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Reply to Employee Drop ER Coverage and Get Individual     
Old 05-12-2017, 07:58 AM   #1
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Employee Drop ER Coverage and Get Individual Employee Drop ER Coverage and Get Individual
So, I can't get a straight answer on this. Maybe my colleagues can help!

Scenario 1: ER renews 8/1/2017. EE doesn't want the ER coverage. Can the EE then get an individual plan (on or off marketplace, no subsidy) if it's not open enrollment in the individual market?

Scenario 2: ER renews 8/1/2017. EE enrolls in ER plan. Then, the individual open enrollment period begins and EE wants to instead get her own plan. Can she leave her ER's plan end of December for a 1/1/2018 Individual plan?

ER has a Section 125. ER offers affordable and qualified health insurance.

Truly cannot get a straight answer on this.

Thanks for any input.
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Old 05-12-2017, 04:55 PM   #2
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kgmom219 on Employee Drop ER Coverage and Get Individual
 
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Employee Drop ER Coverage and Get Individual Re: Employee Drop ER Coverage and Get Individual
If you asked 3 lawyers on this, you would get 3 answers.

The practical answer? Remain enrolled in ER coverage through 12/31 and start ACA coverage on January 1.

Whoever is administering the Section 125 plan is actually the determining body. But I bet if you asked 3 people there, you would get 3 answers again.

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Good things don't come to those who wait. They come to those who work their butts off and never give up.
  Reply With Quote to Employee Drop ER Coverage and Get Individual
Old 05-12-2017, 11:18 PM   #3
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glgamerica on Employee Drop ER Coverage and Get Individual
 
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Employee Drop ER Coverage and Get Individual Re: Employee Drop ER Coverage and Get Individual
Originally Posted by floridashores View Post
So, I can't get a straight answer on this. Maybe my colleagues can help!

Scenario 1: ER renews 8/1/2017. EE doesn't want the ER coverage. Can the EE then get an individual plan (on or off marketplace, no subsidy) if it's not open enrollment in the individual market?

Scenario 2: ER renews 8/1/2017. EE enrolls in ER plan. Then, the individual open enrollment period begins and EE wants to instead get her own plan. Can she leave her ER's plan end of December for a 1/1/2018 Individual plan?

ER has a Section 125. ER offers affordable and qualified health insurance.

Truly cannot get a straight answer on this.

Thanks for any input.
Situation #1: Yes, they qualify for a special enrollment period.

Your job-based health plan is ending for the year and you choose not to renew it. Note: If the plan is affordable and meets minimum value standards, you can buy Marketplace insurance but won’t qualify for a premium tax credit or other savings.

Source: https://www.healthcare.gov/coverage-...llment-period/

(under losing job-based coverage)

Situation #2: It would seem so although I couldn't find the exception in the code.

See example 4 page 3, change in status.

https://www.washcoll.edu/live/files/...june2013nfppdf

I would guess no subsidy and a 30 day window to do it.

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Michael Kuhn, President
GLG America
http://www.GLGAmerica.com
GLG America specializes in workplace benefits like life, disability income, critical illness, accident, supplemental health and other insurance.
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Old 05-13-2017, 09:25 AM   #4
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LGilmore on Employee Drop ER Coverage and Get Individual
 
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Employee Drop ER Coverage and Get Individual Re: Employee Drop ER Coverage and Get Individual
Originally Posted by floridashores View Post
So, I can't get a straight answer on this. Maybe my colleagues can help!

Scenario 1: ER renews 8/1/2017. EE doesn't want the ER coverage. Can the EE then get an individual plan (on or off marketplace, no subsidy) if it's not open enrollment in the individual market?

Loss of coverage creates a 60 day window to buy individual. Can be voluntary or involuntary.



Scenario 2: ER renews 8/1/2017. EE enrolls in ER plan. Then, the individual open enrollment period begins and EE wants to instead get her own plan. Can she leave her ER's plan end of December for a 1/1/2018 Individual plan?


Yes, but going to depend on group size too. Small group this is much harder to do because of participation requirements. Could possibly blow up the group.


ER has a Section 125. ER offers affordable and qualified health insurance.

This is actually the big thing, she loses her pre tax advantage if she goes individual coverage as section 125s are for group plans. I have a lot of employees come to me with this and you have to make them do the math. The 125 usually makes purchasing outside of the group plan more expensive. They just have to pencil it out.


Truly cannot get a straight answer on this.

Thanks for any input.


I would just talk to the employee about the choice.
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Old 05-18-2017, 07:45 PM   #5
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Employee Drop ER Coverage and Get Individual Re: Employee Drop ER Coverage and Get Individual
Scenario 1: ER renews 8/1/2017. EE doesn't want the ER coverage. Can the EE then get an individual plan (on or off marketplace, no subsidy) if it's not open enrollment in the individual market? Yes, called voluntary termination and more than 99.9% of the time will not be allowed a subsidy. SEP applies from loss of grp coverage.

Scenario 2: ER renews 8/1/2017. EE enrolls in ER plan. Then, the individual open enrollment period begins and EE wants to instead get her own plan. Can she leave her ER's plan end of December for a 1/1/2018 Individual plan? Yes, again same voluntary termination from grp and similarly, no subsidies will apply.

This EE will NOT be allowed to use pre-tax dollars to purchase an IFP plan, period (no participation in a Section 125 plan).
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Old 05-18-2017, 07:56 PM   #6
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kgmom219 on Employee Drop ER Coverage and Get Individual
 
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Employee Drop ER Coverage and Get Individual Re: Employee Drop ER Coverage and Get Individual
Originally Posted by rcduggan View Post
Scenario 1: ER renews 8/1/2017. EE doesn't want the ER coverage. Can the EE then get an individual plan (on or off marketplace, no subsidy) if it's not open enrollment in the individual market? Yes, called voluntary termination and more than 99.9% of the time will not be allowed a subsidy. SEP applies from loss of grp coverage.

Scenario 2: ER renews 8/1/2017. EE enrolls in ER plan. Then, the individual open enrollment period begins and EE wants to instead get her own plan. Can she leave her ER's plan end of December for a 1/1/2018 Individual plan? Yes, again same voluntary termination from grp and similarly, no subsidies will apply.

This EE will NOT be allowed to use pre-tax dollars to purchase an IFP plan, period (no participation in a Section 125 plan).

Subsidies will NEVER come into play. Its called the family glitch

Just because you want an Indy plan, doesn't mean you want a subsidy

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Good things don't come to those who wait. They come to those who work their butts off and never give up.
  Reply With Quote to Employee Drop ER Coverage and Get Individual
Old 05-19-2017, 01:17 PM   #7
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Employee Drop ER Coverage and Get Individual Re: Employee Drop ER Coverage and Get Individual
Originally Posted by kgmom219 View Post
Subsidies will NEVER come into play. Its called the family glitch

Just because you want an Indy plan, doesn't mean you want a subsidy
The part about "NEVER" is inaccurate as our state group exchange ALLOWS subsidies for dependents when the right box is checked on the master app

Also, if the current employer sponsored plan offerings are in excess of 9.whatever percent of household gross income. Never say never
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Old 05-22-2017, 12:25 PM   #8
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Employee Drop ER Coverage and Get Individual Re: Employee Drop ER Coverage and Get Individual
All I know is that my GA's compliance dept warns against invalid POP/Section 125 drop outs, because if they violate the POP plan document/tax rules, the whole plan and all employees lose tax deductible status.
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Last edited by yorkriver1; 05-22-2017 at 12:40 PM.
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Old 05-22-2017, 05:06 PM   #9
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kgmom219 on Employee Drop ER Coverage and Get Individual
 
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Employee Drop ER Coverage and Get Individual
Originally Posted by rcduggan View Post

The part about "NEVER" is inaccurate as our state group exchange ALLOWS subsidies for dependents when the right box is checked on the master app

Also, if the current employer sponsored plan offerings are in excess of 9.whatever percent of household gross income. Never say never
Ok. Sorry.

If you lie on the form in CA, you can still get a subsidy.

But you are right. Never should never be used when dealing with health insurance

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Good things don't come to those who wait. They come to those who work their butts off and never give up.
  Reply With Quote to Employee Drop ER Coverage and Get Individual
Old 05-22-2017, 05:44 PM   #10
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Employee Drop ER Coverage and Get Individual Re: Employee Drop ER Coverage and Get Individual
Originally Posted by kgmom219 View Post
Ok. Sorry.

If you lie on the form in CA, you can still get a subsidy.

But you are right. Never should never be used when dealing with health insurance
No lie.

Covered CA SHOP allows employers under 50 employees the option to offer "employee only" group coverage. If they check the employee only box, Covered CA allows the spouse and dependent children to purchase IFP with subsidy (no family glitch applies).

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