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Message © 2023 Benefit Comply, LLC 1 Employee is asking to: Add Coverage Is a HIPAA special enrollment right triggered? • Loss of coverage • Acquisition of a new dependent through marriage or birth/adoption, • Becoming eligible for a Medicaid/CHIP subsidy Drop Coverage Carrier will typically allow coverage to be terminated, but pre-tax elections may be reduced only if there is a recognized change in status or life event. It may not be possible to add coverage mid-year, it depends on plan terms and whether employer and carrier are willing to be more generous than required. If coverage is permitted without a HIPAA special enrollment right, adding coverage must be tied to a Section 125 change in status or life event to allow pre-tax elections to be increased (otherwise any additional employee contribution should be handled after-tax through the remainder of the plan year. No Yes Enrollment must be permitted for the medical plan. For other benefits, it depends upon plan terms. Section 125 rules permit a corresponding increase in pre-tax contributions when a HIPAA special enrollment right is triggered. List of events: • Change in status: o Change in employee’s legal marital status o Change in number of dependents o Change in employment status o Change in dependent eligibility status o Change in residence o Commencement/termination of adoption proceedings • Change in cost of benefits • Significant curtailment or improvement of benefits • Change in coverage under another employer plan (including having a different plan year) • Loss of group health coverage sponsored by governmental or educational institution • HIPAA special enrollment • COBRA qualifying event • Medicare or Medicaid entitlement • FMLA • Enrollment in a public Marketplace