Tag: qualifying events

Question: What are considered qualifying events for individuals to buy coverage from the Marketplace outside of the annual enrollment period? Answer: According to the Healthcare.gov website, individuals may purchase Marketplace health insurance plans outside of the open enrollment period as long as there is a qualifying event.  The site lists the following as qualifying life events that…

Question: What are the Pennsylvania “mini-COBRA” rules, and how do they compare and contrast with the federal COBRA rules?  Please outline eligibility and notification rules. Answer: Eligibility: Pennsylvania law provides employees and their eligible dependents who lose group health insurance coverage through a small employer (those with 2-19 employees) as a result of certain qualifying…

Question: We have an employee with a medical issue who is currently on Medicaid that he will lose soon.  Will this create a qualifying event for him to come onto our plan?  (He can’t be without coverage). Answer: Mid-year election changes under the Section 125 cafeteria plan rules are allowed for status or cost/coverage changes…

Question: If an employee voluntary elected to terminate his individual medical insurance policy, would this be a qualifying event based on DOL guidelines? Therefore, could he enroll in the group plan? Answer: Treasury regulations authorize IRC Section 125 cafeteria plans to allow participants to make mid-year election changes in the case of certain change in…