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Compliance Checklist for HIPAA Special Enrollment

Legislative Brief

Compliance Checklist for HIPAA Special Enrollment


HIPAA requires group health plans to provide a special enrollment opportunity outside of the plan’s initial enrollment period or annual open enrollment period in certain situations. Special enrollment must be made available in the following three situations:

  • A loss of eligibility for other health coverage;
  • The acquisition of a new spouse or dependent by marriage, birth, adoption or placement 
    for adoption; and
  • Becoming eligible for a premium assistance subsidy under Medicaid or a state Children’s Health Insurance Program (CHIP), as required under the Children’s Health Insurance Program Reauthorization Act (CHIPRA).

The Department of Labor (DOL) issued the following checklist to assist group health plans to 
comply with HIPAA’s special enrollment requirements.

 

Download the full HIPAA Special Enrollment PDF

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