Individual & Family

We recommend that employers take their annual open enrollment period to make necessary adjustments to their employee benefits. Benefit information changes from year to year, and may require a change to your company’s benefit strategy. If your company admin has decided to "plan map" they you will automatically be enrolled in the same (or most similar) health plan as the one you originally selected. If they do not have this automated process set up, you must re-select your health plan or you will be denied coverage.

This actually depends on how your specific company has chosen to set up its open enrollment process. If you have selected an option that's referred to as "plan mapping," then the company will make automatic selections for employees who fail to alter their health plans during the open enrollment period. Without alteration on the part of the employee, the company will keep the individual in the same health plan or in the most similar health plan to the individual's original selection. If that employee had previously declined coverage, the company will automatically decline coverage once again. However, if administrators at your company have not selected to "plan map," then any employee who does not actively make a selection during the open enrollment period will be declined coverage. This is even true for employees who had previously been enrolled in a health plan. These employees would need to re-select their health plan to continue using it. If the employee fails to do so during the open enrollment period, they can only enroll in health insurance if they experience a qualifying life event. It's possible that the employer could submit an "exception request" for an employee who missed open enrollment; this would be done through the employer's broker.

All benefit changes should be made during open enrollment. Changes outside of this period can only be processed if you've experienced a sufficient qualifying life event.

A qualifying life event (QLE) is a significant lifestyle change that is either unexpected or unavoidable. In the case of a QLE, employees are able to make changes to their insurance plans outside of the open enrollment cycle. Examples of QLEs are having a baby or divorcing a spouse.