Signed into federal law in 1996, HIPAA makes it easier for individuals to get coverage for pre-existing medical conditions when they move from one job to another. Under the law, individuals are not excluded from coverage or charged more for coverage offered by a plan or issuer, based on health status-related factors. The law requires insurance companies to disclose summary plan descriptions as well as any reduction in covered services or benefits.

HIPAA provides special enrollment rights for individuals who lose their coverage in certain situations, including separation, divorce, death, termination of employment or reduction in hours. Special enrollment rights are also provided if employer contributions toward other coverage terminates.

In addition, HIPAA allows a special enrollment when an employee or dependent is eligible but not enrolled in a group health plan and there is a marriage, birth, adoption or placement for adoption, if coverage is elected within 30 days of the event. Coverage is effective on the date of birth, on the date of adoption placement or on the first of the month following the request for enrollment following a marriage.

If the special enrollment rights apply, the employee may also elect to change health plans by submitting a completed application to the benefits office within 30 days of the qualifying event.

Should you or any dependent reach your lifetime benefit maximum, you have the opportunity to change health plans with required time frames.

As a State of Wisconsin employee, if you do not enroll in a health insurance plan during regular enrollment or these special enrollment opportunities, your coverage will be limited to the Standard Plan with a 180-day waiting period for pre-existing conditions.

Return to UW System State Group Health web page

This document was last revised on January 21, 2010