Open Enrollment

UpdatedDec 10, 2009

Key Takeaways:

Understand the definition of a qualifying event.
Speak with a manager, if you are dissatisfied with the answer you get from customer service.

My son missed open enrollment because he was out of town due to his father's death. Is that a qualifying event?

My son missed his open enrollment at his place of work due to being out of town when his father died. They will not let him on now. Could that be considered a qualifying event?

In most organizations, open enrollment for changing and enrolling in employee benefits plans occurs over a 30- or 60-day period of time, once a year. Open enrollment is often at the end of the calendar year, but can happen at any time of the year based on the rules created by the employer. For traditional benefits plans, I am not aware of federal or state rules that control how employers or insurance providers are to offer open enrollment. I hasten to add that I am far from being a human resources (HR) expert.

Qualifying events

There are rules that govern open enrollment in so-called "cafeteria plans." If the employer in question offers a cafeteria plan, see ChangeOfStatus.com to learn more about the rules for cafeteria plans. So-called "qualifying events" for entering or leaving a benefit plan include birth of an employee's child, spouse's enrollment in another plan, spouse losing a job and thereby losing coverage, and so on.

I confess I am of two minds regarding your question. My first reaction is that open enrollment is typically of such a long duration that it is difficult to foresee a circumstance where a family member on leave from job would not be able to carve out an hour or so in a 30-day period to telephone the HR department and discuss the options, and then fax or mail the completed forms to the employer. Without knowing the circumstances, it strikes me that the death in the family is an excuse for failing to complete some routine paperwork by what should have been a well-known deadline. Attending a funeral is not a qualifying event.

My second reaction is that I do not know the circumstances here. Perhaps the deceased was out of the country. Perhaps the employee was involved in the treatment of the deceased, such as donating an organ. Regardless of the location of the deceased or the employee's involvement, the open enrollment deadline is completely arbitrary. The employer and employee are paying for the coverage and as such are the customers of the insurance company. The insurance company should welcome a new member of the employer's group as each new member should mean more profit for the insurance company.

Accordingly, suggest the employee contact the HR department and explain the situation to a savvy human resources person. I have no doubt that the most junior HR person will parrot, "Open enrollment is closed, open enrollment is closed." A conversation with a more senior HR person who understands that adding an employee is in the best interest of the insurance company will contact the insurance company's account representative and find a way to get the employee enrolled.

To learn more about insurance, please see the Bills.com resource Insurance Information, Resources, Quotes & More.

I hope this information helps you Find. Learn & Save.

Best,

Bill

Bills.com

2 Comments

BBill, Jan, 2010

Thanks for your comments on the Open Enrollment question. You are right that missing open enrollment, or more generally not falling into the norm with respect to insurance enrollment, may raise red flags and the insurance company does not want to be adversely selected.

TTiffany, Jan, 2010

I would disagree about the comment that the insurance company should welcome the new employee based on the idea of profit. There is a term called adverse selection in insurance meaning those who need insurance are more likely to purchase it. It would cause me to pause and question - did he really miss open enrollment or did he find out he needed coverage after the fact? Adding an employee is not necessarily in the best interest of the insurance company. I go back to thought that open enrollment usually has a very clear deadline (30 days prior to the effective date of group coverage) and would find it very hard to believe that he would have had no inkling of this date. Assuming he was out caring for someone prior to their death, he would presumably have been on the family medical leave act during which someone in the HR should have contacted him regarding the enrollment. Overall I think employees need to be more aware of what is going on with their insurance. There can be some exceptions to the rule such as changing insurance companies mid-term, but usually when someone "misses" an open enrollment and wants to add coverage after the fact there is a more serious reason.