Group Health Enrollment
1. Employer Chooses a Plan and Sets Up Enrollment
Plan Selection: The employer works with brokers or insurance carriers to select the best group health plan that fits the company’s needs and budget.
Determine Eligibility: Employers decide which employees are eligible for the plan. Typically, full-time employees are eligible, but the employer can extend coverage to part-time workers, retirees, and dependents if they choose.
Offer Details: Employers will provide employees with details about available plans, including premiums, coverage options (e.g., PPO, HMO, etc.), and the benefits they cover (e.g., dental, vision, mental health).
2. Employer Communicates Plan Information
Employers must ensure employees understand their options, deadlines, and how the process works. Communication may include:
Benefit meetings to explain the details of the plans
Written benefit guides or brochures explaining coverage options
Email reminders about enrollment deadlines
3. Employee Enrollment Process
Employees are provided with information on how to sign up for health insurance. This may be done online through the employer’s chosen insurance carrier or via a paper enrollment form.
Employee Data Needed: Information such as name, address, Social Security number, spouse and dependent info, and medical history may be required for enrollment.
Choose Plan Options: Employees select the health insurance plan that works best for them based on:
Coverage level (e.g., bronze, silver, gold)
Monthly premiums
Deductibles, co-pays, and out-of-pocket maximums
Add Dependents: Employees can often add their spouse and children to their health plan, depending on eligibility.
4. Special Enrollment Periods (SEPs)
Regular Enrollment Period: Employees typically have a set open enrollment period each year when they can enroll in or make changes to their health insurance.
Special Enrollment Periods (SEPs): Employees may qualify for a special enrollment period if they experience a qualifying life event (QLE), such as:
Marriage or divorce
Birth or adoption of a child
Moving to a new location
Loss of other health coverage (e.g., spouse’s insurance)
Becoming eligible for government assistance
During an SEP, employees can sign up for coverage or make changes to their existing coverage outside the regular open enrollment period.
5. Finalizing Enrollment
Verification: Once employees submit their enrollment forms or online applications, the employer’s HR department or insurance broker will verify the information.
Confirmation: Employees receive confirmation of their enrollment, along with an insurance ID card, coverage details, and information on how to use the benefits.