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Qualifying Event - Health Insurance

The Health Insurance Portability and Accountability Act (HIPAA) is intended to ensure portability of health coverage for those individuals who must move from one plan to another as a result of loss of coverage under any other health insurance plan. The act also specifies that plans allow special enrollment opportunities for employees and prohibits using health status (medical underwriting) as a basis for group health insurance eligibility. The special enrollment periods allow an individual to enroll in the plan without any restrictions and are defined as follows:

  • Within 31 days of date of hire for eligible new employees. Coverage is effective the first of the month following the date of hire.
  • Within 31 days of marriage. Coverage is effective the first of the month following the date of marriage.
  • Within 31 days of birth or adoption, or placement for adoption or receiving legal guardianship, or court order to provide health coverage.
    • If the qualifying event is birth, coverage for the newborn is effective the first of the month in which the birth occurred.
    • If the qualifying event is due to adoption or placement of a child, the coverage effective date is the first of the month in which the adoption or placement occurs.
    • If the qualifying event is legal guardianship or court order, the coverage effective date is the first of the month following the legal guardianship or court orders.

Proof of the adoption, placement, legal guardianship or court order will be required.

  • Within 31 days of loss of coverage under any other health insurance plan due to death, divorce, or loss of spouse employer sponsored coverage. Coverage is effective the first of the month following the loss of coverage date. A Certificate of Insurance showing the last date of coverage will be required from the previous carrier.