This notice is being provided to ensure that you understand your right to apply for group health insurance coverage. You should read this notice even if you plan to waive coverage at this time.
Under the special enrollment provisions of HIPAA, you may be eligible, in certain situations, to enroll in a Multnomah County medical plan during the year, even if you previously declined coverage. This right extends to you and all eligible family members.
Loss of Other Coverage
You will be eligible to enroll yourself (and eligible dependents) if, during the year, you or your dependents have lost coverage under another plan because:
Coverage ended due to termination of employment, divorce, death, or a reduction in hours that affected benefits eligibility;
Employer contributions to the plan stopped;
The plan was terminated; or
COBRA coverage ended.
Example: You waived coverage because you were covered under a plan offered by your spouse's employer. Your spouse terminates their employment. If you notify your employer within 60 days of the date coverage ends, you and your eligible dependents may apply for coverage under our health plan.
You must notify the plan within 60 days of the loss of coverage in order to enroll on the Multnomah County medical plan during the year. Otherwise, you will need to wait until the plan’s open enrollment period.
Marriage, Birth, or Adoption
If you gain a new dependent during the year as a result of marriage, birth, adoption or placement for adoption, you may enroll that dependent, as well as yourself and any other eligible dependents in the plan, even if you previously declined medical coverage.
Example: When you were hired by us, you were single and chose not to elect health insurance benefits. One year later, you marry. You and your eligible dependents are entitled to enroll in this group health plan. However, you must apply within 60 days from the date of your marriage.
You must notify the plan within 60 days of the event in order to enroll on the Multnomah County medical plan during the year. Otherwise, you will need to wait until the plan’s open enrollment period. Coverage will be retroactive to the date of birth or adoption for children enrolled during the year under these provisions.
Medicaid or CHIP
Effective April 1, 2009, you will be eligible to enroll yourself and eligible dependents if either of two events occur:
- You or your dependent loses Medicaid or Children’s Health Insurance Program (CHIP) coverage because you are no longer eligible.
- You or your dependent qualifies for state assistance in paying your employer group medical plan premiums.
Example: When you were hired by us, your children received health coverage under CHIP and you did not enroll them in our health plan. Because of changes in your income, your children are no longer eligible for CHIP coverage. You may enroll them in this group health plan if you apply within 60 days of the date of their loss of CHIP coverage.
Regardless of other enrollment deadlines, you will have 60 days from the date of the Medicaid/CHIP event to request enrollment in the Multnomah County medical plan.
Please note that special enrollment rights allow you to either:
- Enroll in your current medical coverage; or
- Enroll in any medical plan benefit option for which you and your dependents are eligible.