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Loss of Dental Only Coverage Entitles Special Enrollment in Medical/Dental Plan


Guest MEJ
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Guest MEJ

Employee had dental-only coverage under COBRA from former employment and chose not to enroll in her current employer's combination of medical/dental plan.

She will be losing dental-only coverage and now wants to join the medical/dental plan of employer. She is losing coverage because the former employer's plan is going away, not because of fraud or non-payment of premiums (which are exceptions in the current plan to joining under Special Enrollment).

I'm thinking we have to let her on the combo medical/dental plan. Advice? Thoughts? Other considerations?

Thanks for any insight you can provide!

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Guest sniffles

If it is an "involuntary loss of coverage" I would let her enroll. As long as she did not just "drop" the coverage.

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Guest SHaddon

I respectfully disagree. The loss of COBRA coverage for dental is a qualifying event that creates a special enrollment right. But the change must be consistent with the loss. In other words, allowing the employee to enroll in medical is not consistent with the loss of dental coverage. I believe that they are only eligible to enroll for dental at this time.

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SHaddon: What if MEJ's plan does not allow for enrollment separately in just the dental, but requires the coverage be combo (medical/dental). Would you have to allow the EE to enroll in the combo coverage so that the dental coverage is continued?

John Simmons

johnsimmonslaw@gmail.com

Note to Readers: For you, I'm a stranger posting on a bulletin board. Posts here should not be given the same weight as personalized advice from a professional who knows or can learn all the facts of your situation.

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Guest SHaddon
SHaddon: What if MEJ's plan does not allow for enrollment separately in just the dental, but requires the coverage be combo (medical/dental). Would you have to allow the EE to enroll in the combo coverage so that the dental coverage is continued?

If the benefits are "bundled" then the employee would be eligible to enroll in any of the benefits that are bundled with the dental.

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