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Health Insurance Reimbursement

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I have worked for the same company for almost two years. When I started I was supposed to get on their health insurance after 30 days. Many mistakes were made by the company and that never happened. I found my own insurance and my employer agreed to reimburse me for my portion. Recently, my boss has enacted a new policy stating that you can be on the company insurance or not be reimbursed. Our company does not offer the open registration until this fall for their insurance. How can I resolve this? PS our company is less than 10 employees. Thanks-J

HIPAA, the Health Insurance Portability and Accountability Act, requires that under some circumstances, employees must be permitted to sign up for health insurance even if it is not the open enrollment period. These circumstances include newly hired employees. They also include employees whose insurance coverage has changed, through no fault of their own.

For example, an employer would be required to enroll a worker even outside of the normal open-enrollment period if the worker lost his or her health insurance due to separation or divorce. It also covers employees who lose health care coverage due to the death, termination, reduction in hours or retirement of a spouse.

In these circumstances, the employer must honor a “special enrollment period” for the employee. This essentially is a window of 30 days when the employee can elect to sign up for the employer’s health insurance, outside of the usual fall “open enrollment” period.

Dependants may also qualify for the special enrollment period after a marriage, birth, adoption or placement for adoption.

Employees qualify for special enrollment when they lose health care coverage.

HIPAA also specifically requires employers to provide special enrollment when the employer’s contributions towards other coverage terminates, which appears to be the situation in this case.

HIPAA is administered by the Employee Benefits Security Administration (EBSA.) For a final determination on this particular situation, contact the EBSA regional office nearest you. For a list of offices, visit the agency’s Web site at www.dol.gov/ebsa or call 1-866-444-EBSA (3272).