Open Enrollment is the only time of year to add or delete dependents unless you have a qualifying event. Qualifying Events would be: marriage, divorce, death, birth or adoption of a child or if your spouse loses their coverage elsewhere.
Upon marriage, birth, adoption, or placement for adoption, what are a plan's obligations to offer special enrollment?
According to the Employee Benefits Security Administration page on the United States Department of Labor website, Employees, as well as their spouses and dependents, may have special enrollment rights after a marriage, birth, adoption, or placement for adoption. In addition, new spouses and new dependents of retirees in a group health plan also may have special enrollment rights after these events.
According to Healthcare.gov, dependent children, can remain or be added to a parent's health insurance policy until they turn 26 years old. Note that they do not have to be financially dependent on the parent, nor do they have to be living with their parents or attending school. They can also be married.
According to the COBRA Guide available on the Employee Benefits Security Administration webpage on the United States Department of Labor website, COBRA – the Consolidated Omnibus Budget Reconciliation Act – requires group health plans to offer continuation coverage to covered employees, former employees, spouses, former spouses, and dependent children when group health coverage would otherwise be lost due to certain specific events.
Those events include the death of a covered employee, termination or reduction in the hours of a covered employee’s employment for reasons other than gross misconduct, a covered employee’s becoming entitled to Medicare, divorce or legal separation of a covered employee and spouse, and a child’s loss of dependent status (and therefore coverage) under the plan.
COBRA sets rules for how and when continuation coverage must be offered and provided, how employees and their families may elect continuation coverage, and what circumstances justify terminating continuation coverage. COBRA generally applies to all private-sector group health plans maintained by employers that have at least 20 employees on more than 50 percent of its typical business days in the previous calendar year. Both full- and part-time employees are counted to determine whether a plan is subject to COBRA. Each part-time employee counts as a fraction of a full-time employee, with the fraction equal to the number of hours that the part-time employee worked divided by the hours an employee must work to be considered full time.
State Continuation is available to employees who are not eligible for COBRA.
Under Texas state continuation, former employees and their family may remain covered under the employer’s health plan for up to nine months, if they are not eligible for COBRA. In addition, state continuation is offered for an additional 6 months after COBRA benefits have been exhausted.
No matter what size your company is, all employers are required to be in compliance with ERISA (Employee Retirement Investment Security Act) if they offer a health or welfare benefit plans, such as health, dental, life, disability, retirement, etc. ERISA was established to ensure that employees are informed of their benefits and their rights. Employers are required to provide an SPD (summary plan description) for all of their benefit plans to every employee.
In many cases, the benefit plans provided by the carriers do not have all of the required information, since it is not a Department of Insurance requirement, but a Department of Labor requirement. An ERISA wrap is designed to provide all of a company’s benefits under one SPD.
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