<p>Can someone please explain a HIPAA regulation to me?</p>
<p>I was under the impression under HIPAA regulations that upon marriage, you are able to change and enroll in new health insurances with your spouse. See below:</p>
<p>A Plan?s Special Enrollment Provisions Must also Permit Employees and Dependents (Who are Otherwise Eligible) to Enroll upon Marriage, Birth, Adoption, or Placement for Adoption
<em>Example:</em> A group health plan allows employees who are already enrolled for coverage to add dependents upon marriage, birth, adoption, and placement for adoption. However, if an employee is not already enrolled, the plan does not permit any enrollment when these events occur. <em>[i.e. such as the University of Wisconsin’s policy]</em>
<em>Tip:</em> HIPAA allows eligible employees and dependents to enroll upon marriage, birth, adoption, or placement for adoption.
Group health plans are required to offer special enrollment to otherwise eligible employees, spouses, and any new dependents upon marriage, birth, adoption, or placement for adoption. Accordingly, an employee who is otherwise eligible, but not enrolled for coverage, can enroll (and can also enroll a spouse and any new dependents, if they are otherwise eligible under the plan) when any of these events occur.
The plan should amend its special enrollment provisions to allow employees and dependents who are otherwise eligible to enroll upon these events. </p>
<p>However, my University is not allowing me and my husband to enroll in dental insurance because I hadn’t enrolled in dental insurance during open enrollment. We are in dire need for dental insurance, as my husband is in braces and needs to get them off to have other very expensive dental work done (some that insurances will cover, some that they won’t).</p>
<p>Are state agencies exempt from this provision?</p>
<p>I’m trying to get answers from the Office of Payroll and Benefits but they are giving me a run around and appear to have no appeals processes nor supervisors (ugh!).</p>
<p>I do not think Hipaa, which is usually about privacy, supersedes open enrolment, unless you are saying your husband was not your husband during open enrolment, you should be able ot add him if he is new and might have a case to change chosen plans with the family change.</p>
<p>If you possessed dental insurance at the time of the marraige, they are required to add your husband at the time of marraige. If you were NOT enrolled in dental insurance on the date you were married, both you and he can enroll, but I believe they are allowed to make you wait until the next open enrollment date. </p>
<p>Hipaa is the health insurance portability accountability act. It did morph into priivacy issues, but started out protecting ones ability to acquire and keep health insurance.
<p>Woah there Ophio, didn’t you, like, get married last weekend? So, congratulations and all that. You are on CC 4 days after the wedding? :eek:</p>
<p>when you write
is that your opinion, or is it from UW policy?</p>
<p><em>edit</em> I see that you got that from the Dept. of Labor website.</p>
<p>So, upon marriage not only can the new spouse enroll in the employee’s plan, but also, that if the employee was eligible but chose not to enroll, the employee and their spouse may do so upon marriage.
There is probably a limit on within how many days of marriage you can enroll. Instead of dealing with UW, can you call the Insurance directly, or is it administered by UW and no-one else will talk.</p>
<p>choco, I believe that when the dept. of labor website says “who are otherwise eligible to enroll upon these events” they are talking about the coverage that one person already has prior to the event.
In other words, if an employee of my company gets married, they can add their spouse to the coverage they already have. Same with a baby being born (there are time limitations on both, it has to be done generally within 30 days). But if an employee has opted out of the dental insurance and then gets married, they don’t get to both opt into the dental insurance until the next open enrollment period.
So the question is: did the OP have the dental insurance herself at the time of the “qualifying event” in this case marriage? If the answer is yes, they have to let her enroll/insure her spouse. If the answer is no then both may have to wait for open enrollment date to come around.</p>
<p>The way flexible benefit plans work is that you have a period to enroll in medical and dental insurances and other benefits the employer may offer during the “open” period. Usually these benefits are “pre-tax” - meaning you do not pay income tax on the cost. Open enrollment is once a year and the employee signs up for what they want.</p>
<p>If you get married, divorced, etc you have a change in “family status” and you can amend your selections at that time. It doesn’t mean you get to change your selections - it means you get to adjust what you already have to adjust for the event.</p>
<p>This is actually based on the IRS. If you can change what you have that is not taxed you can manipulate your income. That is why you must make your elections before the beginning of your taxable year and can only make changes based on defined “life” events.</p>
<p>Having turned down coverage before, you may have to wait until open enrollment. Ask for a copy of the plan, it will spell out the eligibility rules for you. </p>
<p>Not to be mean, but would you drop coverage as soon as his need was taken care of? Insurance simply doesn’t work that way. You can’t buy auto insurance after the accident to fix the accident.</p>
<p>It really has nothing to do with section 125s or flex plans. It’s simply what constitutes a qualifying event. Her policy will the bible. She needs to get a copy and find out what quidelines it has.</p>
<p>I don’t think so, the flex plan is a legal document that dictates open enrollment, etc. </p>
<p>The employer is supposed to coordinate their insurance coverage with the flex plan document. Now, granted all my research was done long ago, but if you allowed employees to pick up insurance and drop outside of the open enrollment period, your plan could be invalidated by the IRS</p>
<p>That’s the website I got my quote. Read it carefully, the quote you posted is the rule that is non-allowable under HIPAA. The tip underneath that quote is how the company should fix the problem.</p>
<p>chocoholic:</p>
<p>Yes, I only got married a few days ago, but I want to get all of this crap out of the way early so I’m not cutting it close if I have to go through any appeals processes. Plus, since I’m a student, I don’t have time to take the traditional honeymoon right now :(.</p>
<p>ebeeee:</p>
<p>It may be legally correct that I ‘opted out’ of dental insurance upon hire, but in my defense was never given the proper paperwork to enroll in my benefits. I had asked the HR person in my department numerous times just after I was hired about dental insurance but she didn’t know how to help me or was just too lazy to. I was persistent, but got tired after a month of bugging her to get an answer at that point (it was probably too late anyway).</p>
<p>Opie:</p>
<p>No, there is no plan to drop the coverage. I was blessed with good teeth, but my husband was dealt a bad hand, so it’s something we will need for the long haul. I already asked about pre-existing conditions clauses and it seems he would be in the clear with any of our insurance options.</p>
<p>Well, I’m not sure what policy to consult. The dental insurance is a separate entity to my health insurance, so I don’t have a plan book (come to think of it, I was never given a plan book for my health insurance here…very strange, I should really take care of that).</p>
<p>Can anyone direct me towards some of these IRS regulations you are speaking of? I’m trying my best to educate myself, but it’s really hard with no education in government.</p>