At about the same time every year, people have the choice of whether to renew their current health insurance plan or switch to a new one. What options they will have, and when this period falls, depends on your work arrangements and the company you work for.

Regardless of when this period occurs and what your plan choices are, it’s referred to as the open enrollment period. As mentioned, it happens once a year, giving everyone who is eligible for a plan to make any necessary changes.

One of the biggest questions that employers and health benefits brokers receive is whether you can change your plan mid-year. It’s not a straightforward yes-or-no answer, so we’ll provide you with a guide to changing health plans mid-year below so you can understand all the ins and outs.

Can Employers Change Health Plans Mid-Year?

Generally speaking, employers will make changes to the health insurance plans they offer their employees before the start of their plan year. Doing so will give workers sufficient time to be able to decide what is best for them during the open enrollment period.

That being said, employers also typically have the ability to make changes to their health plan whenever they want. Doing so might not be a good idea, though, as it can greatly impact participation by employees.

There also might be penalties for making such changes, or limitations as to what changes can be made.

What Rules Must Employers Follow to Change Health Plans Mid-Year?

Employers must always be in compliance with health benefits regulations if they want to avoid penalties. If employers want to make changes mid-year, then, there are three things they have to keep in mind.

First, they must create new ERISA plan documents and distribute these to all employees that contain the changes that are being made. This must be done within 210 days following the start of the plan year.

Second, employees must be given at least 60 days’ notice of these changes before they are implemented.

Finally, employers have to give employees the choice to change their coverage if changes are made mid-year. Essentially, then, the employer will be creating a new open enrollment period for any employee who will be affected by the changes.

Can Employees Change Health Plans Mid-Year?

Employees who are enrolled in group health plans that their employer sponsored don’t automatically have the right to change or cancel their health insurance plan mid-year.

Whether they can do so or not depends on a few things.

If an employee pays for premiums for their health care plan with post-tax dollars, or if their employer offers a few different options and allows for mid-year changes, then they will likely be able to make changes in the middle of a plan year.

If they pay for premiums using pre-tax dollars, though, they will only be allowed to make mid-year changes if certain circumstances exist. In most cases, changes to health care plans by employees can only be made during the normal open enrollment period, which usually starts on November 1 and runs through January 15 — though the dates can vary from one state to the next.

If employees want to make a change outside this window, they usually need to have a qualifying life event that would trigger for them another special enrollment period.

What is a Qualifying Life Event?

For a special enrollment period to trigger for employees, they must be going through what is called a qualifying life event. These events all constitute major changes in one’s life that would naturally require them to make changes to their health insurance coverage.

Examples include if they are moving to a new county or ZIP code, if they’ve experienced a death in their family; if they are no longer eligible for another plan; such as if they turned 26 years old and therefore don’t qualify to be under their parents’ health coverage any longer; if they are starting or losing their employment; if they are having a baby or adopting a child; and if they are getting married, legally separated or divorced.

If any of these qualifying life events happen, an employee would have a special enrollment period of 60 days that would allow them to make changes or purchase a health insurance plan.

Some health insurance carriers may require the employee to submit proof of the qualifying life event before the special enrollment period is opened.

Navigate Mid-Year Health Plan Changes with Beckham Ellis Insurance Group

Changing health plans mid-year can be complicated, both for employers and employees. Knowing what life events trigger special enrollment periods, or how to stay in compliance, can be hard to understand.

When you work with an experienced health insurance broker like Beckham Ellis Insurance Group, you’ll never be confused about how to approach mid-year plan changes. Our team is experienced with all the rules, regulations and know-how to help you navigate mid-year health plan changes and health insurance in general.

If your business is located in the South Carolina or Georgia region, contact us today to learn more.