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Qualifying event, changing plans? California

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  • MrsRedSox
    replied
    Agree with HRinMA and HRWine Country. The qualifying event of the birth of your son allows you to add him as a dependent on your plan outside of the enrollment period; it doesn't necessarily mean you can make any other changes, such as switching plans. Our plan documents (I am the benefits administrator and our company plans are through Aetna) have the same guidelines, which we are careful to abide by or put ourselves at risk of breaking the law.
    Last edited by MrsRedSox; 05-18-2010, 03:35 PM.

    Leave a comment:


  • cbg
    replied
    Even if it's only how the plan is structured, you do not have an argument as the employer is required by law to follow the plan. They MAY NOT allow a change that is not supported by the plan document. That is Federal law.

    It is by no means unusual for a plan to deny changing plans except at open enrollment or in the event of the old plan no longer being available. Moving out of state (and the service area) would be a valid reason to change plans; under the large majority of plans, a birth, death, adoption or marriage is not.

    Leave a comment:


  • HRWineCountry
    replied
    Adding your newborn to your existing plan is 'consistent with' the qualifying event. He's a new dependant and you are allowed to add him to your plan outside of the open enrollment period.

    Switching to a completely new carrier is another thing entirely.

    Your company must follow their own plan. If that's how it was structured, then that's how it must be applied.

    Leave a comment:


  • pcal
    replied
    Right. I'm preparing to argue with HR that the plan documents are extremely vague - the language just says the change must be 'consistent with' the qualifying event.

    What I really want to know at the outset is whether there are legal requirements around this (in which case my complaint doesn't have much point) or whether this is simply how the plan was structured (in which case I think I have a more valid complaint).

    Thanks very much.


    Originally posted by HRinMA View Post
    It may be part of your plan documents which prevent the move. My plan documents do not allow a current employee to pick up insurance midway through the plan year without a qualifying event for the employee.

    The qualifying event is for your child to be enrolled without having to wait for open enrollment. So the event affects your son, not you.C

    Congratulations on your new addition.

    Leave a comment:


  • HRinMA
    replied
    It may be part of your plan documents which prevent the move. My plan documents do not allow a current employee to pick up insurance midway through the plan year without a qualifying event for the employee.

    The qualifying event is for your child to be enrolled without having to wait for open enrollment. So the event affects your son, not you.C

    Congratulations on your new addition.

    Leave a comment:


  • DAW
    replied
    NOT my area of expertise. If you do not get a good answer, try the BenefitLinks website. That is where the benefits experts hang out.

    Leave a comment:


  • pcal
    started a topic Qualifying event, changing plans? California

    Qualifying event, changing plans? California

    My wife and I recently had a child last week. This is a 'qualifying event' which allows me to make mid-year changes to my employer-provided insurance.

    I am allowed to add new dependents to the plan I'm already in (Kaiser), but my employer says that I am not allowed to switch into a different plan (Aetna), which is what I want to do.

    Instead, they say I have to wait until the next open enrollment period (December).

    They also say that this is due to IRS guidelines, not company policy.

    I can find no such guidelines at irs.gov. I called the IRS and they are aware of no such guidelines.

    Is anyone familiar with any such guidelines or laws?

    I live and work in California.

    Thanks very much in advance.
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