Qualifying event - A the loss of coverage under a group health plan on account one of the specific events described in COBRA:
- Death of the covered employee
- Voluntary or involuntary termination of the covered employee’s employment (other than by reason of gross misconduct), or reduction of hours of the covered employee’s employment
- Divorce or legal separation of the covered employee from the employee’s spouse
- Covered employee becomes entitled to benefits under Medicare
- Dependent child ceasing to be a dependent child under the generally applicable requirement of the plan; and
- An employer’s bankruptcy (but only with respect the health coverage for retirees and their families).
Requested Certificate of Creditable Coverage - The Certificate of Creditable Coverage required to be furnished to each individual upon written request made within 24 months after plan coverage terminates. The certificate documents the individual’s Creditable Coverage.
Self-Insured Group Health Plans - Plans set up by employers
who set aside funds to pay their employees health claims. Because
employers often hire insurance companies to run these plans, they may look to
you just like fully insured plans. Employers must disclose in your benefits
information whether an insurer is responsible for funding, or for only administering
the plan. If the insurer is only administering the plan, it is self-insured.
Self-insured plans are regulated by the U.S. Department of Labor.
Serious health condition - Via the Department of Labor's (DOL's) regulations, includes chronic conditions, such as asthma, diabetes, and conditions requiring multiple treatments, such as chemotherapy or kidney dialysis.
Small Group Health Plans - Plans with at least 2 but not
more than 50 eligible employees.
SPD - Summary Plan Description - A summary plan description is an ERISA-required summary of the terms of an employer sponsored “welfare benefit plan” that must be furnished to all participants and COBRA beneficiaries.
Special Enrollment - A time, triggered by certain specific events, during which you and your dependents must be permitted to sign up for coverage under a group health plan. Employers and group health insurers must make such a period available to employees and their dependents when their family status changes or when their health insurance status changes. Special enrollment periods must last at least 30 days.
HIPAA requires Group Health Plans to offer special enrollment rights to certain un enrolled employees and dependents when they experience a mid-year loss of other coverage and when there is a mid-year adoption, birth or marriage.
Special Enrollment Period - A time, triggered by certain
specific events, during which you and your dependents must be permitted to sign
up for coverage under a group health plan. Employers and group health
insurers must make such a period available to employees and their dependents
when their family status changes or when their health insurance status changes.
Special enrollment periods must last at least 30 days. Enrollment in a
health plan during a special enrollment period is not considered late enrollment.
See also Late Enrollment.