Status Change

[Guest Nugi]

I am sorry, I know this is a really dumb question, but I am having a hard time figuring this out. The regs say Health Plans - does that mean (medical, dental and vision) plans altogether or does it refer to just medical. Employee gets married, has medical coverage currently - due to marriage wants to add spouse to medical(that is easy), but now he wants to add vision coverage even though he did not have it before. Do we have to let him add the coverage? Does it fall under the topic of health plans. I know that under HIPAA with the change in rules 4/14/03 Health plans include medical, dental vision and fsas.

Any asssistance would be appreciated.:confused:

[papogi]

Health plans do include medical, dental, and vision as you say. However, whenever you apply family status rules, you must also look at the consistency rules. If the employee has medical coverage, then it would be consistent with the status change to add the spouse to the existing medical coverage. It would not be consistent with the status change to then add another type of coverage such as vision. They will have to wait until open enrollment for that.

[E as in ERISA]

What if the vison plan is for the entire family and the new spouse wears glasses? Wouldn't that then be consistent with the status change?

[papogi]

My interpretation of the status change rules concerning marriage is that the employee can add the new spouse and any dependents to health coverage. If the coverage is medical, then HIPAA would allow even the employee to add coverage if he/she had originally opted-out of that. If the coverage is dental or vision, then HIPAA offers no help to the employee. In those cases, the employee can only add the spouse and dependents to the existing coverage. If the employee does not have dental and vision, then there is nothing to add to. The fact that the wife has glasses is inconsequential. Consistency rules have to do with whether the election change is consistent with the status change, not whether the election change is consistent with the direct needs of the employee and dependents. For example, if an employee has a dependent who reaches the limiting age, he/she can then drop the dependent. If the employee has another dependent for whom he does not want to pay premiums for anymore, he can’t drop that dependent along with the dependent reaching the limiting age. Sure, the election change to drop both dependents is consistent with the needs of the employee, but it is not consistent with the status change.

Say, for example, that the employee opted-out of vision at open enrollment. He now plans to get an eye exam and glasses, but will soon be getting married. By allowing him to come on the vision plan upon marriage, you are allowing him an “open enrollment” to correct mistakes made back at open enrollment.