Health Plan Enrollment Rules

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Employers that sponsor group health plans have some different options available to them for designing their plans’ enrollment process. When it comes to enrollment, health plan sponsors should have rules in place regarding:

  • When employees can enroll in the health plan;
  • When employees’ elections for group health plan coverage take effect; and
  • What method is used for making elections.

There are some federal laws that impact how employers can design the enrollment process. For example, the Affordable Care Act (ACA) limits waiting periods for initial enrollment and requires applicable large employers (ALEs) to provide an annual opportunity for full-time employees to elect coverage. Also, the rules for Section 125 plans (or cafeteria plans) limit when employees can make changes to their pre-tax elections during a plan year.

This Health Plan Enrollment Rules compliance overivew provides a summary of various legal rules surrounding health plan enrollment.

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