New Permitted Election Changes for Cafeteria Plans

IRS Notice 2014-55 contains two additional permitted change rules for health coverage under Section 125 cafeteria plans.  These election change rules for the premium portion of the plan are welcome changes for many employers with non-calendar cafeteria plan years and employees moving from full-time to part-time employment resulting in a reduction in hours.

These permitted election change rules allow employees to revoke their elections to the group health insurance premium and seek coverage elsewhere under certain conditions, but does not include election changes to the health FSA portion of the plan.

Reduction of Hours - allows employees to change their elections under the cafeteria plan during their period of coverage, the plan year, due to moving from full-time to part-time employment resulting in a reduction in hours.  They may revoke their election if they are still eligible or ineligible for the group health plan coverage.

Conditions for revocation due to reduction in hours of service:

• an employee who previously was reasonably expected to average at least 30 hours of service per week now is reasonably expected to average less than 30 hours of service per week; even if the reduction in hours does not result in the employee ceasing to be eligible under the group health plan; and
• The revocation of election from the group health plan corresponds to the intended enrollment of employee and spouse and dependents, if applicable, in another plan that provides minimum essential coverage with the new coverage effective no later than the first day of the second month following the month that includes the date the original coverage is revoked.

Marketplace Enrollment - Participants may now revoke elections for employer health coverage during the Marketplace open enrollment period or a Marketplace "Special Enrollment Period."  For instance, this allows participants in non-calendar year cafeteria plans to switch from employer to Marketplace coverage with no double coverage or loss in coverage for the transition period.  Another example entails employees that may have a change in status event such as marriage or birth.  They may not want to add new family members to their existing employer-provided coverage, but seek coverage for the family at the Marketplace.

Conditions for revocation due to enrollment in Marketplace Qualified Health Plan (QHP):   

• Employee is eligible for the Special Enrollment Period to enroll in a QHP through a Marketplace or employee seeks to enroll in QHP through a Marketplace during the Marketplace's annual open enrollment period; and
• The revocation of election from the group health plan corresponds to the intended enrollment of employee and spouse and dependents, if applicable, in a QHP through the Marketplace for new coverage effective no later than the day immediately following the last day of the original coverage that is revoked.

 For existing Section 125 plans to allow the new permitted election changes, the plan must be amended to provide for such election changes.  The amendment must be adopted on or before the last day of the plan year in which the elections are allowed, and may be effective retroactively to the first day of the plan year.  

(Information provided by WageWorks)

HIPAA Certificates of Creditable Coverage - No Longer Required!

The Health Insurance Portability and Accountability Act (HIPAA) was enacted to, among other things, ensure that health insurance coverage would be portable. When moving from one employer to another, employees worried about whether the coverage from their next employer would cover their or a member of their family's illness or recurring medical condition. Insurance carriers commonly limited or excluded coverage for "preexisting conditions" for a certain period of time or sometimes exclude coverage altogether for some conditions.

To ensure continued, uninterrupted insurance coverage, HIPAA required group health plans to distribute certificates of creditable coverage when covered employees or their spouse or dependents lost coverage. The certificate was used when purchasing or obtaining new coverage to ensure uninterrupted coverage for all preexisting conditions.

The Affordable Care Act (ACA) removed the portability concern altogether by prohibiting group health plans from imposing preexisting condition exclusions for plan years beginning on or after January 1, 2014.

By eliminating preexisting condition exclusions from all group health plans, the need to distribute certificates of creditable coverage is obsolete as of January 1, 2015. Federal agencies have issued final regulations (http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/508-CMS-9949-F-OFR-Version-5-16-14.pdf) amending the HIPAA portability rules so that certificates of creditable coverage are no longer required.