Late applicants in group benefit plans—those who miss their initial enrollment period—often face additional steps and barriers to securing full coverage. In Canada, group benefit plans are structured to encourage enrollment right from the start, making administration smoother and managing risk equitably across employees. Missing this initial period can lead to medical underwriting or limited coverage options, creating challenges not only for employees but also for employers looking to maintain an efficient and cost-effective benefit plan. 

Medical Underwriting: The process by which insurance companies evaluate an applicant’s health history and medical condition to determine eligibility for coverage and set premium rates. This assessment helps insurers manage risk by identifying potential health issues that could impact future claims. 

The Importance of Early Enrollment 

Studies show that nearly 20% of employees in Canada may face coverage gaps simply by missing the initial enrollment period. For employees, late enrollment can limit access to critical benefits or require more intensive qualification processes, especially for high-value coverage like health insurance. Group benefit plans typically have a 31-day enrollment window from the date an employee becomes eligible. 

For example, if an employee becomes eligible on September 1, they must enroll by October 1. Missing this deadline can result in additional steps, such as providing medical underwriting, which may involve medical questionnaires or tests, and there’s no guarantee that coverage will be approved, meaning the employee may face exclusions or increased premiums. Insurers put these rules in place to protect the overall health of the plan. If employees were allowed to join the plan only after experiencing major medical events, it would result in higher claims and, ultimately, higher premiums for all plan members. By requiring medical underwriting or limiting coverage for late applicants, insurers can help keep the costs of group benefits manageable and sustainable for everyone. 

Even if employees opt to waive coverage because they have other insurance, they must still enroll and formally waive coverage within the 31-day window to avoid falling into late applicant status.  

For employers and plan administrators, supporting early enrollment not only reduces administrative complexity but also helps ensure the benefit plan remains efficient and cost-effective, minimizing disruptions and enhancing overall plan management. 

Fun Fact: Companies who work with a consultant that is supported by a dedicated in-house service team report 25% fewer enrollment delays, showcasing the efficiency a team of specialists can bring to plan management. 

Bridging the Gap Between Plan Administrators and Insurers 

A service-backed consulting team is an advantageous approach for minimizing administrative overload and managing unique cases, like late applicants, efficiently. Rather than handling additional back-and-forth communication between plan members and carriers, plan administrators can rely on this team to coordinate directly with the insurer on escalated cases, handling specialized processes and maintaining accurate records and benefits compliance for your organization. 

The Value of a Benefits Consultant and In-House Support 

Late applicants can create significant administrative demands, especially for plan administrators who may not have the resources to handle the extra paperwork, complex underwriting processes, and questions that arise. A benefits consultant, supported by an in-house service team, is invaluable in these situations. They not only guide the plan administrator through late applicant processes but also educate on best practices to prevent such issues in the future. This proactive approach ensures smoother enrollment processes going forward. 

With the expertise of a benefits consultant and the support of an in-house team, managing late applicants becomes more straightforward. Consultants navigate the additional requirements, advocate for the employee where possible, and ensure that any late applicants receive the best options within the plan’s guidelines. This approach helps preserve the integrity of the benefits offering while reducing the administrative burden on plan administrators. 

If you have an employee who has missed the early enrollment period, or if you’re managing late applicants in your benefits plan, Navigate is here to help. Our support extends well beyond initial enrollment, with tailored solutions designed to realign your plan and ensure all employees are properly covered. 

From managing medical underwriting and Evidence of Insurability (EOI) to negotiating with insurers for more favorable terms, our expert team is here to assist at every step. We specialize in simplifying these complex cases, reducing disruptions, and ensuring your benefits remain accessible and compliant, even when dealing with late applicants. 

The process of managing late applicants doesn’t have to be complicated. By embracing early enrollment and seeking the guidance of a benefits consultant, employers and plan administrators can ensure that their benefits plans remain optimized for both the business and employees. With expert support, businesses can reduce administrative strain, enhance employee satisfaction, and ultimately provide a more comprehensive, accessible benefits package. 

Ready to streamline your benefits process? 

Reach out today to see how a dedicated benefits consultant and in-house support team can simplify your plan management and make sure your employees are covered when it counts most. Contact us today to learn how our in-house team can support you!