Can an employee change levels of coverage (from high to low option) wi

[Guest cdp]

We offer 2 options with our medical plans. Employees can elect a high option or a low option. With the high option, the employee pays higher employee premiums, but receives a higher amount of coverage. With the low option, the employee pays a lower premium but receives a lesser benefit. If an employee is enrolled in the high option, but has a family status change could they change to the low option (because of the difference in cost)? For example, an employee has the high option for herself and her spouse. She had a baby and will now need family coverage. Can she change to the low option with the addition of the baby?

[KIP KRAUS]

CDP:

It sounds to me like the choice between the high and low option plans is a personal choice based primarily on the employee's knowledge of his/her possible plan usage. In this particular case, it would appear that the employee chose the high option plan because she perhaps wanted the higher maternity benefit or lower out-of-pocket expenses related to cover the maternity period?

I can't think of a qualifing event that would warrent a change from high to low option or the other way around. Apparently you have a three tier rate for both medical options (single, two person & family)? If so, then the employee's premium is going to increase regardless of which plan she is in. Unless someone out there can come up with a good reason to think otherwise, I would not allow a change in this situation. The employee knew when she chose her coverage what the consequences were going to be after the baby was born. I say you can't have your cake and eat it to.

[jeanine]

We would of course let her add the baby through the addition of family coverage but only on the same plan she has for herself, the high option. If there is an open enrollment period when the enrollees can change from high to low, as is our case, she could change herself and the baby's coverage at that time.

[Guest inslady]

I also would not allow the change from the high to the low plan. Changes must be consistent with the qualifying event -- in this case the addition of a child is not consistent with a desire to change plan types.