When Can Your Employees Make Mid-Year Changes to their Group Health Policy?

When getting a Group health insurance policy companies understand that people are going to sign up for what they need now, and employees’ needs can often change. Maybe there is a new baby on the way so they want to increase their coverage, maybe they just realize that they are covering a lot of stuff that they don’t need. This leaves many companies and employees wondering when and how they can make additional changes to their policy. 

The Standards

The standard is that each year there is one open enrollment period, and this is when people in a group insurance policy can make adjustments to their plan.. However, there are special cases that qualify your staff for a Special Enrollment Period or SEP

automotive worker fixing a car as employee
Any industry employee can opt into a SEP. It just depends on why.

Group Health SEPs are available if your employee has a qualifying event. Here are the most common qualifying events:

  • Death
  • Marriage
  • Divorce
  • A new addition (child) to the family

The qualifying period starts when the event happens and only extends 60 days. Otherwise, it will not be considered eligible for a SEP. This means if someone gets married June 1st, they have 60 days from that date to change their coverage, after that they will have to wait until that year’s open enrollment period.

Other Qualifying Events

Another qualifying event is loss of health insurance. This could happen when someone is covered under their parent’s plan and ages out if they are covered under their spouses’ plan and they lose that plan, or several other reasons. If this happens your employee has 60 days from the date that their current insurance plan ends to get new coverage or change their coverage through you.

Employee writing on a white board with a blue pen
Qualifying events are special circumstances that allow entrance to a SEP. These can be as simple as moving.

A change in residence also gives entitles an employee to a SEP. These mid-year changes are:

  • Moving to a shelter
  • Transitioning as a seasonal worker
  • Going to a new location for school
  • Entering the US
  • Moving to a new home

In this instance, the employee must have health insurance before then to qualify. Also, a small move like an extended vacation or sabbatical does not allow for a SEP.

Additional circumstances that might qualify for a SEP:

  • Starting service in an organization like Service Year or Americorps
  • Leaving incarceration
  • Becoming a member of a First Nationer tribe
  • Becoming a US citizen

The last thing to keep in mind is if any of these qualifying factors do arise, employees will need to have the correct information to verify an SEP. They all require documentation, but those papers are easily found. For example, a birth certificate for a child is mandatory, this is a valid proof of documentation for the verification process.

business owner speaking with her employees about special enrollment periods
Talk to your employees about these periods. It can be a confusing time, and they will appreciate both your knowledge and guidance.

If you find yourself looking for a new, or first group health insurance plan, EZ.Insure offers solutions. Your agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing replies@ez.insure, or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.




About The Author:
Cassandra Love

With over a decade of helpful content experience Cassandra has dedicated her career to making sure people have access to relevant, easy to understand, and valuable information. After realizing a huge knowledge gap Cassandra spent years researching and working with health insurance companies to create accessible guides and articles to walk anyone through every aspect of the insurance process.

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