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HIPAA Special Enrollment Rights

If you declined enrollment in a HealthChoice health plan because you had other health insurance coverage (excluding Excepted Benefits) or Indian or military health benefits, you can enroll:

  • Within 30 days of the date you lose other coverage; or
  • During the annual Option Period (only current employees).

Excepted Benefits are the four categories of benefits as established in section 2791 of the PHS Act, section 733 of ERISA, and section 9832 of the Internal Revenue Code, as summarized in IRS Bulletin 2015-14 and subsequent regulatory guidance. These excepted benefits include, but are not limited to:

  • Vision coverage;
  • Dental coverage;
  • Long-term care insurance;
  • Medicare supplement coverage;
  • Automobile liability insurance;
  • Workers’ compensation;
  • Accidental death and dismemberment insurance; and
  • Specific disease coverage (such as cancer).

Certain qualifying events allow a midyear benefit change; however, an enrollment or change form must be completed within 30 days of the qualifying event. Examples of midyear qualifying events include:

  • A change in your legal marital status, such as marriage, divorce or death of your spouse;
  • A change in the number of your dependents, such as the birth of a child;
  • A change in employment status that affects your eligibility or that of your spouse or dependent;
  • An event that causes your dependent to meet, or fail to meet, eligibility requirements;
  • Commencement or termination of adoption proceedings;
  • Judgments, decrees or orders (your employer may allow changes only to health and dental);
  • Medicare eligibility for you or a dependent;
  • Medicaid eligibility for you or a dependent; only two changes are allowed per plan year, once out and once back in or vice versa;
  • Changes in the coverage of your spouse or dependent under another employer’s plan;
  • Eligibility for leave under the Family Medical Leave Act (FMLA); and
  • USERRA.

To request special enrollment or obtain more information, current employees contact your insurance/benefits coordinator. Former employees contact HealthChoice member services at 1-405-717-8780 or toll-free 1-800-752-9475. TDD users call 1-405-949-2281 or toll-free 1-866-447-0436.