Open Enrollment Compliance Checklist

Open enrollment can be an exciting yet confusing time for employees. While they’re busy thinking about what they’ll need to prepare for the upcoming year, HR professionals should take the time to ensure open enrollment compliance by reviewing all plan documents, understanding upcoming changes, and deciding which notices should be included in distributed open enrollment materials. 

If you’re looking to make a compliant open enrollment a positive experience for the entire workforce, follow this open enrollment compliance checklist that covers what you need to be doing now.

Pre-Enrollment Period

The pre-enrollment period is about getting the word out about open enrollment and answering employees’ questions. You should expect this time to be hectic, as employees need to make sure they’re clear on what they can expect for benefits in the following year. 

As you might expect, the HR department is likely to receive a lot of phone calls, emails, and visits during this time, so it’s important that you and your team are well-prepared for it. You can get ready by taking the following steps:

  • Gather information on legislative changes to healthcare laws and understand how this might affect your employees in the future
  • If you haven’t already, integrate online enrollment features into your existing website, HRIS, or company intranet
  • Plan and execute your mass information campaigns, such as mailers, emails, or intranet posts
  • Meet with employees one-on-one or in groups to review coverage options, provide essential information, and answer any questions
  • Create a “frequently asked questions” resource to hand out to employees, as well as post in prominent places around the office or intranet

The HR team should remain as available as possible during this time, maintaining an open-door policy for all employees. For compliance purposes, you should also do the following:

These checklist items are non-negotiable, as they are what keep you away from ACA-related fines and penalties.

During Open Enrollment

Your employees are entitled to receive specific information during this period. Make sure you provide them with the following: 

  • A complete schedule for the open enrollment period, including start and end dates
  • A statement of their current coverage
  • A comprehensive explanation of plan and premium changes
  • Plan summaries
  • Open enrollment forms and a booklet that includes general information and insurer contact information; if open enrollment is handled in a platform, ensure all employees have access to enroll

You will also want to ensure you comply with all ACA disclosure requirements. You may need to see to it that employees are given some of all of the following:

  • Summary of benefits and coverage
  • Grandfathered plan notice and notice of patient protections
  • COBRA notice
  • Notice of HIPAA special enrollment rights
  • Annual CHIPRA notice
  • Women’s Health & Cancer Rights Act (WHCRA) notice
  • Newborns’ and Mothers’ Health Protection Act (NMHPA) notice
  • Medicare Part D notices
  • HIPAA privacy notices
  • Summary plan description
  • Michelle’s Law notice

Make sure that you send these disclosures and notices to the appropriate party within a reasonable time frame. Your employees have rights and need to be able to make informed decisions about their healthcare. 

After Open Enrollment

Once open enrollment ends, the first thing you need to do is ensure you check every open enrollment form or online enrollment submission has been completed by employees. As you go through each form, you’ll want to:

  • Look for any information that may have been incorrectly filled out
  • Search for sections that are incomplete or where information is missing altogether. Employee forms will not be properly processed without all necessary information, and this could result in delays or interruptions in care 
  • Once you have finished looking over the forms, make sure to submit all forms to the correct carrier; if employees enrolled through a platform, you or your broker should ensure the information has been transmitted to the carrier

After all forms are submitted to and processed by the carrier, you will need to follow up with each employee.

  • Ensure they’ve received their ID cards. 
  • During your follow-up phase, make sure to reach out to ask employees whether they have questions or need anything clarified about their benefits 

Finally, the post-enrollment period is also a good time to review any healthcare provisions that may affect your employees and ensure that you are in total compliance to avoid any possible penalties down the road.

Keep Your Employees Top of Mind with Open Enrollment Compliance

As you and your colleagues embark on yet another open enrollment period, it’s vital that you continue to keep your employees top of mind through open enrollment compliance – this protects them and you. You’ll want to ensure that the information you provide is accurate and up-to-date so there are no issues or delays in your employees and their loved ones receiving the care they need. 

Not only does this provide an opportunity to build trust and loyalty with employees, but it can also help improve their engagement and efficiency at work. A healthy and well-cared-for workforce is a productive workforce. 

Ensuring open enrollment compliance and processes to help things smoothly during this hectic is just one more thing HR professionals can do to help their company get to the next level.