Special Enrollment for Marriage, Birth, and Adoption
When an employee gets a new spouse, a newborn or an adopted child, a plan that offers dependent coverage must open a special enrollment window. This page covers who can enroll and the date coverage starts for each event.
The New Dependent Rule.
General information, not legal advice. These cards lead to the overview and two closely related pages.
HIPAA Special Enrollment and the Newborns’ Act
The overview of this series, with all five topics, the sources and a first-steps list.
Special Enrollment Windows and Effective Dates
The 30-day floor, the 60-day public program rights and the coverage start dates.
Special Enrollment After Loss of Other Coverage
Which losses of other coverage open a special enrollment right, and which do not.
Which Events Count.
ERISA section 701(f)(2), 29 U.S.C. 1181(f)(2), applies if a plan offers dependent coverage. The participant, or a person who met the waiting period but missed enrollment, must gain a new dependent through marriage, birth, or adoption or placement for adoption. That event opens the window.
The statute adds that a spouse may be enrolled as a dependent in a birth or adoption case, if the spouse is otherwise eligible. An employee who never joined the plan can therefore enroll together with the new child.
The regulation, 29 CFR 2590.701-6(b), spells out which combinations of employee, spouse and child can enroll for each event. If a plan is not clear on that point, ask your carrier before you tell an employee no.
When Coverage Begins.
If the request is made in the first 30 days, no waiting period may apply. For a marriage, coverage starts no later than the first day of the first calendar month after the plan receives the completed request. For a birth, coverage starts on the date of birth. For an adoption or placement for adoption, coverage starts on the date of the adoption or placement.
The regulation’s example is a child born on March 15, who can be covered as of March 15. The date of birth, not the date of the request, sets the start, as long as the request falls inside the plan’s window.
A marriage works differently. Coverage follows the month after the request, so an employee who marries on the 20th and asks on the 22nd is not covered from the 20th. Employees often assume otherwise, which is worth a line in your enrollment guide.
Wait for Dependent Coverage.
The 30-day period runs from the later of two dates: the date dependent coverage became available under the plan, or the date of the marriage, birth, adoption or placement. The regulation applies the same idea when dependent coverage was not generally available at the time of the event.
This protects employees in a plan that had no dependent tier or that added one mid-year. It also means an employer cannot count the 30 days from the event alone if dependent coverage had not yet opened.
The Pre-Tax Side.
Special enrollment decides whether the plan must admit the person. It does not decide whether an employee may change a pre-tax payroll election. That is a separate test under the cafeteria plan rules, and the two can give different answers for the same event.
Our page on Section 125 written plans and election rules covers the pre-tax side. Read both before telling an employee what the payroll change will be.
For dependent students who take a medical leave, Michelle’s Law is its own rule. Our page on it explains how it works.
Related Rules and Tools.
Section 125 Cafeteria Plans: Written Plan and Election Rules
How pre-tax election changes work, which is a separate test from special enrollment.
Michelle’s Law and Dependent Student Coverage
The separate rule for dependent students who take a medically necessary leave.
Employee Eligibility Classes in Group Health Plans
Who a plan may treat as eligible and how classes are drawn.
Laws and Sources
ERISA section 701(f), 29 U.S.C. 1181(f): special enrollment periods for loss of other coverage, new dependents, and Medicaid and CHIP.
29 CFR 2590.701-6: the regulation on special enrollment periods, notice and effective dates.
General information, not legal or tax advice.
Quick Answers.
Short replies on this page’s topic, each tied to a fuller guide.
When does a newborn’s coverage start under special enrollment?
On the date of birth, if the employee requests enrollment within the plan’s window. The regulation uses a child born March 15 as its example.
Can a new spouse and an employee who declined coverage both enroll?
The statute lets a spouse enroll as a dependent in a birth or adoption case if otherwise eligible, and the regulation sets out the combinations that apply for each event. Confirm the exact combination with your carrier.
Does a marriage change a pre-tax election automatically?
No. Special enrollment decides plan eligibility. A pre-tax payroll change falls under the cafeteria plan election rules, which are a separate test.
The Rest of This Series.
Newborns’ Act 48 and 96 Hour Hospital Stay Rules
The childbirth stay minimums, the cost-sharing limit and the no-authorization rule.
Special Enrollment and Newborns’ Act Notices
The notice at the time of offer, the hospital-stay statement and the plan document terms.
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