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 30 days from the triggering event to select and enroll in a plan. However, if your special enrollment period relates to the gain or loss of Medicaid or Children’s Health Insurance Program eligibility, you will have 60 days to select and enroll in a health plan. Your coverage will become effective on the first day of the following month if you make your selection between the first and fifteenth day of the month. If you make your selection later in the month, your coverage will typically not become effective until the first day of the second following month. However, exceptions are provided in certain circumstances. First, coverage is effective on the date of birth, adoption, or placement for adoption. Second, if you get married or lose minimum essential coverage, your health plan must ensure your coverage is effective on the first day of the following month.

When it’s time to renew your coverage, you will remain in the health plan you selected the previous year, unless you choose to terminate your coverage in that plan, you enroll in another health plan through the health insurance marketplace, or the plan is no longer available to you. (45 C.F.R. § 147.104; 29 C.F.R. § 2590.701-6).

Individuals with no coverage
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