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Labor FAQ Outlines Special Enrollment Guidance


  10:50:00 pm, by MedBen5   , 351 words,  
Categories: News, Health Care Reform, Compliance

Labor FAQ Outlines Special Enrollment Guidance

Department of Labor

The Department of Labor (DOL) recently issued another FAQ in its series addressing implementation of the Affordable Care Act (ACA). In addition to guidance on the 21st Century Cure’s Act and other items, the DOL’s FAQ Part 35 focuses on new special enrollment requirements for group health plans.

As most plan sponsors know, group health plans are required to provide special enrollment periods to current employees and dependents when such employees or dependents lose eligibility under another group health plan or health insurance coverage in which the employee or their dependents were previously enrolled, and upon certain life events, such as when a person becomes a dependent of an eligible employee by birth, marriage, or adoption or dependents reach the plan’s limiting age.

DOL FAQ 35 now clarifies that employees and their dependents are eligible for special enrollment in a group health plan if they are otherwise eligible to enroll in the plan and, at the time coverage under the plan was previously offered, they had other group health plan or health insurance coverage (regardless of whether the coverage was obtained inside or outside of a Marketplace) for which they have lost eligibility.

Accordingly, if an individual loses eligibility for coverage in the individual market, including coverage purchased through a Marketplace (other than loss of eligibility for coverage due to failure to pay premiums on a timely basis or termination of coverage for cause, such as making a fraudulent claim or an intentional misrepresentation of a material fact), that individual is entitled to special enrollment in group health plan coverage for which he or she is otherwise eligible. These individuals will be eligible for special enrollment in the group health plan coverage regardless of whether they may enroll in other individual market coverage, through or outside of a Marketplace.

Plan sponsors should check their group health plans to make sure that the plan’s special enrollment provisions include an option for individuals losing eligibility for coverage inside or outside of the ACA Marketplace.

MedBen clients who have questions regarding this requirement are welcome to contact Vice President of Compliance Caroline Fraker at 800-851-0907 or

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