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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?

TTT
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B Thomas
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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
  • Are you also employed? – Joe Sep 12 '17 at 15:20

3 Answers3

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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.

jigglypuff
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TTT
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    @HartCO - oh wow. I agree. I fixed the typo in the question and adjusted my answer. Funny that a single missing letter "t" had completely changed the question. Thx. – TTT Sep 12 '17 at 15:58
  • My husband has coverage. I do not work and have been covered by his plan for 5 years. When he filled out the forms for the new year which began Sept. 1, he inadvertently checked No when asking about me for medical coverage but yes for dental. We had no idea about his mistake until my doctor's office called me to verify my insurance because the insurance company told them I had been termed. My husband immediately called HR and was told he had not elected to cover me with health insurance but only dental. In essence, he checked no when he meant to check yes. Payment due end of this week. – B Thomas Sep 12 '17 at 16:06
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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
  • @JimmyJames - can you please point to a federal law that prohibits it? – TTT Sep 12 '17 at 18:06
  • @JimmyJames - for what it's worth, here are some people claiming they were able to fix mistakes like this: http://ask.metafilter.com/256142/Drop-family-members-from-insurance-outside-of-enrollment-period – TTT Sep 12 '17 at 18:18
  • It appears to be PPACA. – JimmyJames Sep 12 '17 at 18:20
  • @JimmyJames - that link is behind a login. – TTT Sep 12 '17 at 18:24
  • @TTT Weird. Let's try this again: https://www.shrm.org/resourcesandtools/tools-and-samples/hr-qa/pages/isopenenrollmentforemployeehealthinsurancebenefitsrequired.aspx – JimmyJames Sep 12 '17 at 18:26
  • I have the page open and can refresh it but when I got to that link or paste the link in a new one, I get the login. – JimmyJames Sep 12 '17 at 18:28
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    @TTT That link you posted has the following in it "The IRS has also indicated - informally - that certain mistaken elections might be able to be corrected, basically based on facts and circusmtances, but only where there is clear and convincing evidence that an actual error (not a human "I forgot") has occurred (this would be more for a technical glitch and not likely to fly for "I thought I did but didn't")." Emphasis mine. – JimmyJames Sep 12 '17 at 18:29
  • @TTT I added links to IRS stuff in my answer. – JimmyJames Sep 12 '17 at 18:34
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    @JimmyJames - that link didn't work either. (You can probably test it in a private/ingocnito browing window). I don't consider this mistake "I forgot" but rather "I misread". Also, losing coverage is a qualifying event any time of year, let alone 11 days after it happened, even if intentional. (e.g. I'm taking my spouse off my policy because she is getting a new job with insurance starting sep 1. Oops, she didn't get the job, let's re-instate her insurance.) I believe this is a no-brainer for getting re-instated because OP goes from insurance to no insurance for 11 days and wants it back. – TTT Sep 12 '17 at 18:35
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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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    Separately, and arguably more importantly, the IRS is involved because of the pre-tax nature of employee contributions and the tax exempt nature of benefits received from the employer. This is materially different than the ACA laws forcing carriers to accept mid-year enrollments under "obamacare." There is too much nuance in the difference between carrier directed ACA LAWS and employer directed IRS TAXATION here for someone to google for 3 minutes to become an expert on the topic. – quid Sep 12 '17 at 19:09
  • @quid Can you find something that shows there's a 30 day window to correct this? I'm sure that would be helpful to the OP if you did. – JimmyJames Sep 12 '17 at 19:23
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    @TTT "I don't consider this mistake "I forgot" but rather "I misread". I don't see how that matters. Look, it's your reference. No human errors: "not likely to fly for "I thought I did but didn't" – JimmyJames Sep 12 '17 at 19:48
  • This person should have their husband request the employer SPD because it will outline these specifics. Again, the employer is the gatekeeper of this kind of thing, the IRS merely outlines a few plan requirements and several permissions allowed to the employer in order to offer tax-free benefits. Also of note, IRS requirements and permissions for removing someone from a plan are different than rules for adding someone, it'll be in the (unnamed) employer SPD (which probably isn't on the internet), the regulations are also different between qualified and taxable benefits. – quid Sep 12 '17 at 20:00
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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
  • I don't find this answer (or this kind of answer) helpful to questions like this; it's just supposition and hope, rather than actual information. – Joe Sep 12 '17 at 22:55
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    @Joe - there is plenty of anecdotal evidence of other companies fixing problems like this (and also plenty of companies that won't budge), so the answer to "is it true that nothing can be done" seems to be "No, that's not necessarily true", even though many companies choose not to take action. I think the distinction is important because if they choose not to fix it, her husband may be more inclined to start looking to work somewhere else. (Which perhaps he wouldn't consider if there really was nothing they could do even if they were willing to try.) Of course, all companies are different... – TTT Sep 13 '17 at 01:03
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    @Joe - that being said, I agree with you that this answer isn't necessarily helpful to OP, as only people within the company can actually help. But it does point out that perhaps you shouldn't just give up after speaking to one HR rep – TTT Sep 13 '17 at 01:27
  • Divorce and remarry. That's a qualifying event. :- ) But hey, maybe its quick and easy in Texas. I don't know. – Paul Cezanne Sep 13 '17 at 09:09
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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.

JimmyJames
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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
  • @TTT It's a bunch of IRS goobledy-gook for sure but I just see that you must enroll in the period open-enrollment period (I saw some yada about prior to plan effective too.) I know for sure that if you don't file for FSA reimbursement before the due date specified by your employer, the IRS requires you lose it, no matter what any one else wants to do. This is covered by the exact same IRS rules. Unless they call out exceptions, I'm seeing no reason to assume there are some. – JimmyJames Sep 12 '17 at 21:14
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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.

Johnny
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