Mid-Year Election Changes - What Is Allowed?

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A mid-year election change is not open enrollment.

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Wednesday Wisdom

United States

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Mid-Year Election Changes - What Is Allowed?


Mid-Year Election Changes - What Is Allowed?Online version A mid-year election change is not open enrollment. by Wednesday Wisdom 1 An employee with family medical, dental, and vision coverage gets divorced. Within 30 days, they request to: Drop their spouse from all coverages. Switch from family coverage to employee-only for all benefits. What is permitted ON ACCOUNT OF THE DIVORCE? a Allow all requested changes b Allow dropping spouse but not changing to employee-only coverage for all benefits (e.g., change to employee/child) c Deny all changes. d Allow changes only to medical coverage. 2 An employee voluntarily drops medical coverage under their spouse’s plan during the spouse’s open enrollment. They now want to enroll in your employer’s medical plan midyear. What is permitted? a Allow enrollment in medical coverage —it’s a loss of coverage under HIPAA special enrollment. b Allow enrollment only in medical if plan document permits (i.e., is a recognized event in their §125 cafeteria plan document). c Deny—this is not a permitted midyear change. d Allow enrollment in medical, dental, vision if plan document permits (i.e., is a recognized event in their §125 cafeteria plan document). 3 An employee has a baby and requests within 30 days to: Enroll the child in medical. Add spouse to medical (previously waived). Increase FSA election. What is permitted? a Allow all changes. b Allow only adding the child. c Allow adding child and spouse, but not FSA change. d Allow adding the child and increase the FSA election, but not adding the spouse. 4 An employee gets married and goes on a month-long African Safari for their honeymoon. Upon return to work, 45 days later, the employee submits their election change request to add their new spouse and change from the HDHP to the PPO. What is permitted? a Allow enrollment—it’s a valid event, the employee was out of the country and could not enroll the spouse while away. b Allow if carrier approves. c Deny—request not timely (i.e., within 30 days of the marriage) d Allow enrollment of the spouse, but not the change to the PPO. 5 An employee's spouse loses group coverage due to termination of employment. The former employer pays for COBRA (i.e., COBRA subsidy) for 3 months post termination. At the end of the employer-paid COBRA the employee submits an election change request to enroll the spouse onto their medical plan due to a loss of COBRA coverage. What is permitted? a Allow enrollment—involuntary loss of group coverage is a HIPAA special enrollment event. b Allow enrollment if carrier approves. c Allow enrollment if the cost of COBRA is too expensive for the spouse to continue after the subsidy ends. d Deny—request not timely. Loss of a COBRA subsidy is not a change in status event. 6 An employee’s child turns 26 and loses eligibility. The employee requests to: Drop the child and the spouse. Switch from family to employee only. Increase HSA contributions. What is permitted? a Only allow dropping the child. b Only allow dropping the child & spouse and changing coverage tier. c Only allow dropping the child & increasing HSA contributions. d Deny all changes. 7 An employee says their current medical plan is too expensive and wants to switch to a lower-cost plan midyear. What is permitted? a Allow change if cost savings are significant. b Allow exception if the coverage cost is an economic hardship for the employee. c Deny—no permitted status change. d Allow only prospectively (e.g., at next payroll cycle). 8 An employee is enrolled in their spouse's medical plan and lose eligibility due to a divorce. The employee submits a request form within 30 days of the divorce decree to: Enroll in medical, dental and vision coverage. Add their child to dental & vision. Decrease their voluntary life benefit. What is permitted? a The employee can make changes to all benefit coverages (e.g., open enrollment) due to a divorce. b The employee can only enroll in medical, the coverage being lost due to the divorce. c The employee can enroll in medical, dental & vision & decrease their voluntary life benefit due to the divorce but not add their child to dental & vision. d The employee can enroll in medical, dental & vision and add their child to dental & vision, but not decrease their voluntary life benefit.

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Mid-Year Election Changes - What Is Allowed?

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About this activity

Created by

Download the paper version to play

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Mid-Year Election Changes - What Is Allowed?Online version

by Wednesday Wisdom

An employee with family medical, dental, and vision coverage gets divorced. Within 30 days, they request to: Drop their spouse from all coverages. Switch from family coverage to employee-only for all benefits. What is permitted ON ACCOUNT OF THE DIVORCE?

An employee voluntarily drops medical coverage under their spouse’s plan during the spouse’s open enrollment. They now want to enroll in your employer’s medical plan midyear. What is permitted?

An employee has a baby and requests within 30 days to: Enroll the child in medical. Add spouse to medical (previously waived). Increase FSA election. What is permitted?

An employee gets married and goes on a month-long African Safari for their honeymoon. Upon return to work, 45 days later, the employee submits their election change request to add their new spouse and change from the HDHP to the PPO. What is permitted?

An employee’s child turns 26 and loses eligibility. The employee requests to: Drop the child and the spouse. Switch from family to employee only. Increase HSA contributions. What is permitted?

An employee says their current medical plan is too expensive and wants to switch to a lower-cost plan midyear. What is permitted?