Can an employee change medical plans (other than at Annual Enrollment)

[Guest Dick Sonntag]

We have a cafeteria plan that offers several HMOs, a POS, a PPO and a Catastrophic (Cat) plan. Employees choose the Cat plan if they have other coverage. If an employee with a Cat plan has a life status change, we permit the employee to change from single to family or family to single. We do not permit a change to one of the other plans until Annual Enrollment (per our understanding of the Cafeteria rules pertaining to life status changes). Does HIPAA supercede this and permit a change in plans? We would like to permit this if we can support this with a cite.

[Guest Paul]

That is a little strange but I believe you can do that. First, the regulations under cafeteria plans list the various events that allow mid-year changes. The regs then say there are premissible not mandatory. In other words, you can list some or all of the events. Therefore, it seems to me you could place other restrictions on the changes. That is, if you do not have to let them change in the first place, it seems you can limit the change to only single to family coverage. HIPAA says you have to allow them onto the plan during a special enrollment period. So it seems that if you let them onto the plan you only have to let them onto that plan not other plans you are sponsoring. I do not have all the cites but if you really need them e-mail and I can try to look them up.