LIFE CHANGES

REQUIRE HEALTH

CHOICES

KNOW YOUR BENEFIT OPTIONS

EMPLOYEE BENEFITS SECURITY ADMINISTRATION

UNITED STATES DEPARTMENT OF LABOR
Life Changes 

Require Health 

Choices... 

Know Your 

Benefit Options

If you know your 

benefit options, you 

can better protect 

yourself and your 

dependents. With 

some basic information, 

you can take common-sense steps to 

make sure you have the 

level of health care coverage you 

need at every stage of your life.

Marriage

What You Need to Know: When you get 

married, you can change your health coverage. 

You can add yourself, your new spouse and 

children to your employer’s plan, enroll in your 

spouse’s employer’s plan, or find coverage through 

the Health Insurance Marketplace (Marketplace). 

Get the details on all of your special enrollment 

options and be sure you understand how the 

different plans work. You’ll want to know the 

benefits covered, the amounts of any deductibles 

or copays you will be required to pay, what you will 

pay for premiums, and whether you can continue 

with the same doctors. 
What You Need to Do: To qualify for special 

enrollment into an employer’s plan under the 

Health Insurance Portability and Accountability 

Act (HIPAA), you must request enrollment for 

yourself, a new spouse, and children in your 

employer’s plan or your spouse’s employer’s plan 

within 30 days of your marriage. If you choose 

to enroll in coverage through the Marketplace, 

you must select a plan for yourself and your 

family within 60 days of getting married. 

Review the information on all options and compare 

before you decide which health coverage is best 

for you. 

Pregnancy, Childbirth, 

and Adoption

What You Need to Know: Under the Patient 

Protection and Affordable Care Act (ACA), many 

employer plans and all plans purchased through the 

Marketplace must include benefits for pregnancy, 

childbirth, and newborn care. Most plans also 

cover well-baby and well-child care with no 

copayment, coinsurance or deductible as long 

as you use a network provider. 

Birth and adoption (including placement for 

adoption) may trigger a special enrollment 

period during which you, your spouse, and new 

dependents can enroll in your employer’s plan or 

in a Marketplace plan. Under the Newborns’ and 

Mothers’ Health Protection Act (Newborns’ Act), 

plans that provide maternity or newborn benefits 

generally must provide coverage for mothers and 

newborns to stay in the hospital at least 48 hours 

following a vaginal delivery or 96 hours following 

a cesarean section, unless the doctor or other 

attending provider, in consultation with the mother, 

discharges earlier. If your state has a law that 

provides similar protections and your plan offers 

coverage through an insurance policy or HMO, 

then you may be protected under state law rather 

than under the Newborns’ Act. Your plan must 
provide you with a notice regarding your rights to 

a hospital stay following childbirth. If your plan is 

insured, the notice must describe your protections 

under state law. 

What You Need to Do: Review your plan’s 

Summary Plan Description (SPD) and Summary 

of Benefits and Coverage (SBC) to find out what 

your plan covers for maternity and newborn 

benefits as well as for well-baby and well-child 

visits. To learn more about your state law’s 

requirements for hospital stays after childbirth, 

visit the National Association of Insurance 

Commissioners’ Website at naic.org and 

go to “States & Jurisdiction Map” to find your 

state insurance commissioner’s office. 

To request special enrollment in an employer plan, 

you must notify your plan within 30 days of your 

child’s birth, adoption, or placement for adoption. 

The child’s coverage will be effective on the date 

of the birth, adoption, or placement for adoption. 

Your plan may require that the notice be in writing. 

If you choose to enroll your child in Marketplace 

coverage, you must do so within 60 days of the 

birth, adoption, or placement for adoption.

When Your Child is 

No Longer a Dependent

What You Need to Know: If your employer’s 

plan offers coverage for dependent children, your 

child can stay on your plan until age 26. Once 

your child “ages out” the child may be eligible for 

coverage under his or her own employer’s plan, 

for special enrollment in Marketplace coverage or 

may be eligible to purchase temporary extended 

health coverage for up to 36 months under the 

Consolidated Omnibus Budget Reconciliation Act 

(COBRA). Generally, COBRA covers group health 

plans maintained by employers with 20 or more 

employees.
What You Need to Do: To special enroll 

in Marketplace coverage, your child must enroll 

within 60 days of aging out of your plan. To elect 

COBRA coverage, you must notify your employer 

in writing within 60 days of your covered child 

reaching age 26. In turn, your plan should notify 

your child of the right to extend health care 

benefits under COBRA. Your child will have 60 

days from the date the notice was sent to elect 

COBRA coverage. 

Death, Legal Separation, 

and Divorce

What You Need to Know: When an 

employee covered under an employer-sponsored 

health plan dies, legally separates, or divorces, 

the covered spouse and dependent children need 

to consider their options for health coverage. If 

the spouse has an employer health plan available 

at work, the spouse and any dependents may be 

eligible to special enroll in that plan. Or, they may 

be able to special enroll in health coverage through 

the Marketplace.

The spouse and any dependent children also may 

be eligible to continue their existing health coverage 

for up to 36 months. The plan should notify them 

of their right to purchase extended health care 

coverage under COBRA. Most plans require 

eligible individuals to make their COBRA election 

of coverage within 60 days of the plan’s notice.

What You Need to Do: To special enroll in 

health coverage, the spouse and dependent children 

must request special enrollment in the spouse’s 

employer’s plan within 30 days of the loss of 

coverage or select a plan in the Marketplace within 

60 days before or 60 days after the loss of coverage.

For COBRA coverage, the employer must notify 

the plan within 30 days if the employee who is 

covered by the health care plan dies. If there is a 
divorce or legal separation, the covered employee, 

spouse, or dependent children must notify the plan 

in writing within 60 days. In case of death of the 

covered employee, divorce, or legal separation, 

the plan should notify the eligible spouse and 

dependent children who would lose coverage under 

the plan of their right to purchase temporary 

extended health care coverage. Most plans require 

eligible individuals to make their COBRA election 

within 60 days of the plan’s notice.

For More Information:

The Department of Labor’s Employee Benefits Security 

Administration (EBSA) administers several important 

health benefit laws governing your employer-provided 

health plan – how it works, how you qualify for benefits, 

your basic rights to information, and how to make claims 

for benefits. In addition, there are specific laws protecting 

your right to health benefits when you lose coverage 

or change jobs. EBSA also oversees health care laws 

covering special medical conditions.

Visit the Employee Benefits Security Administration’s 

Website at dol.gov/ebsa to view the following 

publications. To order copies or to request assistance 

from a benefits advisor, contact EBSA electronically at 

askebsa.dol.gov or call toll free 1-866-444-3272.

• An Employee’s Guide to Health Benefits Under COBRA

• Retirement and Health Care Coverage...Questions 

 and Answers for Dislocated Workers

• Your Health Plan and You – Know Your Health 

 Coverage Protections

• Top 10 Ways to Make Your Health Benefits Work for You

• Work Changes Require Health Choices...Protect 

 Your Rights

You also may visit the U.S. Department of Health and 

Human Services Website at HealthCare.gov or call 

1-800-318-2596 to find out more about Marketplace 

plans. Or contact your state insurance commissioner’s 

office.

December 2014

EMPLOYEE BENEFITS SECURITY ADMINISTRATION

UNITED STATES DEPARTMENT OF LABOR