Thank you for speaking with me a few minutes ago. I have a PPO through my employer, and I am having a baby in September of this year. I thought that it was either a California or Federal law that this was a qualifying event and meant that I could change health plans. The screenshot from the CA department of Insurance that I’ve enclosed seems to say that. However, my employer says that isn’t the case and that only applies to individual plans.
What do you think?
J. B., Esq.
It appears that unlike Individuals who can change plans during a qualifying event – trigger, group plans only allow dependents to be added or new enrollment, not to change plans. This opinion is based on:
Health Net Employer Manual Page 19
Qualifying Life Events – insurance.ca.gov
Individual/Family and Group health coverage sold in California only allows new membership during an annual open enrollment period. Enrollment works this way because if people were allowed to purchase insurance anytime, people could wait until they got sick and the system wouldn’t work.
There are exceptions to the annual open enrollment period. These are called qualifying life events and if you experience one or more of them, you can buy new coverage or change your existing coverage. Below is a list of the qualifying life events:
More Insurance Company Administrative Pages
- Blue Cross – Anthem
- Blue Shield
- California Choice – A Private Exchange
- Health Net
- Kaiser Permanente
- Sharp Health Plan
- SHOP – Covered CA for Small Business
- United Health Plan – Pacificare