Termination of Catostrophic Coverage as a Qualifying Event

[Guest tracygil]

An employee has terminated his catastrophic coverage through his spouse and now wants to enroll in our medical, dental and vision plans. I don't believe that this would be a qualifying event but wanted to get someone else's opinion.

Any thoughts are appreciated!

[jsb]

It would depend on why the catastrophic coverage is lost. As long as there is a status change event permitted by your plan, and the change request is timely, it could be allowed.

If he simply dropped the other coverage and now wants onto your plan, I think not.

[SLuskin]

Doesn't the coverage have to be substantially similary coverage? I am not sure why dropping catastropic coverage would permit enrollment in the dental or vision plans, and seems "iffy" for the group medical plan as well. Especially if this catastrophic coverage is one of the voluntary worksite payroll deduct products.

[Guest tracygil]

Thank you! After asking the employee a few more questions, I've found that he was enrolled in medical, dental and vision ~ I'm not sure why the plan is "titled" catastrophic ~ through his spouse. After speaking with the benefits rep, it sounds to me like they don't operate under Section 125 as employees/spouses can opt out at any time. So, would his choosing not to participate in his spouse's plan be a qualifying event?

This is getting confusing!