Outside health insurance cheaper

[TPA Bob]

 

We have a participant in a premium only plan who is asking to drop his dependent group coverage due to  qualifying for cheaper individual coverage through the State of Oklahoma (Sooner Care). I have looked at our language (Sungard / Corbel/ FIS) post-Affordable Care Act and it appears this is not a change of status and would not be allowed.  

 

Any thoughts?

[Debbie]

It should qualify as a special enrollment period/qualifying event.

[mdm09]

Assuming Sooner Care is a form of Medicaid (not Exchange coverage), an employer-sponsored plan can (but is not required to) allow an individual who loses Medicaid to enroll in the plan mid-year, but the reverse is not true--the plan cannot allow an individual to drop plan coverage mid-year if he or she enrolls in Medicaid.  See Treasury Reg. 1.125-4(f)(5).

[Peter Gulia]

If you'd like to read the rule mdm09 refers to, here's a link:

https://www.ecfr.gov/cgi-bin/text-idx?SID=2dd0cb953fab89b3f5b297cd598aa3f8&mc=true&node=se26.2.1_1125_64&rgn=div8

 

 

[jsb]

Have to disagree with mdm09 on one point. Under 1.125(4)(e), entitlement (enrollment) in Medicaid (or Medicare) would permit a drop of coverage, if the employer's plan permits.

If Sooner Care is not the state version of Medicaidl, it is likely an individual plan that would not permit a change in election