Health insurance - qual event?

S

StarSon2028

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Feb 22, 2023
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Greetings, SA parents!

Just trying to wrap my mind around what “evidence of qualifying event” we will provide to our health insurance company when DS is covered by tricare.

My understanding is that we have 30 days from the date DS picks up Tricare to make this change to our policy. However, any documentation DS might provide us to this effect will be after CBT.

I searched the forum but nothing on qual events that I see. Thanks for your help!
 
You don't need a qualifying event to remove a person from your healthcare plan. You can remove yourself or spouse or dependents at any time. You only need a qualifying event when you need to join a plan outside of open enrollment.
 
StarSon2028 said:
Greetings, SA parents!

Just trying to wrap my mind around what “evidence of qualifying event” we will provide to our health insurance company when DS is covered by tricare.

My understanding is that we have 30 days from the date DS picks up Tricare to make this change to our policy. However, any documentation DS might provide us to this effect will be after CBT.

I searched the forum but nothing on qual events that I see. Thanks for your help!
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I know the USNA new plebe info recommends parents keeping their son or daughter on current family medical insurance, even though covered by TRICARE starting on Day 1, in case the midshipman voluntarily or involuntarily separates from USNA. It happens every year, the attrition, and keeping him on is likely easier than adding back. Once on active duty, while at home or traveling, TRICARE covers 100% of emergency and urgent care. All active duty people are instructed on how to use TRICARE with civilian providers if the need arises. He won’t need his family medical or dental, but it’s there as a safety net.

Your son receives something directing him to report on a certain day. Those serve as the orders to active duty in the military for the first time and document his transition to military active duty status. If you want to take him off the minute he crosses that line, I would call your insurance provider and see what they need to document a child going into military service. Though I have only ever heard of a “qualifying event” needed to add someone, not remove.

Is it USMA? Have you received direction from them to remove him from family policy once he reports in?

The link below is part of USNA midshipman Permit To Report, their official guidance for entering upon active duty.
 
A little more info - with DS off our plan we will change our plan level. This does require a qualifying event.
 
@Capt MJ Thank you!

DS and Dh and I have read all USMA documentation and it advises us to maintain dental coverage. That’s it.

The “reporting” document sounds like the answer here.
 
StarSon2028 said:
A little more info - with DS off our plan we will change our plan level. This does require a qualifying event.
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When you say change your plan level, do you mean go from family to employee and spouse? Or, change the specific benefit plan that you are on now that junior is no longer on the plan?
 
justme said:
Obviously ask your plan administrator, but I would think it would be. Its a new job.
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Yeah, it's definitely a qualifying event - I'm wondering what documentation we would use to verify this to our health insurance admin. As Capt MJ pointed out, USMA's "report to" documentation may satisfy this.
 
StarSon2028 said:
@jebdad We would be moving from a family plan to an employee/spouse plan.
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Again, check with your administrator, but you don't need a qualifying event to change from family to employee and spouse. In this particular case you are just removing a dependent. Now, if you are asking if you can use the situation of removing your child to change your benefit plan to a different benefit package, my experience would be that what your are experiencing is not a qualifying event or trigger. In the benefits world, a qualifying event, in the simplest of terms under the ACA, is an "involuntary loss of coverage." Your son is gaining coverage under tricare and you and your spouse have not involuntarily lost your coverage.

Maybe you are on a state plan or self insured plan with a different set of rules, but that is how it works on plans subject to ACA. In my profession, the activity of changing a person from family to employee and spouse or from employee and spouse to employee would not require any type of documentation other than the request of the subscriber to do so.
 
That's really helpful, @jebdad

I assumed with DS coming off our plan, we had a qualifying event. But, your explanation makes a lot of sense and I will follow up with our plan admin. Thanks so much for taking the time to explain it!
 
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