Can a Spouse Leave the Plan at Anytime

URDRWHO

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Maybe things have changed but I always thought a qualifying event outside of open enrollment was to add a dependent to the plan or make benefit changes such as deductibles. I was talking to an HR person and they said that a spouse can not leave a plan. Coventry is the plan carrier and said that is not true, a spouse can leave the plan at anytime for any reason, they just can't get on the plan at anytime for any reason. The spouse is starting his own business and is getting his own health plan. He of course will be on his own plan. OR has the IRS gotten its hand into everything and now handcuff your spouse to a plan?
 
Another great HR know-it-all.

If you look at the certification study guides, there are long chapters (30+ pages) dedicated to every subject - except health insurance, which is a 5-7 page section. And that enables them to tell brokers they are wrong every chance they get.

Love it.
 
That is my position. I'm getting up there in years (once or twice I have been wrong in those years) but I think I am correct on this one. The HR person said to call the broker because she is saying what the broker told her. Doing an online search and I was amazed at the amount of people that say the same thing as she said and people billing themselves as benefit managers. On the face what the HR person is saying is even if the spouse got a job where the employer paid 100% of his premium, it was a better plan, the spouse could not drop coverage. I know under Obama-care things are changing but that would be a ridiculous change. Open enrollment and qualifying events are to prevent adverse selection, not to handcuff you to a plan.
misinformed HR person....yes a spouse and child can drop off at any time......
 
The HR person said to call the broker because she is saying what the broker told her.

and the broker loses money.....hahahahaha....call the insurance company direct ......tell them they need to drop the spouse and email you the paperwork to turn into HR to get this done......
 
Just a quick note. The answers are correct, anyone can drop medical coverage anytime they want. But where the HR person might be mistaken is if there is a 125 plan, which has other rules.

Even if they had a 125 plan, the dependent can drop medical coverage but the employee will still be requried to continue any dependent cost contribution. Using the following example; employee portion was free and the dependent cost is $100 per month, with a premium conversion 125 plan. The dependent can drop medical coverage off anniversary but the employee would still be required to have the $100 taken out of their paycheck.
 
I believe they do have an FSA and that falls under Section 125. Premium payments may also be pre-tax basis, I'm not sure. So maybe the HR person is quoting Section125 rules and not insurance rules. What you are saying is; the spouse cancels coverage; the employer would continue deducting a spouse premium but the spouse could never file a claim on that policy? I can't think of what at the moment..... but that idea seems to disobey the idea of insurance. If the insurance company is still getting paid, they would need to pay all spousal claims. If not, there is no risk and therefore it isn't insurance.
Just a quick note. The answers are correct, anyone can drop medical coverage anytime they want. But where the HR person might be mistaken is if there is a 125 plan, which has other rules.

Even if they had a 125 plan, the dependent can drop medical coverage but the employee will still be requried to continue any dependent cost contribution. Using the following example; employee portion was free and the dependent cost is $100 per month, with a premium conversion 125 plan. The dependent can drop medical coverage off anniversary but the employee would still be required to have the $100 taken out of their paycheck.
 
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I believe they do have an FSA and that falls under 125. Premium payments may also be pre-tax basis. So maybe the HR person is quoting 125 plan document stuff. What you are saying is --- the spouse cancels coverage; the employer would continue deducting a spouse premium but the spouse could never file a claim on that policy? I can't think of what at the moment but that seems to disobey the idea of insurance. If the insurance company is still getting paid, they would need to pay all spousal claims. If not, there is no risk and therefore it isn't insurance.

You seem to be forgetting that tax law and the IRS got involved via the section 125. Logic is often counter productive when dealing with the IRS.

Also, don't forget this may just be laziness on the part of HR. If the spouse leaves the group, that creates paperwork. Guess who gets to handle it?
 
Ah yes, IRS and logic - two things that do not belong together.
You seem to be forgetting that tax law and the IRS got involved via the section 125. Logic is often counter productive when dealing with the IRS.

Also, don't forget this may just be laziness on the part of HR. If the spouse leaves the group, that creates paperwork. Guess who gets to handle it?
 
I don't think that's quite right, about the premium and 125's. Pretty sure there's an out.


skimming a section 125 booklet.. it looks like spouse starting a business is a change. One thing are we talking premium or healthcare/childcare expenses? two different animals under a plan. If it's reinbursement accounts, pretty much stuck. Insurance premiums, nope.
 
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