What Happens If an Employee Misses Open Enrollment?

After all the time and attention that HR pros give open enrollment, it can be hard to imagine how an employee could miss the window for electing their benefits. However—even when it's for their benefit(s)—your priorities are not always their priorities, and some workers may put it off, thinking they'll have more time to ask questions and get clarification later.

So, open enrollment can easily pass some by. Here's what can happen and how HR can help.

What Happens If an Employee Misses Open Enrollment?

Open enrollment consumes a large amount of HR's time and energy, making it nearly impossible to forget about. But employees are also balancing their workload, home life, childcare, and the holidays—all while trying to stay safe and healthy during a global pandemic that's been hard to predict.

Still, missing open enrollment can make a bad situation worse. If your organization doesn't offer auto-enrollment, then workers who miss the window may be left out in the cold without any coverage. Missing open enrollment means limited options, but here a few situations to consider:

1. Qualifying Life Event:

   An employee may be in luck if they have a qualifying event coming up. A qualifying life event is a change to an individual’s circumstances, which allows them to make adjustments to their benefits despite the time of the year. Qualifying life events include the following:
• Change in Household: A change in household means getting married or divorced, having a baby or adopting a child, or death in the family.
• Change in Residence: A change in residence includes the following: moving to a different ZIP code or county, a student moving to or from the place where they attend school, a seasonal worker moving to or from the place they both live and work, and moving to or from a shelter or other transitional housing.
• Other Situations: There are other situations that count as qualifying life events, such as loss of health coverage for someone turning 26 (who was covered under a parent’s insurance) or AmeriCorps members beginning or ending their service.
  

2. Short-Term Plans:

   Short-term, or limited-duration, coverage is a health insurance plan that is meant to only last a short time, like a few months to a year. Plans like short-term coverage and critical illness allow year-round enrollment but are not regulated by the Affordable Care Act (ACA) because they are not considered minimum essential coverage. Even though they’re not compliant with the ACA’s individual mandate, the federal penalty for noncompliance is currently $0. Some states, however, do have penalties for individuals without minimum essential coverage. Be sure to check your state laws.

3. Medicaid or Children’s Health Insurance Program (CHIP):

   If an employee qualifies for Medicaid or CHIP, they can enroll at any time, all year long. Eligibility depends on income and varies from state to state.

How Can HR Help an Employee Who Misses Open Enrollment?

If an employee misses open enrollment, it’s important that HR first respond with empathy and understanding. HR is still the caretaker of company culture, even when administering benefits. It’s equally important to understand why they missed the deadline and help them avoid the same mistake in the future.

1. Administrative Error:

   When looking into the issue, work with the employee and the health insurance broker to make sure there wasn’t an administrative error. It's possible the employee had actually selected benefits but failed to confirm their election for some reason. An all-in-one human resources information system—or HRIS like BerniePortal—can help you streamline open enrollment and benefits administration, saving time and decreasing error.

2. Communication:

   Did the employee miss open enrollment because of a lack of communication? Was the employee confused about the process? It is the employee’s responsibility to sign up for benefits during open enrollment as long as the employer provides plenty of notice. But there may be ways to improve or enhance open enrollment communication. An HRIS like BerniePortal can also improve communication through its Benefits Administration and Compliance features.

3. Auto-Enrollment:

   Consider also whether or not your company should offer auto-enrollment to help employees avoid missing open enrollment. Auto-enrollment—also known as passive enrollment—is a benefits enrollment strategy that employers use to simplify the process and maintain benefits participation. Using a passive benefits enrollment strategy through an HRIS like BerniePortal, employers simply roll over each employee's elections from the previous enrollment period. This can help ensure employees don’t miss out on electing their benefits and lose coverage.

Additional Resources

You can stay informed, educated, and up-to-date with open enrollment, benefits administration, and other important topics using BerniePortal’s comprehensive resources:

• BerniePortal Blog—a one-stop-shop for HR industry news
• HR Glossary—featuring the most common HR terms, acronyms, and compliance
• HR Guides—essential pillars, covering an extensive list of comprehensive HR topics
• BernieU—free online HR courses, approved for SHRM and HRCI recertification credit
• HR Party of One—our popular YouTube series and podcast, covering emerging HR trends and enduring HR topics