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My medical insurance coverage through my spouse's employer was terminated because my spouse mistakenly checked the wrong box during the annual open enrollment.

I've been on my husband's insurance plan for five years and nothing should have changed. He unknowingly checked the wrong box to continue my dental coverage but not my health care.

Coverage was terminated as of August 31 and I only learned yesterday because I had a doctor appointment for which their office could not confirm coverage. A call to HR at my husband's work informed us of the mistake. HR told us nothing could be done to correct it. Is this true?

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    Can you edit and add country tag – Dheer Sep 12 '17 at 12:34
  • Do you mean you had a dentist appointment? Or do you not have health insurance either? – Michael Sep 12 '17 at 13:57
  • I meant the medical was terminated not the dental. I still have dental insurance. – B Thomas Sep 12 '17 at 14:13
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    When was the employer's open enrollment? How big is the employer? What state are you in? What state is the employer headquartered in? Depending on how large the employer is, your husband should call HR again to talk to someone else, AND he should talk to his direct manager. – quid Sep 12 '17 at 15:08
  • Enrollment ended Aug 31. Texas for both. Several hundred employees. – B Thomas Sep 12 '17 at 15:13
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HR told us nothing could be done to correct it. Is this true?

Probably not. I think it helps that only 11 days (now 12) has passed since coverage ended. It's possible the (incorrect) premium hasn't even been paid yet out of your husband's paycheck.

IMHO, there would be someone at the company that can help you fix this. I'm sure they can get creative and make it work. For example, if your husband quit for one day and then was re-hired, he would be eligible to re-enroll. That is obviously ridiculous, but it's the kind of out-of-the box thinking that HR could consider if they can't fix it through the normal methods.

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    This. The employer is the gatekeeper, your husband needs to find an advocate within the company to fix this. This is a fixable problem, if the right person is involved. – quid Sep 12 '17 at 16:56
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    HR can definitely fix this if they want to. If nothing else, they can call the insurance company to change the enrollment. The sooner it is done, the better (and easier). – xxbbcc Sep 12 '17 at 17:59
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    This is an IRS issue. Why is everyone so sure that HR can fix this? I'm finding only info that federal law prohibits 'fixing' this. – JimmyJames Sep 12 '17 at 18:00
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    HR is the gatekeeper of eligibility, moreso with groups over 100 employees. Silly mistakes like this are fixed during every single open enrollment, but the carrier can't fix it because the employer is the gatekeeper of eligibility. So "why is everyone so sure HR can fix this?" because HR can ESPECIALLY when less than 30 days has elapsed; if you can find the motivated advocate within the employer, your husband should talk to his direct superior, that is the person most likely to be an advocate to fix this problem that the miscellaneous HR assistant doesn't want to bother with. – quid Sep 12 '17 at 18:43
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    @quid is correct. In a previous life, I worked for an insurance agency. We would fix these mistakes all the time within the first 30 days after enrollment. You just need HR to approve it, send it to the broker of record, and have them contact the insurance company. Why 30 days? It just seems to be what insurance companies will back date applications. They may throw something in to reject claims during that times. – Anthony Genovese Sep 12 '17 at 20:02
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Unfortunately, the HR department is probably correct here. This is related to IRS Section 125 rules. Once you have finalized the enrollment, you cannot change it unless you have a 'qualifying event'. If you are employed and your employer offers insurance, loss of your husbands insurance is a qualifying event for you and you should be able to enroll with your employer. Otherwise, the qualifying event should allow you to enroll in any plan offered in your area under ACA (Obamacare).

Please update with what happens here since your experience may help others in a similar predicament.

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    It seems odd to me that the IRS would consider event X (losing one's insurance) to be a qualifying event for obtaining insurance from place A (marketplace) but not place B (spouse's employer). – TTT Sep 12 '17 at 19:02
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    Isn't loss of coverage a qualifying event? – ricksmt Sep 12 '17 at 19:13
  • @TTT Loss of insurance through a family member is only a qualifying event at your own employer. – JimmyJames Sep 12 '17 at 19:16
  • @TTT The details are described in the second IRS link under the section titled "Change in coverage of spouse or dependent under other employer’s plan." – JimmyJames Sep 12 '17 at 19:20
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    @JimmyJames - I can't find anything specifically in there that forbids correcting a mistake? IMHO, the intent of the rules seems to lean the other way. It's almost as if (but not quite) that the employer should have taken steps to make sure the spouse has coverage somewhere else before waiving spousal coverage. (e.g. Your spouse doesn't have any health insurance, and you want to waive it anyway. Are you really really sure you want to do this? Check here if yes.) Hehe. – TTT Sep 12 '17 at 20:04
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This web page and comment by G&R Partners (a firm that provides payroll and benefits services to other companies, I'm not endorsing them, I found them in a web search) suggests that while an employer has no legal obligation to assist an employee after a benefits mistake, the IRS does allow some flexibility to correct mistakes:

Legally, employers are not required to do anything for employees who have missed the open enrollment deadline. In fact, the terms of your benefits plans may prohibit you from making exceptions for employees who do not make benefits elections within a certain time period, such as before the new plan year begins.

...

However, IRS officials have offered guidance that, where there is clear and convincing evidence that an individual has made a mistake in an election or that the employer has made an administrative mistake in recording that election, the election can be undone, even retroactively. These administrative errors include incorrect digits in the Social Security numbers, or obvious typos. Theses administrative errors allow an employer to change ONLY things that are directly affected by the error.

So it seems that you have hope, but you need to convince the employer to go out of their way to assist you, which may be difficult to do since there's no legal obligation for them to do so, and they face some liability if they are not able to convince the IRS that this was a correction for an unintentional mistake.

I am certain that mistakes can be corrected after open enrollment because a data entry error by our benefits provider left me without dental insurance, I discovered it about a month after open enrollment ended, reported it to HR with a copy of my enrollment form showing that I selected the coverage, and they got it fixed with the benefits provider. But this one was easy to prove that it was a mistake since I had the form showing that I selected coverage.

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