Status changes and effective dates

jarmstrong

This may seem like a dumb question but I have two answers and want to know which answer is correct. I have administered all status changes, except birth, with the change beginning the first of the next month, meaning prospective rather than retroactive to the date the event occured. So, if the employee marries May 15 and adds his wife, we would make the change June 1, not back to May 15. I'm now at a company that makes all changes retroactive and again, I've never been taught that way. Can anyone point me to the regs that states anything about when changes should occur?

mushroomHR

Our effective dates are always the date of the event. You may want to check with your carrier or your SPD for the information. I don't know if there are any regs to answer your question; I would think it would be the way your policy is written and administered.

marc

We try to make the effective dates as close as possible to the actual dates. Our insurance carriers however, have these contingencies written into the plans and tell us when the effective dates are. And each carrier is a little bit different. On top of that, some of them give you free coverage for portions of the month. For example, our health insurance changes are effective immediately, but they do not bill for the coverage if it happens after the 15th day of the month, however if the change happens on the 10th of the month, they bill for the whole month.

Carey

Isn't one of the first things HIPAA did was mandate continuous coverage? If I lose my job on 5/15 and need to enroll in my husband's company's group insurance, the status change is 5/15 and my coverage has to be effective 5/15 doesn't it?

irenesmsaclaims

To the last post, continous is best, but not mandated by HIPAA. It can be when enrollment form is received, first of month, date of event, etc. It does vary. The request must be made within the 30 days of the event. (Check plan document or policy for special enrollment effective dates). You may be thinking of COBRA, where coverage is continuous unless waive and then revoke the waiver within the election period.