New Special Open Enrollment Under CHIP of 2009

The Children's Health Insurance Program Reauthorization Act of 2009 was signed into law on February 4, 2009.  One part of this legislation created two additional special open enrollment rights for certain individuals to elect group health plan coverage.  Effective April 1, 2009, group health plans must allow employees and dependents who are eligible for but not enrolled in group health plan coverage to enroll for the following two additional situations:

1. The employee or dependent is eligible under a state Medicaid plan or state children's health insurance program (CHIP) and the Medicaid or CHIP coverage is terminated.  This loss of coverage allows the employee to request enrollment under the group health plan no later than 60 days after termination of the Medicaid or CHIP plan.
   
   
2. The employee or dependent becomes eligible for a premium assistance subsidy under a state Medicaid plan or CHIP.  The employee would need to request enrollment in the group health plan no later than 60 days after the date the employee or dependent is determined to be eligible for the premium assistance subsidy.

Employers that receive requests from employees to add themselves or dependents under these new special enrollment rights should submit paperwork to Tufts Health Plan through the current process established for special enrollments.

Please note, the law also created annual employer notice requirements which will be effective starting in 2010.  For plan year 2010, employers are required to provide notices by the later of: (1) the first day of the first plan year after February 4, 2010; or (2) May 1, 2010.  (For plan years beginning from February 4, 2010 through April 30, 2010, the notice must be provided by May 1, 2010.  For plan years beginning on or after May 1, 2010, the notice must be provided by the first day of the next plan year (January 1, 2011 for calendar year plans)).  The notice may also be provided concurrently as open enrollment materials or the plan SPD.

The Department of Labor has released a model notice for employers use.  A copy of the model notice and related information are available at the Department of Labor’s Web site under “Children's Health Insurance Program.”  Employers should direct questions relating to this to their account manager.