Guest wewolfru Posted January 24, 2001 Posted January 24, 2001 I'm looking for help with the "consistency rules" under a 125 cafeteria plan that allow to have employees make changes mid year to an election if they have a life event and the change is consistent with the life event. If an employee gets married, we know they can add a new spouse to an HMO. If they say their new spouses doctor does not participate with the HMO, can we allow a change to our indemnity option. Are we stretching the consistency rules?
KIP KRAUS Posted January 25, 2001 Posted January 25, 2001 For what it's worth, right or wrong we do not let employees change plans if their doctor doesn't participate in one of our HMOs. Usually that type of information is available before a person enrolls in the HMO.
SLuskin Posted January 31, 2001 Posted January 31, 2001 Yes, that is stretching it. A doctor belonging or not belonging to a network is not a family status change. If all the ob-gyns in a county leave an HMO network (actually happened in Palm Beach Co, Fl.)the employees can revoke that election and join the employer's PPO. I have only seen that one case in 10 years of doing this.
Recommended Posts
Create an account or sign in to comment
You need to be a member in order to leave a comment
Create an account
Sign up for a new account in our community. It's easy!
Register a new accountSign in
Already have an account? Sign in here.
Sign In Now