Both markets only allow enrollment or plan changes during open enrollment or a special enrollment period.
Access to these special enrollment periods is regulated by the government.
How Are Special Enrollment Periods Regulated?
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Specifically,29 CFR 2590.701-6, and in permitted election changes for Section 125 plans (26 CFR 1.125-4).
(Note that this differs from the individual market, where special enrollment periods generally last 60 days.)
They includemarriage,birth, or adoption of a child, andinvoluntary loss of other health coverage.
And it also includes situations in which a current or former employers contributions to the persons premiums terminate.
These circumstances include:
The employer’s plan documents will detail exactly how special enrollment periods work.
These rules must be followed the same way for all employees who are eligible for coverage.
But they are also available during special enrollment periods triggered by certain qualifying life events.
Special enrollment periods generally must last at least 30 days.
KFF.Health insurance coverage of the total population.
Department of the Treasury.Tax treatment of cafeteria plans.
Society for Human Resource Management.Understanding Section 125 cafeteria plans.
Cornell Law School, Legal Information Institute.29 CFR 2590.701-6 - special enrollment periods.
Internal Revenue Service, Employee Benefits Security Administration, Department of Health and Human Services.Short-term, limited-duration insurance.Fed Regist.
2018;83;38212-38243.
Cornell Law School, Legal Information Institute.26 CFR 1.125-4 - permitted election changes.
Internal Revenue Service.Notice 2014-55.
Additional permitted election changes for health coverage under 125 cafeteria plans.
