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(Health Insurance Portability and Accountability Act of 1996)

New federal regulations for UC medical plans

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 changed certain eligibility requirements for UC’s medical program as of January 1, 1998. Recently, the Departments of Labor, Treasury, and Health and Human Services issued final regulations expanding the HIPAA portability provisions affecting UC’s medical program effective January 1, 2006. The HIPAA portability rules do not apply to UC’s dental plan.

I. Special enrollment opportunities: Eligible employees and family members not enrolled in a UC medical plan are provided a “special enrollment opportunity” to enroll in a UC medical plan because they have lost other medical coverage as follows:

  1. An employee or a family member who opted out of UC medical coverage because of other medical coverage may enroll in a UC plan when the other employer stops paying for the applicable person’s other coverage.
  2. An employee or a family member who ceases to be eligible under another medical plan due to loss of dependent status may enroll in a UC plan.
  3. An employee or a family member may enroll in a UC medical plan if their other medical plan ceases to offer benefits for a class of employees to which they belong.
  4. An employee or a family member no longer resides, lives or works in the service area of another non-UC employer’s HMO plan.
  5. An employee or a family member who reaches a lifetime maximum on all benefits under another non-UC medical plan may enroll in a UC plan.

When these events occur, an employee or family member will be given a 31-day period of eligibility in which to enroll in a UC medical plan.

Please remember that family members cannot be enrolled in a UC medical plan independently. An employee must be enrolled in the UC medical plan in order to enroll eligible family members and all eligible family members must be enrolled in the same plan as the employee.

II. New UC medical plan transfer opportunities: Employees enrolled in a UC medical plan will have new opportunities to transfer from one UC medical plan to another UC medical plan as follows:

  1. If an eligible family member experiences a “special enrollment opportunity” described above, an enrolled employee can transfer to any other UC medical plan for which he/she is eligible during the family member’s 31-day period of initial eligibility.
  2. If an enrolled employee or family member reaches a lifetime maximum on all benefits under a UC medical plan, the employee may transfer both the employee and family member into another UC medical plan.
  3. Enrolled employees adding a newly eligible family member during the family member’s 31-day period of initial eligibility will now be given the opportunity to switch medical plans at the same time.
  4. Employees enrolled in a UC HMO plan may transfer into another UC medical plan within 31 days of the date they no longer reside, live or work in that HMO’s service area.

To request special enrollment or obtain more information, contact your local Benefits Office.