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Married and Aged Out of Parent's Plan

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I just need to confirmation on this event: we have an employee who is married and was covered by his parent's employer. His coverage ended on 6/30/19. He wanted to use his special enrollment period to enroll not only himself, but also his spouse (who has no qualifying loss of coverage). I told the employee he could not enroll his spouse, at this time, but am getting some push back and just wanted to make sure I am not mistaken.


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His loss of coverage is a Special Enrollment event (under HIPAA Portability rules). As such, he is allowed to enroll for coverage for both himself and his spouse. There is an exception if your health plan (1) requires an employee declining coverage to state in writing the reason for declining coverage is the existence of other coverage and (2) at or before the time the employee declined coverage, the employee is provided with notice of the requirement to provide the statement (and the consequences of the employee's failure to provide the statement), and the employee does not provide the statement. In that case the employee's request to add the spouse could be refused.

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