Benefit Enrollment Form
Table of Contents
Table of Contents
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What is a Benefit Enrollment Form?
Benefit enrollment forms capture employee data during the different types of enrollment periods (e.g., open enrollment, special enrollment, and new hire enrollment). The form can be an actual physical form or part of your employee self-service software portal, such as Eddy or UKG.
The forms record the benefit choices employees make and/or changes to them. As well as helping you administer benefits, the form can also be used to ensure and document compliance to meet various federal and local requirements. The forms do not include employees’ personal benefit information or the employee or employer’s shared costs of benefits.
Why Benefit Enrollment Forms Are Important
Enrollment forms provide a wealth of information to help your organization plan and administer its benefit strategies. These forms allow you to capture pertinent information, avoid compliance mistakes, and inform your DEI initiative.
1. Capture Pertinent Information
The forms contain important personal information about the employee, such as dates of births, social security numbers and addresses, as well as benefits elected. Your organization may consider one enrollment form to capture enrollment for all lines of coverage, or a different form for each coverage being offered. The forms do not include the employee/employer shared costs, as these rates may fluctuate.
2. Avoid Compliance Mistakes
Enrollment forms record whether employees have enrolled in or waived group benefits. For instance, if you have more than 50 full-time employees, you will need this data to complete IRS forms 1094 and 1095, which record health care coverage.
3. Inform DEI Initiatives
Company benefit plans are typically one size fits all. However, as companies strive for a more inclusive workplace culture, the data collected from your enrollment form will allow you to keep an eye on trends regarding employee benefits.
For example, insurance status is a fundamental predictor of the quality of care a patient receives. Private insurance often delivers higher-quality and more consistent care than publicly funded insurance programs such as Medicaid and CHIP (Children’s Health Insurance Program). Racial disparities in health coverage account for barriers to healthcare access faced by many Black, Indigenous, and People of Color (BIPOC), resulting in disproportionate gaps in coverage, inconsistent access to services, and poorer health outcomes.
If the data collected from your enrollment forms shows that many employees of color waive employer-sponsored benefits, you will want to explore why.
When Should Employees Fill Out the Enrollment Form?
Employees may complete an enrollment form when they first become eligible as a new hire, experience a qualifying event, or during open enrollment each year.
New Hire Enrollment Period
During this period, new hires who are eligible for benefits have a special enrollment window to elect benefits as a new employee (e.g., 30 or 60 days after hire date).
Qualifying Event Enrollment Period
A qualifying event is a change in life circumstances that allows you to alter an existing health insurance policy or sign up for a new one outside of open enrollment periods.
Open Enrollment Period
Open enrollment is an annual period that employees can enroll and/or make changes to their insurance plans.
What to Include on Your Benefit Enrollment Form
Your benefit enrollment forms should provide you with the information you need to finalize enrollments until the next enrollment period. Be sure to craft your enrollment forms so that they give you the information you need to enroll, for compliance, and/or make changes to an employee’s benefits.
Basic information to collect are:
- Employee demographics (Date of birth, address, SSN, etc.)
- Reason for enrollment (Open enrollment or qualifying event)
- Any change status (employee address or phone change)
- Information on spouse and/or children ( who will be enrolled in the plan
- Other coverage the employee has
- Authorization of Disclosure of Personal Health Information
- Nondiscrimination notice
- Authorization/signature line
1. Employee and Dependent Demographics
Employee and dependent demographics, such as gender, race, address, date of birth and social security numbers, are meant for enrollment, reporting, and data-analysis purposes only. For example, to provide you with a rate, insurers use demographic information to estimate health care costs your group is likely to incur.
2. Reason for Enrollment
This is another compliance issue. Employer-sponsored health insurance plans, including medical and dental benefits, Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA), are typically classified as pre-tax deductions (called Section 125 or a Cafeteria Plan). They provide your employees the opportunity to pay certain benefits on a pre-tax basis, increasing their take-home pay.
Under the Section 125 rule, employees are able to make changes to their benefit enrollment when they experience a qualifying event, such as the birth and/or adoption of a child. (A qualifying event is a change in life circumstances that qualifies them to change their benefits).
There are penalties for organizations that do not follow these guidelines. The enrollment form documents why the change was made.
3. Change Status
For compliance purposes such as tax forms, you need to ensure that the employee’s address, phone number, etc. are current.
4. Other Group Insurance
Employees can have more than one health insurance plan. It is imperative that all of them are recorded on the form.
When an employee is covered under two health plans, one serves as the primary plan while the other is secondary. Primary insurance pays first, paying the claim as if it were the only source of coverage.
The secondary insurance plan picks up some or all of the cost left over after the primary plan has paid the claim. This is known as coordination of benefits. Your employee does not choose which plan is primary and/or secondary, this is coordinated between the insurance carriers.
Failure to disclose other insurance may lead to loss of coverage and/or claims not paid.
5. Authorization to Disclose Personal Health Information
The authorization to disclose personal health information authorizes insurance agents/carriers to obtain information related to but not limited to an employee’s medical, dental, and vision history and treatment (including mental health, substance abuse treatment/conditions, and AIDS-related information, if any) for all lawful purposes relating to the administration of the employee’s benefits, including determining or reviewing coverage claims, quality assurance, clinical resource management, and utilization review for services that an employee and their dependent request or receive. Be sure to review this language with legal counsel.
6. Nondiscrimination Notice
The nondiscrimination notice informs the employee that the carrier complies with federal civil rights laws and does not discriminate based on race, color, national origin, age etc.
7. Authorization Signature
The authorization signature of the employee is important, because with it, they acknowledge that they have read and agreed to the terms stated on the benefit enrollment form. That includes authorizing deductions, if any, and promising that the information provided is true and accurate to the best of their knowledge.
Though here we have focused on the most common use of enrollment forms, please note that these forms are not just limited to medical, vision, and dental coverage; they can also be used for employer-sponsored retirement plans and ancillary products such as life insurance.
The questions on enrollment forms vary widely and will be specific to the needs of your organization. For example, you may need contact information for beneficiaries for those plans that pay upon death.
Lastly, benefit enrollment forms and their requirements vary from state to state and locale to locale. Be sure to speak with your broker and/or insurance carrier to learn what additional language may be required.
How to Help Employees Correctly Fill Out an Enrollment Form
Clear communication with employees is important; always explain the purpose of the form.
Be sure to use clear language in your form. The form should be concise, but it should include explanations where necessary. Make sure every question is data you absolutely need.
Consider your form’s structure. Think about how the form progresses from start to finish. Are the questions organized in a flow that makes sense? Avoid an overly crowded form and aim for a simple and clean layout.
When using a software service, set up your enrollment form in such a way that conditional logic applies; that way, the employee will only see what is relevant. (Conditional logic in software means configuring rules that cause the interaction to change based on the user’s responses. It reduces the abandonment rate. It is great for mobile users and creates a user-friendly experience.
Example Benefit Enrollment Forms
Below you will find links to a few samples of benefit enrollment forms.
Boston University Employee Benefit Enrollment Form
The form notes the type of enrollment, employee demographics, plans provided, other coverage, and signature line.
Colonial Life & Accident Enrollment Form
This form is used to enroll employees in ancillary benefits that are secondary types of insurance coverage.
North Carolina 401(k) Enrollment Form
This form is used to enroll employees in a defined-contribution retirement account that allows employees to save a portion of their salary.
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Questions You’ve Asked Us About Benefit Enrollment Forms
Wendy is a HR professional with over 10 years of HR experience in education and health care, both in the private and non-profit sector. She is the owner of KHRServices, a full service HR management agency. She is also SHRM and HRCI certified, serves as a HRCI Ambassador, and voted 2021 Most Inclusive HR Influencer.
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