Completing the open enrollment process on time ensures that employees are able to obtain the best health insurance coverage for themselves during the upcoming year. Employers should take an active role in streamlining the process as much as possible by updating their previous benefits packages to better reflect current employee needs and preferences and making sure that employees understand their rights and responsibilities throughout every step of the process. 

Here is an overview of what open enrollment is, what the general timeline is, and how employers can leverage benefits administration software and other open enrollment strategies to support employees throughout the open enrollment process. 

What Is Open Enrollment? 

Employees typically have one opportunity each year to enroll in a new healthcare plan for the upcoming calendar year. This window is known as open enrollment. During open enrollment, employees may select an employer-sponsored insurance plan, enroll in Medicare, or choose another option through the government marketplace. 

Choosing Employee Benefits Packages: What to Consider

Offering benefits packages that sufficiently meet your employees' needs requires putting a significant amount of thought into considering what they are most looking for and what your company can afford to provide. 

Here are some of the most important things to consider when creating employee benefits packages that work well for both your company and your employees. 

Budget

Benefit plans need to make sense for the amount of money that your company can reasonably spend per employee. Most employers cannot realistically offer the most comprehensive plans in their industry, which means that they must find strategic ways to provide the best value for their employees. 

Benefits Plan Details 

Each plan within your employee benefits package includes several key pieces of information that impact how your employees can use their benefits and what kind of coverage they can expect to obtain in specific situations. Some key details to consider when creating benefits packages for your employees to choose from include: 

• Premiums
• Deductibles and out-of-pocket maximums
• Network coverage and specific facilities or providers that employees can choose from
• Prescription drug coverage
• Coverage for spouses or other family members
• Coverage for specific risks that are common in your industry

Employee Preferences 

Considering feedback from your employees can help you choose premiums, provider networks, and other benefits that best align with what they are looking for whenever possible. Your HR department can consider feedback from the previous open enrollment period to create a better experience and survey employees about what innovative employee benefits packages they are most interested in before the open enrollment period begins.

How Does Open Enrollment Work? 

Prior to each open enrollment period, employers should make the options they will be offering available so that employees can review their current coverage and consider which plan they are most interested in. Most employees can apply online, by phone, or by using a paper application. Employees often find this process to be the most straightforward when their employer leverages a benefits administration software program.

Employers should provide clear information ahead of open enrollment, including:

• Descriptions of each plan option
• Key enrollment deadlines
• Contact details for HR or benefits coordinators

Understanding the Impact of the Affordable Care Act (ACA)

The Affordable Care Act (ACA) was designed as a way to make health insurance more widely accessible and less expensive for all Americans and plays a critical role in shaping open enrollment policies and the responsibilities employers must fulfill.

Under the ACA, employers with 50 or more full-time equivalent employees (FTEs) are required to offer affordable, minimum essential healthcare coverage. Businesses with fewer than 50 FTEs are not mandated to provide health care coverage to all employees, though many still do for a competitive advantage.

The ACA also regulates plans offered through the federal and state health insurance marketplaces, which employees may explore during open enrollment if the employer-sponsored plans do not meet their needs.

Typical Open Enrollment Timeline

Open enrollment takes place from late fall through early winter and provides coverage through the following calendar year. The standard open enrollment period generally begins on November 1st of each year, and applicants who complete the process by mid-December will be covered by their new plan starting on January 1.

Applicants may make changes to their plan or complete the enrollment process until the open enrollment period officially ends in mid-January. Coverage for changes or enrollments that occur after the initial mid-December deadline will begin on February 1.

Exact dates may vary based on an employer's location or specific policies. Employees may also qualify to enroll or make changes during a Special Enrollment Period if they have a specific reason to need to do so outside of the regular open enrollment period.

Supporting Employees During Open Enrollment

Each employee is ultimately responsible for completing their open enrollment process on time, but there are several steps your company can take to help them understand what to do and make sure that they feel supported throughout the process.

Here are four helpful tips for ensuring that your employees have the tools they need to understand their options and make informed decisions.

Prioritize Clear Communication

Making sure that your employees have the resources they need to understand the options that are available to them during each open enrollment period is a must. Comparing plans effectively can be difficult when little to no information about what might make each option a good fit is provided, and employers should take the initiative to clearly describe the pros and cons of each plan in language employees can clearly understand.

Employers must also clearly explain what employees need to do during the open enrollment process and make sure that they know when the deadlines for each step are. This information should be shared in multiple formats to be certain that all team members see it, such as emails, website banners, announcements within your company's employee portal, and in-office paper signage.

Employers should also make sure that a point of contact is introduced to employees so that they know who to contact if they have questions during the open enrollment process and how to do so.

Provide Personalized Support and Address Specific Needs

Every employee's needs are different, and employers should put plenty of effort into offering plans that meet these needs as effectively as possible.

While it is probably not realistic for every team member to fully personalize their plan to get the exact benefits they want, employers should carefully research the premiums, deductibles, networks, co-pays, and other elements of the benefits packages they are considering offering to make sure that they reasonably align with what employees are looking for.

Offering packages that are tailored to specific employees, such as new hires, can also help them get the most out of their benefits.

Employers should also provide plenty of support throughout the open enrollment process to make sure that employees thoroughly understand what their options are and what they need to do to complete the signup process.

Representatives from your HR department or other leaders of your company should offer group workshops to share information about what the plans your company will be offering look like, how to choose one that is a good fit, and how and when to sign up. Offering one-on-one counseling sessions can also be a helpful way to make sure that individual employees can get their questions answered.

Support COBRA Participants and Qualified Beneficiaries

Beneficiaries of a COBRA participating employee will also be allowed to elect benefits through the open enrollment period. Keep in mind that beneficiaries may also choose different health care plans offered by the business if they so choose. Notices on plan details and open enrollment dates should be given to employees or their qualified beneficiaries if applicable.

Individuals who experience a qualifying event under the federal or their state’s COBRA law will also have the ability to participate in the open enrollment period.

Common qualifying events can include:

• Voluntary or involuntary job loss
• Reduced in hours worked
• Death of the covered employee

All employers should be familiar with federal COBRA law compliance requirements and should contact their state’s Department of Labor for any questions regarding state-specific COBRA Laws.

Best Practices

Preparing for your open enrollment period requires an active approach: you’ll want to make sure the process is streamlined, user-friendly, and compliant.

Some of the best practices your business will want to leverage for a successful open enrollment period include:

• Utilizing HR technology to support the process
• Managing recordkeeping and reporting requirements
• Requesting feedback from your workforce after open enrollment

Leverage Technology Throughout the Open Enrollment Process

Using technology to your advantage can significantly simplify the process of helping your employees sign up for a new benefits plan during the open enrollment process.

Having all your employees register through a benefits administration software program can be a much more straightforward process than keeping track of paper forms or otherwise requiring them to complete the process on their own.

The platform you choose should also offer a mobile app solution option while providing user-friendly tools to make sure that your employees find it easy to use.

Maintain Accurate Reporting and Recordkeeping

Employers must retain and submit various documents related to open enrollment, particularly under the ACA, COBRA, Employee Retirement Income Security Act (ERISA), and applicable state laws. Accurate recordkeeping helps ensure compliance and protects against audits or penalties.

Key records you will want to maintain include:

• ACA Forms 1095-C and 1094-C: Report offers of coverage (for employers with 50 or more FTE employees)
• Benefit Plan Documentation (per ERISA): includes employee notices, benefits election forms, and plan summaries
  
  • These documents must be kept for at least 6 years
• COBRA Documentation: notices and election forms when an employee loses coverage
• State-specific Filings: Some states require reporting similar to the ACA, such as California, New Jersey, and Massachusetts

Follow Up After the Open Enrollment Period

Taking the initiative to learn about what your employees liked about their open enrollment experience, how they feel about their new benefits, and what they think could have gone better can help your HR department plan ahead to make appropriate changes during the next open enrollment period to provide your business with a competitive employee benefits package. This feedback can help your team continue to improve your employees' experience and ability to use their benefits effectively over time.

Common Questions Regarding the Employee Benefits Open Enrollment Season

Understanding the entire planning process for your benefits open enrollment can be confusing, particularly when considering ACA and COBRA laws on top of supporting your employees throughout the process. Here are some questions and answers that may help clarify the steps:

When Does Open Enrollment Usually Take Place?

The standard open enrollment period for most employer-sponsored plans and government marketplaces begins November 1st and ends sometime in mid-January. To ensure coverage starts on January 1st, employees typically need to enroll by mid-December.

Keep in mind that some states have extended open enrollment periods. Each year may vary from the last, so it is essential to check with your state’s Department of Labor for more details on the exact start and end dates.

Can Employees Change Their Benefits After Open Enrollment?

Employees can only change their enrolled benefits if they experience a qualifying event, which may include marriage, birth / adoption of a child, or job loss. These events trigger a special enrollment period, usually within 30 to 60 days of the event. Otherwise, benefits remain locked in for the plan year.

Can Employees Waive Coverage During Open Enrollment?

Yes, employees can choose to waive employer-sponsored benefits if they have alternative coverage, such as through a spouse or government program. Employers should collect signed waiver forms to document the decisions and maintain compliance records.

How Do COBRA Participants Enroll in Benefits During Open Enrollment?

COBRA participants and qualified beneficiaries who have experienced a qualifying event, including job loss or divorce, must be allowed to enroll or make changes during open enrollment. Employers are responsible for providing proper notices and ensuring these individuals have the same options as active employees.

Prepare Now for a Successful Open Enrollment Season

Preparing early, ideally months ahead of the November 1st start date, can make a significant difference in your open enrollment success. By understanding the process, aligning timelines, and leveraging the right tools, all while maintaining compliance, your business can deliver a more efficient employee experience.

If you need help planning or executing your open enrollment strategy, contact us today.