Special Enrollment Periods Special enrollment periods are only allowed in specific circumstances. Generally, a special enrollment period arises when an employee or an eligible dependent loses coverage under another health plan or when an enrollee gains a new eligible dependent.
Employees enrolling or dependents added during a special enrollment period are subject to a 12- month pre-existing condition exclusion period. The 12-month pre-existing condition exclusion period does not apply to newborns or newly adopted children enrolled within 31 days of birth or adoption. A participant will receive credit for prior creditable coverage that occurred without a break in coverage of 63 days or more.
An enrollee may apply for High Option for Children during a special enrollment period.
NOTE: An enrollee adding coverage due to a special enrollment event may change coverage types (Base to Select, or Select to Base). Each coverage type is independent of the other; therefore, there is no deductible or out-of-pocket credit if an enrollee changes coverage types during a calendar year.
Special Enrollment Periods resulting from loss of coverage An employee, dependent of a covered employee, or dependent of a COBRA participant who loses coverage under another health plan will be eligible to enroll for coverage in the Plan if the following apply:
The employee declined coverage for himself or his dependents when first eligible because the employee or dependent was covered by other health insurance coverage; or the COBRA participant declined coverage for his dependent when first eligible because the dependent was covered by other health insurance coverage; and
The employee or dependent lost other coverage as a result of any of the following qualifying events:
The employee or dependent is no longer eligible for coverage. (Loss of coverage due to non-payment of premiums does not qualify.)
The employer ceased to contribute toward the cost of the other health plan, and it was terminated.
The employee or dependent’s COBRA continuation has run out.
To enroll for coverage under these circumstances, an Application for Coverage form must be submitted within 31 days of losing coverage under the other plan and appropriate premium payments must be made. As part of the application process, proof of loss of coverage must be provided. If these requirements are met, coverage under the Plan will take effect the first day following the loss of other coverage.