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CHP Late Enrollment: Special Enrollment Eligibility |
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Workers and/or their dependent(s), who previously declined CHP coverage due to other coverage in another health plan, may be eligible to enroll in the CHP at a later date under the special enrollment provisions if they are eligible for coverage and the following conditions are met. Workers at Worker Choice employers (those who offer more than one CHP Option) may also change their CHP Option if they qualify for special enrollment. Application for special enrollment in the CHP must be received by Concordia Plan Services as soon as possible but no later than 30 days (unless otherwise indicated – see item #4 below) after the event (i.e., loss of other health coverage or the reason for requesting CHP enrollment).
- Statement of reason for declining coverage. The worker must provide a statement at the time coverage is declined indicating the reason for declining coverage. To be eligible for special enrollment, the worker must have declined coverage due to coverage under another plan. Any break in covered periods must be less than 63 days.
- COBRA coverage exhausted. If coverage was declined for a worker and/or any dependent(s) because the other coverage was COBRA continuation coverage, the COBRA continuation coverage must be exhausted before the special enrollment will be available. Any break in covered periods must be less than 63 days.
- Loss of other coverage. If the other coverage that applied to the worker and/or any dependent(s) when enrollment was declined was not COBRA continuation coverage, then to be eligible for the special enrollment period, the coverage must be lost due to a loss of eligibility for the other coverage or the employer contributions toward the other coverage must have ended. Loss of eligibility includes a loss of coverage due to divorce, legal separation, death, termination of employment, or reduction in hours of employment. Loss of coverage does not include a loss due to failure of the participant to pay premiums for any reason or termination of the other coverage for cause. Any break in covered periods must be less than 63 days.
- Children’s Health Insurance Program (CHIP) Reauthorization Act of 2009. Effective April 1, 2009. Group health plans and health insurance carriers are required to permit a worker (or dependent of the worker) who is eligible—but not enrolled for coverage—to enroll for coverage if: 1) The worker (or dependent) is covered under a state Medicaid or state children’s health insurance plan and coverage is terminated as the result of the loss of eligibility for Medicaid or state children’s health insurance coverage; or 2) The worker (or dependent) becomes eligible for premium assistance—to purchase coverage under the group health plan— provided by the applicable state Medicaid or state children’s health insurance plan; and 3) The worker requests coverage no later than 60 days after the date eligibility is lost or the date the worker (or dependent) is determined to be eligible for state premium assistance.
- New dependent due to marriage, birth, adoption, or placement for adoption. If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and/or your dependents. However, you must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption.
- Certification. A certificate of prior coverage must be submitted with the request for special enrollment. In the absence of a certificate of prior coverage, the individual has the right to demonstrate prior coverage by (1) attesting to such coverage, (2) providing corroborating evidence (e.g., a doctor’s bill or pay stub showing payroll deduction), and (3) cooperating with the plan to demonstrate coverage. If an individual does these three things, it will be the same as presenting a certificate.
If you have specific questions regarding special enrollment eligibility, please contact our office at 888-927-7526 or send an email to info@ConcordiaPlans.org.
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