An employee had a child in December 2022, but they have not yet added her to the employer’s group health plan. With the COVID-19 extension relief ending soon, is there still time to add her?

There is still time! The standard deadlines for an employee to notify the plan of a HIPAA special enrollment right (SER) have been significantly extended because of COVID-19 relief guidance. These deadline extensions are mandatory and are still in effect.

To review, HIPAA requires that group medical plans provide midyear special enrollment opportunities under certain circumstances. A HIPAA SER can arise in the event of a birth or a child’s adoption/placement for adoption, marriage, loss of eligibility for other group coverage or health insurance, loss of Medicaid or CHIP coverage, or a gain of eligibility for a Medicaid or CHIP premium assistance program.

The COVID-19 relief guidance extends the normal 30- and 60-day HIPAA special enrollment periods until the earlier of one year or 60 days after the declared end of the COVID-19 National Emergency. The COVID-19 National Emergency is scheduled to end on May 11, 2023. Since the event occurred in December 2022, the extension will end 60 days after the National Emergency ends, and the normal deadline will begin running.

Note that of the HIPAA SERs, only the birth, adoption or placement of adoption events allow for retroactive coverage. Therefore, a newborn would be eligible to enroll in the employer’s group health plan with coverage retroactive to the date of birth. If the employee was enrolled in the medical coverage and the employer offered more than one option, the HIPAA SER would also permit a change in benefit options (e.g., from HMO to PPO). Finally, the employee would be required to pay their share of the premiums for this coverage dating back to the date of birth.