor only for employees who use a computer where they work as an integral part of their duties; anyone else (spouses, former employees, employees without work computers) has to consent in advance.
  • Keep: The enrollment packet contents by year.

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