| Issue: |
An employee whose wife had a baby two weeks ago has requested that his wife and newborn be added to his current medical coverage. The employee had elected family coverage in your medical plan during open enrollment and listed himself and one child for coverage. Through her employer, the wife has individual coverage, which she is being allowed to drop. In addition, she is currently on short-term disability leave from her job. Must you allow enrollment of the newborn? What about the wife? |
 |
|
Answer: |
Yes, the birth of a child triggers a special enrollment right for both the newborn and the wife.
A group health plan that makes coverage available to dependents of employees must allow an employee who is covered under the plan, or who is eligible for coverage, to enroll himself (if not currently covered) and certain dependents under HIPAA’s special enrollment period rules.
A covered or eligible employee may add the following dependents under the special enrollment rules:
- a new spouse upon marriage;
- a spouse after the birth, adoption, or placement for adoption of a new child; and
- a person who becomes a dependent of the employee through birth, adoption or placement for adoption.
Length of enrollment period. The special enrollment period must be at least 30 days, beginning on the date of the marriage, birth, adoption or placement for adoption.
Source: CCH HIPAA Guide for Employers
|
