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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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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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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 supports Canada
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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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