Group Health Plan Enrollment Rules

Employers that sponsor group health plans have some different options available to them for designing their plans’ enrollment process. When it comes to enrollment, health plan sponsors should have rules in place regarding:

  • When employees can enroll in the health plan?
    • An initial enrollment period when an employee is first eligible
    • An open enrollment period that occurs before the start of each plan year
    • Mid year enrollment periods that are triggered by specific events
  • When employees’ elections for group health plan coverage take effect?
    • After Wait Period
    • Open Enrollment
  • What method is used for making elections?
    • Affirmative elections
    • Default (or automatic) elections
    • Rolling (or evergreen) elections

There are some federal laws that impact how employers can design the enrollment process. For example, the Affordable Care Act (ACA) limits waiting periods for initial enrollment and requires applicable large employers (ALEs) to provide an annual opportunity for full-time employees to elect coverage. Also, the rules for Section 125 plans (or cafeteria plans) limit when employees can make changes to their pre-tax elections during a plan year.

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The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.