Late Enrollee (Health Care) Law and Legal Definition

A late enrollee is an eligible employee or dependent who does not enroll in a group health plan during the initial enrollment period. Instead s/he enrolls on a date other than either the earliest date on which coverage can begin under the plan terms or on a special enrollment date. A late enrollee is different from a special enrollee who enrolls in the special enrollment period. As per the provisions of the Health Insurance Portability and Accountability Act (HIPAA), a late enrollee will be subjected to a maximum pre-existing condition exclusion.

Pursuant to 26 USCS § 9801(b)(3), the term "late enrollee" means, with respect to coverage under a group health plan, a participant or beneficiary who enrolls under the plan other than during:

(A) the first period in which the individual is eligible to enroll under the plan; or

(B) a special enrollment period under subsection (f).