Table of ContentsView AllTable of ContentsSpecial Enrollment PeriodsHow RegulatedQualifying Life Events
Table of ContentsView All
View All
Table of Contents
Special Enrollment Periods
How Regulated
Qualifying Life Events
Employer-sponsored health plans are available to employees when they first become eligible for the coverage and annually during the employer’s open enrollment period.
But employees also have an opportunity to enroll or make changes to their coverage during special enrollment periods, which are linked to certain qualifying life events.
This article will explain what you need to know about special enrollment periods for employer-sponsored health plans. You’ll learn how they differ from special enrollment periods for individual health insurance and employers’ flexibility in terms of special enrollment periods.
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What Are Special Enrollment Periods for Employer-Sponsored Health Coverage?
Special enrollment periods give employees an opportunity to enroll in coverage, add or drop family members from the plan, switch to a different plan (if the employer offers multiple plan options), or drop their coverage altogether.
Special enrollment periods are also an opportunity to start, stop, or make changes to an employee’sflexible spending account(FSA) contributions. (Note that health savings account—HSA—contribution changes do not require a special enrollment period, and can be started, stopped, or changed at any time.)
These enrollment opportunities are available when an employee first becomes eligible for coverage, and each year during the employer’s annual open enrollment period. But they are also available if an employee experiences certain qualifying life events that trigger a special enrollment period.
Note that in the individual (self-purchased) market, coverage can be dropped at any time, and family members can be removed from a plan at any time. That is not the case for employer-sponsored health insurance, which can only be dropped during open enrollment or a special enrollment period.
How Are Special Enrollment Periods Regulated?
For employer-sponsored health coverage, special enrollment period rules are in the Code of Federal Regulations. Specifically,29 CFR § 2590.701-6, and in permitted election changes for Section 125 plans (26 CFR § 1.125-4).
(Note that the special enrollment period rules for employer-sponsored plans are not the same as the rules for individual health insurance special enrollment periods, which are detailed at 45 CFR § 155.420.)
When an employee experiences a qualifying life event, the employer must generally allow them a special enrollment period of at least 30 days, during which they can enroll or make changes to their coverage, or drop their coverage (note that this differs from the individual market, where special enrollment periods generally last 60 days).
Several qualifying events will trigger special enrollment periods for employer-sponsored health insurance. They includemarriage,birth or adoption of a child, andinvoluntary loss of other health coverage.
Involuntary loss of other health coverage includes loss of other employer-sponsored coverage, loss of individual market coverage, loss of Medicare or Medicaid coverage, or the exhaustion ofCOBRA. And it also includes situations in which a current or former employer’s contributions to the person’s premiums terminate.
The loss ofshort-term health insurancedoestrigger a special enrollment period for employer-sponsored health insurance.(That is not the case for individual market health insurance; the termination of a short-term health plan does not give a person an opportunity to enroll in an individual market plan.)
Loss of other health coverage is not considered a qualifying event if the person chooses to cancel it or fails to pay the premiums.
Optional Qualifying Life Events for Section 125 Plans
In addition, an employer that offers a Section 125 plan (again, that’s how employers offer health benefits on a pretax basis)has the optionto offer special enrollment periods for a variety of other circumstances, but is notrequiredto do so. These circumstances include:
Summary
For employer-sponsored health plans, there are specific, federal rules for when employees can enroll or drop coverage, add or drop family members from the plan, or switch to a different plan (if multiple plans are offered).
Special enrollment periods generally must last at least 30 days. Some qualifying events—such as loss of other coverage—always trigger a special enrollment period, while others are optional for the employer and may or may not be offered.
A Word From Verywell
If you have employer-sponsored health insurance, pay close attention to your plan options during open enrollment, and try to pick the coverage that makes the most sense for you (and your family, if you’re covering anyone besides yourself).
Understand that your plan choice and your FSA election, if applicable, will generally be locked in for the full plan year. But also know that if you have a change in circumstances, you may be able to enroll, drop, or change your coverage mid-year.
Your employer will explain how their rules work, and the better you understand them, the better you’ll be able to navigate the process if and when you have a qualifying event.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kaiser Family Foundation.Health insurance coverage of the total population.Department of the Treasury.Tax treatment of cafeteria plans.Society for Human Resource Management.Understanding Section 125 cafeteria plans.Cornell Law School, Legal Information Institute.29 CFR § 2590.701-6 - special enrollment periods.Internal Revenue Service, Employee Benefits Security Administration, Department of Health and Human Services.Short-term, limited-duration insurance.Fed Regist. 2018;83;38212-38243.Cornell Law School, Legal Information Institute.26 CFR § 1.125-4 - permitted election changes.Internal Revenue Service.Notice 2014-55. Additional permitted election changes for health coverage under § 125 cafeteria plans.
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kaiser Family Foundation.Health insurance coverage of the total population.Department of the Treasury.Tax treatment of cafeteria plans.Society for Human Resource Management.Understanding Section 125 cafeteria plans.Cornell Law School, Legal Information Institute.29 CFR § 2590.701-6 - special enrollment periods.Internal Revenue Service, Employee Benefits Security Administration, Department of Health and Human Services.Short-term, limited-duration insurance.Fed Regist. 2018;83;38212-38243.Cornell Law School, Legal Information Institute.26 CFR § 1.125-4 - permitted election changes.Internal Revenue Service.Notice 2014-55. Additional permitted election changes for health coverage under § 125 cafeteria plans.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Kaiser Family Foundation.Health insurance coverage of the total population.Department of the Treasury.Tax treatment of cafeteria plans.Society for Human Resource Management.Understanding Section 125 cafeteria plans.Cornell Law School, Legal Information Institute.29 CFR § 2590.701-6 - special enrollment periods.Internal Revenue Service, Employee Benefits Security Administration, Department of Health and Human Services.Short-term, limited-duration insurance.Fed Regist. 2018;83;38212-38243.Cornell Law School, Legal Information Institute.26 CFR § 1.125-4 - permitted election changes.Internal Revenue Service.Notice 2014-55. Additional permitted election changes for health coverage under § 125 cafeteria plans.
Kaiser Family Foundation.Health insurance coverage of the total population.
Department of the Treasury.Tax treatment of cafeteria plans.
Society for Human Resource Management.Understanding Section 125 cafeteria plans.
Cornell Law School, Legal Information Institute.29 CFR § 2590.701-6 - special enrollment periods.
Internal Revenue Service, Employee Benefits Security Administration, Department of Health and Human Services.Short-term, limited-duration insurance.Fed Regist. 2018;83;38212-38243.
Cornell Law School, Legal Information Institute.26 CFR § 1.125-4 - permitted election changes.
Internal Revenue Service.Notice 2014-55. Additional permitted election changes for health coverage under § 125 cafeteria plans.
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