What are some examples of events that can trigger a loss of eligibility for coverage?
• Divorce or legal separation results in you losing your spouses health insurance; • A young dependent, because of age, work, or school status, is no longer a covered “dependent” under a parents plan; • Your spouses death leaves you without coverage under his or her plan; • Your spouses employment ends, as does coverage under his employers health plan; • Your employer reduces your work hours to the point where you are no longer covered by the health plan; • Your plan decides it will no longer offer coverage to a certain group of individuals (for example, those who work part time); • You no longer live or work in the HMOs service area; • You have a health claim that would meet or exceed the plan’s lifetime limit on all benefits. These should give you some idea of the types of situations that may entitle you to a special enrollment right.
Loss of eligibility for coverage may occur when: • Divorce or legal separation results in you losing your spouses health insurance; • A young dependent, because of age, work, or school status, is no longer a covered “dependent” under a parents plan; • Your spouses death leaves you without coverage under his or her plan; • Your spouses employment ends, as does coverage under his employers health plan; • Your employer reduces your work hours to the point where you are no longer covered by the health plan; • Your plan decides it will no longer offer coverage to a certain group of individuals (for example, those who work part time); • You no longer live or work in the HMOs service area; • You have a health claim that would meet or exceed the plan’s lifetime limit on all benefits. These should give you some idea of the types of situations that may entitle you to a special enrollment right.
