Why must I provide a reason for declining coverage?

Employees who choose to decline one or more lines of coverage offered by a company for themselves or their dependents must sign a waiver and provide a reason for declining.

The waiver that the employee will be required to sign will overview what declining coverage means for themselves and their dependents, including:

  • Confirming that the only way to enroll themselves or a dependent prior to the company's next Open Enrollment period (up to 12 months) is through a qualifying life event.
  • References to pre-existing conditions in the waiver do not apply to anyone under 19 who is enrolled in an Affordable Care Act-compliant health plan.

These reasons directly affect the company's ability to qualify for insurance coverage (see Participation Rules for Carriers for more information), and should be accurately reported.

For each line of coverage declined (medical, dental, or vision), select a reason from the list of categories for existing coverage:

  • Covered by parent's plan
  • Covered by spouse's plan
  • ChampVA
  • CHIP
  • Indian Health
  • Medicaid
  • Medicare
  • Tricare/ Champus
  • Individual Off-Exchange
  • Individual On-Exchange
  • Other Insurance Coverage
  • Retirement Plan
  • Student
  • Association coverage
  • Canadian Provincial Health Care
  • Coverage through another employer
  • Religious 
  • My reason is not listed
  • Other Coverage, same employer

Not all employee-supplied reasons may be valid. To ensure that the reason for declining coverage is valid, select the "My reason is not listed" option only if no other provided reason is applicable. This will generate a text box for you to enter why you're declining coverage.

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