If you have an employee wishing to make a health coverage election change for their domestic partner, is it the same as one for a spouse?  Check out the answer below.

Question

Can employees make mid-year enrollment changes to add or drop their domestic partner?

Answer

Special enrollment rules under the Health Insurance Portability and Accountability Act (HIPAA) allow employees to add coverage mid-year for a new spouse, but not for a domestic partner (since no marriage has occurred). On the other hand, the HIPAA rule for a mid-year enrollment in the event a dependent losing his or her coverage under another plan does apply to domestic partners (if eligible for the employer's plan).

Cafeteria plans may allow mid-year changes in accordance with IRS regulations for permitted election changes. Although not required, employers that extend health plan eligibility to domestic partners also often provide for midyear enrollment changes under their cafeteria plans.

Beware of discrepancies between the group health insurance policy and the cafeteria plan document. Carriers are required to include the mandatory HIPAA special enrollment rules in group policies, but they often omit the optional cafeteria plan provisions. Always check all documents and policies before allowing an employee to make a midyear change. Self-funded employers should ensure that any stop-loss insurance protection applies with respect to all persons who are eligible under the group plan.