Your Compliance Edge

Open Enrollment

Open enrollment is the period of time each year in which eligible employees may enroll in your health plan. During this time- typically a couple of months prior to the new plan year- employees must review your offerings and decide which benefits to select. Some plans may stay the same from year to year, with adjustments for any changes in the law, while other plans may feature significant new benefits. Much of what is offered is up to the employer. Health plan options often include traditional medical coverage, but may also include other health benefits, such as:

  • Health Savings Accounts (HSAs)
  • Flexible Spending Arrangements (FSAs)
  • Health Reimbursement Arrangements (HRAs)
  • Gym memberships
  • Wellness programs

Understanding Options

Except in certain circumstances prescribed by law*, employees and their families must enroll in your plan during the open enrollment period set by the plan; they will not be able to change their mind and sign up for coverage in the middle of the plan year. Thus, it is important for employees and any of their eligible family members to understand all of their options for the coming year during enrollment season. Employees should consider how frequently they expect to use doctors’ services, drug prescriptions and other health care items or services. Your employees may also want to confirm that their doctors are in the network provided by the plan. 

Your health plan can make this process easier by proactively promoting employee engagement in open enrollment, and making resources available online or through your company intranet. To seek assistance in this regard, you may want to contact your insurance carrier for promotional materials.     

* Special Enrollment under HIPAA

Under HIPAA, certain events that happen to employees or their dependents trigger a right to “special enroll” in your employer-sponsored group health plan. Special enrollment generally means that the employee or dependent will have 30 days from the date of the event to request coverage in your group health plan, regardless of your open enrollment period. Special enrollment rights under HIPAA arise out of:

  • The loss of other health coverage; or an employer terminating contributions toward health coverage; and
  • A person becoming a new dependent through
    • Marriage;
    • Birth;    
    • Adoption; or
    • Placement for adoption

For more on special enrollment in health plans under HIPAA, please visit the HIPAA section.

Sample Open Enrollment Communication Materials

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