Employee has private insurance but the cost has risen so high she cannot afford it. She wants to be put on company group. Open enrollment was in March. She could not go on our insurance until June. Would the rise in her premium be considered a qualifying event in order to put her on in June since she has missed the open enrollment?

  1. 1305 POINTS
    Neil Steinman
    Owner, Orange County Health & Life Insurance,
    I assume you're referring to a rise in cost of your current health insurance premium. If the employee's share of the annual premium is greater than 9.5% of their annual household income, that would created a qualifying event.  For an individual, and income change would be considered a qualifying event if your new income causes you to become eligible (or ineligible) for a subsidy (Advanced Premium Tax Credit) or if it causes you to have a change in your Cost Sharing Reduction (in other words, if you become eligible for a Silver 73 when you previously had a Silver 70, for example).
    Answered on May 24, 2014
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