I just need some clarification on Late Enrollees. An employee waived coverage through her employer due to having coverage through her husband's employer. The husband's benefit plan changed at the last open enrollment to higher copays and employee contribution. This couple has now realized that the benefit plan through the wife's employer is a better deal and want to enroll. Is this a qualifying event under late enrollee provisions? If so, doesn't enrollment have to happen within 30 days of the qualifying event?

It would normally be a QE, but timeliness is a key issue. Over 30 days is shakey. I wouldn't allow it after 30 days. I don't think it should take long to figure out that one plan's benefits are better than the other and that the cost is higer.

You didn't mention if this was an ERISA plan. If so, it's my understanding under the HIPAA Special Enrollment provisions, that a simple change in the spouse's plan such as higher contributions, would not be a qualifying event which would allow them to switch plans. The only way this scenario works is if the spouse's employer terminated it's contributions for coverage. An employer's reduction (but not cessation) of contributions would not trigger a special enrollment right.

Thanks. I also found information that it would only be a QE if the employer discontinued contributions, which is not the case.


NancyBR