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 because of loss of coverage under any other 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.
An eligible employee, retiree, or surviving spouse receiving a periodic distribution from an eligible retirement plan may enroll in the NDPERS health, dental, vision, or prescription drug plan if you apply within 31 days of one of the following qualifying events:
- Date of retirement* defined as either:
- The last day of active employment if member does not defer his/her retirement benefit or take a lump-sum refund of his/her retirement account
Date of first retirement check if member deferred his/her retirement benefit.
*Proof of retirement may be required.
- Member’s 65th birthday or eligibility for Medicare
- Member’s spouse or eligible dependent’s 65th birthday or eligibility for Medicare
- The loss of coverage in a related insurance plan sponsored or provided by member’s employer or member’s spouse’s employer, if covered through spouse’s employer group plan. This includes loss of coverage due to the death of, or divorce from, a spouse as well as completion of COBRA continuation coverage period with that plan
- Marriage
- Birth or adoption, placement for adoption, receiving legal guardianship of eligible dependent, or court order to provide 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.
If a member or surviving spouse does not enroll within 31 days of any of the above qualifying events, he/she will have forfeited his/her rights to enroll in the respective NDPERS Plan in the future.