For businesses that provide health care insurance for staff, open enrollment is a hectic time of year. Collecting all the documents needed to assure employees are enrolled properly is a complex process that requires a lot of organizational ability. Whether you manage open enrollment on your own or use an outside consultant, numerous reminders are sent urging employees to review their options, ask any questions and get their paperwork in by the deadline so they don’t miss out.
Most companies keep a checklist of who has submitted their documents and whose are still outstanding: calling, texting and emailing to get the paperwork completed. Try as you may, some employees still miss the deadline for open enrollment. Generally, staff members who miss the deadline will have to wait until the next open enrollment (next year) for coverage.
Missing the deadline for open enrollment could result in no coverage or no change(s) in coverage. When a staff member fails to submit their enrollment documentation on time for new coverage, they will have to wait until next open enrollment to join your plan(s). If they fail to make any changes to their benefits elections during open enrollment, every previous election will remain in place, but they will have to wait until the next open enrollment period to make changes to their plan(s). The only exceptions are special enrollment periods that could allow an employee to join or change coverage, but special enrollment is only triggered by qualifying events.
A special enrollment can occur at any time of the plan year. Employees who have a “life-changing event” are allowed to opt in or out of coverage(s) during this time. The special enrollment period is limited: employees who have a qualifying event will have 30 days from the date of the event to make any additions, deletions or changes in their coverage. Miss the 30-day deadline and they will have to wait until the next open enrollment period to make any elections.
Life-changing events that qualify employees to make changes to their health coverage are specific situations that can trigger enrollment. They revolve around two main categories: basic life events or loss of other coverage.
Basic life events occur when someone becomes eligible or ineligible to join the plan. When a child is born, for example, they can be added to the plan. For marriage and divorce, additions or deletions can be made. The following events allow for the special 30-day window to change coverage:
In some instances, employees lose other coverage which can trigger the special 30-day window to change coverage. If an employee divorces, for example, their spouse may remove them from another plan, giving access to yours. These losses can trigger special enrollment:
Some special cases also allow employees to make changes outside of the open enrollment period:
Court orders: typically in the event of divorce or legal separation, a judge can require businesses to allow employees to make changes to coverage.
Extended, unpaid leave of absence: employees who take more than 30 days of unpaid leave (non-medical leave) can stop coverage during the leave and reinstate coverage upon their return to work.
A best practice for business is to require waivers from any employee who declines coverage under an employer plan. Whether they have coverage from a spouse or parent, or simply elect not to purchase, have the staff member sign a waiver acknowledging their choice that clearly outlines the implications of having to wait until the next open enrollment period.
Provided the employer has given ample notification, it is the employee’s responsibility to enroll themselves or their dependents into a plan or make changes to their coverage. If an employee fails to do so, the employer is not responsible for any losses they incur.