A Participant Missed the Enrollment Deadline or Did They?

We frequently receive questions from clients about what to do when an employee misses the window to enroll their new spouse or child.   Often the employee has a compelling reason and the employer wants to help, because if they didn’t, they wouldn’t be calling me, they would just deny the enrollment as late.   In the past few months, I have received a few of these calls and on each occasion the client was surprised when I told them, the employee didn’t miss their deadline.   So this post is a reminder that the DOL’s COVID relief for participants is still in effect.

In May of 2020 shortly after the pandemic started (when most of us still thought COVID was only going to last a few months), the DOL issued guidance that extended the deadlines for a number of benefit provisions in order to provide participants relief due to the pandemic.   One of the deadlines that was tolled was the HIPAA special enrollment deadline.  The normal deadline under HIPAA to make an enrollment change due to special enrollment is 30 days.  However, this COVID relief provided that a participant’s deadline would toll until 60 days following the end of the National Emergency.   In 2021, the DOL clarified this relief to provide that the tolling period is actually the earlier of 1 year or 60 days following the end of the National Emergency.   Last month, President Biden extended the National Emergency again, so this relief is still applicable.

Under this COVID relief, an employee who had a special enrollment event would have the normal 30 days plus one year to enroll.  Therefore, any employee who got married, had a baby, or lost other group health plan coverage in the last 13 months is still in their window to enroll themselves and/or their dependents in the plan.   Most employers have not experienced employees coming forward to make changes months later.  You are much more likely to have the employee who comes forward on day 35 or 45 that just forgot to make the change or didn’t know the deadline.  Currently, you still must allow that employee to make the enrollment change as their enrollment would be timely even if the reason they missed the deadline had nothing to do with COVID.

The other deadlines that were extended by this relief include the COBRA election and payment time frames and all ERISA claims deadlines (including FSA submission periods).    If you have questions on this relief, please reach out to any Graydon employee benefits attorney.