QUESTION

When can I enroll in my small employer plan?

Individuals with coverage | Coverage for Employees of a Small Employer |
ANSWER

Your employer can choose to begin offering coverage at any point during the year, but he or she is likely to require employees to enroll during an annual open enrollment period, unless you are a new employee.

Outside of your employer’s annual open enrollment period, there may be changes in your coverage or circumstances, known as “triggering events,” that allow you or your dependent to enroll in or change a plan during a special enrollment period. Special enrollment periods will be provided if you or a dependent (if your employer covers dependents):

  • Lose minimum essential coverage (for example, if you or your dependent were previously covered by your spouse’s health plan, but are dropped from that coverage; or if the insurer providing the plan you were enrolled in through your employer discontinues the plan).
  • Gain a dependent or become a dependent through marriage, birth, adoption or placement for adoption.
  • Lose eligibility for coverage (for example, if you move or get a divorce or have a reduction in the number of hours making you ineligible for coverage).
  • Lose eligibility for coverage under Medicaid or Children’s Health Insurance Program coverage.
  • Become eligible for assistance with your employer-sponsored plan through Medicaid or Children’s Health Insurance Program coverage.

In most instances, you will have 60 days from the triggering event to select and enroll in a plan. Your coverage will generally become effective on the first day of the month following plan selection. However, exceptions are provided in certain circumstances. For example, coverage is effective on the date of birth, adoption, or placement for adoption.

When it’s time to renew your coverage, many employers will allow you to remain in the health plan you selected the previous year without taking any further action. If there are other plan options available to you, your employer will likely offer you an opportunity to switch plans during the annual open enrollment period. (45 C.F.R. § 147.104; 29 C.F.R. § 2590.701-6).

Individuals with no coverage
Individuals with coverage
Coverage for small employers
Post enrollment issues