---
kind: "section"
citation: "42 C.F.R. § 407.20"
title: "42"
number: "407.20"
heading: "Special enrollment period related to coverage under group health plans."
url: "https://uscodex.org/cfr/42/407.20"
---

# §407.20. Special enrollment period related to coverage under group health plans.

- (a) **Terminology—**
  - (1) **Group health plan (GHP) and large group health plan (LGHP).** These terms have the meanings given them in [§ 411.101](/cfr/42/411.101.md) of this chapter except that the “former employee” language of those definitions does not apply with respect to SEPs for the reasons specified in [§ 406.24(a)(3)](/cfr/42/406.24.md?p=a-3) of this chapter.
  - (2) **Special enrollment period (SEP).** This term has the meaning set forth in [§ 406.24(a)(4)](/cfr/42/406.24.md?p=a-4) of this chapter. In order to use a SEP, an individual must meet the conditions of [paragraph (b)](#b) and of paragraph [(c)](#c) or [(d)](#d) of this section, as appropriate.
- (b) **General rule.** All individuals must meet the following conditions:
  - (1) They are eligible to enroll for SMI on the basis of age or disability, but not on the basis of end-stage renal disease.
  - (2) When first eligible for SMI coverage (4th month of their initial enrollment period), they were covered under a GHP or LGHP on the basis of current employment status or, if not so covered, they enrolled in SMI during their initial enrollment period; and
  - (3) **For all months thereafter, they maintained coverage under either SMI or a GHP or LGHP.** (Generally, if an individual fails to enroll in SMI during any available SEP, he or she is not entitled to any additional SEPs. However, if an individual fails to enroll during a SEP because coverage under the same or a different GHP or LGHP was restored before the end of that particular SEP, that failure to enroll does not preclude additional SEPs.)
- (c) **Special rule: Individual age 65 or over.** For an individual who is or was covered under a GHP, coverage must be by reason of the current employment status of the individual or the individual's spouse.
- (d) **Special rules: Disabled individual.** 4 Individuals entitled on the basis of disability (but not on the basis of end-stage renal disease) must meet conditions that vary depending on whether they were covered under a GHP or an LGHP.
  - (1) For a disabled individual who is or was covered under a GHP, coverage must be on the basis of the current employment status of the individual or the individual's spouse.
  - (2) For a disabled individual who is or was covered under an LGHP, coverage must be as follows:
    - (i) Before August 10, 1993, as an “active individual”, that is, as an employee, employer, self-employed individual (such as the employer), individual associated with the employer in a business relationship, or as a member of the family of any of those persons.
    - (ii) On or after August 10, 1993, by reason of current employment status of the individual or a member of the individual's family.
- (e) **Effective date of coverage.** The rule set forth in [§ 406.24(d)](/cfr/42/406.24.md?p=d) for Medicare Part A applies equally to Medicare Part B.

## Notes

### Amendments

[61 FR 40346, Aug. 2, 1996]

### Authority

Authority: 42 U.S.C. 1302, 1395p, 1395q, and 1395hh.

### Source

Source: 53 FR 47204, Nov. 22, 1988, unless otherwise noted.

### Amendments

[61 FR 40346, Aug. 2, 1996]