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  1. 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.
  2. Hi, I just need to confirmation on this event: we have an employee who is married and was covered by his parent's employer. His coverage ended on 6/30/19. He wanted to use his special enrollment period to enroll not only himself, but also his spouse (who has no qualifying loss of coverage). I told the employee he could not enroll his spouse, at this time, but am getting some push back and just wanted to make sure I am not mistaken. Thanks!
  3. I have the following two questions regarding exchange open enrollment periods and termination of an employer contribution towards a former-employee's COBRA coverage. I have also provided additional information and references to relevant information. Thanks in advance! Does termination of an employer contribution towards a former employee’s COBRA coverage create a special enrollment period to enroll in exchange coverage for the former employee? Information on the healthcare.gov website indicates that an individual may change from COBRA to a Marketplace plan outside of an open enrollment period if the individual’s COBRA costs change because his former employer stops contributing towards the COBRA coverage, and the individual is required to pay the full cost (see https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/ and https://www.healthcare.gov/unemployed/cobra-coverage/). This is inconsistent with the regulations, which provide that termination of employer contributions can create a special enrollment period “in the case of an employee or dependent who has coverage that is not COBRA continuation coverage.” 26 CFR 54.9801-6(a)(3)(ii), which is incorporated by reference into 45 C.F.R. §155.420 regarding special enrollment periods. Assuming the former employee drops the COBRA coverage once the employer contributions end and is otherwise eligible for advance payments of the premium tax credit, does termination of employer contributions towards a former employee’s COBRA coverage that results in the COBRA coverage being “unaffordable” under Code section 36B and 26 C.F.R. § 1.36B-2 create a special enrollment period to enroll in exchange coverage for the former employee because the former employee would be newly eligible for advance payments of the premium tax credit (which creates a special enrollment period pursuant to 45 C.F.R. §155.420(d)(i)(6)(iii))? REGTAP FAQ ID 1496 provides that “f they are voluntarily dropping coverage outside of Marketplace open enrollment (their COBRA has not yet expired), they would not qualify for a special enrollment period. During the next open enrollment period or when their COBRA expires, they could enroll in a QHP and may be eligible for APTC;” however, must the former employee wait until the next open enrollment period if termination of the employer contribution results in the coverage no longer being “affordable,” and therefore, would be newly eligible for advance payments of the premium tax credit because the individual is ineligible for qualifying coverage in an eligible-employer sponsored plan in accordance with 26 CFR 1.36B-2(c)(3).
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