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Brown & Brown — Conference Presentation (May 2025)
38 slides from Brown & Brown's conference presentation, May 15, 2025
Slide 1: This Webinar Will Start Momentarily
This Webinar Will Start Momentarily. Thank you for joining us.
Slide 2: Status Changes and HIPAA Special Enrollments
Status Changes and HIPAA Special Enrollments M AY 1 5 , 2 0 2 5 Presented By: Presented by the Regulatory and Cindy Niesen Legislative Strategy Group
Slide 3: Disclaimer
DISCLAIMER Brown & Brown, Inc. and all its affiliates, do not provide legal, regulatory or tax guidance, or advice. If legal advice, counsel or representation is needed, the services of a legal professional should be sought. The information in this document is intended to provide a general overview
Slide 4: HIPAA Special Enrollments
HIPAA Special Enrollments A Coverage Issue
Slide 5: HIPAA Special Enrollment
HIPAA Special Enrollment GENERAL RULE HIPAA requires group health plans to provide special Special Enrollment does not apply to: enrollment opportunities to • Stand-alone dental and vision plans employees and their dependents into the • Retiree-only plans “Excepted employer-sponsored group • Insured
Slide 6: HIPAA Special Enrollment: Who is Eligible to Enroll?
HIPAA Special Enrollment Who is Eligible to Enroll? • Employees may elect coverage for themselves, their spouses and their children (even if they were not previously enrolled in coverage) » Employee may elect coverage just for the employee only and not cover any dependents » Employee who covered the
Slide 7: Special Enrollment Events
Special Enrollment Events Loss of Coverage Under Another Group Health Plan • The individual is currently eligible for coverage • Other coverage must have been terminated under the employer’s group health plan, and because: » Waived coverage when it was offered, » COBRA has been exhausted, or reflect
Slide 8: Special Enrollment Events
Special Enrollment Events Other Loss of Coverage Gaining New Spouse or Dependents • Loss of coverage in the individual market • Marriage » Plan must allow at least 30 days from • Birth, adoption, placement for adoption or the date coverage ends for individual to foster care request enrollment » Must
Slide 9: Other Special Enrollment Events
Other Special Enrollment Events Gaining Eligibility for Medicaid/CHIP • Gaining eligibility for premium assistance under Medicaid or CHIP coverage or » Plan must allow individual to request enrollment within 60 days after becoming eligible for Medicaid/CHIP premium assistance BROW N & BROW N | 9
Slide 10: When Must Coverage Begin?
When Must Coverage Begin? Birth, adoption, placement for Marriage, loss of other coverage and adoption or foster care gaining new Medicaid/CHIP Subsidy Coverage is retroactive to the date of No later than the first of the month the event following later of the date of the event or the date of the re
Slide 11: What Coverage Can be Elected?
What Coverage Can be Elected? • For HIPAA Special Enrollments, the HIPAA Special Enrollments do not participant may elect any available benefit allow employees to drop coverage package option offered to similarly situated (unless there is an intervening status eligible participants at open enrollmen
Slide 12: Section 125 Cafeteria Plan Status Changes
Section 125 Cafeteria Plan Status Changes
Slide 13: Cafeteria Plans – Code § 125
Cafeteria Plans – Code § 125 • Must be in writing (i.e., must have a Section 125 Cafeteria Plan document) • Must offer a choice between a qualified benefit or taxable cash » Qualified benefit = health plan, dependent care FSA, health FSA, etc. » Taxable cash = the employee's regular, non-reduced tax
Slide 14: Election Rules
Election Rules • Benefit elections are irrevocable except for a qualifying status change • Only the employee is allowed to make, revoke or change elections • Elections are not required to be on paper documents - electronic media may be used • Employers can rely on employee’s attestation of status ch
Slide 15: Status Changes: The General Rules
Status Changes: The General Rules • A Section 125 plan is not required to allow any pre-tax » Exceptions: election change, or a Section 125 plan may be selective in o Plans should allow new pre-tax elections for which changes are allowed (compared to required HIPAA HIPAA Special Enrollments (30 days
Slide 16: Status Changes: The General Rules – Tag-Along Rule
Status Changes: The General Rules Tag-Along Rule • The preamble to the final regulations indicates that dependents directly affected by the status change event plus other dependents may be added on a pre-tax basis, if allowed under the terms of the applicable benefit plan • Remember HIPAA Special En
Slide 17: Status Changes: The General Rules
Status Changes: The General Rules • The status changes affecting group health plans generally apply to the medical, dental and vision plan » These all provide coverage for medical issues per IRC 213(d) Remember: Section 125 • HIPAA Special Enrollments generally apply status changes are all about onl
Slide 18: Special Election Rule for New Employees
Status Changes: The General Rules Special Election Rule for New Employees • A cafeteria plan may provide new employees 30 days after their hire date to make an election with retroactive coverage (back to the date of hire) if there is no waiting period for eligibility » The election is effective as o
Slide 19: Status Changes: HIPAA Special Enrollments
Status Changes: The General Rules HIPAA Special Enrollments • Loss of other coverage » Loss of eligibility; exhaustion of COBRA; Special Enrollments employer ceases contributions; loss of provide the right to Medicaid/CHIP coverage mid-year coverage • Gaining eligibility for premium assistance under
Slide 20: Status Change Event: Change in Employment Status
Status Change Event Change in Employment Status that Affects Eligibility for the Plan or Benefit • Change in employment status of the employee, or a spouse or dependent of the employee, that affects the individual’s eligibility under a cafeteria plan including: » Commencement or loss of employment »
Slide 21: Termination and Resumption of Employment (30-Day Safe Harbor)
Status Change Event Termination and Resumption of Employment (30-Day Safe Harbor) < > • Employee is rehired less than 30 days after • Employee is rehired more than 30 days after termination of employment, then: termination of employment, the plan may (as » Employer must reinstate prior election defi
Slide 22: Gain or Loss of Dependent Status
Status Change Event Gain or Loss of Dependent Status • Event causing an employee’s dependent to satisfy or cease to satisfy the eligibility requirements for coverage • An increase or decrease in the number of family members or dependents who may benefit from coverage under the plan BROW N & BROW N |
Slide 23: Status Change Events: Residence, Adoption, Court Orders
Status Change Events A change in the place of residence of the employee, spouse or dependent that affects eligibility EXAMPLE: Moving into or out of an HMO service area, affecting eligibility Adoption • Commencement or termination of an adoption proceeding may be recognized as a status change Judgme
Slide 24: COBRA Qualifying Events
Status Change Event COBRA qualifying events • If an employee, spouse or dependent becomes eligible for COBRA continuation coverage (or any similar state law) under the group health plan of the employee’s employer » Cafeteria plan may permit the employee to elect to increase payments in order to pay
Slide 25: FMLA and Unprotected Leaves of Absence
Status Change Event F M L A A N D U N P R O T E C T E D L E AV E S O F A B S E N C E Commencement of FMLA leave • Make same election changes as permitted for employees on non-FMLA leave • If employee is on unpaid FMLA leave, the employer must allow employee to revoke coverage or continue coverage bu
Slide 26: Return from Leave
Status Change Event F M L A A N D U N P R O T E C T E D L E AV E S O F A B S E N C E Return from leave • If the election is revoked during the leave, and the start and end of the leave are in the same plan year: » If leave is 30 days or less, initial annual election is reinstated on return to acti
Slide 27: Gaining or Losing Medicare or Medicaid Entitlement
Status Change Event Gaining or Losing Medicare or Medicaid Entitlement • A change in entitlement of employee, employee’s spouse or employee’s dependent for Medicare/Medicaid will allow the employee to change health coverage » Loss of entitlement allows employee to add coverage » New entitlement allo
Slide 28: Significant Cost and Coverage Changes
Status Change Event Significant Cost and Coverage Changes • This status change event does not apply to health FSAs • Automatic cost increases or decreases may also allow employees to make a mid-year election change • What is “significant?” Significant Curtailment of Coverage Without loss of coverage
Slide 29: Addition or Improvement of a Health Plan Benefit Package Option
Status Change Event Addition or Improvement of a Health Plan Benefit Package Option • The plan may permit all eligible employees to elect coverage under the new or improved option » This includes eligible employees who had not previously made an election under the plan » Not applicable to health FSA
Slide 30: Change in Coverage Under Another Employer-Sponsored Health Plan
Status Change Event Change in Coverage Under Another Employer-Sponsored Health Plan • The plan may permit eligible employees to make an election change that is consistent with a change made under another employer plan (including a plan of the same employer or another employer) • The other plan must
Slide 31: Mismatching Plan Years of Other Employer Sponsored Plan
Status Change Event Mismatching Plan Years of Other Employer Sponsored Plan • An eligible employee can make a mid-year health plan election change corresponding with an open enrollment period change made by a spouse or dependent when the plan of that individual’s employer has a different period of c
Slide 32: Reduction in Hours that does not Lead to Loss of Coverage
Status Change Event Reduction in Hours that does not Lead to Loss of Coverage • Employees in a stability period may prospectively revoke their medical plan elections, if: » The employee is reasonably expected to average less than 130 hours of service per month because of a change in employment statu
Slide 33: Enrollment in Marketplace (Exchange) Coverage
Status Change Event Employee’s and/or Family Member’s Enrollment in Marketplace (Exchange) Coverage Employee may prospectively revoke election, if: • The employee and/or family member is eligible for special enrollment in a Marketplace plan OR the employee and/or family member wants to enroll in a M
Slide 34: Special Rule: Group-Term Life Insurance and Disability Coverage
Special Rule Group-Term Life Insurance and Disability Coverage • Participants may be allowed to increase or decrease group- term life insurance and disability coverage due to any status change » Election change must be on account of and correspond with a change in status that affects eligibility for
Slide 35: Special Rule: Health Savings Account (HSA)
Special Rule Health Savings Account (HSA) • If pre-tax contributions to an HSA are included under the cafeteria plan, participants must be permitted to prospectively change HSA contribution elections no less frequently than once per month » HSA election changes are not subject to Section 125 status
Slide 36: Special Rule: Dependent Care Assistance Plans (DCAPs)
Special Rule Dependent Care Assistance Plans (DCAPs) • Includes most of the life events listed earlier, plus: » Divorce or legal separation (e.g., custodial parent may make new election, non-custodial parent may drop existing election) » Employee gains qualified dependent (e.g.: adult child or paren
Slide 37: HRCI and SHRM Credits
HRCI and SHRM Credits This Program, ID No. 699461, has been approved for 1.00 HR (General) recertification credit hours toward aPHR , aPHRi , PHR®, PHRca®, SPHR®, GPHR®, PHRi and SPHRi recertification through HR Certification Institute® (HRCI®). Brown & Brown is recognized by SHRM to offer Professio
Slide 38: Find your solution at BBrown.com
Find your solution at BBrown.com DISCLAIMER: Brown & Brown, Inc. and all its affiliates, do not provide legal, regulatory or tax guidance, or advice. If legal advice counsel or representation is needed, the services of a legal professional should be sought. The information in this document is intend