Health Plan Enrollment Rules

Compliance Overview

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;

  • When employees’ elections for group health plan coverage take effect; and

  • What method is used for making elections. 



Employer-sponsored group health plans typically have three enrollment periods:

·   An initial enrollment period when an employee is first eligible  

·   An open enrollment period that occurs before the start of each plan year

·   Midyear enrollment periods that are triggered by specific events


·   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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