Plan Document and SPD Language for CHIP Special Enrollment
The right exists in the statute whether or not your plan says so, but your documents should match it. This page covers where the language goes, what DOL says about the SPD and the points we could not confirm.
What Your Documents Should Match.
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 60-Day CHIP Special Enrollment Window
The rule your documents need to state.
The Employer CHIP Premium Assistance Notice
The annual notice that can travel with the SPD.
What The Rules Say About Notice.
Section 701(f)(3)(A) says a group health plan shall permit enrollment in the two CHIP situations, so the right does not depend on a plan provision. Documents matter because they are how employees learn the right and how enrollment staff apply it.
The special enrollment regulation, 29 CFR 2590.701-6(c), calls for a notice describing special enrollment rights, furnished at or before the time an employee is first offered the chance to enroll. The text we reviewed does not mention Medicaid or CHIP, so we cannot say the regulation itself requires the CHIP events in that description.
DOL’s FAQs say the special enrollment notice can be included in the SPD if the SPD is given at or before the time the employee is first offered the opportunity to enroll, and otherwise should be given separately, for example with the application.
Language We Recommend.
This is our practice, not a federal text requirement. In the eligibility or special enrollment section, list the two events in plain words: loss of Medicaid or CHIP coverage because of loss of eligibility, and eligibility for state premium assistance toward this plan. State the request period as 60 days from the termination date or from the eligibility determination date.
Say who to contact and how to submit a request, and note that the state’s letter helps document the date. Keep the Medicaid and CHIP events apart from the 30-day events so readers do not merge the windows.
State a coverage start date. The statute text does not give one for these two events, and we did not find a federal start-date rule at a primary source, so the document should say what your plan and carrier actually apply.
Reviewing The Documents.
Lay the plan document, the SPD or wrap, the carrier certificate and the enrollment form side by side and search each for special enrollment. Note where the CHIP events are missing or where a different window appears.
Ask the carrier or administrator in writing whether it accepts a request within 60 days and what start date it applies.
Send the annual CHIP notice in the same package so the employee sees the right and the state contacts together.
What We Could Not Confirm.
We found no CHIP-specific SPD content rule in the sources we read. DOL’s CHIPRA materials describe the SPD only as one way to deliver the employer notice. If someone tells you the SPD must contain particular CHIP wording, ask for the citation.
Check that the document you rely on to carry the notice is actually delivered to all employees on time. That is DOL’s stated condition for using enrollment or SPD materials as the delivery vehicle.
Final plan wording is a legal drafting task, so have counsel approve it.
Related Rules And Tools.
ERISA Part 7 Group Health Plan Requirements Checklist
The wider federal rules for group health plans.
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 Health Coverage Portability (HIPAA) Compliance FAQs: DOL answers on the Employer CHIP Notice, the annual requirement, the model notice and the SPD.
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 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 documents, the SPD and the regulation.
Can the CHIP notice go inside the summary plan description?
Yes, if the SPD reaches all employees on time under DOL’s disclosure rules. DOL’s FAQs and fact sheet list the SPD, enrollment packets and open season materials as acceptable delivery vehicles.
Should our plan document list the Medicaid and CHIP events?
We recommend it. The statute requires the plan to permit enrollment in both situations, and listing them keeps your documents consistent with it. We did not find a federal rule that dictates the exact wording.
Does the regulation at 29 CFR 2590.701-6 cover the CHIP events?
The text we reviewed covers loss of other coverage and new dependents and does not mention Medicaid or CHIP. The CHIP right comes from ERISA section 701(f)(3), 29 U.S.C. 1181(f)(3).
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 60-Day CHIP Special Enrollment Window
The two events and the 60-day request period.
The Employer CHIP Premium Assistance Notice
Who sends the annual notice and the penalty for missing it.
How CHIP Premium Assistance Works With Your Group Plan
The subsidy, the voluntary election and the state request for plan information.
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