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Navigating health insurance can be complicated, especially when it comes to understanding when employees are eligible to make changes to their plans. Since the Affordable Care Act's implementation, individuals and small businesses can only enroll or make adjustments during specific times—known as open enrollment periods—unless they experience a qualifying life event for insurance. These qualifying events trigger a special enrollment period, giving employees the opportunity to adjust their coverage.
As an employer, managing these rules to ensure compliance and support your workforce is essential. But understanding the nuances of open enrollment and a qualifying life event for insurance can be tricky. In this post, we’ll clarify the basics of open enrollment and explain what constitutes qualifying life events for insurance. Plus, we'll share tips on how you can help your employees maximize the benefits available to them.
If you still have questions, don’t worry—Axcet HR is here to provide the expert guidance you need, making the benefits process as seamless as possible.
RELATED: Small Business Health Insurance and the PEO Option >>
In the individual health insurance market, whether through the government exchange or directly with an insurer, federal open enrollment occurs from November 1 - January 15 as of the 2024 coverage year, and will remain the same for the 2025 coverage year. Coverage under plans selected during open enrollment typically begins January 1 of the following year. Unless an employee experiences a qualifying life event for insurance purposes, they must select coverage during the enrollment window to be eligible.
Keep in mind, open enrollment isn’t just for solo entrepreneurs. Small businesses with less than 50 employees that sponsor healthcare for their staff are also required to adhere to the open enrollment period.
During this time period, employees who have recently become eligible, or wish to change their plans, can do so. Employer-sponsored health plans may have enrollment periods that differ from the government marketplace; however, the period is usually in the fall, and new coverage still begins on January 1 of the next year.
And while small businesses are not legally required to offer health insurance, it has become more widely accepted as a good business practice. Not only do good employee benefits help attract and retain top talent, but a healthy workforce makes for a productive workforce.
There’s just a small window of time to obtain health insurance, and for many, the enrollment period window can be missed–resulting in added stress and worry due to lost coverage or the inability to change plans. Now what?
The key exception to obtaining or changing coverage outside of the open enrollment period is if an employee experiences a qualifying life event for insurance purposes, or a "QLE".
Qualifying life events for insurance aren’t determined by employers; rather, they are set by the government. However, it often falls on employers to help employees understand their eligibility status. Certain life events, like getting married or having a baby, allow affected employees to make health insurance plan changes outside of your business's open enrollment period.
The window during which an employee can use their QLE to enroll or modify coverage typically lasts for 31 days from when the qualifying life event occurs.
These exceptional circumstances include:
When you partner with a PEO, like Axcet HR Solutions, for your business’ HR needs, you’ll gain access to Fortune 500 benefits small businesses typically don’t have access to, all at an affordable rate. Axcet HR Solutions has more than 35 years of experience delivering PEO health insurance and employee benefits to small and mid-sized businesses in Kansas, Missouri and across the country.
When you choose us to administer your business’ employee benefits, you’ll experience these great perks:
Interested in learning more about how Axcet HR Solutions can help? Schedule a consultation with us today.
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