Is a Spouse Losing Insurance a Qualifying Life Event? – Zupnick Associates

This year’s Open Enrollment period gives us until January 2022. Don’t be caught off guard by pushing it off!
Download yourCreditable and or Non-Creditable Sample Medicare Part D Notices here.
You can find more helpful Open Enrollment Resources and Guides by visiting SHRM, here.

(by Andres Rojas)

Health insurance is a priceless commodity that not enough Americans have. Unfortunately, the pandemic has stretched out our country’s economy and health care system to the limit. Millions of workers and families have either lost income or their employer insurance amidst the worst crisis we have faced in recent memory. 

But not everything is lost, though, because there are still ways you can start 2021 with full coverage. If a spouse lost his or her spousal insurance coverage due to a qualifying event, he or she might still qualify for a special enrollment period in 2021.

What Is a Qualifying Life Event?

The open enrollment period is the only time of the year when employees can sign themselves and their families for employer insurance.

Normally, a worker who didn’t sign up during open enrollment would’ve to wait until the next year to do so. However, if that worker didn’t sign up due to experiencing a qualifying life event that disrupted his plans, he can still sign up during a special enrollment period.

The most common qualifying life events are:

  • Loss of health coverage.

  • Change of residence.

  • Changes to the insured person’s civil status or household.

Since spouses are often grouped in with workers’ health insurance policies, they can also qualify for a special enrollment period if they lost their spousal insurance. This way, the spouse can sign up for a marketplace, individual, or workplace insurance plan (if he or she found a job) outside of the open enrollment season.

Who Qualifies for a Special Enrollment Period?

There are three main situations where a spouse losing insurance is considered a qualifying life event: after a divorce or legal separation, after the insured spouse’s death, or if the insured spouse becomes unemployed.

Loss of Coverage Due to Divorce or Legal Separation

Compared to individual policies, spousal insurance is an inexpensive way to insure a worker’s family.

Many employers offer group policies that can cover an entire worker’s family. Likewise, spouses can also get coverage through an individual health insurance policy. 

In case of divorce, though, the company or the insured worker may remove his/her former spouse from the plan. And while the children can still receive coverage, the former spouse will no longer be considered an eligible dependent – with a few noted exceptions:

  • Depending on the settlement, the former spouse might still receive coverage from the ex’s health plan.

  • Alternatively, the former spouse could also apply for COBRA benefits and stay in his/her ex’s plan for up to 36 more months.

Whatever the case is, losing coverage due to divorce or legal separation is a qualifying life event that makes a former spouse eligible for an open enrollment period.

Loss of Coverage Due to the Death of the Covered Spouse

2020 was the deadliest year in our history. Last year, more than 300,000 Americans died of COVID-19 – by comparison, 407,300 US soldiers during WWII.

For those who lost a spouse in 2020, living without their loved ones is already hard enough. However, the virus’s persistent threat means widows also have to worry about their livelihood while continuing to mourn.

Loss of spousal insurance due to the death of the insured partner is a qualifying life event that makes the grieving spouse eligible for a special enrollment period.

In some instances, spouses who have lost their loved ones to COVID are eligible for workers’ death benefit compensation.

However, in other cases, employers have left workers’ COVID-related deaths unreported, leaving thousands of families to deal with the lost income, medical bills, and funerary expenses on their own.

Loss of Coverage Due to Unemployment

The pandemic also ramped up unemployment numbers – especially among the Latino and African-American communities. 

According to the Bureau of Labor Statistics, there were 9.8 million people unemployed in November last year. To make matters worse, stimulus checks and unemployment benefits are hard to get.

COBRA allows formerly covered spouses to extend their employee coverage for another 18 months. However, COBRA premiums are expensive and come out entirely of the former employee’s pockets.

The best option for the unemployed worker and his spouse is to sign up for a special open enrollment period within 30 days of having lost his or her job-based health coverage.

Don’t Leave Your Employees Hanging in 2021

So far we’ve talked a lot about the challenges that employees are facing. But who are we kidding? The pandemic hasn’t been exactly kind to employers either.

The loss of business opportunities, the travel restrictions, and the disruptions to their supply chains mean many companies today are looking to cut costs wherever they can. However, cheating valuable employees out of their much-needed health benefits should never be the answer.

Companies that have cut their employees loose have faced public backlash and could end up paying more in terms of legal fees in the future. So instead of cutting corners, why not help your former employees get through the crisis?

Whether it’s reporting COVID-related deaths to OSHA or helping ex-employees and their spouses to apply for COBRA benefits, standing by your staff will only benefit your company in the long run.

Leave a Reply