medical plan & chnage in status

[alexa]

A single employee who waived medical at open enrollment got married

He now wants to enroll himself and his wife

can he do so before next open enrollment?

[jsb]

Yes, provided that the enrollment request is within 31 days of the event.

[alexa]

Yes, provided that the enrollment request is within 31 days of the event.

[alexa]

Yes, provided that the enrollment request is within 31 days of the event.

Even if employee did not sign up at open enrollment time

Guess I thought employee had to be enrolled to add spouse or drop his own coverag eif now eligible for spouse plan

I know FSA rules have been liberalized a bit since 2002 - do you have a specific site for this?

Much thanks!

[leevena]

You might want to start your research by looking at the various documents the current carrier supplied to you. I don't know what state or carrier you have, but start with the employee documents and also try the employer administrative kit (if one was provided).

Also, you identified one particiular reason that someone can change their enrollment status off open enrollment time. There are a few others, which should be explained in the materials from your carrier.

Good luck.

[papogi]

HIPAA Special Enrollment would apply in this case, so the employee and spouse could come on the plan (the plan that the employee originally opted out of), as long as the employee opted out at last year's open enrollment because he/she had coverage elsewhere. That's how I remember the HIPAA regs to read anyway.

[jsb]

The item below is from the DOL Website. There is more information available there.

6. A Plan’s Special Enrollment Provisions Must also Permit Employees and Dependents (Who are Otherwise Eligible) to Enroll upon Marriage, Birth, Adoption, or Placement for Adoption

Example: A group health plan allows employees who are already enrolled for coverage to add dependents upon marriage, birth, adoption, and placement for adoption. However, if an employee is not already enrolled, the plan does not permit any enrollment when these events occur.

Tip: HIPAA allows eligible employees and dependents to enroll upon marriage, birth, adoption, or placement for adoption.

Group health plans are required to offer special enrollment to otherwise eligible employees, spouses, and any new dependents upon marriage, birth, adoption, or placement for adoption. Accordingly, an employee who is otherwise eligible, but not enrolled for coverage, can enroll (and can also enroll a spouse and any new dependents, if they are otherwise eligible under the plan) when any of these events occur.

The plan should amend its special enrollment provisions to allow employees and dependents who are otherwise eligible to enroll upon these events.

[alexa]

The DOL website was quite helpful. Much thansk!

[Kirk Maldonado]

The DOL website has a lot of very useful information on many topics, most of which is written in "plain English." I reccomend that people look on the DOL website for basic overviews of topics.