received before such date. 42 U.S.C. Genetic information may not be treated as a preexisting condition in the absence of a diagnosis of the condition related to the information. Organ 42 USC The plan may not include a waiting period for organ transplant benefits Transplant §300gg-3(a); because such a waiting period excludes, for the waiting period, benefits Waiting WAC specifically relating to conditions requiring transplants. Period Eligibility Special 42 U.S.C. Plan can use open enrollment periods but must offer Special (Cont’d) Enrollment §300gg-1(b)(1); Enrollment where required. 45 CFR 147.104(3). Periods – 45 C.F.R. Plan must enrollment to eligible persons regardless of open Federal Law §146.117 (a)(3)(i) enrollment requirements (“special enrollment”), in the following situations: 42 U.S.C. Employee loses other coverage If the employee didn’t enroll during open enrollment because they had other coverage. 42 U.S.C. Dependent loses coverage §300gg-3(f)(1)(A) During open enrollment, the dependent had other coverage. Allow both dependent and employee to enroll, but not any other dependents unless they also have their own special enrollment qualifying event. 42 U.S.C. Employee or any dependent other coverage (other than for nonpayment or fraud) due to: (f)(1)(c)(ii) Divorce or legal separation Death of an employee under whose coverage they were a dependent Termination or reduction in the number of hours worked Discontinuation of employer contributions; or (f)(1)(c)(i) Exhaustion of COBRA continuation coverage
received before such date. 42 U.S.C. Genetic information may not be treated as a preexisting condition in the absence of a diagnosis of the condition related to the information. Organ Transplant Waiting Period 42 USC §300gg-3(a); WAC The plan may not include a waiting period for organ transplant benefits because such a waiting period excludes, for the waiting period, benefits specifically relating to conditions requiring transplants. Eligibility (Cont’d) Special Enrollment 42 U.S.C. §300gg-1(b)(1); Plan can use open enrollment periods but must offer Special Enrollment where required. 45 CFR 147.104(3). Periods – Federal Law 45 C.F.R. §146.117 (a)(3)(i) Plan must enrollment to eligible persons regardless of open enrollment requirements (“special enrollment”), in the following situations: 42 U.S.C. Employee loses other coverage If the employee didn’t enroll during open enrollment because they had other coverage. 42 U.S.C. §300gg-3(f)(1)(A) Dependent loses coverage During open enrollment, the dependent had other coverage. Allow both dependent and employee to enroll, but not any other dependents unless they also have their own special enrollment qualifying event. 42 U.S.C. Employee or any dependent other coverage (other than for nonpayment or fraud) due to: (f)(1)(c)(ii) Divorce or legal separation Death of an employee under whose coverage they were a dependent Termination or reduction in the number of hours worked Discontinuation of employer contributions; or (f)(1)(c)(i) Exhaustion of COBRA continuation coverage
cl-forms-19-hmo-sg-analyst-checklist.docx