What to Do When an Employee Misses Open Enrollment 

Open enrollment gives employees an opportunity to review their benefits and select coverage for the upcoming plan year. But even with reminders and clear deadlines, some employees may forget to submit their elections or realize they missed the deadline after enrollment closes. 

For small business owners, a missed enrollment deadline can lead to difficult conversations, especially when an employee needs health insurance or wants to change coverage. While employers generally cannot reopen enrollment for one employee just because they missed the deadline, exceptions may apply depending on the employee’s circumstances and the benefit plan’s terms. 

Knowing how to respond, communicate options, and strengthen your enrollment process can help employers handle these situations consistently while supporting their workforce. 

Key Takeaways 

• Employees who miss open enrollment generally must wait until the next enrollment period to make changes unless an eligible exception applies. 
• Certain qualifying life events may allow employees to enroll in or change coverage outside the regular enrollment window. 
• Employers should review plan documents and consult their benefits administrator before making enrollment decisions. 
• Clear deadlines, documented communications, and accessible enrollment resources can help prevent missed elections. 
• Reviewing enrollment activity and employee questions after each cycle can help businesses improve their benefits administration process. 

What happens when an employee misses open enrollment? 

An employee who misses the open enrollment deadline generally cannot make new benefit elections until the next enrollment period unless they qualify for a special enrollment opportunity or another exception applies. 

The outcome depends on the employee’s existing coverage, the benefit type, and the plan’s rules. 

For example, an employee who does not enroll in employer-sponsored health insurance may have to wait until the next annual enrollment period to obtain coverage through the employer. An employee who already has coverage may be unable to change plans, add dependents, or adjust certain elections until the next eligible enrollment opportunity. 

Other benefits, including flexible spending accounts (FSAs) and health savings accounts (HSAs), may have different election and contribution rules. Employers should not assume every benefit follows the same process. 

What should employers do when an employee misses the deadline? 

Employers should respond promptly, review the applicable plan rules, document the situation, and explain the employee’s available options without promising an exception. 

A consistent response helps employers address the employee’s concern while avoiding inaccurate information or inconsistent treatment. 

1. Confirm the employee’s enrollment status 

Determine whether the employee completed any part of the enrollment process and whether their existing elections will continue into the next plan year. 

Review the employee’s enrollment record, any submitted elections or waivers, and the communications they received about the deadline. 

This can clarify whether the employee missed enrollment entirely, failed to complete a required step, or submitted an election that wasn’t processed correctly. Those situations may require different follow-ups. 

2. Review the plan’s enrollment rules 

Check the plan documents, enrollment materials, and applicable deadlines before deciding what happens next. 

Confirm whether the plan allows for any corrections, what procedures apply to late submissions, and whether a qualifying event could provide another opportunity to enroll. 

If the employee believes they completed enrollment but their election is missing, contact the benefits administrator or carrier to investigate before treating the issue as a missed deadline. 

3. Explain the employee’s options 

Once the available options are confirmed, explain them in straightforward language. 

If the employee cannot enroll outside the regular period, let them know when the next enrollment opportunity will occur and whether any other coverage options may be available. If they may qualify for a special enrollment period, explain the steps for verifying eligibility and submitting a request. 

Avoid guaranteeing coverage dates or making exceptions without authorization. Clear communication can help employees make informed decisions while reducing confusion and repeated follow-up. 

4. Document the conversation 

Keep an appropriate record of the employee’s question, the information reviewed, the guidance provided, and any follow-up actions. 

Documentation helps HR teams maintain consistent practices, resolve administrative discrepancies, and identify recurring enrollment issues. Handle benefits information in accordance with applicable privacy and recordkeeping requirements. 

Can an employee enroll after missing open enrollment? 

An employee may be able to enroll after the deadline if they qualify for a special enrollment period or another exception permitted by the plan. Eligibility depends on the circumstances and the applicable rules. 

Employers should distinguish between an employee who simply forgot to enroll and one whose circumstances have changed in a way that may create special enrollment rights. 

What is a special enrollment period? 

A special enrollment period allows eligible employees or dependents to enroll in certain group health plans outside the regular enrollment window after specific qualifying events. 

Under federal rules, qualifying circumstances can include: 

• Loss of other health coverage: An employee or dependent loses eligibility for other health coverage, such as coverage through a spouse’s employer. 
• Marriage: An eligible employee or dependent experiences a marriage that triggers special enrollment rights. 
• Birth, adoption, or placement for adoption: An employee gains a new dependent through one of these events. 
• Certain Medicaid or CHIP changes: Special enrollment rights may apply when an employee or dependent loses Medicaid or Children’s Health Insurance Program (CHIP) coverage or becomes eligible for certain premium assistance. 

For many federally protected group health plan special enrollment events, the request must be made within 30 days. Some Medicaid- and CHIP-related events allow a 60-day request period. Other rules may apply depending on the event and coverage involved. 

Employers should verify the applicable deadline and requirements rather than assume every life change qualifies. The U.S. Department of Labor provides additional guidance on special enrollment rights. 

What if the employee simply forgot to enroll? 

Forgetting a deadline generally does not, by itself, create a qualifying life event or a right to enroll late. 

Employers should explain this distinction respectfully while checking whether the employee’s circumstances provide another legitimate enrollment opportunity. If no exception applies, the employee may need to wait until the next enrollment period for employer-sponsored coverage. 

Employees who need coverage sooner can also investigate individual health insurance options and eligibility for a Marketplace special enrollment period through HealthCare.gov. Eligibility depends on the applicable Marketplace rules, not simply on missing an employer’s deadline. 

Should employers make an exception for an employee who missed open enrollment? 

Employers should not reopen enrollment or make an exception without confirming that the plan and applicable requirements permit it. 

It can be tempting to make an exception when an employee has a compelling reason for missing the deadline. However, an informal exception may conflict with plan rules, carrier procedures, or requirements for administering benefits consistently. 

Before taking action, employers should: 

• Review the plan documents and applicable enrollment procedures. 
• Confirm whether the situation qualifies for a permitted exception or correction. 
• Consult the benefits administrator, broker, or plan administrator as appropriate. 
• Determine whether any documentation or formal approval is required. 
• Communicate the decision and next steps to the employee. 

Employers should also investigate whether an administrative error contributed to the missed enrollment. For example, if an employee reports submitting an election before the deadline, the business should review the available records rather than automatically attributing the issue to the employee. 

How can small businesses prevent missed open enrollment deadlines? 

The most effective way to reduce missed enrollments is to make the process clear, accessible, and easy to complete before the deadline arrives. 

Open enrollment can be particularly challenging for small businesses where HR responsibilities are handled alongside payroll, hiring, and daily operations. A structured process helps employees understand their responsibilities and gives employers more time to answer questions. 

Communicate before, during, and near the end of enrollment 

Do not rely on a single announcement. Introduce the enrollment period early, explain the deadline, and send reminders as the closing date approaches. 

Communications should clearly identify: 

• The start and end dates of the enrollment period. 
• The benefits employees can review or select. 
• Any required actions, including actively submitting elections or waiving coverage. 
• Where employees can access plan information and enrollment instructions. 
• Who employees should contact for assistance. 

Include the time and time zone of the deadline when relevant, particularly if employees work across multiple locations. 

Make enrollment information easy to understand 

Benefits materials should help employees understand both their choices and the actions required to complete enrollment. 

Use plain language to explain plan options, employee contributions, dependent eligibility, and important deadlines. Offer opportunities for employees to ask questions before the enrollment period closes. 

For employees who do not regularly work at a computer, consider additional communication methods such as team meetings, printed notices, or manager-led reminders. 

Track completion, not just communication 

Sending an email does not necessarily mean an employee has completed enrollment. 

Where your benefits platform allows it, monitor enrollment progress and identify eligible employees whose elections remain incomplete. Follow up with those employees before the deadline, while respecting applicable privacy requirements. 

Establish a clear process for waiving coverage. 

If employees can decline offered benefits, explain how to document that decision and whether any affirmative action is required under the plan. 

Maintain appropriate records of elections and waivers, and confirm that employees understand the difference between actively declining coverage and leaving an enrollment process incomplete. 

Review what went wrong after enrollment closes. 

Treat missed elections as an opportunity to evaluate the process, not just an individual employee’s mistake. 

Consider whether employees received enough notice, whether instructions were easy to follow, whether the enrollment platform created confusion, and whether managers knew how to direct benefits questions. 

What should employers do after open enrollment ends? 

Employers should confirm that elections were processed correctly, communicate next steps, and review enrollment records before new coverage takes effect. 

Closing the enrollment window is not the final step. Businesses should reconcile submitted elections with their benefits administration records and promptly address discrepancies. 

As part of this review, employers should: 

• Confirm that elections and waivers were recorded accurately. 
• Verify dependent information and other required enrollment details. 
• Review employee contribution amounts and applicable payroll deductions. 
• Confirm that approved changes are reflected in the appropriate benefits systems. 
• Follow up on unresolved discrepancies with the benefits administrator or carrier. 
• Retain enrollment documentation according to applicable requirements. 

This review can help identify issues before employees begin using their new coverage or notice unexpected payroll deductions. 

How can GMS help businesses manage employee benefits? 

For small and growing businesses, open enrollment responsibilities can become difficult to manage alongside everyday HR needs. 

Group Management Services (GMS) helps businesses manage HR administration and employee benefits through a range of services designed to simplify the administrative side of employment. Contact GMS today to improve enrollment coordination, keep employee information organized, and spend less time on administrative tasks.