Where the move affects eligibility, the employee can make an election change that is on account of and consistent with the event (the change in residence). This last option is addressed in #2 below.Ģ) Change in Residence Affecting EligibilityĪ change in residence of the employee, spouse, or dependent creates a permitted election change event for the employee where the move affects the employee’s, spouse’s, or dependent’s eligibility for coverage. If the parties have not legally separated, the employee needs to wait until the soonest of a) the final divorce, b) the next OE, or c) a different permitted election change event to drop the spouse.
If the parties have already legally separated, the spouse needs to be removed from the plan immediately (and provided COBRA rights), assuming the plan terminates eligibility upon legal separation. Most plans treat legal separation as a loss of eligibility event in the same manner as a final divorce. In many situations, the couple will obtain a legal separation order prior to the divorce finalizing. The first item to confirm is that the employee and spouse have not already legally separated. Can the employee drop the spouse from coverage when she moves? Prior to the divorce being finalized, the spouse is moving to New York, which outside the regional service area of the HMO that they’re both covered under.
Question: An employee and spouse are in the process of finalizing a divorce. A divorce in process and the spouse moving out of state prior to the divorce provide complications.
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