As a plan administrator for a group health plan, there are many different rules and regulations you need to keep track of. Our brokerage does not charge any fees to help you understand these rules. Each year, your medical plan renews and employees can enroll in the plan during the Open Enrollment period. After the Open Enrollment period, people can still join the coverage if they experience a Qualifying Life Event. Qualifying Life Events on group health plans allow employees or dependents to enroll mid year.

Qualifying Life Events on Group Health Plans

Compared to individual plans, there are many similarities with Qualifying Life Events on group health plans. The most common Qualifying Life Events on group health plans are:

  • Satisfying new hire waiting period.
  • Transitioning from part time to full time and satisfying the waiting period.
  • Involuntary loss of minimum essential coverage. (An involuntary loss of coverage cannot be caused by non payment.)
  • Getting Married or Divorced.
  • Had a baby, adopted a child, or placed a child up for foster care.

The major difference in the group market is that insurance carriers are usually flexible with retroactive enrollments, regardless of the circumstance. For example if someone involuntarily lost coverage, most insurance carriers will allow retroactive enrollments up to 60 days. This is not available for people applying with a loss of coverage Qualifying Life Event in the Individual and Family market.

Just like individual and family plan Special Enrollment periods, insurance carriers will usually request proof of the Qualifying Life Event. For example, to add a spouse because of a marriage, insurance carriers will want to see a certified marriage certificate.

As of today, most insurance carriers do not request proof of payroll for newly hired employees who satisfied their waiting period.

Your Options

If you do not have a Special Enrollment Period, you cannot enroll in a plan with a 90 day waiting period like the individual market. You will need to wait until the group health plan’s Open Enrollment Period to get coverage. If you are waiting to get coverage on your group health plan, we recommend enrolling in the individual market for a few months.

If you need help assessing your current group health plan contract, give us a call. We will help you understand when and how employees can enroll. Our brokers will also help you submit the enrollment paperwork to the insurance carrier for free.