Will this count as Qualifying Change of Event?

[MBMom]

What is the name of your state? CA

My husband is currently employed with a large company (also a union if that counts) who he currently has health insurance (HMO) through. I am employed for a company with less than 50 employees who I also have insurance (PPO) coverage through. I enrolled myself and two children in my insurance plan with my job first (in order to keep the boys insured), but did not enroll my husband because we figured he could just enroll himself in his employer's insurance when he waiting period was over. My insurance is quite expensive. When my husband's waiting period was over, we enrolled in his insurance. My husband was a little mislead as to the premium costs. Because we thought it was so cheap, we enrolled my husband, myself and the kids. Couldn't hurt to have secondary insurance, right? Of course, once enrolled, we found out the premium amount we were given is per paycheck (weekly) instead of monthly, which ends up adding up to more than I'm paying monthly through my employer for just me and the kids. We decided it would be smarter to just add my husband to my insurance instead of pay double through both our employers. Of course, since his plan is under Section 125, we are unable to cancel unless during the open enrollment or unless there is a qualifying change of event.

Here's my question:
In my husband's employee handbook, it states that he can cancel or change his insurance if obtaining coverage through spouse's employer and it's during spouse's open enrollment. My husband's open enrollment is not until June of next year, but my open enrollment is this month. My husband is not covered on my insurance, but I would like to add him. Would this qualify as a change of event? Or not since myself and the children are already covered under my insurance?

The reason I am unsure is because when my husband asked his employee relations manager if he could get a change of status form, they told him he wouldn't be able to cancel his insurance. He didn't even explain what he was doing, but she said "no matter what, they ain't gonna let you." So far, with what I've said, does it appear that we may run into any problems?

Please let me know if this doesn't make sense.

[cbg]

I understand the question and it makes perfect sense. I'm just checking on one small detail regarding the Section 125 factor and will get back to you shortly.

[cbg]

Okay, it's as I thought.

This is NOT a qualifying event, particularly when this is a Section 125 plan. The law VERY strictly regulates these.

You are going to have to wait until your husband's open enrollment. Then, he can drop his coverage and come onto yours within 30 days. At that time, you can use the fact that his coverage has had a significant change in premium cost as a QE.

[MBMom]

Thanks for finding out for me,cbg. The only reason I guess I would question this is because it specifically states in my husband's handbook he was given when he was enrolling, that he would be able to make changes during spouse'e open enrollment. I know you probably can't answer to that since it's more employer specific. But I'll go back and read it again and see if there were any "loopholes" I should've caught on to. If I have any more questions, I'll let you know. Thanks again!

[cbg]

Doesn't matter what the employee handbook says. The employee handbook can't trump Federal law. If his plan is a Section 125 plan, he CANNOT legally drop coverage at this time. The employee handbook is wrong.

[MBMom]

Where does it state this law regarding our situation that you are referring to? I would like to show my husband. When I try to explain this to him, it only makes him mad, but maybe if he actually saw something himself that would make it more real (instead of me just telling him).

[cbg]

It's in Section 125 of the IRS code. But I can't point you to the exact page.

[cranda]

Hi.

My parents are going through the exact same thing. My father would like to drop his insurance and get onto her insurance but after speaking to his company he received a letter from his company headquarters stating he could not drop it until his next open enrollment, due to seciton 125.

However, my father has recently been diagnosed with Diabetes and is wondering if this could fall under the "life changing event". Financially, the diabetes can cause financial difficulties in my opinion. Any ideas?

Thank you very much.

[TinkerBelleLuvr]

Life changing events: birth of a child, death, marriage, divorce, adoption ... get the drift.

[ecmst12]

You should start your own thread if you have a question. But no, a new diagnosis is not a qualifying event.

[cbg]

I agree that you should have started your own thread instead of tacking it onto one from 2004. But no, a new diagnosis is not a qualifying event by any definition.