Author Topic: Qualifying Life Event when gaining (not losing) coverage  (Read 189 times)

Paul der Krake

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Qualifying Life Event when gaining (not losing) coverage
« on: June 02, 2021, 03:04:54 PM »
Trying to find an authoritative and source on this, but my googling is failing me.

Scenario:
Spouse A has job, spouse B doesn't. A and B enroll in A's employer coverage.
Later, spouse B gets job with immediate eligibility, outside of A's open enrollment.

Does A's plan have to let spouse B drop off the plan outside of open enrollment if they so choose?
Does A's plan have to let spouse A and B drop off the plan outside of open enrollment if they so choose?

BlueMR2

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Re: Qualifying Life Event when gaining (not losing) coverage
« Reply #1 on: June 02, 2021, 05:41:24 PM »
I'm really not sure if it's HAVE TO in all cases, but all the insurance plans I'm currently familiar with do require a spouse (B) that becomes eligible for their own coverage to take it within 30 days of it being offered.  That's where my strong familiarity stops and I start guessing...  (A) basically re-enrolls back into their old plan, so perhaps they could opt out then?

Peachtea

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Re: Qualifying Life Event when gaining (not losing) coverage
« Reply #2 on: June 02, 2021, 06:37:45 PM »
I believe the answer is no, but you should check spouse A's plan documents for what it defines as qualifying life event. If the plan defines spouse gaining insurance as a life event, then I think the employer must allow you to drop the insurance. My employer included that as a qualifying life event and I had no problem dropping my insurance mid-year to join my spouse's new employer's plan. (I actually did this twice.)

My basis for this answer is that HIPAA is the law that governs when an employer must let you specially enroll. The DOL EBSA enforces HIPAA. Their brochures only refer to spouse losing eligibility and their regulations do too. Here's the regs https://www.law.cornell.edu/cfr/text/29/2590.701-6 You could call their hotline if you wanted to confirm.

This article talks about when the IRS allows an employer to let employees change their health care elections and specifically mentions spouse's gaining insurance as one. https://www.shrm.org/resourcesandtools/tools-and-samples/hr-qa/pages/midyearelectionchangeshealthinsurance.aspx

The article also says that employer is only required to allow the HIPAA special enrollment. Which makes sense to me. Again, if you wanted direct from the source info I'd call up DOL.