HIPAA Notice of Special Enrollment Rights with COVID-19 Update

Father holding baby
 
 

Musicians who qualify for enrollment as Participants (ʺQualified Participantʺ) with the benefit plans offered by the Fund may sometimes decline enrollment in the Fundʹs benefit plans for themselves or their dependents (including their spouse) because they presently have other health insurance or group health plan coverage.

If so, the Qualified Participant may be able to enroll themselves and their dependents in the Fundʹs benefit plans outside of the regular enrollment period in the event a Qualified Participant or their dependents lose eligibility for that other coverage (or if the employer stops contributing toward your or your dependents’ other coverage).

The following occurrences are just some events that may trigger a Special Enrollment Event for a Qualified Participant:

  • Loss of eligibility under other coverage you may have had;

  • Loss of eligibility due to divorce or legal separation;

  • Death of a qualified Participant’s spouse which leaves the Participant with no coverage;

  • Participantʹs spouse’s employment ends, as does insurance coverage; and -Participantʹs Spouse loses coverage due to reduction in hours;

  • The birth/adoption/placement for care of a child; -Marriage of a qualified Participant;

  • Loss of eligibility under Medicaid/CHIP by a qualified Participant, and;

  • Gain of eligibility for Medicaid/CHIP premium assistance by a Qualified Participant.

HIPAA SPECIAL ENROLLMENT NOTICE REQUIREMENTS

Due to the onset of the COVID‐19 Pandemic, the notice requirements for electing a HIPAA special enrollment have changed. Thus, and as discussed below, during what is known as the ʺOutbreak Periodʺ Qualified Participants will have more time to elect a HIPAA special enrollment. Once the ʺOutbreak Periodʺ is declared over by the federal government, the HIPAA special enrollment notice rules will revert to the normal time‐lines as reviewed below.

COVID‐19: SPECIAL ENROLLMENT DURING
THE ʺOUTBREAK PERIODʺ

During what is known as the ʺOutbreak Periodʺ – the time during which the federal government recognizes your state or locality as having been or still feeling economic effects from the COVID‐19 pandemic – extra time is allowed for HIPAA special enrollments. Thus, from March 1, 2020, and for as long as Los Angeles County, California, is designated as being within an ʺOutbreak Period,ʺ the following time frames applies for a Qualified Participant to request a special enrollment:

  1. During the ʺOutbreak Periodʺ all deadlines impacting the requesting of a HIPAA special enrollment are automatically extended by sixty (60) days. So, if the Fundʹs normal window for notification by the Qualified Participant of a Qualifying Event is thirty (30) days, that deadline is now ninety (90) days from the occurrence of the Qualifying Event.

  2. When the ʺOutbreak Periodʺ for Los Angeles County is declared over by the federal government, an extra sixty (60) days will be automatically added to all deadlines impacting the requesting of a HIPAA special enrollment. At the end of the ʺOutbreak Period,ʺ and if you incurred a Qualifying Event during the ʺOutbreak Period,ʺ but you have not yet notified the Fund of that Qualifying Event, the Qualified Participant will have an additional sixty (60) days from the announcement that the ʺOutbreak Periodʺ is over.

REGULAR HIPAA SPECIAL ENROLLMENT DEADLINES

For all Qualifying Events that occur outside of the ʺOutbreak Period,ʺ the Qualified Participant must request enrollment within thirty (30) days after your or your dependents’ other coverage ends. In addition, if the Qualified Participant has a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your dependents. This type of Qualifying Event – birth/adoption/placement of child ‐ also is governed by a thirty (30) daysʹ notice and enrollment time‐line or any longer period that applies under the plan] after the marriage, birth, adoption, or placement for adoption.

REQUESTING A SPECIAL HIPAA ENROLLMENT

It is the responsibility of the Qualified Participant to timely notify the Fundʹs Administrative Office of any Qualifying Event that might entitle you to a Special Enrollment. The Fund will only process timely notifications of a Qualifying Event and there is no guarantee that the Fund will acknowledge or process any request for special enrollment that is not provided on a timely basis to the Fundʹs Administrative Office.

To request special enrollment or obtain more information, contact:

PROFESSIONAL MUSICIANS, LOCAL 47 AND
EMPLOYERSʹ HEALTH & WELFARE TRUST FUND
C/O PACIFIC FEDERAL
1000 N. Central Ave. #400
Glendale, CA 91202
818‐243‐0222

 
COVID-19, Coronavirus, Insurance Benefits, HIPPAAS Design