HIPAA Special Enrollment Rights
There are four circumstances under which you will qualify for HIPAA special enrollment rights:
  • You acquire a new dependent. If you acquire a new dependent as a result of marriage, domestic partnership, birth, adoption or placement for adoption, you may enroll yourself and your new dependent (and your spouse or domestic partner, if you are acquiring a dependent child for any of the reasons listed here) in Stryker's plan. If you are already enrolled for health coverage when you acquire a new dependent, you may enroll your dependent.
To exercise your special enrollment rights, you must enroll yourself and/or your dependents no more than 30 days after the date you acquire the new dependent. If you acquire a dependent child through birth, adoption or placement for adoption, the new election will be effective on the date the dependent child was acquired. If you acquire a dependent through marriage, the new election will be effective on your date of marriage.
If you don't enroll within 30 days, you may still enroll within the 120-day period described in "Eligibility" and "Making Changes", but all contributions for coverage will be deducted from your paycheck on a post-tax basis for the remainder of the plan year in which you properly completed the enrollment (and will be payable retroactively to the date the child was acquired). If you don't enroll within the 120-day period, you generally will not be permitted to enroll until the next annual enrollment period.
  • You or a dependent loses other coverage. If you waived health coverage because you or your dependent had other medical coverage (including COBRA coverage), you may enroll yourself and your dependents if you or your dependents subsequently lose eligibility for that other coverage (or exhaust your COBRA coverage) or if employer contributions for that coverage are terminated.
For this purpose, "loss of eligibility" includes, but is not limited to:
    • A loss of coverage that results from termination of employment, reduction in hours of employment, or divorce, termination of domestic partnership, death, or cessation of dependent status (e.g., reaching the maximum age to be eligible as a dependent under a plan);
    • In the case of HMO coverage, a loss of coverage that results when an individual no longer resides, lives or works in a HMO service area and there is no other benefit package available to the individual; and
    • A situation in which a plan no longer offers any benefits to the class of individuals of which that individual is a part.
Loss of eligibility for other coverage does not include a loss due to the failure to pay premiums on a timely basis, voluntary termination or termination of coverage for cause (such as fraud), or loss of coverage with no qualifying life event. See "When Coverage Ends" for more information about termination of coverage for cause.
  • You lose Medicaid/CHIP eligibility. If you or an eligible family member loses eligibility for coverage under Medicaid or a State Children's Health Insurance Program (CHIP), you may have special enrollment rights.
To exercise your special enrollment rights, you must enroll yourself and/or your dependents no more than 30 days after the date the other coverage ends. In the case of a loss of Medicaid or CHIP eligibility, the special enrollment period continues until 60 days after the loss of eligibility.
If you don't enroll within 30 days, you may still enroll within the 120-day period described in "Eligibility" and "Making Changes", but all contributions for coverage will be deducted from your paycheck on a post-tax basis for the remainder of the plan year in which you properly completed the enrollment (and will be payable retroactively to the date eligibility was lost). If you don't enroll within the 120-day period, you generally will not be permitted to enroll until the next annual enrollment period.
You will be asked to provide documentation regarding the date the other health plan coverage ended.
  • You gain Medicaid or CHIP eligibility (i.e., become eligible for a Medicaid or CHIP premium assistance subsidy). If you or a family member becomes eligible for a premium assistance subsidy under Medicaid or a CHIP to obtain coverage under the plan, you may have special enrollment rights.
If you or an eligible dependent becomes eligible to have Medicaid or CHIP assist in the payment of your coverage under the Stryker Health and Welfare Plan, you may enroll yourself and your eligible dependent for medical coverage under the plan, provided you contact your Benefits representative no more than 60 days after you or your dependent is determined to be eligible for such assistance.
If you don't enroll within the 60-day period, you may still enroll within the 120-day period but all contributions for coverage will be deducted from your paycheck on a post-tax basis for the remainder of the plan year in which you properly completed the enrollment (and will be payable retroactively to the qualifying life event). If you don't enroll within the 120-day period, you generally will not be permitted to enroll until the next annual enrollment period.
Documentation regarding the gain of Medicaid or CHIP coverage or eligibility for premium assistance under those programs will be required.