Open Enrollment Mandatory?

[Guest insurbroker]

Is it legal or are there any other issues if a 350 employee company, decides that the employees do not get an annual open enrollment for their group medical plan? The only way an employee can get on the plan is if he/she signs up when hired, or if there is a life changing event... other than that, they do not have the option to get on it.

Is this allowed? Is it legal? Does this open the door to DOL issues?

[Sandra Pearce]

There is no law that requires a health plan to have an annual open enrollment period. HIPAA requires that the plan adhere to HIPAA's Special Enrollment rules.

[Guest insurbroker]

Sandra, can you advise on what those SPECIAL ENROLLMENT provisions are.. and do you see any other legal ramifications? Are the Special Enrollment provisions referring to "Life Change Events"? Thank you for your help

[GBurns]

insurbroker

The medical plan is not the cafeteria plan and vice versa. I see these items confused very often.

While there is no requirement for an annual enrollment for the medical plan, there is a requirement for an annual election for the employee's salary deduction agreement in order to deduct the employee's share of the premium for the medical plan and the FSA amount.

There would be no annual enrollment if there is no employee contribution.

How do they handle dependent coverage?

[leevena]

I agree with all the earlier comments. However, you may want to read your plan contract and see if it require's an annual open enrollment to take place.