My wife and I have a QLE (Qualifying Life Event) for new insurance: a job change. The document is dated April 12. We apparently have 30 days to enroll in new insurance now.

When we spoke to Health Advocate, they advised that we would be required to pay for the new plan starting from April 1--in other words, be doubly-insured retroactively for two weeks. Our preferred way of starting insurance, if it must begin on the first of a month, would be to start May 1, and simply be without insurance from April 12 to May 1. We'd still be within the 30-day enrollment period, so that seems to make sense to me.

Something smells fishy to me about the requirement to enroll retroactively starting from April 1, based on a document dated April 12. It also seems fishy to me that I'm required to pay contributions for a month of insurance that I don't want, don't need, and can't use.

Is anyone familiar with insurance that can give me some clarity on this?

  • There can be serious consequences if you are not continously insured. I'm not sure, but I think the insurance could then decline any cost related to pre-existing conditions. Make sure to understand all consequences of a gap.
    – Aganju
    Commented Apr 28, 2021 at 2:24
  • @Aganju According to the Kaiser Family Foundation, "insurers in states with community rating waivers could vary premiums by health status for enrollees who have had a gap in insurance of 63 or more consecutive days in the last year." This would be a gap of less than 20 days.
    – Yehuda
    Commented Apr 28, 2021 at 2:33
  • @Aganju that’s not accurate since the ACA, health insurers have to take you as you are with no pre-ex. Yehuda the Bill referenced in that KFF article never became a law so it’s not relevant. What is Health Advocate in relation to your employer’s plan, is it just some third party you contacted for advice?
    – quid
    Commented Apr 28, 2021 at 5:32
  • 1
    When did you start the job? What document are you referring to? There’s a common plan eligibility language referred to as the wash rule, where you (the participant) is eligible and effective on your date of hire, but the billing begins the first of the current month if you’re hired on or before the 15th of the month; or the first of the following month if you are hired after the 15th. That could be your employers plan arrangement. Your preference for coverage start is essentially irrelevant. Health plans have very rigid eligibility rules and I suspect you’re missing some details.
    – quid
    Commented Apr 28, 2021 at 5:54


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