Spousal Coverage Changes

[Christine Roberts]

An employee is covered as a dependent under his spouse's group health plan. He now wants to switch to his own employer's group health plan. Can he do so (and add his wife as a dependent) without any change in status other than dissatisfaction with wife's insurance? The example in the Sec. 125 regulation refers to different plan years for the spousal and employee plans - is this a prerequisite for the change??

[KIP KRAUS]

Christine:

You come up with some good ones. It’s my interpretation that being dissatisfied with a particular medical in and of itself is not a QE. Dissatisfaction with s particular plan is addressed at open enrollment of the employee or spouse.

This may not be your particular situation, but what if an employee gets pregnant and decides that her husband’s plan pays more for maternity? This could be considered dissatisfaction with a particular plan. Would this be a QE? I wouldn’t think so.

[Christine Roberts]

Kip, I agree with your analysis. I was thinking of this Q&A -- http://www.benefitslink.com/cgi-bin/qa.cgi...feteria_plans-- but that involves dropping coverage during mid-year upon joining a spouse's plan.

Thanks for the reply!