How to handle employee who missed open enrollment due to sick leave

[Guest MikeD]

Has anyone ever dealt with this? Basically, an employee was in the hospital during the open enrollment election period. Now that he has returned to work, he would like to change his benefits elections. The plan document is silent on the issue. Does anyone know of any authority that would allow him to make a new election? I can't find anything that would justify this.

[GBurns]

Why do you refer to it as a "new election"?

If he was not available during open enrollment, he could not have made an election. If he made no election How can you be saying that "he would like to change his benefits election"? What is there to change if he was absent and therefore made no election? You cannot have it boths ways.

In almost all cases that I have seen over the years, an employee is required to make an election each open enrollment. It is not a new election, it is just the election for that plan year. The "old"/previous election is expired, it is no more, it cannot be changed. If the employee does not make an election in the required time frame the Plan Document calls for a default position to take effect in lieu of the election. However, most have an actively at work or similar provision, and wording regarding the inability to make an election because of extentuating circumstances.

I suggest that you make sure that your PD does not have such an extentuating conditions clause or other clause that might be applicable.

Also, most open enrollments have a cut-off date that is some time after the OE date. Has this passsed?

Was this employee still on the payroll? Was this employee on FMLA?

Even then, unless prohibited by the Plan Document. an election can be as late as the day before the applicable pay is constructively received. Section 125 only requires that the election be prospective. Section 105 only requires that the coverage not be retroactive. So as long as there is no coverage the election can be as late as the day before the payroll period, as long as your Plan Document does not state otherwise.