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What To Do if an Employee Missed Open Enrollment at Work

Employee researching insurance options after missing open enrollment period at work

Even with weeks of communication in advance, employees may report that they missed open enrollment at work. This can happen for a variety of reasons, including a change in family status, work or information overload, or challenges in navigating the benefits enrollment process.

Regardless of the reason, this common situation can result in added financial burden on the employee, additional missed days at work due to lack of proper health coverage, and frustration for both employee and employer. While employers have little ability to "bend the rules" for employees when they have missed open enrollment at work, there are some options that can help both employer and employee.

Who Is Responsible if an Employee Misses the Open Enrollment Period?

While employers have certain responsibilities to notify employees about benefits-related deadlines, the responsibility of registering for benefits and completing any required paperwork falls on the employee. As part of the open enrollment process, employers should help make employees aware of what happens if they missed open enrollment.

If an employee missed open enrollment at work, they are generally no longer eligible to sign up for benefits unless one of a few special exceptions applies. If the employer gave proper notice to employees communicating open enrollment deadlines, there is very little that can be done legally to help the employee after the fact, so a proactive approach and providing detailed information before and during open enrollment works best.

Options for an Employee Who Missed Open Enrollment at Work

The most common option for employees who missed the 30-day enrollment period is simply to wait until the next enrollment period to register for benefits. However, this may not be practical, especially for employees with growing families. In some circumstances, employees may be granted a special exception that allows them to retroactively register for benefits outside the standard enrollment window when they missed health insurance enrollment.

Special Enrollment Period (SEP)

HR managers should be prepared to address the common employee question "What is a special enrollment period?" A special enrollment period is a designated time outside of the standard open enrollment period for employees to change or update their insurance plan elections that are granted when the employee experiences a qualifying life event. Qualifying life events can be circumstances that change an employee's status for benefits, such as changing the number of individuals in the household who are covered under a benefits plan. Other qualifying life events that would make an employee eligible for SEP can include:

  • Loss of existing health coverage
  • Turning 26 and being dropped from a parent's coverage
  • Change in number of eligible family members due to birth, death, adoption, or other family status change
  • Moving
  • Change in work hours or job position that could affect insurance eligibility

Medicaid/CHIP Health Coverage

If an employee experiences a decrease in income, they may be eligible to apply for health coverage through the government's Medicaid and Children's Health Insurance Program (CHIP). Medicaid provides health insurance to low-income individuals, while CHIP provides health insurance to children of low-income families. Individuals who are below the income thresholds set by the government's programs can apply for coverage any time of year. To apply for benefits and verify eligibility, individuals should complete the online screener application.

Short-Term Health Insurance

Individuals who are in transition may qualify to register for a short-term insurance plan if offered in their state. Short-term insurance is a plan that provides health insurance for 30-364 days (depending on your state) to act as a stopgap when there is a lapse in longer health coverage.

To qualify, individuals must have experienced a loss in permanent coverage due to a job change, layoff, becoming a college student, or missing open enrollment. Short-term coverage is typically cheaper than traditional health plans, but only relatively healthy individuals will qualify. This option is designed to provide temporary coverage in case of emergency health situations until the employee can regain permanent health insurance.

How Can Employers Prevent Their Employees From Missing the Open Enrollment Deadline?

Missing open enrollment can be a costly mistake for employees, so employers should take adequate steps to help their employees through the enrollment process. When employees miss open enrollment and lose health coverage, this can add financial and emotional burdens that may affect their health, well-being, and productivity at work.

There are simple steps employers can take to ensure a successful open enrollment period. These include:

  • Requiring waivers of coverage: Waiver of coverage documents verify that employees reviewed and declined benefits options during the open enrollment period. These waivers also protect an employee's ability to immediately enroll for benefits if they lose coverage from an outside health plan, such as a spouse's employer.
  • Regularly educating employees: Providing multiple information channels during open enrollment can ensure that employees are well-informed and have the resources to make decisions about their benefits.
  • Asking for employee feedback: Employees can be a great resource for offering suggestions about the best ways to structure benefits enrollment to ensure maximum participation.

Prevent Employee Missed Open Enrollment Periods With Paychex

Since there is little wiggle room with open enrollment deadlines, employers should focus on preventing employees from missing the annual deadline. Starting the conversation about open enrollment early and providing multiple information channels throughout the open enrollment period can help ensure that employees haven't missed open enrollment at work. If your HR team is already overloaded during open enrollment season, trusted HR consulting services can help lighten the load and generate ideas for the best ways to support your employees through open enrollment.

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* This content is for educational purposes only, is not intended to provide specific legal advice, and should not be used as a substitute for the legal advice of a qualified attorney or other professional. The information may not reflect the most current legal developments, may be changed without notice and is not guaranteed to be complete, correct, or up-to-date.

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