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A.J.
A.J., Employment Lawyer
Category: Employment Law
Satisfied Customers: 4275
Experience:  Licensed to practice law, I have experience in Employment, Appeals, and Landlord/Tenant Law
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My employer has an "open enrollment" period May-April and my

Resolved Question:

My employer has an "open enrollment" period May-April and my wife's has one that is Jan-Dec. My company has said that my wife (and our 3 children) may move to my plans which is better and nominally free during her open enrollment.

A concern is that my company is smaller and seems to change benefits frequently. Can they change my benefits mid-year without notice with worse terms? If so does this constitute an "event" that my wife's employer would be obligated to re-implement her insurance? If at my open enrollment the same happens does my wife's employer have to reciprocate and allow all of us to move back even though it is their mid-year?
Submitted: 1 year ago.
Category: Employment Law
Expert:  A.J. replied 1 year ago.

SavyLawyer :

Hello, and thank you for contacting Just Answer. My name isXXXXX am an employment law professional, and I look forward to answering your question this afternoon.

SavyLawyer :

A company can change benefits without cause or notice, but generally cannot change benefits in the middle of a benefits term. Generally, a benefits terms is one year, although it would be worth checking with your company directly to see what their benefits term is (one month, 6 months, 1 year, etc). So, in answer to your first question, a company can change the benefits it offers to an employee and the employee's family, but generally only once the benefits signed up for have expired.

SavyLawyer :

As for what a "qualifying event" is, this is ultimately determined by the plan itself, but generally refers to a major life status change. A change in benefits is arguably not enough, so long as benefits remain available. Generally a qualifying event means losing a job and not having access to benefits, or something of that nature. Just a change in benefits structure is probably not enough, although it would be worth checking the language of the benefits package itself. There should be language explaining what a qualifying event is.

SavyLawyer :

So, in short, an employer can change benefits structures (or even stop paying for benefits altogether if they have less than 50 employees), but could not do so until the benefits term has ended. This is generally on an annual basis. As for what qualifies as a "qualifying event", generally you are talking about big changes, such as loss of coverage because of a change in employment status. However, a change in benefits may be a qualifying event under your insurance plan, you would ultimately have to check the terms of the plan itself (if your company has an HR department, they may be able to help you with this).

SavyLawyer :

Does that make sense? I hope this helps, and let me know if you require any additional information or clarification of anything that I have said (never be afraid to ask for clarification!). Otherwise, please remember to RATE my answer so that I can receive credit for my work.

JACUSTOMER-skclr0ph- :

Yes this makes sense. The one part I did not see is the open-enrollment to open-enrollment reciprocity. My wife's and my employers benefit year are 6-months apart as in her year is Jan to Dec and mine is May to April. My employee has "OK'd" her and my children to come to my benefit plan during HER open enrollment period would her employer reciprocate? If not is this a one way deal and the only "out" would be 6 months without benefits?

SavyLawyer :

There is no guarantee that her employer would reciprocate, that would ultimately be a question for her employer. Now there should never be a period where anyone is not insured at all, because loss of insurance entirely is likely a qualifying event that would allow someone to enroll even where it is not during the open enrollment period.

SavyLawyer :

Just because one employer has agreed to extend the enrollment period does not mean that another one will. Again, if insurance were to be lost altogether, that is a different issue, because that is generally a qualifying event that allows enrollment.

JACUSTOMER-skclr0ph- :

I see so we would have to put up with the "worse-deal" for 6 months until her open enrollment.

SavyLawyer :

Based on the information provided, yes, unless her employer's plan includes as a qualifying event a reduction of benefits provided by a spouse's employment, as opposed to just losing them altogether.

JACUSTOMER-skclr0ph- :

Thank you excellent answer you will be rated accordingly!

SavyLawyer :

This is why it will be important to get clarification from the other employer, to determine what a "qualifying event" is for them. Also, it never hurts to have an attorney review the terms of the plans in person and in confidence, where possible.

JACUSTOMER-skclr0ph- :

Are you offering said assistance?

JACUSTOMER-skclr0ph- :

For a fee of course and at what schedule?

SavyLawyer :

Unfortunately no, this is an informational site only, I am not even allowed to provide a direct referral to an attorney. I am simply encouraging what I believe to be a prudent course of action. A good place to start looking for an attorney should you choose to use one is your state's bar association, which is an association of attorneys (sometimes voluntary, sometimes not, depending on the state).

JACUSTOMER-skclr0ph- :

OK again thank you

SavyLawyer :

You are most welcome. I wish you and your family the best of luck going forward, and let me know if you need any additional related information. Otherwise, please remember to RATE my answer so that I can receive credit for my work.

A.J., Employment Lawyer
Category: Employment Law
Satisfied Customers: 4275
Experience: Licensed to practice law, I have experience in Employment, Appeals, and Landlord/Tenant Law
A.J. and 8 other Employment Law Specialists are ready to help you

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