Special Enrollment Rights

[French]

We have an employee who is covered under his spouse's health plan along with a dependent. Apparently the dependent is no longer eligible under the spouse's plan - we are assuming that it is due to aging out but we don't not yet have all the details. We offer several self insured plans that allow coverage until age 25 without being a student. The employee would like to enroll himself and his dependent in one of these plans now. Is this considered a special enrollment? We think the dependent should just be offered COBRA. Thanks.

[Guest dsw713]

Usually, there has to be a qualifying event (i.e. the spouse lost her coverage through layoff) before an employee can jump back into your health care program. Otherwise, the employee would have to wait until your next open enrollment period (usually at plan renewal), to make the change over to your plan. I would agree that the dependent should go the COBRA way under the spouse's coverage.

[Guest katevv]

We have an employee who is covered under his spouse's health plan along with a dependent. Apparently the dependent is no longer eligible under the spouse's plan - we are assuming that it is due to aging out but we don't not yet have all the details. We offer several self insured plans that allow coverage until age 25 without being a student. The employee would like to enroll himself and his dependent in one of these plans now. Is this considered a special enrollment? We think the dependent should just be offered COBRA. Thanks.

HIPAA Special Enrollment Rights may apply assuming the dependent aged out of other plan. Special enrollment rights may apply with respect to the employee, dependents of the employee, or both. If it is the employee who loses coverage, then the employee and any dependents (including the spouse) may qualify as special enrollees. If it is an employee's dependent who loses coverage, then that dependent and the employee may qualify as special enrollees. Refer to Treas. Reg. § 54.9801-6(a)(2)(ii) or DOL Reg. §2590.701-6(a)(2)(ii) for further guidance.