qualifying event documentation

[Guest georgia]

to establish a mid-year qualifying event has occurred our health plan requires documentation of the underlying reason behind a loss of other health coverage. we've been told other cafeteria plans accept HIPAA creditable coverage certs as the only required documentation to establish a qualifying event. we wonder if we've gotten out of sync with other plans and/or the IRS. any thoughts regarding either approach are welcome.

[Guest b2kates]

We accept creditable coverage certs as appropriate documention. The cert is only issued upon loss of coverage

[Sandra Pearce]

Our plan only allows entry when loss of coverage is due to loss of eligibility for the coverage; therefore, we require a copy of the COBRA offer or a letter from the (former) employer stating the coverage was lost due to termination of employment, reduction of hours or loss of dependency status, etc.

[Guest Benmark]

We have just finished doing a search for an on-line benefits admin vendor. The companies we looked at had a number of big-name clients (with average employee populations in the 3-5K range). We were told by each of the firms we interviewed that only very rarely do firms ask for qualifying event documentation but rather rely on certification from the employee. The employer reserves the right to request documentation at its discretion.

I followed the discussion with a query to our insurance broker/consultant--a large benefit consulting firm in Los Angeles. They said the same thing--only very few of their clients request qe documentation.

BTW, we currently ask for documentiaton, but in the programming of the new system which will begin shortly, are contemplating the positions espoused by our consultant and the benefit admin vendors.

Any thoughts?

[Guest ybahti]

The IRS does allow employers to generally rely on the employe's certification. We do however require documenttion for most QLEs and we have found that some employees do fabricate QLE to suit their needs or lack of needs for services. To it is a tool for fiscal responsibility - this becomes even more important for self-insured plans.

[oriecat]

Would there be any sort of discrimination issue or other problem if you require documentation for people to add coverage because of a special enrollment event, but you don't require it if people want to drop or reduce coverage because of one?