Initial Enrollment


Reference

 

An initial enrollment period is typically offered for new hires or those newly eligible to participate in a benefit plan. For some employers, the initial or open enrollment period is the only time employees (and dependents) can enroll in the plan; or, it is the only time they can enroll with being subjected to preexisting condition exclusions (subject to HIPAA Special Enrollment provisions).

Enrollment Process

Although not required under ERISA, an initial/open enrollment period can give employers an opportunity to put in place a consistent process for determining eligibility, informing participants about plan terms and conditions, and distributing important disclosures and notices. Therefore, employers should consider providing the following information to employees eligible to participate in a benefit plan:

Please Note: Employers with fully insured plans should coordinate their open enrollment activities with their insurers and maintain consistency with the insurer’s process and notices.

Plan Enrollment Information

The forms should clearly state that eligibility is based on the terms of the plans, and cannot be presumed just because open enrollment information was provided.  In other words, simply receiving the forms does not automatically mean they are eligible to participate in the plan. Under a fully insured arrangement, the insurance company may provide these forms and information.

Plan Documents

If other summary information about the plan is used, it must be consistent with the SPD and other benefit descriptions.

Notices When Eligible or Upon Enrollment

See the Notices and Disclosures: When Eligible or Upon Enrollment for a list of notices that should be provided to employees when they are newly eligible or enrolled in the group health plan.

Opt-Out Notices (for employers that have opted-out of certain requirements)

Please note that one or all of these notices may be included in the SPD rather than distributed separately provided that the SPD is distributed according to the distribution requirements that apply to each notice

However, employers will want to consider any administrative problems that may complicate that strategy where the law requires a notice to be provided to both the employee and a spouse or dependents. For example, employers would need to make sure a a copy of the SPD was sent to an employee’s covered spouse to satisfy the COBRA notice requirements.  Similarly, SPDs would need to be given to eligible employees who declined coverage to satisfy the HIPAA preexisting condition and special enrollment notice requirements.

Recipients

Employers must ensure that all eligible employees receive open enrollment materials. Otherwise, the employer may be responsible for benefits to eligible individuals who are not enrolled in the plan because the employer did not provide or process the necessary forms.

Employers should also remember that certain inactive employees and their beneficiaries may be eligible for the plan(s) and take steps to deliver materials to them.

In general, employers want to consider the following groups of employees when distributing open enrollment materials:

Delivery

ERISA does not specifically address how open enrollment materials should be delivered.

However, when choosing delivery methods, an employer should keep in mind that:

To ensure full compliance, many employers choose to follow the requirements for delivery of ERISA materials. Click Here to review those requirements in the Delivery Methods Compliance Topic.

Grandfathered Plans Losing Grandfathered Status (for plans subject to the ACA)

If your plan is losing grandfathered status, please be sure it has been amended to include all the ACA provisions that do not apply to grandfathered plans. These include, but are not limited to:

See page 2 of the Maintaining Grandfathered Plan Status document for a listing of ACA requirements exempted by virtue of grandfathered plan status. Also see the Dashboard compliance activities on grandfathered and non-grandfathered plans for additional information on the requirements for non-grandfathered plans.