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Treas. Reg. § 1.125-4(b) permits a cafeteria plan to allow an employee to revoke
an election under the group health plan during a period of coverage and to make a new
election that corresponds with the special enrollment rights under § 9801(f). Special
enrollment rights under § 9801(f) concern rights to enroll in a group health plan due to
loss of other coverage or certain family events, but do not include the ability to enroll in
a Qualified Health Plan through a Marketplace.
Interaction with § 4980H
Under § 4980H, an applicable large employer is subject to an assessable
payment if the applicable large employer does not offer minimum essential coverage to
its full time employees and one or more full time employees receive the premium tax
credit under § 36B. Under Treas. Reg. § 54.4980H-3(d), an applicable large employer
may use the look-back measurement method to determine the status of an employee as
full-time or not full-time. Under the look-back measurement method, for purposes of
§ 4980H, an employee determined to be full-time based on hours of service during a
measurement period must be treated as a full-time employee during a subsequent
stability period, regardless of the employee’s hours of service during the stability period.
Thus, under the look-back measurement method, an employee could have a change in
employment status (for example, a change from a full-time position to a part-time
position) resulting in a reduction in hours that does not change the employee’s status as
a full-time employee for purposes of § 4980H, at least for some period of time. Under
certain health plan designs intended to avoid any potential assessable payment under
§ 4980H by offering coverage to employees for all periods during which the employees
are classified as full-time employees for § 4980H purposes, the change in employment
status would not result in a change in an employee’s eligibility for the group health plan.
Because the change in employment status would not result in a change in the
employee’s eligibility for the group health plan, under Treas. Reg. § 1.125-4(c), the
cafeteria plan could not allow the employee to change the employee’s election under
the cafeteria plan during the period of coverage.
Interaction with Enrollment in a Qualified Health Plan Through a Marketplace
Under the current change in status rules under Treas. Reg. § 1.125-4, a cafeteria
plan may not allow an employee to revoke an election under the group health plan
during a period of coverage solely to enroll in a Qualified Health Plan through a
Marketplace. For an individual enrolled through a cafeteria plan in a group health plan
with a calendar plan year, the employee may continue his or her coverage under the
plan for the remainder of the plan year and then immediately begin coverage under a
Qualified Health Plan purchased through a Marketplace. However, an individual
enrolled through a cafeteria plan in a group health plan with a noncalendar plan year
might not be able to synchronize the change in coverage to avoid an overlapping period