Q. I am hearing that the actively at work clause is not enforceable for health insurance. Will you please provide your input and any documentation I can share with our office?
A. HIPAA has a prohibition on “actively at work” provisions if the rule would prohibit an individual who is not actively at work on the day the individual would become eligible for benefits. However, this rule only applies if the absence is due to a health factor. So, if an employee is on vacation and not “actively at work” when they become otherwise eligible, the plan can exclude them until they return to work. The key is to not have the absence from work be based on a health factor.
These rules are different than requiring someone be actively at work to maintain coverage. If someone is on a leave of absence, a plan can drop them from coverage for not working the required number of hours to maintain eligibility. Obviously, the language of the plan or policy is determinative.