Consistency Rule for Change in Residence as a Status Change

[Guest RW]

How does the consistency rule apply to the change in residence as a status change? What if someone moves to an adjacent apartment? Please provide examples.

[SLuskin]

This means that if you are enrolled in your employer's HMO, and you move out of the service area - and the HMO cannot provide you with any services except for emergency care- you can revoke that election and elect on a prospective basis another health plan sponsored by your employer. Right now, it looks like if there is not an alternate plan available, no election change is permitted.

[KIP KRAUS]

I agree with SLuskin. However, I don't see how moving to an ajacent apartment could result in loss of an HMO coverage. One would think that the entire apartment building or even an adjacent apartment building would still be in the HMO area. HMO coverage areas usually are defined by cities, counties/parishes and or towns, not by streets and buildings, or latitudes or longitudes.

[Lisa Hand]

Obviously moving within the same block or normally the same town would not satisfy the definition of a move which effected access to benefits and would not justify a change in election.

[Guest RW]

Can anyone think of a situation where a change in residence ever qualify for a change in status for any other cafeteria plan under the consistency rules? (Dependent care flex -- under the newest proposed regulations -- or a group term life program?

[JWK]

RW: An example could be a child going off to college, moving out of the coverage area of a region-specific HMO. I agree it would be rare to have an event for an employee that wouldn't already qualify under the change in worksite rule.

[Guest EMK]

In several geographic areas which border other states, etc., changing residence (but not worksite) might affect eligibility in an HMO. For example, if you work in NYC and move from NYC to CT or NJ. Other examples would be Chattanooga or Memphis, TN, St. Louis, MO, etc.

[SLuskin]

An example in change of residence which would permit a change in the daycare election under the new proposed regs - let's say that you have a kid an a certain daycare and the cost is $90/week. You move to a different area (company has locations in different states) and the weekly going rate for daycare is $75. You can change your election accordingly.