3
  • Employer provides four plans, with the following three that interest me, PPO, HMO, CDHP
  • During open-enrollment I choose PPO.
  • I marry. This counts as a QLE.

Am I allowed to change to CDHP midyear?

From my readings and understanding, this QLE only allows me to elect coverage for spouse under my current medical coverage.

Is my understanding correct that I may not change my health plan? Furthermore, no QLE exists that allows one to change health plan chosen during initial open-enrollment?

Improve this question
  • 1
    Is this in the United States? – yoozer8 Nov 7 '19 at 17:45
  • 1
    Assuming US based on the language used. Have you asked your plan administrator? The answer is going to vary based on factors we don't know (which state you live in, whether your coverage is employee- or government-based, and who the plan admin is). The customer service folks at your plan should be able to tell you, or you can find the answer in your plan documentation (or ask HR if it's employer based). – dwizum Nov 8 '19 at 14:43
  • 2
    Can you provide a link to the document that you think limits your choices when there is a QLE? – mhoran_psprep Nov 8 '19 at 14:54
-1

The below from appears to state one may be able to change one's plan.

Health Gov Site

Since the 2019 Open Enrollment Period is over, you can now enroll in or change a Health Insurance Marketplace plan only if you have a life event that qualifies you for a Special Enrollment Period.

Also this from law site regarding Marketplace

ยง 155.420 Special enrollment periods.

(a) General requirements -

(1) General parameters. The Exchange must provide special enrollment periods consistent with this section, during which qualified individuals may enroll in QHPs and enrollees may change QHPs.

Though the above is only discussing plans purchases thru state marketplace. Adding as partial answer for other viewers.

Improve this answer
  • Just as an FYI, even though this makes it sound like "yes, you can change your plan," Marketplace plan changes due to QLEs are usually fairly limited - but it depends on the specifics of the QLE and the plan you're already in. In some cases you can only change to certain other plans (i.e. in the same Metal), or you can enroll the new spouse in other plans but you're not allowed to change yours, and so on. – dwizum Nov 8 '19 at 16:29
  • Dependent tiered coverage, like employee+spouse, isn't available to individuals, unlike employer plans. the question asks if a spouse must enroll as a dependent under the employee's chosen plan election, a situation that doesn't exist in individual markets. – quid Nov 9 '19 at 16:20

Your Answer

By clicking โ€œPost Your Answerโ€, you agree to our terms of service, privacy policy and cookie policy

Not the answer you're looking for? Browse other questions tagged or ask your own question.