Qualifying event

[Guest Bishop88]

Employee waives medical coverage when hired. Employee doesn't not have other medical coverage. Employee is married. Is this a qualifying event and is the employee allowed to enroll in medical plan because he added a dependent even though he currently has no medical coverage?

[MARYMM]

Employee waives medical coverage when hired. Employee doesn't not have other medical coverage. Employee is married. Is this a qualifying event and is the employee allowed to enroll in medical plan because he added a dependent even though he currently has no medical coverage?

As I understand the rules, this would be a qualifying event for a participant to add the new spouse. This employee is not a participant, so must wait until open enrollment. Or enroll in new spouses' employer's plan, if any.

[jpod]

Are you asking a Section 125 question or are you asking whether the insurance plan will permit the employee to sign up now? If the insurance plan won't let the employee sign up now, isn't the Section 125 question rendered moot? For what it's worth, where is the change in circumstances justifying the employee's sign-up if he personally wasn't covered in the first place?

[Guest Bishop88]

Are you asking a Section 125 question or are you asking whether the insurance plan will permit the employee to sign up now? If the insurance plan won't let the employee sign up now, isn't the Section 125 question rendered moot? For what it's worth, where is the change in circumstances justifying the employee's sign-up if he personally wasn't covered in the first place?

Yes--the employeee is not covered. He gets married. Can he enroll in plan now? I think the answer is no but can't find the details in the regulations. If he was covered by the plan he could add spouse.

[QDROphile]

What does the plan say? Even if the law would allow an election based on the event, the plan has to allow it. Perhaps you can get an adequate statement, or absence of an adequate statement, for your answer from the plan terms. Besides, there is more latitude for interpreting plan terms than determining the law. But you have to be careful if you conclude that the plan allows the election. Then you have to determine that the terms or interpretation of the plan is consistent with the law allows.