Plan change during qualifying event – Cigna – In Arizona

Hi All,

I have an employer health plan that is absolutely astronomical in price. They offer 3 plan options through Cigna that I outlined below. Here is the situation.

My employer didn’t do open enrollment until December 21st 2023 where they announced they were switching us from UHC to Cigna. All premiums increased by nearly 30%. My wife and I had just found out she was pregnant and I knew we would have more doc visits in 2024 so opted to go on the PPO to for the $40 copays. (HSA doesn’t have copays just 20% after deductible is met). I had asked our broker at the time if I would be able to change plans after the birth of our child to the lower cost option and she said yes, because its a qualifying event. I asked if the PPO would cover all of the claims associated with the birth and she said yes, you are covered by the plan in place during the time of service.

Fast forward to today, she is no longer with her company and the new guy is telling me that their Cigna contact is telling him that if i change plans it would be back dated to the date of my qualifying event, in this case, the day my child was born. If that happens, my financial responsibility significantly increases due to the higher deductible and OOPM. If i stay on the PPO, it is an insane amount of money to pay monthly. My questions are around if anyone here has done what I am considering and weather or not I should accept that a plan change must be backdated. There have been two pay periods since my childs birth and i have been charged for the new ppo family premium on both. I asked if that would be refunded and he doesn’t know. I asked why the effective date of the plan change wouldn’t be the date i changed the plan or the date of my first premium payment because if it must be backdated why wouldn’t people just stay on a super cheap plan and then change to a lower deductible plan during a qualifying event to have coverage backdated? This doesn’t make sense to me so I am looking for other thoughts and opinions on this.

PPO 1000 Plan: – Monthly Premium (Employee + Family): $1,884.26 – Deductible: $1,000 (Individual), $2,000 (Family) – Out-of-Pocket Maximum: $4,000 (Individual), $8,000 (Family)

HSA 6500 Plan (Local Plus Network): – Monthly Premium (Employee + Family): $1,101.06 – Deductible: $6,500 (Individual), $13,000 (Family) – Out-of-Pocket Maximum: $6,500 (Individual), $13,000 (Family)

HSA 6500 Plan (Open Access Plus Network): – Monthly Premium (Employee + Family): $1,236.28 – Deductible: $6,500 (Individual), $13,000 (Family) – Out-of-Pocket Maximum: $6,500 (Individual), $13,000 (Family)

Let me know if additional details are needed.

submitted by /u/not-explaining-shit
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