I am an employee in CA that participated in our company health insurance program during normal enrollment.

Mid year (well after enrollement period), my wife began working and her company paid 100% for health insurance. Obviously we switched.

My employer says that ERISA regulations prevent me from switching from my company health insurance program to my wife's health insurance program after the open enrollment period. Is this true?

Impact - we switched to my wife's health insurance and actively used her insurance. My company will not stop taking health care deductions out of my paycheck until open enrollment occurs; 5 months after we switched. They are refusing to reimburse me.

Thanks for your help in advance.

-stu

Well, it's IRS regulations rather than ERISA regulations but yes, it's true.

Did you sign up for your wife's insurance as soon as you were eligible for it? There might be a loophole for you.

CBG,

Yes, we applied applied as soon as she was hired.

Our HR dept is citing ERISA requires them to keep me on my current health plan because ERISA requires consistency(?) among employees at a company. "No employees can switch during non enrollment period...not event to take spouse's insurance". That seems like an overly aggressive policy and does not sound like a reg or law. This sounds like a company policy, which is the point I was trying to make with the HR dept.

Sounds like I am stuck till open enrollment.

-stu

Well, in truth they are correct. Because of the pre-tax nature of the benefits, Federal law prohibits their allowing an employee to make a change except during open enrollment or during a life event. Most companies will consider becoming eligible for new insurance that they were not previously eligible for, such as when a spouse becomes eligible for insurance at a new job, as a life event. That's why I asked if you signed up immediately upon eligibility. But if their plan document, which is a legal document which is subject to Federal audit, does not include this as a life event, then you are right, there is nothing you can do until open enrollment.

CBG,

Yes, we applied applied as soon as she was hired.

Our HR dept is siting ERISA requires them to keep me on my current health plan because ERISA requires consistency(?) among employees. "No employees can switch during non enrollment period...not event to take spouses insurance". That seems like an overly aggressive policy and does not sound like a reg or law.

-stu

It is, though. Section 125 of the IRS code.

The actual law is Internal Revenue Code Section 125. If you do a websearch on "section 125 qualifying event" you will get a ton of hits. This is a very real law and a very real rule associated with that law. IRS even changed the rules in 2009 to impose very real penalties on employers who violate this rule. It is just not ERISA. That is also a real law, but not the law that this rule comes from.

http://www.benefitconsultinginc.com/Questions.htm

Can employees change their elections at any time?
Employees can only change their elections annually during the enrollment process. Any changes after the start of the plan must be related to a qualifying event. Click here (http://www.benefitconsultinginc.com/qualifying_events.htm) to view a partial list of Qualifying Events.