Are There Options for Employees Who Miss Open Enrollment?

As an employer, you strive to provide healthcare benefits to staff members. Open enrollment season is a busy and hectic time in your organization and you work hard to make sure every employee has the paperwork they need to get coverage for themselves or their family. 

But some employees, no matter how hard you plead, simply don’t get their paperwork filled out in time for the deadline. As an employer, is there anything you can do to help? 

The options are few, but there may be a solution in limited circumstances. Understand first that under the law you can’t force employees to enroll in your plan, nor are you obligated to do so. As long as you’ve made the necessary notifications and reminders (and you should document that you have done so), the responsibility for loss of coverage lies with the staff member. Having said that, many employers still want to help, but there are only a few circumstances in which they may be able to do so. 

Here are some of the limited options.

Is there another qualifying event?

In the absence of any other reason, if there is another qualifying event that could impact access to coverage, employees should move quickly to enroll. Qualifying events are outlined under the law as: 

• Birth, adoptive, or foster placement of a child in the employee’s household 
  • Employee must choose family coverage 
• A change or loss of spousal benefits or coverage
• Death of a dependent or spouse
• Marriage
• Divorce
• Legal separation
• Court order to provide coverage

If any of these events occur, most plans allow the employee only 30 days to complete and submit the required enrollment forms. Failure to enroll during that special enrollment period will result in the employee being ineligible to enroll until the next open enrollment. 

Is the employee eligible for Medicare/CHIP benefits?

Just like private insurance, the ACA exchanges have an open enrollment period that closes by the end of the year. If an employee missed your organization’s private open enrollment, they may be able to enroll in the ACA marketplace if they are eligible for Medicare or CHIP (Children’s Health Insurance Program) benefits. 

Signing up for these coverages is open year-round, not just during the annual open enrollment periods for private or ACA insurance coverages. In general, an employee with a family of four will need to be under a specific earning threshold to qualify. 

Employers must stress that options for employees to gain healthcare coverage for the coming year are limited if they miss the open enrollment period.

The Federal government provides a screening tool to determine if an employee and their family will be eligible. If so, they may enroll at any time, even outside the open enrollment window. 

Was it an administrative error?

There are some very limited instances in which an employee missed the open enrollment period through an administrative mistake, or through no fault of their own. Employees, for example, who are out in the field and unreachable for the entirety of the open enrollment period should have been notified well in advance of open enrollment to fill out the paperwork, but it may have fallen through the cracks. 

Remote workers may have been mailed paperwork to incorrect addresses, never receiving their notifications. In these instances, you may be able to work with your plan provider to allow for enrollment past the window, but allowing the employee to enroll will likely be at their sole discretion.

Would short-term coverage help?

In most states, workers can purchase short-term healthcare insurance if they are not covered under any other plan. These plans are typically low-cost and low coverage. Staff members purchase these plans as an individual. They may find they get limited benefits — almost none provide maternity coverage — but may cover catastrophic illness or accidents. 

Employees will need to shop (on their own) for the plan that provides the best coverage for their needs. These plans are not approved under the ACA and can even exclude pre-existing conditions. Depending on the state, some plans will only be available for three months — others can be in force for up to 3 years. 

What not to do if your employee misses open enrollment

Some businesses may be tempted to try to work around an open enrollment mishap. Employers may consider asking the employee to resign for a short period of time, then rehire them — triggering a special enrollment qualifying event. This could prompt your insurance carrier to deny coverage. It’s important to check with your carrier to verify any required waiting period to reinstate benefits before you make a decision to ask an employee to resign.  

Employers must stress that options for employees to gain healthcare coverage for the coming year are limited if they miss the open enrollment period. The consequences for the coming year could be devastating if there is a serious medical issue. The responsibility, however, is ultimately in the hands of the staff member.