Get Added to Your Group Health Plan Outside of Open Enrollment
You might be searching for a way for you or your employee to get enrolled in your group health plan outside of open enrollment. If so, you’re in luck since this article answers just that.
With group health plans, there are many different rules and laws to keep track of. If you need help, our brokerage does not charge any fees to assist with your group health plan.
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 nonpayment.)
- Getting Married or Divorced.
- Had a baby, adopted a child, or placed a child up for foster care.
An Important Action for New Parents:
If you’ve recently had a baby or adopted a child, it’s important to get in touch with a broker within 14 days of the event. This ensures your baby is added to your group health plan without any complications. Acting quickly is the best way to avoid any potential gaps or delays in coverage for your child.
Retroactive Enrollments
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.
Common Mistakes with Qualifying Life Events (QLEs):
- Delaying Action: Don’t procrastinate! Waiting too long to report a QLE, even with flexible group plans, can lead to stress and potential coverage gaps.
- Incomplete or Incorrect Paperwork: Insurance carriers need specific proof. Missing or inaccurate documentation can significantly delay your enrollment.
- Assuming Automatic Enrollment: A QLE doesn’t automatically enroll you. You must actively report the event and complete all necessary paperwork.
- Misunderstanding Effective Dates: Don’t assume immediate coverage. While often retroactive, confirm the exact effective date for services with your HR or broker.
- Ignoring Deadlines: Even with flexibility, there are time limits to act after a QLE. Missing these windows can complicate or prevent coverage adjustments.
- Not Confirming Coverage Scope: A QLE allows specific, related changes (e.g., adding a baby). It generally doesn’t open a full enrollment period to switch plans or make unrelated changes. Always clarify what’s permissible.
Your Options
If you do not have a Special Enrollment Period, talk to a broker. You might need to wait until the group health plan’s Open Enrollment Period to get coverage.
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.
