Jump to content

COBRA and Tolled Special Enrollment Rights


Recommended Posts

Scenario:  Employee's spouse's employment was terminated.  She is eligible for 12 months of fully subsidized COBRA continuation coverage followed by an additional six months of unsubsidized coverage as required by COBRA.

The spouse is nearing the end of the 12-month period of subsidized coverage and the employee wants to enroll the spouse in his employer's plan effective at the end of subsidized period.

HIPAA's special enrollment rights would, in general, permit the employee to enroll the spouse in his plan in lieu of her electing COBRA (i.e., 12 months ago) and again at the end of the 18-month COBRA period.  But there is, in general, no special enrollment right to add coverage in the middle of COBRA continuation coverage.

In the COVID-19 relief (which in my view was not the previous Administration's best effort), the requirement that a participant inform an employer of a special enrollment right within 30- or 60-days (depending on the event) is tolled until basically the end of the pandemic.

Must the employer permit the employee to enroll his spouse in the plan as he requests because the notification requirement is tolled?  Or did the employee's special enrollment right for his spouse go away when she elected subsidized COBRA?

Any thoughts are appreciated.

Link to comment
Share on other sites

Did the employee's 30-day HIPAA special enrollment period based on the spouse's loss of eligibility (caused by termination of employment) finish running prior to the start of the Outbreak Period on 3/1/20?

If not, that window is still open to enroll based on the initial event.  As you noted, loss of subsidized COBRA coverage is not a HIPAA special enrollment event, but the initial loss of eligibility for active coverage upon termination of employment was.

I can't think of any reason why the HIPAA special enrollment right would be voided by enrollment in COBRA.

Link to comment
Share on other sites

Even if the spouse's notification of special enrollment right was tolled, the special enrollment would be retroactive to the date that was missed. Theoretically this would mean having to add the spouse to coverage retroactive to her loss of employment that created the enrollment right.

I cannot see how the COVID-19 extended deadline period would create an opportunity to enroll the spouse prospectively when she has to start paying for COBRA which is what the employee is hoping to do.

Link to comment
Share on other sites

2 hours ago, Christine Zinter said:

Even if the spouse's notification of special enrollment right was tolled, the special enrollment would be retroactive to the date that was missed. Theoretically this would mean having to add the spouse to coverage retroactive to her loss of employment that created the enrollment right.

I cannot see how the COVID-19 extended deadline period would create an opportunity to enroll the spouse prospectively when she has to start paying for COBRA which is what the employee is hoping to do.

@Christine ZinterThe standard HIPAA special enrollment right to enroll as of the first of the month following the special enrollment request would apply if the 30-day window did not run before the start of the Outbreak Period on 3/1/20.  The retroactive enrollment would apply only for birth, adoption, or placement for adoption.

Summary here: https://www.theabdteam.com/blog/hipaa-special-enrollment-events-2/

Here's the relevant cite:

29 CFR §2590.701-6(a)(4):

(4)  Applying for special enrollment and effective date of coverage.
(i)   A plan or issuer must allow an employee a period of at least 30 days after an event described in paragraph (a)(3) of this section to request enrollment (for the employee or the employee's dependent).

(ii)   Coverage must begin no later than the first day of the first calendar month beginning after the date the plan or issuer receives the request for special enrollment.

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
 Share

×
×
  • Create New...