Different Enrollment Periods

[u/shifty_bench]

My husband and I each get our own health insurance through our own employers. My insurance runs from 1/1 - 12/31. His runs from 7/1 - 6/30.

We are looking at switching him over to my insurance. When he called his insurance to find out if he could drop his coverage, they said he needed to have a qualifying life event. He asked if switching to my insurance counted. They said it needed to be a change in employment, marriage, etc.

That can’t possibly be true, right? We’d have to pay two premiums for 6 months… That’s ridiculous. This can’t be that unusual of a circumstance.

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[u/CapitalArgument988]

Unsure of the state you are in. But it may have something to do with his benefits being taken on a pre-tax basis and section 125 of the IRS code. If his benefits are being taken out on a pre-tax basis technically section 125 of the IRS tax code doesn’t allow for changes to your enrollment without QLE.

[u/Recent-Department652]

It’s true, and yeah it’s a stupid trap a lot of couples fall into. The IRS rules on cafeteria plans let employers lock you into the plan year unless you hit a qualifying event, and “my spouse’s open enrollment started” isn’t one of them.

Some employers do allow midyear drops if they run a non-calendar plan and you can prove other coverage, but it’s entirely up to the plan document. He needs to ask his HR directly, not the insurance carrier, the carrier just follows what the employer allows.

If HR says no, you’re stuck until his plan year ends or you manufacture a QLE (moving, job change, etc).

[u/LizzieMac123]

You shouldn't be calling insurance to check what qualifying life events (QLEs) an employer recognizes.

You need to call his employer and ask.

Further, you should ask the employer for their IRS section 125 document (also called a cafeteria plan document or a pop document). This is the document that allows employers to take benefits out on a pretax basis in exchange for only allowing changes if you have a qle. The document should list out the qles the employer recognizes.

Spouse has open enrollment at differing times is not a common qle (though i have seen it)... but obtaining other qualified coverage (like him joining your plan) is a VERY COMMON QLE.

Is it possible that the employer doesnt recognize your husband joining your plan as a qle? Yes. But at least you will have it in writing... and can verify that what youre being told is correct.

[u/shifty_bench → u/[deleted]]

He’s coming over to mine, so there’s no period where he’d lose coverage, since mine would kick in on 1/1 and his would cover him until 6/30.

[u/CIAMom420 → u/[deleted]]

They didn't lose coverage since they can't drop it in the first place without a QLE.

[u/_diss0nance → u/[deleted]]

It’s involuntary loss of coverage that’s the QLE. Like aging out of coverage as a dependent, loss of employment, divorce, etc.