Employers must define eligibility rules and follow federal timelines for enrolling employees and dependents in group health plans. This section answers common questions about waiting periods, special enrollment rights, dependent eligibility, and how to handle rehires, midyear changes, or missed deadlines.
Enrollment and Eligibility Topics
Waiting Periods
Under the ACA, employers can’t impose waiting periods longer than 90 calendar days. These FAQs explain how to stay compliant and when coverage must start.
Eligibility Classes
Employers can set eligibility rules (like full-time status), but they must apply them consistently and avoid discrimination. These FAQs explain how to define and document eligibility properly.
Open Enrollment Periods (OEPs)
Each year, employers must give eligible employees a chance to enroll, change plans, or add dependents during the open enrollment window. These FAQs explain how OEPs work and what employers need to communicate.
Special Enrollment Periods (SEPs)
Certain life events (like marriage, birth, or loss of other coverage) trigger a midyear enrollment right. These FAQs explain when SEPs apply, how long employees have to enroll, and what documentation may be required.
HIPAA Special Enrollment Rights
HIPAA requires plans to allow midyear enrollment after certain events. These FAQs cover which rights are required by law and how they relate to SEPs and Marketplace rules.
Effective Date Rules
Coverage start dates depend on the type of enrollment (initial, OEP, or SEP). These FAQs explain how to apply the correct effective date under ACA and ERISA guidelines.
Waivers and Declinations
If an employee waives coverage, employers should collect a signed form. These FAQs explain what to include and why proper documentation matters.
Rehires and Reinstatements
If an employee returns to work, employers must determine whether to restart the waiting period or reinstate coverage. These FAQs walk through the 13-week break-in-service rule and other scenarios.
Dependents and Domestic Partners
Employers must define who qualifies as a dependent and determine whether to offer coverage to domestic partners. These FAQs explain common policies and compliance considerations.
Life Events
Marriage, divorce, birth, and other events that open a special enrollment period.
Coordination of Benefits
How payment works when you are covered by two health plans.