The 60-Day CHIP Special Enrollment Window: Two Events, One Clock
An employee who is eligible for your plan but not enrolled can ask to join within 60 days after losing Medicaid or CHIP coverage, or after being found eligible for state premium assistance. This page walks through both events.
What The Statute Says.
General information, not legal or tax advice.
CHIPRA Premium Assistance and CHIP Special Enrollment
The overview of the whole series, with the short version of the law.
The Employer CHIP Premium Assistance Notice
How employees learn that premium assistance exists in their state.
Plan Document and SPD Language for CHIP Special Enrollment
Where the 60-day rule belongs in your plan documents.
Two Triggers, Two Start Dates.
Section 701(f)(3)(A) of ERISA, 29 U.S.C. 1181(f)(3)(A), says a group health plan shall permit an employee who is eligible, but not enrolled, to enroll if either of two conditions is met. The first is that the employee or a dependent was covered under a Medicaid plan under title XIX or a state child health plan under title XXI, and that coverage ended because of loss of eligibility. The employee must request coverage under the group plan not later than 60 days after the date the coverage ended.
The second is that the employee or a dependent becomes eligible for assistance with the cost of the group plan coverage under the Medicaid or CHIP plan. Here the 60 days run from the date the employee or dependent is determined eligible for that assistance, not from the date any program coverage ended. Two different events, two different start dates.
DOL’s fact sheet and its HIPAA compliance FAQs describe the same rule: the plan must give at least 60 days to request coverage after either event.
Why This Window Is Longer Than The Others.
Other special enrollment events carry a shorter minimum. The regulation at 29 CFR 2590.701-6 requires at least 30 days after a loss of other coverage or the arrival of a new dependent. The Medicaid and CHIP rights come from the statute itself and run 60 days. An enrollment team that applies one 30-day rule to everything will turn away a request the law says it must accept.
The regulation text we reviewed does not mention Medicaid or CHIP, so the 60-day period rests on the statute and on DOL’s guidance. If your handbook or enrollment system hard-codes a single window for all special enrollment events, this is the item to fix.
Setting Up The Process.
Decide who receives these requests and write the 60-day rule where that person can find it. Requests often come from a parent holding a letter from the state, not from an HR form.
Record the date on the state’s letter. For a loss of coverage, use the termination date. For premium assistance, use the eligibility determination date. Count 60 days from the right one.
Confirm the person is eligible under your plan’s own terms but not enrolled. The statute applies to an employee who is eligible but not enrolled, so it does not widen who is eligible.
Common Misreadings.
Tying the window to open enrollment. The clock starts with the state’s action, not with your plan calendar.
Assuming a coverage start date. The statute text on this right sets the request window and does not state when coverage must begin. We did not find a federal start-date rule for these two events at a primary source, so this is not confirmed. Your plan document should state a start date, and it is worth asking your carrier what it applies.
Treating the request as optional. The statute says the plan shall permit enrollment when the conditions are met.
Related Rules And Tools.
ERISA Part 7 Group Health Plan Requirements Checklist
The wider set of federal rules for group health plan design and notices.
A Compliance Calendar for Your Plan Year
A plan-year view of the dates that matter.
Affordable Care Act for Employers
The employer mandate, reporting and the other federal rules beside this one.
Laws And Sources
ERISA Section 701(f), 29 U.S.C. 1181: The statute text for the CHIP special enrollment right in paragraph (f)(3), the employer notice duty and the plan administrator disclosure to states.
29 CFR 2590.701-6: The special enrollment regulation. The text we reviewed covers loss of other coverage and new dependents and does not mention Medicaid or CHIP.
DOL EBSA Fact Sheet, HIPAA Special Enrollment and CHIPRA: DOL’s summary of the two special enrollment events, the 60-day request period and the employer notice.
DOL Health Coverage Portability (HIPAA) Compliance FAQs: DOL answers on the Employer CHIP Notice, the annual requirement, the model notice and the SPD.
DOL EBSA, CHIPRA: The Department of Labor page for the Children’s Health Insurance Program Reauthorization Act and its employer topics.
General information, not legal or tax advice.
Quick Answers.
Short replies on the 60-day window and who can use it.
Does the 60-day window apply to dependents as well as employees?
Yes in effect. The statute lets an eligible but unenrolled employee enroll when the employee or a dependent loses Medicaid or CHIP coverage or becomes eligible for premium assistance. DOL’s fact sheet describes the right as covering employees and dependents.
When does the 60 days start if the state approves premium assistance?
On the date the employee or dependent is determined eligible for the assistance, under 29 U.S.C. 1181(f)(3)(A)(ii). It does not run from the plan’s open enrollment date.
Is the window the same 30 days as other special enrollment events?
No. The regulation at 29 CFR 2590.701-6 provides at least 30 days for loss of other coverage and for new dependents, while the Medicaid and CHIP right in the statute is 60 days.
The Rest Of This Series.
CHIPRA Premium Assistance and CHIP Special Enrollment
The overview of the whole series, with the short version of the law.
The Employer CHIP Premium Assistance Notice
Who sends the annual notice and how it can travel with enrollment materials.
How CHIP Premium Assistance Works With Your Group Plan
What the state may pay and what stays voluntary.
Plan Document and SPD Language for CHIP Special Enrollment
Language for your documents and the points we could not confirm.
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