So let’s talk about open enrollment, that one time of year when everyone in HR wants to scream, and half the employees treat it like it’s optional (spoiler: it’s not).
It’s the small window where employees can actually make real decisions about their benefits, things like health insurance, dental plans, vision coverage, and all that grown-up stuff we pretend we understand but usually click through without reading.
To dive deeper into the difference between fringe benefits and perquisites, read our blog.
For employers and HR, open enrollment is not just a routine task, it’s a legal deadline, a financial deadline, and a “don’t mess this up or someone’s going without coverage” deadline. Miss it, and someone ends up panicking in January when they find out their old plan expired and the new one never kicked in, because, guess what, they never enrolled.
This blog breaks down what open enrollment is, what happens when an employee misses it, and how you should respond when they come running to HR saying, “Wait, I didn’t know it was over.”
What Is Open Enrollment?
It’s the annual period, usually a couple of weeks, when employees can make changes to their benefits. Sign up. Drop a plan. Add a dependent. Switch providers. It’s the only time to do it unless they’ve had a Qualifying Life Event (QLE), like getting married, having a kid, or losing other coverage.
QLEs are those major life events that shake things up, happy or sad, and during these times, people are often overwhelmed. Planning a wedding, dealing with a death, or adjusting to a new baby doesn’t exactly leave you time to think about insurance forms. And that’s understandable.
Now, as for open enrollment deadlines, they’re usually clearly communicated through multiple channels. Employees get emails, messages, sometimes even physical notices. Portal access details are shared ahead of time, and the dates are right there, usually in bold, underlined, or flashing red. Many companies even go the extra mile with Zoom sessions or Q&As to make sure everyone understands what’s at stake.
But no matter how much communication goes out, emails, reminders, countdowns, someone always misses it. Every. Single. Time.
What If an Employee Misses It?
Here’s the simple answer to the above question: they’re out of luck until next year, unless they qualify for a QLE.
Missing open enrollment means:
- No new enrollment if they weren’t already covered
- No changes to existing plans (can’t switch or drop)
- No adding a spouse or kid unless there’s a triggering event
And no, “I forgot,” “I was on vacation,” or “I thought HR would remind me” don’t count as qualifying events. That’s just… unfortunate planning, maybe a mistake, maybe carelessness, but definitely not a valid excuse.
So if they missed the deadline and haven’t had a QLE? They’re locked into whatever coverage they had before, or stuck with nothing at all if they didn’t have any. That includes health, dental, vision, everything. Technically, there’s nothing we can do at that point, since providers have their own rules and regulations, which can only be waived in the case of a valid QLE.
What Qualifies as a Life Event?
Only specific situations allow changes outside open enrollment. These include:
- Marriage or divorce
- Birth or adoption of a child
- Loss of other health coverage (like a spouse losing their job or aging out of parental coverage)
- Death of someone covered under the plan
- Change in dependent status (e.g., a child turning 26 and losing eligibility)
- A significant change in your or your spouse’s employment status (like switching from part-time to full-time, or vice versa)
- Moving to a new ZIP code or county that affects your plan options
- A change in income that affects your eligibility for premium subsidies or Medicaid
- Gaining U.S. citizenship or lawful presence
- A legal separation or annulment
- Court orders requiring coverage (like in child custody situations)
These events usually allow a 30-day window (sometimes 60, depending on the provider) to report the change and update benefits. Outside of that? No dice.
How to Respond When Someone Misses the Deadline
Let’s be honest: dealing with this is awkward. But here’s how to handle it like a pro.
So yes, mistakes happen. People forget. They get distracted. But that doesn’t mean the rules suddenly bend to make room for that. And honestly, they can’t, because the control isn’t even with HR. It’s with the insurance provider. These are legal and contractual terms. We don’t make the rules, and we definitely can’t override them.
But if someone misses open enrollment, here’s how you should respond:
1. Be Clear
Start with the facts. Calmly explain that open enrollment is closed and no changes can be made unless they’ve had a valid QLE. There’s no hidden shortcut, no backdoor, and no “HR magic wand” that’ll fix it. You can’t override the system, and it’s better if they hear it straight.
2. Ask Question
Sometimes the employee actually does have a valid QLE but doesn’t realize it qualifies. Don’t just shut the door, ask questions. “Did your spouse lose their job?” “Did you move?” “Was there a major family change recently?” If the answer’s yes and the event fits the QLE list, move ahead with processing. If not, stay firm.
3. Point to What’s Still Possible
If health coverage is off the table, that doesn’t mean all options are gone. Depending on your setup, they might still be able to enroll in voluntary benefits like accident insurance, life coverage, or EAP services. Also point them toward public options, some may qualify for Medicaid or ACA marketplace plans. The goal here is to help them explore any remaining avenues, not leave them stranded.
4. Document Everything
Keep records. Every conversation, every email, every question they asked and what you told them, write it down. It protects you, and it helps you spot patterns. If five people from the same team all claim they “had no idea” there was a deadline, well… now you know something’s off. Documentation also helps when employees try to claim they were never informed, you’ll have proof you were crystal clear.
5. Audit Your Communication Strategy
If one person misses the deadline, that’s on them. But if it’s a bunch of people? That’s a you problem. Go back and review your communication. Were the emails easy to understand? Did you repeat the deadline? Was the portal link buried under a bunch of text? Could someone who barely checks their email still catch the key info? You’re not here to babysit, but your messaging should be so obvious it’s basically foolproof.
Conclusion
Open enrollment isn’t just another checkbox on the HR to-do list. It’s serious business, with real consequences if ignored. And while it’s frustrating (for everyone involved) when an employee misses the deadline, the response doesn’t have to be cold or chaotic.
What matters is staying clear, consistent, and professional, while also being human about it. Mistakes happen. People get overwhelmed. Life is messy. But part of our job is knowing where the boundaries are, and gently but firmly holding the line.
At the same time, every missed enrollment is also a feedback opportunity. If multiple people didn’t get the message, maybe the message needs fixing. If everyone’s confused by the portal, maybe it’s time to simplify the process. The goal isn’t just to enforce rules; it’s to make sure those rules are visible, understood, and followed. Human resources training can help teams deliver these messages more clearly and empathetically.Because here’s the truth: the best way to handle missed enrollments… is to stop them from happening in the first place. So yes, open enrollment can feel like herding cats. But a little clarity, a lot of prep, and some smart communication can save everyone a headache, and maybe even a few panicked January emails.
