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I recently took up a job in CA (the hustle-bustle place) after completing my PhD. I was on F1 during my studies and now I am on OPT. At the time of my joining, I was given a 30 day window by my company to complete health insurance plan selection + enrollments for the 2015 year.

I initially enrolled in a family plan, but later realized that my wife cannot stop her insurance until year end. Hence, I tried to de-enroll in the family plan and enroll in an individual plan. But this I did 1 day outside of the window I was given (damn, I was so close!).

Now, I am being told by my company that I have to stay enrolled in the family plan because some IRS guidelines specify only a 30 day window for plan selection + enrollments. Since I came from a university setting, that too doctoral studies, its kind of a jolt to have such sharp adherence to a deadline.

But after much thought, I wanted to try this further. Online I haven't found much information about whether this 30 day period is crisp & necessary---may be I am not just good enough to search these topics.

Can anyone shed some light on this? Please include citations of sources/laws.

  • I'm confused, it is more or less year end right now, is it not? – mikeazo Dec 11 '15 at 21:08
  • I joined in a job recently (1-2 months ago). So, for these last few months, I got onto a company provided family insurance plan. On the 31st day, I decided to move to an individual plan, but they did not allow me to do it. Initially, they said the move should be possible, and I had to write a few emails---but as weeks rolled, I was told it cannot be done. – And Or Dec 11 '15 at 23:59
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When you got a job, that also triggered a Qualifying life event for your spouse. A qualifying life event triggers a new open season window where you can make changes.

A change in your life that can make you eligible for a Special Enrollment Period to enroll in health coverage. Examples of qualifying life events are moving to a new state, certain changes in your income, and changes in your family size (for example, if you marry, divorce, or have a baby) and gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder.

Check with you wife's employer to see if you are still in the window to cancel her insurance. There may have even been two events: getting the job, and getting the insurance.

Here are more detailed examples.

Most people pick their insurance options when they start a new job or during the annual open season. Your complication is that those two events are either close together, or they overlap.

Lets say that a single person has insurance; and so does the person they are dating. The in the middle of the year they get married. The government calls the wedding a qualifying life event. They can decide during that window to merge plans. They can even decide to go from a plan with no dental to one with dental, or can pick the one with maternity coverage.

Now lets say that the person who has the family policy loses their job. Of course they would want to switch; and they can because loss of a job is a qualifying life event.

Now when that person is hired into a new job, they can decide to switch again.

The list of events that are considered a qualifying life event is long: marriage, divorce, birth, death, adoption, job change, eligibility change, age, retirement...

And if it is an event that impact one spouse, it also impacts the other.

Complication due to both spouses working

When both spouses work and are eligible for insurance, the two employers want to coordinate benefits. They feel that if the other employer doesn't have to cover their employee it is unfair. Some require that the other spouse must get coverage from their employer, or they charge a higher rate.

When both parents have family coverage they generally use the birthday rule to determine which is primary and which is secondary.

These are separate issues from Qualifying life events and open season.

  • I am not clear on how my joining a job & getting health coverage (which I previously didn't have for a few months) would be a qualifying life event for my spouse. Can you elaborate on it? Any citations, kindly include. – And Or Dec 12 '15 at 0:14
  • Also, my spouse took health coverage for her and our daughter from her employer. I cannot cover for my spouse and for my daughter with my family insurance because my month of birth comes after her month of birth. (This is a really weird thing that I found out when we visited a doc's office last month.) Provided this, can it be claimed that my attempt to get insurance for my spouse & daughter should not have gone through in the first place? @BlakeP – And Or Dec 12 '15 at 0:22
  • For some reason it didn't notify me, sorry about the late response.... Regarding not being able to add your spouse/child to a family plan due to the birth dates -- that is a very odd requirement. I would check with your employer, not the doctors office, regarding that stipulation. I don't know what your birth month coming before your wife's birth month has to do with any thing. It is definitely worth talking to your employer about though. – BlakeP Dec 14 '15 at 20:19
  • As for how getting a job is a qualifying event... The IRS decides what is and is not. My HR department mentions "Employee's spouse gains or loses coverage through employment." as a valid qualifying event. But you only have 30 days following the "event" to file a change, which would have been the same 30 days you had for your election period. – BlakeP Dec 14 '15 at 20:21
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What you are talking about is typically referred to as "Open Enrollment". My understanding is that the purpose of having a specified time period to enroll is to prevent people from only signing up whenever they require it. Small excerpt with longer explanation:

Without an open enrollment period and a requirement to have coverage, many healthy people could forgo insurance until they became sick or injured and then purchase insurance when they needed to utilize health care, leaving only high utilizers in the insurance risk pool. Risk pools need premium dollars from healthy people to help cover the cost of high utilizers.

Colorado Consumer Health Initiative

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