More updates on Special Election Periods

New York State of Health was able to continue its technology-plagued webconference today, and it was quite informative.  A couple of interesting items of note, in addition to my last post:

An employee that is newly eligible for COBRA is also eligible for a Special Enrollment Period (SEP) under the rules.

However, an employee who drops their COBRA coverage, or gets cancelled for non-payment, is not eligible for an SEP, and therefore has to wait to get insurance until the next Open Enrollment period (January 1).

An employee who loses coverage at the end of their coverage period (ie., 18 months) gets a SEP.

If a company changes their contributions to the health insurance, raising it above the 9.5% threshold, the employee get a SEP as well.

9.5% threshold – If the cost of single coverage is more than 9.5% of the household Modified Adjusted Gross Income, they meet this test.

* * * * *

When an individual changes plans under a Special Election Period, they start over on the deductible and out of pocket maximums! There is no “carryover” or “credit” from the prior plan.   This was a surprise to most everyone.  This has the effect of really limiting changes mid-year even under an SEP.