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InformationYou Need to Know
FULL-TIME AND PART-TIME (30 OR MORE HOURS PER WEEK)
Summary of Benefits and Coverage
HIPAA
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) impacts group health plans by improving the availability and portability of health coverage. HIPAA also requires that group health plan participants be given the following notice:
Notice of Special Enrollment Rights – if you are declining enrollment for yourself or your dependents (including your spouse) because of other health insurance coverage, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the employer stops contributing toward your
or your dependent’s other coverage). However, you must request enrollment within 31 days after your
or your dependents’ other coverage ends (or after
the employer stops contributing toward the other coverage). In addition, 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 your dependents, provided that you request enrollment within 31 days after the marriage, birth, adoption or placement for adoption.
To request special enrollment or obtain more information, call Employee Services at 866-977-7378.
Effective April 1, 2009, as a result of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA), an employee or dependent of an employee who is eligible for but not enrolled in coverage under the HCSC Group Health Plan (GHP) may be permitted to enroll for coverage when certain conditions are met:
1. Termination of coverage under Medicaid or CHIP. The employee or dependent is covered under a Medicaid or a CHIP plan and coverage of the employee or dependent is terminated for loss of eligibility for
this coverage; the employee may request coverage under HCSC’s GHP, if the employee requests coverage no later than 60 days after the date of termination of coverage; or
2. Gain of eligibility for premium assistance coverage under Medicaid or CHIP. The employee or dependent becomes eligible for premium assistance, as to coverage under the GHP under Medicaid or CHIP plan, if the employee requests coverage under HCSC’s GHP no later than 60 days after the date
the employee or dependent is determined to be eligible for this assistance. It is important to note that the new 60-day special enrollment period does not change the current HIPAA portability rule, which requires an employee to provide 31 days of notice to request coverage under the group health plan for all other special enrollments.
This 60-day provision is only applicable to the two CHIPRA conditions cited above.