The ACA established an annual Special Open Enrollment Window (SOEW) for fully insured small group health insurance. This one-month period allows eligible small employers to enroll in group coverage without meeting standard employee participation or employer contribution requirements.
Timing:
- November 15 – December 15 each year
- Coverage is effective January 1 of the following year
Purpose & Background
The SOEW was created to help small businesses that struggle to meet participation and/or contribution rules – often because employees decline coverage due to cost or other coverage. During SOEW, carriers must accept eligible small groups regardless of participation or contribution levels, provided the group applies during the window.
Key Rules
- Applies to Small Group Market Only. There is no equivalent window for the large group market.
- Only participation and contribution requirements are waived during SOEW. All other standard underwriting rules still apply, including eligibility documentation, ownership verification, etc.
- Carriers are typically very strict about submission deadlines and required documentation during SOEW. Late or incomplete submissions are usually not accepted, with little to no flexibility.
ALE Considerations
Applicable Large Employers (ALEs) remain fully subject to the ACA’s Employer Shared Responsibility rules even if they use the SOEW to secure coverage.
- ALEs must still offer affordable, minimum value coverage to all full-time employees and their dependents.
Using SOEW does not exempt ALEs from §4980H penalties or ACA IRS reporting obligations.
Market Size Reminders
The definition of “small group” varies by state:
- California: 1–100 employees
- Most Other States (including Nevada): 1–50 employees
SOEW applies only within each state’s small group market.