March 9, 2009

New HIPAA Special Enrollment

On February 4, 2009, President Obama signed the “Children's Health Insurance Program Reauthorization Act of 2009”, which re-authorizes the program to provide health coverage for low-income children. This law will affect employers in several ways:

Special Enrollment

This law requires health plans to offer two new special enrollment events as follows:

  1. An employee, or an employee’s dependents who are otherwise eligible for the employer plan, and who lose eligibility for Medicaid or CHIP, and who request enrollment within sixty (60) days, will be afforded a special enrollment opportunity.
  2. Employees, or dependents who are otherwise eligible for the employer health plan, and who become eligible for premium assistance through Medicaid or CHIP, and who request enrollment within sixty (60) days, will, likewise, be granted a special enrollment opportunity.

Generally, all health plans are subject to these rules, however, HSAs and high-deductible health plans are specifically excluded.

Plans should be reviewed and amended to provide for the new special enrollment opportunities.


Disclosure Notice – the employer will be obligated to provide a disclosure notice explaining the potential availability of premium assistance. This notice can be provided in the SPD, or with open enrollment materials. A model disclosure notice is to be developed within one (1) year of the law’s enactment. The notice requirement will become applicable to plan years beginning on or after the date the model disclosure notice is developed.

Coordination Notice – a coordination notice will also be required. This notice will be used to advise the state Medicaid services about the plan provisions so the Medicaid office can then determine how it can best coordinate with the employer plan. A group will be appointed within the next couple of months to develop this notice. This notice will be required to be used on the first of the plan year following the development of the notice.

As the model notices become available, we will provide them to you.


The information contained in this Benefit Beat is not intended to be legal, accounting, or other professional advice, nor are these comments directed to specific situations.

As required by U.S. Treasury rules, we inform you that, unless expressly stated otherwise, any U.S. federal tax advice contained in this Benefit Beat is not intended or written to be used, and cannot be used, by any person for the purpose of avoiding any penalties that may be imposed by the Internal Revenue Service.


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