Client's HR states he cannot disenroll from group health plan when starting Medicare

newbie2001

Expert
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As the title states my client's HR department states he cannot disenroll mid-year from his group health plan. This is complete BS. Every single one of my clients who continued to work after 65 were able to drop their group health plan mid-year.

Can someone please advise how to educate the HR department on this? The client started Medicare on 6/1 and is still being charged for his group plan on his paycheck. Client its T65 this June.

Thank you.
 
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It’s a QLE, qualifying life event, he is now Medicare eligible, that creates a Special Enrollment Period allowing him to make a plan change (drop his coverage) outside of his employers normal open enrollment period.
 
Since he is T65 he should have a QLE. If he were past 65 and just wanting to drop group and go on Medicare then they don't have to allow that and can make him wait until plan OE (I know this isn't his situation just mentioning it).
 
perhaps client could ask employer for a copy of the employer's actual 125 plan document to review in order to see if this employer plan is written to exclude any midyear changes.

I would think, as an employee covered under the plan, they would be entitled to receive a copy of the plan document if requested.
 
I encountered this a few years ago. Client worked for large utility company. HR said since he participated in an FSA he could only leave the plan during open enrollment.



A qualifying event affects your eligibility for FSA coverage, and you can only make changes to your FSA that are "consistent" with that event. Always contact your third party administrator (who handles your FSA account) about qualifying events, or check your Summary Plan Description for guidelines on which changes you are allowed to make under your plan. As mentioned before, not all employers or FSA plans allow employees to make mid-year changes.


 
I encountered this a few years ago. Client worked for large utility company. HR said since he participated in an FSA he could only leave the plan during open enrollment.



A qualifying event affects your eligibility for FSA coverage, and you can only make changes to your FSA that are "consistent" with that event. Always contact your third party administrator (who handles your FSA account) about qualifying events, or check your Summary Plan Description for guidelines on which changes you are allowed to make under your plan. As mentioned before, not all employers or FSA plans allow employees to make mid-year changes.


My client is already enrolled in a MAPD plan… what did you do with yours?
 
My client is already enrolled in a MAPD plan… what did you do with yours?

He is someone I had known for years who had given me a number of referrals while he worked for this company.

I shared what I knew about FSA plans, he went back to HR, they told him he had to wait until open enrollment . . . so we did.

Does you client plan to disenroll from the MAPD and enroll again during open enrollment or keep EGH and MAPD?
 
He is someone I had known for years who had given me a number of referrals while he worked for this company.

I shared what I knew about FSA plans, he went back to HR, they told him he had to wait until open enrollment . . . so we did.

Does you client plan to disenroll from the MAPD and enroll again during open enrollment or keep EGH and MAPD?
Right now the situation is trying to get a 3-way call with his HR as soon as possible. They refuse to communicate over phone and only want to talk over email. Classic.
 

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