Understanding Enrollment Types
Current: Enrollments are Active OR Ended and have NOT been replaced with another enrollment record. Enrollment records created outside of the open enrollment window (New Hire, Newly Eligible, Life Events, Modify Current Enrollments) are set to current.
Open: Enrollments have been processed through an open enrollment window. Open enrollment records will move into a current status when the open enrollment window is closed out.
Prior: Enrollments are historical records which HAVE been replaced by a more recent enrollment record.
Pending: An enrollment record that is pending HR approval or employee agreement due to company settings. When enrollment settings are configured to "Pending Until HR Approves" or "Pending Until All Completed", new hire enrollments will remain in a pending status until HR approves or employee completes their enrollment by agreeing to their Enrollment Summary. Once a pending record is approved, it will move into a current status.
Note: In the Row-Based Ad Hoc report options, the setting of Default under “What type of enrollment” will pull all 4 enrollment types. This can be useful to capture enrollments for both new hire and open enrollment records in one report as the open enrollment reports are designed to only pull enrollments in an open status.
Two Active Open Enrollment Windows
EN can only support ONE active open enrollment window at a time. The open enrollment window is designed to manage plans with SAME renewal dates. Our open enrollment process works best when all plans are on the same renewal schedule. We understand that may not always be the case.
If the group has multiple plan start dates they should create two OE windows. Let’s say our company has health plans that are effective 12/1/17 and also cafeteria plans that are effective 1/1/18. Our recommendation is to first create an open enrollment window for the 12/1/17 health plans. Once employees have completed their enrollment elections for the health plans, we should close out the 12/1/17 open enrollment window. At that point, we can open another open enrollment window for the 1/1/18 cafeteria plans, for the employees to make their elections.
Warning: In the example above, if the company decided to include the 1/1/18 cafeteria plans in the 12/1/17 open enrollment window, the cafeteria enrollments would be created with an effective date of 12/1/17. Which is wrong as the cafeteria plans do not begin until 1/1/18.
Warning: Note, that if your company offers HSA/HRA plans in addition to Medical and Limited Purpose FSA plans, these benefits must be shows in the same enrollment window in order for the system to properly capture eligibility. We have built logic into these benefit types so that an employee cannot enroll in a HSA/HRA and Medical FSA at the same time. Similarly, employees cannot enroll in a Limited Purpose FSA unless they have a HSA/HRA enrollment record. In order for this logic to work as expected, employees must make their selections in the same window."
Tip!: With 2 separate open enrollment windows, communicate the process to the employees so they understand how the plans will display.
My New Hire Employees Cannot See the Plans from Open Enrollment
Employees can ONLY enroll in a future dated plan if an open enrollment window is active at that time. We usually see this obstacle become an issue when open enrollment windows are closed prior to the plan effective date.
For example, if the open enrollment plans are effective 10/1 and the group closes out OE prior to 10/1 (let’s say 9/20). New hires will not see the plans in their new hire window from 9/20 to 10/1 as the open enrollment window is not active due to the close. After 10/1 the plans will display again for new hires. OE should not be closed out until the effective date of the plans (10/1 in our example). Employee Navigator will automatically schedule the closeout on the latter of (1) the OE Effective Date or (2) the Administration Ends date.
Do I Have to Close Open Enrollment to See the Open Enrollment Reports?
Reports can be run to capture open enrollment elections WITHOUT closing the open enrollment window. A common misunderstanding is that must close out OE in order to pull OE reports. That is incorrect. Open enrollment reports can be run once the Ending Plans have been mapped
For more information on reporting, take a look at this article: Open Enrollment Reporting
New Hire Employees Are Not Pulling on the Open Enrollment Reports
Enrolling through a new hire window always creates a CURRENT enrollment record. Our open enrollment reports are designed to capture enrollments in an OPEN status. Current enrollment records are not captured in the open enrollment reports. If the group is looking for a report for both NH and OE elections, they should use the Row-Based Ad Hoc reports.
Article: Open Enrollment Reporting
Can I Import Enrollment into Open Enrollment?
Importing enrollments always creates CURRENT enrollment records. Therefore, we are not able to import enrollments into an OPEN status.
Ending Plans Tab
The Ending Plans tab will display any plan ending on the last date before your open enrollment effective date. The actions available under the tab only apply for Employees that did not make their elections in EN during the open enrollment window. If our group has 100 employees total; Let’s say that 80 employees have completed their elections in EN and 20 employees have not. The Ending Plans tab is concerned with the 20 employees that have not completed OE. What should happen to their enrollments for the next year?
For example, if an employee has Employee + Family coverage in the 2017 Medical plan, what should happen to their enrollment for 2018, if the employee does not log into EN and make their elections? We provide you with 3 options:
Passive Enroll: This process will transfer the current enrollment into the new plan. You or the group must match the current plans to the new renewal plans for EN to know how to proceed.
- From our example, EN will move the 2017 Medical plan Employee + Family coverage into the selected plan (2018 Medical plan)
- If an employee makes a change to the election after the Passive Enroll option was selected, the system will overwrite the Passive Enroll and update the enrollment with the employee’s new adjustment.
- Alternatively, a Passive Enroll will not overwrite an election that was actively selected by a user prior to the Passive Enrollment mapping.
Warning: If the EE is not eligible for the designated replacement plan, the EE's coverage will be dropped effective the last day of the ending plan, and the EE will not be enrolled in the replacement plan for the upcoming plan year. EN will not passively enroll an EE into an ineligible plan.
Passive Decline: This process will end the current coverage for an individual not making an open enrollments election. Along with ending the coverage for 2017, it will also copy the current enrollment and apply a declination record with the renewal dates.
- From our example, EN will end the 2017 Medical plan and copy the 2017 record to create a declination record for the medical benefit.
- New 2018 record will state:
- 2017 Medical Plan - Current - Decline - Start date 1/1/18 - End date 12/31/17
- New 2018 record will state:
- If an employee decides to elect medical coverage after the Passive Decline option was applied, the system will overwrite the Passive Decline and update the enrollment with the employee’s new adjustment.
End All Elections: With this process, the plan is not replaced with a new plan. The system will end coverage for an individual not making an open enrollment election.
- From our example, EN will end the 2017 Medical plan. No 2018 medical benefit record will be created.
- If an employee decides to elect medical coverage after the End All Elections option was applied, the system will create a 2018 enrollment record with the employee’s new adjustment.
Tip!: We recommend discussing the options, under Ending Plans, with the group in order to determine how to proceed. The process should also be communicated with the employees so they are aware of the consequences of not actively making elections in EN.
Tip!: We recommend using the either the Passive Enroll or End All Elections options. We recommend not using the Passive Decline option as it is still a work in progress. For updates, we recommend subscribing to our Product News and Updates.
Some Recommendations for the Client
- Plan ahead! Talk to the client and the carriers to have everything sorted out with enough time to build and test.
- Sync up plan renewal dates whenever possible to avoid multiple open enrollment windows.
- Shortened open enrollment window for Employees are generally more effective than longer windows.
- Communicate deadlines to client. Let them know what is required in EN as far as gathering data, plan builds and reporting after open enrollment.
- Create demo employees and TEST, TEST and TEST! Testing is the best way to stay ahead of trouble.
- Encourage blackout on demographic changes that are tied to eligibility.
- Eligibility changes during open enrollment can be confusing and create multiple windows. Also, if an employee becomes ineligible, they may have already enrolled in plans during open enrollment.
What Other Materials Can I Review to Prepare for Open Enrollment?
Open Enrollment Bootcamp Webinar - The 2016 recorded version is on our support site. More to come shortly!
Open Enrollment Reporting- Reviews all OE reporting options to help you capture the information you want.
Ask the community - In the Community page on our Help Center. If you are unsure about a response, run it by other EN users. The Community page can offer advice from other users and their best practices.