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Special events enrollment under HIPAA

Under the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), there are special events that may allow you to add health insurance coverage if you did not elect health coverage for yourself and/or your dependents during your initial eligibility period or during Open Enrollment:

Loss of Other Coverage

If you are declining enrollment for yourself and/or your dependents (including your spouse) because of other health coverage, you may be able to enroll yourself and/or your dependents if you or your dependents lose eligibility for that coverage, or if the employer stops contributing towards your or your dependent's coverage. To be eligible for this special enrollment opportunity, you must request enrollment within 31 calendar days after your other coverage ends or after the employer stops contributing towards the other coverage. If the 31-day deadline falls on a weekend or holiday, enrollment forms must be received prior to the weekend or holiday.

Proof Documents Submission Requirements

Examples of Required Dependent Proof Documents

New Dependent as a Result of Marriage, Birth, Adoption, or Placement for Adoption

If you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and/or your dependent(s). To be eligible for this special enrollment opportunity you must request enrollment within 31 calendar days after the marriage, birth, adoption, or placement for adoption. If the 31-day deadline falls on a weekend or holiday, enrollment forms must be received prior to the weekend or holiday.

Medicaid Coverage Effective April 1, 2009

Beginning April 1, 2009, The Children's Health Insurance Program Reauthorization Act of 2009 (CHIP) added a special enrollment event under HIPAA. UNM will allow you and/ or your dependent who is eligible (but not enrolled for coverage) to enroll if either of the following events occur:

Termination of Medicaid or CHIP Coverage

If you and/or your dependent are covered under a Medicaid plan or under CHIP, and your coverage and/or your dependent's coverage under such a plan is terminated as a result of loss of eligibility.

Eligibility for Premium Assistance under Medicaid or CHIP

If you and/or your dependent become eligible for premium assistance under Medicaid or CHIP, including under any waiver or demonstration project conducted under or in relation to such a plan. This is usually a program where the state provides employed individuals with premium payment assistance for their employer's group health plan, rather than direct enrollment in a state Medicaid program.

Under CHIP, you have 60 calendar days to enroll in the UNM Medical Plan if you experience either of the above Qualifying Change of Status Events.

If you are adding a dependent to your Medical, Dental, and/or Vision coverage, you are required to submit proof of your dependent's eligibility. Refer to the Eligibility and Enrollment section for this information.

Proof Documents Submission Requirements

Examples of Required Dependent Proof Documents