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 Is Open Enrollment?

What Happens If an Employee Misses Open Enrollment?

Missing the open enrollment window can have significant consequences, especially for employees who rely on their benefits for essential healthcare coverage. Here’s what could happen:

1. No Coverage:
   If your organization does not offer auto-enrollment, employees who miss the deadline may lose their opportunity to secure coverage for the upcoming year.

2. Limited Options:
   Employees may need to explore alternatives such as short-term health plans, Medicaid, or CHIP, which may not offer the same level of coverage as employer-sponsored benefits.

3. Out-of-Pocket Costs:
   Without proper coverage, employees could face steep out-of-pocket expenses for healthcare services.

Options for Employees Who Miss Open Enrollment

Employees who experience a QLE may still have an opportunity to adjust their benefits. Common QLEs include:

Change in Household: Marriage, divorce, childbirth, adoption, or a death in the family.
Change in Residence: Moving to a different ZIP code, county, or state.
Other Situations: Loss of coverage due to aging out of a parent’s plan (e.g., turning 26) or starting/ending AmeriCorps service.

2. Short-Term Health Plans

Employees can consider short-term health insurance plans, which offer temporary coverage for a few months to a year. These plans:

• Allow year-round enrollment.
• Are not regulated by the Affordable Care Act (ACA).
• May not meet ACA’s minimum essential coverage requirements, leading to potential state penalties.

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

How Can HR Help an Employees Who Miss Open Enrollment?

HR professionals play a key role in guiding employees through benefits challenges. Here’s how HR can help:

1. Respond with Empathy: Missing open enrollment can be stressful. Start by understanding the employee’s situation and offering reassurance.

2. Check for Administrative Errors: Verify that the missed enrollment wasn’t due to an error, such as incomplete submissions or system glitches. Tools like BerniePortal’s HRIS can reduce errors and streamline benefits administration.

3. Improve Communication: Evaluate your communication strategies to ensure employees fully understand the open enrollment process. Consider sending:

• Multiple reminders via email or text.
• Clear instructions and deadlines.
• FAQs or educational resources.

4. Offer Auto-Enrollment: Implementing auto-enrollment can prevent employees from losing coverage. With tools like BerniePortal, employers can use passive enrollment strategies to roll over prior elections, reducing the risk of missed deadlines.

Additional Resources

You can stay informed, educated, and up to date with important HR topics using BerniePortal’s comprehensive resources:

• BernieU—free online HR courses, approved for SHRM and HRCI recertification credit
• BerniePortal Blog—a one-stop shop for HR industry news
• HR Glossary—featuring the most common HR terms, acronyms, and compliance
• Resource Library—essential guides covering a comprehensive list of HR topics
• HR Party of One—our popular YouTube series and podcast, covering emerging HR trends and enduring HR topics
• Community—the HR Party of One Community forum, a place devoted to HR professionals to ask questions, learn more, and help others