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Extended travel as a qualifying event?


jsb
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Employee's wife and children travel back to the home country each year for 2 months. During their absence, the employee wishes to delete them from all health plans and then add them back on when they return.

Would you consider an extended vacation out of the country by family members, and then the return, to be qualifying events that would allow cafeteria plan election changes?

Thanks!

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Technically they are not "ineligible" to be covered, they are just out of the plans' service areas. Plans are all managed care, so no routine services are available when out of the country, but that would also apply to a vacation to another state, or even another part of our state. However, emergency services can be reimbursed based on a bona fide emergency.

If a dependent moved (permanently) out of the plan service area, we would consider it to be a qualifying event. It is the temporary, albeit long(ish) term, nature of the extended out of country travel that is causing the conundrum.

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I agree that this is like a long vacation, and I don't see it as a qualifying event.

This sentence intrigued me, though:

If a dependent moved (permanently) out of the plan service area, we would consider it to be a qualifying event.

For example, if a child who is under age 26 moved (permanently) to the other end of the country, they would be out of the service area, but what is the qualifying event? The law says that the child is still eligible for coverage under the parent's plan.

I ask because if living far away can be a qualifying event here, then adult children under age 26 who live far from service area of their parent's plan may have a claim to being eligible for ACA credits and subsidies for Marketplace plans.

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The qualifying event would be the move out of the service area of the plan, which in our case, is a move out of the service area of EVERY plan we offer. While the law says the child is still eligible for the parent's plan, does the law contemplate requiring the parent to maintain coverage when the ONLY coverage available is in an emergency room? Similarly, if moving out of the plan service area is not a qualifying event, how does a large national company justify allowing its employee to drop a local HMO and pick up new coverage when the company transfers the employee from, say, California to New Jersey?

It would be a similar situation for a spouse, which comes up from time to time, where the spouse's job requires a relocation out of the area and you now have a commuter marriage. While this might involve the spouse acquiring group coverage through the new employer, which is by itself a QE, I have had also them move and pick up individual coverage in their new locale, which is not a stand-alone QE. Should I require the spouse to stay enrolled in our local plan that cannot be used?

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A little different scenario.

Mom lives in California, dad lives in Phillipines. Minor child (now 2 y.o.) spends 6 months with mom and 6 months with dad each year. Do we have QEs here that allow us to add and delete the child from coverage as the child changes country of residence?

Have yet another family where dad and the kids went home to the middle east from Sept.to January. Is a 5 month absence from the plan service area more compelling than the 2 month trip in the original post?

I just don't have enough imagination to make this stuff up! I wonder what's next?

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OK, yes, as a significant curtailment of coverage for 125 plans.

While the law says the child is still eligible for the parent's plan, does the law contemplate requiring the parent to maintain coverage when the ONLY coverage available is in an emergency room?

So far I haven't seen any ACA discussion beyond the basic rule that eligibility for a parent's plan makes you ineligible for the credit and subsidy. I think that residing outside the parent's HMO service area would qualify the adult child for the credits and subsidies, because the child does not have reasonable access to basic health care services, but I have not seen any proclamation to that effect.

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