An LGHP becomes a GHP when it is no longer a “large plan,” as described in HI 00805.266A.3. When this situation occurs, family members (other than a disabled worker and his
or her spouse) who did not enroll while the plan was an LGHP can only enroll during
the 8-month period that begins the month following the last month the GHP was an LGHP.
The worker and his or her spouse can enroll any time while covered under the GHP based
on current employment status or during the 8-month period that begins the month following
the month the GHP coverage or employment ends, whichever occurs first.
Example of when an LGHP becomes a GHP
Leslie and her son, Michael, both disabled beneficiaries, have been covered under
her working husband’s LGHP since they first became eligible for Medicare in 1995.
They did not enroll in SMI.
In February 2010, her husband’s employer reduced the staff to less than 100 employees
for the balance of that year. Based on the reduction, the LGHP became a GHP effective
January 01, 2011.
While Leslie can enroll under the SEP provisions at any time while covered under the
GHP based on current employment status, Michael can only enroll January 2011 through
August 31, 2011 (the 8-month period following the last month the GHP was an LGHP).