Rule 20:06:39:71 Special enrollment triggers.
enrollment triggers. After December 31, 2013, a health insurance issuer
offering health insurance coverage in the individual market outside the
Exchange must allow for an individual or dependent to enroll or change from one
plan to another as a result of the following qualifying events:
(1) The death
of the covered individual;
termination of individual's employer coverage other than by reason of gross
misconduct, or reduction of hours of the covered employee's spouse;
divorce or legal separation;
becoming entitled to benefits under XVII of the Social Security Act;
child ceasing to be dependent child;
proceeding in a case under Title 11, United States Code, commencing on or after
July 1, 1986, with respect to the employer from whose employment the covered
individual retired at any time;
individual gains a dependent or becomes a dependent through marriage, birth,
adoption, or placement for adoption; and
qualified individual or enrollee gains access to nongrandfathered health plan
as a result of a permanent move.
A health insurance
issuer in the individual market must provide, with respect to individuals
enrolled in non-calendar year, a limited open enrollment period beginning on
the date that is 30 calendar days prior to the date the policy year ends in
This section does not
apply to grandfathered plans.
Source: 39 SDR
203, effective June 10, 2013; 41 SDR 93, effective December 3, 2014.
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