Ezel / IRS Rulings / 201212011

CCA 201212011: IRS distinguishes continuation coverage from special enrollment rights

Number
201212011
Outcome
Advice
Document type
Chief Counsel Advice
IRS subject
Failure to Satisfy Continuation Coverage Requirements of Group Health Plans (See Also 162.33-00|et. seq.)
Topics
Excise taxes
Code sections
§ 4980B, § 9801, § 125, § 6110
Ruling dated
December 14, 2011
Publicly released
March 23, 2012
Source
View Official PDF

Apply this to your situation

This page covers legal advice the IRS Office of Chief Counsel wrote for IRS staff, issued in 2012, which can't be cited as precedent. Ask about your situation and see what the current Code and IRS guidance say, with citations.

Currency note: this determination was released in 2012
Statutory amendments, regulation changes, court decisions, or later IRS guidance may have changed the analysis since then. Treat this page as historical context, not current tax advice. Verify current law before relying on any specific rule, threshold, or position mentioned here.
Not precedent. Under 26 U.S.C. § 6110(k)(3), this written determination may not be used or cited as precedent. It is advice from the IRS Office of Chief Counsel to IRS personnel on the facts they presented, and identifying details were redacted by the IRS before release. The official IRS release (linked on this page as a PDF) is the authoritative source.
About this page: The plain-English summary and ruling snapshot below were written by Ezel based on the official IRS release. The full text is the IRS's own document.
View official IRS release (PDF)

Plain-English summary

The Office of Chief Counsel explained the difference between continuation coverage and other health plan enrollment rules. It stated that section 4980B concerns an individual's ability to continue group health coverage at the individual's own expense after losing eligibility because of a listed event. It distinguished special enrollment rights under section 9801(f), which can apply after loss of other coverage, marriage, birth, adoption, or placement for adoption. It also noted that cafeteria plan rules under section 125 and Treasury Regulation § 1.125-4 may allow election changes after certain changes in family status or coverage cost.

Ruling snapshot

  • Question: Which health coverage rules apply after an individual loses eligibility for group coverage or experiences a change in family status?
  • Outcome: Advice given.
  • Key authorities: IRC §§ 4980B, 9801(f), and 125; Treas. Reg. § 1.125-4; 26 U.S.C. § 6110(k)(3)

Full text (IRS public release)

ID: CCA-114518-11 Number: 201212011
Release Date: 3/23/2012
Office: ------------------------
UILC: 4980B.00-00

From: ---------------------------
Sent: Wednesday December 14, 2011 5:18 PM
To: -------------------------
Cc:
Subject: RE: Constituent Question

Section 4980B concerns an individual's ability to continue coverage at their own expense after they have lost eligibility for group coverage due to one of the listed events. The concept you are probably thinking of is special enrollment rights under section 9801(f), which allow an employee to enroll themself and family members upon loss of other coverage or marriage, birth, adoption, or placement for adoption. You may also be thinking of cafeteria plan rules under §1.125-4 (which i am less familiar with), which allow changes in election under a section 125 cafeteria plan with certain changes in family status or in the cost of coverage.

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