Would this be change in status for med?

[masteff]

Odd situation... 19-year old employee, should be covered thru State program by DHS and foster care system. Coverage was wrongly terminated in August. She is now in process of getting reapproved and was told by DHS to not take our insurance during annual enrollment.

My question: Suppose she's denied in a couple months. (I wouldn't expect her to be denied but just thinking ahead while we're still in open enrollment.) Is that denial of coverage a sufficient change in status at that time? I know if she was actively covered and lost it, then it would be. But what about where the State's rules say she should be covered and DHS said not to take it and is then denied?

[leevena]

This can be a tough situation. With all due respect to the DHS staff, my initial reaction would be not to believe them. Let's assume that someone at DHS made an honest error when telling her that she will be re-enrolled and she misses the OE period. Do you think the medical carrier would allow her to enroll then? Probably not. I have seen a few similar instances over the past few years and each time the carrier would not allow them to enroll. Thats not to say that your carrier would do the same.

Without knowing the exact time frames, I would suggest that she begin the enrollment for your health plan. Since you are in the OE period, it sounds like the coverage will not be starting until Nov 1 or Dec 1. This would give her some extra time to make a decision.

[masteff]

Thanks for the reply. Looking at the other way.... would it be a change in status if she enrolled now and then regained DHS coverage in a month or three? Would we then be able to drop her on our plan?

[leevena]

Thanks for the reply. Looking at the other way.... would it be a change in status if she enrolled now and then regained DHS coverage in a month or three? Would we then be able to drop her on our plan?

Yes she can, but you may want to look at the govt plan first. Some require no current coverage, or a minimum amount of time that the person is not covered by another plan.

[masteff]

but you may want to look at the govt plan first.

Yep, that was going to be my next step if I decided to stick my nose further into it. She seems content to let DHS process her paperwork and is confident that she's still eligible for the plan despite the improper termination in August, so I'll probably just leave well enough alone.

Thanks for the insights.

[Chaz]

I'm not sure if she is enrolled in your plan and later becomes eligible for the DHS plan that she can drop your plan. The regs only talk about election changes being permitted when a participant LOSES coverage in a government plan, not the other way around.

[leevena]

I'm not sure if she is enrolled in your plan and later becomes eligible for the DHS plan that she can drop your plan. The regs only talk about election changes being permitted when a participant LOSES coverage in a government plan, not the other way around.

There are no regulations that stop an employee from dropping coverage. What in particular are you speaking about?

[masteff]

But if becoming active under the DHS plan causes ineligibility under the company's plan, wouldn't the change in eligibility for insurance be a change in status? Of course that assumes the employee would become ineligible and not that the company's plan would simply become secondary.

(Though leevena hit on the bigger issue, that the DHS plan requires no current coverage.)

[leevena]

Masteff...It sounds like you are trying to be helpful for this person by covering all of the possible bases. May I suggest you not provide any specific advice, it may get you caught up in a bigger problem. Also, I did not say that the DHS plan requires no prior coverage, I said it might.

As for your comment in the last posting...But if becoming active under the DHS plan causes ineligibility under the company's plan, wouldn't the change in eligibility for insurance be a change in status? Of course that assumes the employee would become ineligible and not that the company's plan would simply become secondary."---What do you care if she becomes active under the DHS plan and then loses company group plan or has a change in status. She is still covered by the DHS plan. Am I missing something in your question?

[papogi]

I think Chaz is referring to Treas Reg 1-125-4, Supp Info, Explanation of Provisions, #2. It says that the regs do not allow a cafe plan participant to cease participation in the cafe plan if he or she becomes eligible for SCHIP during the year. I've heard of complications about interpreting that reg depending upon which of 3 possible options a state chooses to allocate their SCHIP money, so that reg applies in some cases and doesn't apply in others. I think that is where Chaz is coming from.

[masteff]

so I'll probably just leave well enough alone.

Thanks all.