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Special Enrollment for Employees Who Originally Declined Group Benefits

Employees might decline enrollment in their company’s small group health insurance policy for any number of reasons, but what happens if they later change their minds? Fortunately, the law does provide for a Special Enrollment Period under those circumstances. That’s good news, because under California law we all must enroll in a health insurance policy or face a penalty at tax time next year. That requirement began on January 1 of this year.

For many reasons, a worker might change their mind after once declining coverage. In most cases, such as loss of coverage under another plan, or due to marriage or addition of a new child, they have 30 days to request enrollment in the small group plan. However, if the lost coverage was CHIP or Medi-Cal, a 60-day enrollment period will apply.

Currently, anyone who previously denied coverage for any reason can now enroll in a healthcare plan. You do not need to experience a qualifying life event in order to take advantage of this opportunity. However, the time to enroll does differ from one carrier to the next, so we advise acting now in order to have access to as many options as possible.

Coverage will be equivalent to other enrollees. Special enrollees in small group plans must be offered the same benefits as those who signed up during the original enrollment period. They cannot be charged more than those who enrolled when first eligible.

Benefits cannot be denied on the basis of a preexisting condition. The Affordable Care Act protects potential enrollees from being denied healthcare coverage on the basis of a condition which was present prior to enrollment.

Enrollees cannot be asked to complete a physical or submit a health history before joining the small group plan. A general questionnaire may be used, provided it does not request genetic information and is not used to deny, restrict, or delay benefits.

A group health plan cannot charge an individual more than any other similarly situated individual, based on any health factor.

Contact us to learn more about small group health coverage, and we can help you determine whether a Special Enrollment period applies to your situation.