Late Enrollee Group Employer Plans
Qualifying – Trigger Event  QLE and get a Special Enrollment?

Special Open Enrollment – Late Enrollee
Employer Group Plans

If you or your dependent(s) (including a spouse/domestic partner), didn’t enroll in an Employer Group plan when you were first employed, you may be able to enroll yourself or your dependent(s) in this health benefit plan or change health benefit plans as a result of certain

Special Open Enrollment for entire group – Don’t have to meet contribution or Participation requirements 

Qualifying triggering events, including:

(1) you or your dependent loses minimum essential coverage;

A.   Voluntary loss doesn’t count into the Individual Market and probably not for group. ^{Health Care.Gov} *  As President Trump said Insurance is very complicated.

(2) you gain or become a dependent;

(3) you are mandated to be covered as a dependent pursuant to a valid state or federal court order;

(4) you have been released from incarceration;

(5) your health coverage issuer substantially violated a material provision of the health coverage contract;

(6) you gain access to new health benefit plans as a result of a permanent move;

I don’t see a move in the CFR  maybe it’s just a CA rule?  Just a Blue Cross rule, in their application.

Individual Rules on permanent moves.  It’s virtually the same wording, gain access as a result of a permanent move.  See also the Insurance Company Interpretations available on that page.

(7) you were receiving services from a contracting provider under another health benefit plan, for one of the conditions described in Section 1373.96(c) of the Health and Safety Code and that provider is no longer participating in the health benefit plan;     See our webpage on continuity of care

(8) you are a member of the reserve forces of the United States military or a member of the California National Guard, and returning from active duty service;

or

(9) you demonstrate to the department that you did not enroll in a health benefit plan during the immediately preceding enrollment period because you were misinformed that you were covered under minimum essential coverage.

You must request special enrollment within 60 days from the date of the triggering event to be able to enroll yourself or your dependent(s) in this health benefit plan or change health benefit plans as a result of a qualifying triggering event. ^{Specimen Policy Page 121} *  ^{Blue Cross Group Employee Application}  * ^{CFR 54.9810-6  Health Care Reform Regulation on Special Enrollment for Employer Plans} 

 1357.500.  As used in this article, the following definitions shall apply:

(f) “Late enrollee” means an eligible employee or dependent who has declined enrollment in a health benefit plan offered by a small employer at the time of the initial enrollment period provided under the terms of the health benefit plan consistent with the periods provided pursuant to Section 1357.503 and   who subsequently requests enrollment in a health benefit plan of that small employer, except where the employee or dependent qualifies for a special enrollment period provided pursuant to Section 1357.503.

10753 (l) “Late enrollee” means an eligible employee or dependent who has declined health coverage under a health benefit plan offered by a small employer at the time of the initial enrollment period provided under the terms of the health benefit plan consistent with the periods provided pursuant to Section 10753.05 and who subsequently requests enrollment in a health benefit plan of that small employer, except where the employee or dependent qualifies for a special enrollment period provided pursuant to Section 10753.05. It also means any member of an association that is a guaranteed association as well as any other person eligible to purchase through the guaranteed association when that person has failed to purchase coverage during the initial enrollment period provided under the terms of the guaranteed association’s health benefit plan consistent with the periods provided pursuant to Section 10753.05 and who subsequently requests enrollment in the plan, except where the employee or dependent qualifies for a special enrollment period provided pursuant to Section 10753.05.

Learn more⇒

• Individual
• Employer Group
  • Check the Administrative Page for the relevant Insurance Company
• Section 125 Cafeteria Plans What changes are permitted – Special Enrollment Periods?
• Code of Federal Regulations CFR §146.117   Special enrollment periods.
• CFR 147.104 Guaranteed Availability of coverage
• DOL Compliance Assistance Guide (see icon below or in right column)
  See also ECFR.gov
• NEW CA Mandate for Individuals to have Health Insurance!