Late enrollment--administrative exception

[JWK]

I'm interested in hearing how employers are handling the situation where an employee misses an enrollment deadline, e.g., to enroll a new dependent. Say the plan has a 30 day enrollment window and the employee requests enrollment after the window closes. Do you allow administrative exceptions? What would an employee have to show to qualify for an exception? Ever been sued over this issue? Assume no cafeteria plan issues.

Thanks for your insights.

[KIP KRAUS]

JWK,

Our HMOs have a premium rate bsais of single and family. If an employee is married and enrolled in a family contract esentially any newly aquired dependent is coverd at birth or adoption. Adding a new dependent does not in this situation change the employee's contribution. If an employee fails to add a new dependent it merely delays coverage, because we have no pre-existing condition limitations. We will allow them to add the dependent beyond the 30 days.

If you have a medical plan that has pre-existing medical limitations and HIPPA does not come into play, you may have a problem with allowing late entrants.

Of course, there are always employer errors, which could justify enrolling a dependent retroactivley, if you know what I mean.

I have work for several employers and this has always been an issue on occasion. Just how leanient the employer and insurer wants to be determines what happens. However, as you know, once an acception is made it can be construed as the norm.

[Guest REverly]

JWK,

We have a self insured plan with no pre-existing. We currently have a situation where an employee forgot to add his newborn. He stopped into our department since the insurer had no record of the baby being added to the plan. The employee came to us 6 months after the birth of the baby to add the baby. Besides missing the 31 day window our plan has, he had also missed the opportunity to add the baby during Open Enrollment. We had looked into our options of agreeing to add the baby to the plan. As Kip had mentioned, once you make an exception you now have to do the same for everyone in the future. Other thing that we had to consider was Stop-Loss coverage. Our insurer will not apply our Stop-Loss limit to the baby. If this baby has considerable illnesses or complications, as a self insured plan, we risk paying more than we bargained for. I'd recommend that you check with your insurer what type of items such as this (if your self-insured) that you may be liable for. The other sticky part that you have to work out is your readyness to set precedence for all future extensions of the enrollment window.