Mid-year plan-to-plan changes under HIPAA.

[jsb]

We have mandatory plan enrollment (participants cannot elect "No Coverage"), and participants with other comprehensive coverage typically take our $10,000 deductible Cat plan in order to take advantage of our liberal "cash back" allowance. When they lose their comprehensive coverage through their spouse, they want to switch to one of our higher-level plans. We permit them to add their spouse and/or other dependents, but do not permit plan changes. Searching for cites to HIPAA regs that would permit a participant to make a mid-year election change from a Catastrophic type health plan to a comprehensive plan, based on the occurrence of a qualifying status change event (eg. spouse loses coverage under other plan, birth of a child, etc.). We'd like to permit the change, if we could find something in the regs to "hang our hat" on. Thanks.

[KIP KRAUS]

In my opinion, HIPAA has no authority to allow plan coverage changes. To my way of thinking changes are governed by Section 125 provided you are utilizing 125 pre-tax premiums. Doesn't sound like your situation would be authorized under 125. Just my got feeling.