Can one change plans if they have a qualifying event like a new born or only enroll or add dependents?

Question

Hi Steve,  

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.

Answer

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

Anthem Employer Administrative Manual 

shrm.org/

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:

Individuals     *   Employer Group

54.4980B-4 

ajg.com/faqs

More Insurance Company Administrative Pages

Carriers – Companies

 

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