Client's HR states he cannot disenroll from group health plan when starting Medicare

[LeeV]

As the title states my client's HR department states he cannot disenroll mid-year from his group health plan. This is complete BS. Every single one of my clients who continued to work after 65 were able to drop their group health plan mid-year.

Can someone please advise how to educate the HR department on this? The client started Medicare on 6/1 and is still being charged for his group plan on his paycheck. Client its T65 this June.

Thank you.

I am a group guy, not Medicare, so bear with me. Newbie2001, you may want to cool down a bit and get some additional information from the group. From the perspective of the group world, it is possible for the employer to deny the request to drop the employer sponsored plan. It is rare that this occurs, but it can be done, and I have seen a few over the years. The key here is the Section 125 plan and what is written into the SPD regarding this issue. While the IRS allows employers with Section 125 Plans to disenroll employees mid-year, the employer is not required to do so.

 

[somarco]

@newbie2001 Do you really believe HR will bow to your will?

 

[LostDollar]

I am a group guy, not Medicare, so bear with me. Newbie2001, you may want to cool down a bit and get some additional information from the group. From the perspective of the group world, it is possible for the employer to deny the request to drop the employer sponsored plan. It is rare that this occurs, but it can be done, and I have seen a few over the years. The key here is the Section 125 plan and what is written into the SPD regarding this issue. While the IRS allows employers with Section 125 Plans to disenroll employees mid-year, the employer is not required to do so.

Caveat, NOT an agent,

Re the suggestion I made earlier, Is the plan required to provide the employee a copy of the plan document on request like I suggested earlier?

If so, and relating to the email comment earlier, it seems like getting a copy of the plan document as an email attachment and finding and reviewing whatever the appropriate section is would be the way to verify employer HR statements.

I never did that, but it seems to me like when I was working I got an annual notification I could do so.

 

[LeeV]

Caveat, NOT an agent,

Re the suggestion I made earlier, Is the plan required to provide the employee a copy of the plan document on request like I suggested earlier?

If so, and relating to the email comment earlier, it seems like getting a copy of the plan document as an email attachment and finding and reviewing whatever the appropriate section is would be the way to verify employer HR statements.

I never did that, but it seems to me like when I was working I got an annual notification I could do so.

Yes, a copy of the SPD document must be provided to the insured. The insured should have received one when first enrolled. Thereafter these are either emailed once per year or a notice will go out once a year with a link or instructions on how to get a copy. If the insured states that they have never received one, I would be suspicious of that statement.

Also, it is important to ask for the SPD, not a plan document. SPD is the ruling document; all others are subordinate.

 

[LostDollar]

Yes, a copy of the SPD document must be provided to the insured. The insured should have received one when first enrolled. Thereafter these are either emailed once per year or a notice will go out once a year with a link or instructions on how to get a copy. If the insured states that they have never received one, I would be suspicious of that statement.

Also, it is important to ask for the SPD, not a plan document. SPD is the ruling document; all others are subordinate.

Thanks for taking the time for an answer.

That matches up with the very vague memories of what happened with my plan at my last employer before retirement.

I hope OP takes notice of what you have said.

 

[LeeV]

Thanks for taking the time for an answer.

That matches up with the very vague memories of what happened with my plan at my last employer before retirement.

I hope OP takes notice of what you have said.

I am willing to bet a large pepperoni pizza that HR is correct on this one.

 

[somarco]

"Large" is subjective . . . can you be more specific?

 

[somarco]

Right now the situation is trying to get a 3-way call with his HR as soon as possible. They refuse to communicate over phone and only want to talk over email. Classic.

You are nothing to them. There is no reason they should agree to a 3-way.

You hubris will not accomplish what you think it will.

In my younger days I tilted at a lot of windmills and most of the time it was a wasted effort.

 

[newbie2001]

@newbie2001 Do you really believe HR will bow to your will?

So I might have overreacted a little bit, have been working with this specific client since April and its been a headache every time they call me. Kids get involved, feeding them wrong info. All kinds of fun stuff.

I called HR and they were actually extremely helpful and we had it resolved in less than 10 minutes.

But from some of the other posters, I will keep in mind having the beneficiary check with their HR departments BEFORE recommending applying to Part B moving forward. I see online where some HR departments will straight up deny disenrollment until the companies open enrollment period.

Thanks for the help everyone.

 

[somarco]

having the beneficiary check with their HR departments BEFORE recommending applying to Part B moving forward

Don't assume HR always knows how Medicare works . . .