Health Insurance changes Illinois

Here is my situation. I'm divorced from my first wife with whom I have 2 children and remarried. The insurance plan offered by my employer is not a very great plan. My second wife's employer offers a much better level of coverage, slightly more expensive but with the difference in coverage we decided it made sense to switch. The main complaint with my employers plan is that it does not cover some of the medication my son is on. We enrolled into my wife's plan, and when I went to cancel my plan through my employer, they viewed it as a qualifying event but they required a letter from the Illinois Dept of Healthcare and Family Services stating it was ok for them to drop me from the plan. When I called up IDHFS, I honestly felt like they became combative as soon as I mentioned I was the non custodial parent. I asked my ex wife if she could please call which she claimed to do willingly ( I explained the better coverage, she saw it first hand filling our sons meds, she was on board and convinced.) She claimed they said that this had to be court ordered for IDHFS to send the requested letter to my employer. Despite the fact that I already had proof of coverage from my current wifes plan. So now we are currently stuck paying 2 plans, and it seems as if they are forcing our hand to stay in the garbage plan offered by my employer. Any advice? Sorry I know when I read this it seems kind of jumbled please let me know if I need to clarify any points. But if anyone has any advice to get IDHFS to submit the letter to my employer it would be greatly appreciated. As I said my ex-wife stated she would gladly sign any needed documents stating she agrees with the insurance change if it was required.

Thanks

-DoubleCoveredNotbyChoice in Chicago

Here's the thing.

About 95% of employer-sponsored plans in the US are covered under Section 125 of the IRS code. If your portion of the premium is taken pre-tax, or if taking it pre-tax is an option, then your plan is a 125 plan.

Under 125 plans, once you make your elections during your initial hire, or your annual open enrollment period, you are locked into those elections for the entire plan year unless you have a qualifying event. Then the change can only be made as of the date of the qualifying event. You have a window, usually 30 days (never shorter, occasionally longer) after the qualifying event to make your elections, which are retroactive to the qualifying event date.

But the kicker is that you need independent verification of the qualifying event supporting it. The court order would bypass that requirement.

It's not entirely clear to me how you enrolled in your wife's plan and how long after you attempted to drop your employer's coverage. Was it your wife's open enrollment period? Her first date of hire? How long after that did you attempt to drop your own coverage?

It was during my wife's open enrollment. I tried dropping my plan as soon as I had the proof of coverage through her plan. My employer wasn't disputing that it was a qualified event, they said I needed a letter from Illinois dept of health and family services stating it was ok to drop my plan.

Did you ask your employer's plan administrator WHY you'd need a letter from a state agency that it was ok to drop the plan and ask them to cite what they're relying on in writing?  (I'm not sure employer's correct about it being a qualified event, but we can't know if the plan considers getting coverage under a spouse's plan a qualifying event (at least not outside you having recently been married).

I'd first confirm why with employer plan administrator that the government entity acknowledging your (kid's?) coverage under a different plan means it's ok to drop is required.  Then you might want to pester the head of this state agency you're referring to, as well as the state insurance commission and also cc your state legislative representatives (and perhaps call their offices to ask them to help if need be; a simple letter from such a person intervening is sometimes all it takes).

The employer IS correct about it being a qualifying event; obtaining other coverage has always been considered a valid reason to change plans. The Federal government understands that open enrollment for the husband and wife might be at different times and it is specifically permitted under the law.

However, I also cannot understand why the plan administrator is insisting on permission from the state agency. As long as you provided written verification from the new plan/your wife's employer that there was coverage in place as of x date (you did, didn't you?) that should be all that you need. What reason are they giving you for the additional verifications?

(BTW, this is exactly what I do for a living so I'm quite familiar with the details.)

cbg:

However, I also cannot understand why the plan administrator is insisting on permission from the state agency.

That seems odd to me, too, unless the employer had been given a copy of a court order saying that the OP had to carry insurance for the child. In that case, the employer might be nervous that the employee would be in violation of the court order by dropping the coverage.

That is a possibility, and if that is the case, I can see why the employer would be nervous.

If it is not the case, though, I think the employer is overstepping his role to a great degree.

And assuming you are shown to be correct I'd expect to get reimbursed for the second unnecessary plan deduction --make a point of same...

It amazes me how quickly time can go by, I've been meaning to post an update.

Still paying for both insurances. There is a court order for insurance coverage. Is this something that I can hire an attorney to help rectify? Is it something just a letter could take care of? My ex wife is all for us using my current wife's plan, it is a much better level of coverage and we have both seen the benefits of that.

Any guidance is appreciated, Thanks again

Laymans view...did you in writing clearly request being dropped and follow up with clear submission that you were factually in compliance via new coverage? 

I  can recall being in HR and somebody wanted paper to cya.....but if you have supplied request and more I think employer has gone too far..it's not up to them to require order..unless they can show me....at some point to push wrong buttons can get you fired.

personally I'd be researching if.how to get all my money back as well!

I'd at least run it by an attorney. Even with a court order, since you have proof of other coverage I think your employer is overstepping to a great degree.

BTW, when is your Open Enrollment period?