Your Employee Missed Open Enrollment. Now What?

November 27, 2018
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sick employee missed open enrollment

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.

Can you apply for health insurance after open enrollment?

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.

What is a “life-changing event” for health insurance?

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

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:

  • Birth of a child
  • Adoption of a child
  • Marriage
  • Divorce
  • Death of a spouse that provided health care coverage
  • Death of a dependent
  • Dependent becomes ineligible (age 26)
  • Dependent acquires other insurance

Loss of Other 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:

Change in employment status

  • Separation or reduction of hours that leaves the employee ineligible for benefits  
  • New hires, or change from part-time to full-time status
  • Loss of other coverage: for employees previously covered by a spouse or parent
  • Divorce
  • Death of a spouse or parent who provided coverage
  • Retirement – eligibility for Medicare coverage

Special circumstances

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.

What are Waivers of Coverage?

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.

Who is responsible if the employee misses open enrollment?

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.

This post was originally published in August 2018.

About

Riia O’Donnell is a Human Resource professional with over 15 years of hands-on experience in every discipline of the field. A subject matter expert, she has written for the online HR market for over 8 years. Her first job, at age 15, was working the early morning shift at a local bakery on weekends.

Category: HR Tips & Trends, Benefits, Health Care Cost


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