Cafeteria Plans: Changing Elections Mid-Year

 February 20 2018     Diane Cross

Can I change my benefit elections? This question, or some similar variation, is all too common for employers to hear after the open enrollment period has ended. A response is not always a quick yes or no – per Section 125, which provides the rules for administrating a Section 125 plan (commonly referred to as a “cafeteria plan”), participant elections are generally irrevocable for the plan year.  In other words, participants ordinarily may not change an election mid-year.  As with many rules, there are applicable exceptions, discussed below. 

If certain conditions are met, a plan may allow for a mid-year election change – that is, a change requested outside of open enrollment.  In order for a participant to change an election mid-year, the change must be (1) allowed by the plan and (2) triggered by one of the IRS recognizes permitted election change events.  While plans do not have to allow for employees to change their elections, most do.  

For a mid-year election change to be allowed, the cafeteria plan must permit it in the written Section 125 plan document.  While allowing a mid-year election change is a matter of plan design, the plan can only do so as permitted by the IRS.  Those permitted election change events include: 

  • Change in marital status
  • Change in the number of dependents
  • Change in employment status
  • A dependent satisfying or ceasing to satisfy dependent eligibility requirements
  • Change in residence
  • Commencement or termination of adoption proceedings
  • Significant cost changes
  • Significant curtailment (or reduction) of coverage
  • Addition or improvement of benefit package option
  • Change in coverage of spouse or dependent under another employer plan
  • Loss of certain other health coverage (such as government provided coverage, e.g. Medicaid)
  • HIPAA special enrollment rights (contains requirements for HIPAA subject plans)
  • COBRA qualifying event
  • Judgment, decrees, or orders
  • Entitlement to Medicare or Medicaid
  • Family Medical Leave Act (FMLA) leave
  • Pre-tax health savings account (HSA) contributions (employees are free to change their HSA contributions whenever they wish, in accordance with the their payroll/accounting department process)
  • Reduction of hours
  • Exchange/Marketplace enrollment 

While a cafeteria plan does not have to allow for all of the permitted election change events as listed above, it cannot more generous than the IRS permits.  When an employee experiences a mid-year election change event as recognized by the IRS and allowed by the plan, the change must be effective prospectively (with the exception for retroactive changes permissible under HIPAA special enrollment events such as birth or adoption).  In addition, the requested change must be consistent with the event – an election change must correspond with requested change in status.  For example, if an employee requests to change elections due to a divorce, the employee may drop coverage for the former spouse.  

Employers should reference their Section 125 plan document to not only determine what is permitted when an employee asks about a mid-year change, but confirm that the plan allows for mid-year changes as intended.  Please contact your HORAN representative with any questions.