Can a Plan require proof of good health of late applicants who do not qualify for special enrollment?
A. No. HIPAA prohibits group health plans from using health related factors to determine eligibility. Therefore, an employers plan can no longer require a late applicant to satisfy Proof of Good Health. Late applicants, however, can be subject to a pre-existing condition limitation period of 18 months from the effective date of coverage, if there is no prior creditable coverage. Late applicants can also be limited as to when they enroll if it is not the result of a “Life Event”. Plans with open enrollment periods may require participants to wait until that time period to enter the employer sponsored plan. Q.
Related Questions
- For admitted applicants who decide to enroll at Wheaton, we will require proof of high school graduation in the form of an official high school transcript with a graduation date. What is the suggested high school preparation curriculum for homeschool students?
- Can a Plan require proof of good health of late applicants who do not qualify for special enrollment?
- What are group health plans obligations with respect to special enrollment opportunities?
