When Open Enrollment Goes Wrong: 5 Breakdowns Beyond Configuration (and How to Prevent Them)
By Leah Joyner, Principal Consultant & Founder, HCM Tech Advisory
I’m often called upon to fix the system or process after open enrollment did not go well. Almost always, the first explanation I hear is that the system was not configured properly. In other words, whoever configured the system gets blamed.
Sometimes the system was indeed configured incorrectly. But once I begin looking more closely, I usually find that the person who configured it was only one part of the problem. Were the instructions clear? Was there a record of what the person had been asked to change? Did someone with benefits expertise review the setup? Did anyone independently test what was built? And after employees submitted their elections, did someone confirm that the correct information reached payroll and the insurance carriers?
The person configuring the system should absolutely be accountable for their work. But there also need to be checks and balances. One person should not be responsible for interpreting the instructions, configuring the system, and deciding whether everything was done correctly.
When open enrollment goes wrong, it is usually not because of one mistake or one person. It is often a combination of issues, including a lack of documentation, review, testing, follow-through, and reconciliation. These issues can lead to incorrect coverage, inaccurate payroll deductions, or employees believing they have coverage, such as supplemental life insurance, that was never approved.
Here are five open enrollment breakdowns HR and benefits teams should address before the next open enrollment.
- Lack of Documentation: What Was Decided, Changed, or Approved?
Open enrollment (OE) decisions are often made through a series of meetings, emails, spreadsheets, and conversations. A rate changes at the last minute. An eligibility rule is clarified. A plan design is updated. Someone asks the configuration analyst to correct the setup. But if those decisions and instructions are not documented in one place, it becomes difficult to confirm what was requested, what was completed, and who approved it.
This becomes an even larger problem when team members or consultants change. The new person may inherit a system without knowing why it was configured a certain way. The team may repeat mistakes from prior years because no one documented what went wrong or how it was resolved.
Documentation does not have to be complicated. HR should maintain a clear record of:
• Finalized plan and eligibility decisions
• Instructions provided to the consultant or configuration team
• Changes made to the enrollment setup
• The person responsible for reviewing and approving each change
• Issues identified during testing and how they were resolved
• What worked, what didn’t, and what should be handled differently next year
After open enrollment, the team should hold a post-OE meeting while the experience is still fresh. This gives everyone an opportunity to discuss what worked, what did not, and what needs to change. The team should then update its checklist and use that record as the starting point for planning the following year.
- Too Much Responsibility Is Placed on One Person
In some organizations, the same person who receives the instructions also interprets the benefit rules, makes the configuration changes, and confirms that the changes work. This creates too much dependence on one person, regardless of how experienced that person may be.
A configuration consultant may understand how to configure the enrollment system but may not be a benefits expert. If the instructions are incomplete or open to interpretation, the consultant may make a reasonable assumption that does not reflect how the plan is supposed to work. Without an independent review, that assumption can make it all the way to open enrollment.
Open enrollment needs checks and balances. The responsibilities for giving direction, making changes, reviewing the work, and testing the results should be clear. Those responsibilities do not always require four different people, but the person making a change should not be the only person deciding whether it is correct.
Before configuration begins, it is important to identify who has the authority to interpret the plan, who can approve changes, and who is responsible for validating the final result.
- Testing Beyond Quality Assurance (QA)
When configuration analysts test, their primary focus is to QA their setup. They are confirming that the setup works, that an employee can log in and move through the enrollment flow, and that the system was configured according to their interpretation of the instructions they received. But testing cannot stop there.
The HR and benefits team must determine whether the right employees are seeing the right plans, rates, coverage options, and eligibility rules. Are enrollment dependencies working as they should? Do the results accurately reflect how the benefits are supposed to work? That requires someone who understands benefits and the organization’s plan offerings. A tester needs to be able to read the plan documents, create realistic employee scenarios, and recognize when the results do not make sense.
For example, what happens when an employee moves from part time to full time? Adds a new dependent? Has wellness credits available? Covers a spouse who has access to other coverage? Reaches an age that changes a life insurance rate? Works in a different location? Testing only the easiest scenarios can create a false sense that everything is ready. All applicable scenarios, including exceptions and less common situations, should be tested. It takes a benefits expert or someone with years of experience to understand many of these intricacies.
Each meaningful update should be documented and tested. The team should also perform regression testing, which means confirming that a new change did not break something that was already working. An update that may seem small or easy can cause significant downstream issues. Testing should consider the full path of an election, including eligibility, coverage amounts, payroll deductions, and the files sent to insurance carriers and other vendors.
Open enrollment testing should not stop when an employee can make an election. The organization must also confirm what happens after the employee clicks “submit.”
- Evidence of Insurability Elections Are Not Managed
When an employee elects a life insurance amount above the guaranteed issue (GI) limit, the additional coverage typically requires evidence of insurability (EOI). In essence, this means the employee must provide the required health information to the insurance company before the additional coverage can be approved.
The election will typically appear as pending in the enrollment system while the insurance company waits for the information or reviews the request. This is where the process tends to break down. Someone should be responsible for tracking pending elections from beginning to end. That includes following up when an employee has not completed the required information, recording the insurance company’s approval or denial, updating the enrollment system, and making sure payroll deductions reflect only the coverage that was actually approved.
If no one owns that process, pending elections can remain unresolved for months or even carry into the next open enrollment. An employee may think the full amount was approved because it still appears in the system, even though the insurance company never approved it.
Evidence of insurability is not a one-time open enrollment task. It is an ongoing administrative process that needs a defined owner, regular follow-up, and a clear method for closing the loop with the employee, payroll, and the insurance carrier.
- Lack of Enrollment Reconciliation
So many changes happen to benefits eligibility and plan design each year that it is important to reconcile enrollment records. Passive enrollment does not eliminate the need for reconciliation. In fact, it can allow outdated elections or incorrect information to carry forward without being noticed.
Some of the biggest reconciliation issues occur when organizations fail to compare:
• Carrier enrollment data against the enrollment system
• Benefit elections in the enrollment system against carrier bills
• Rates in the enrollment system against payroll deductions
Enrollment data should be reviewed monthly to catch new hires, terminations, life events, and retroactive changes that can all create discrepancies. When differences are identified, someone should be responsible for researching the issue, making sure the appropriate corrections are completed, and confirming that the enrollment system, carrier records, billing, and payroll are aligned.
Regular reconciliation catches issues that may have been missed elsewhere in the process and helps keep enrollment data clean and accurate. Consistent review can also reduce the work required during the ACA filing process, since cleaning up eligibility and coverage data is one of the biggest drains. Regular reconciliation throughout the year makes that process much easier.
Build the Controls Before the Next Open Enrollment
Employees experience open enrollment through the communications they receive and the elections they make. But a successful open enrollment depends heavily on the work happening behind the scenes.
Clear documentation gives the team a reliable record of what happened and why. Checks and balances prevent one person’s misunderstanding or mistake from reaching employees. Benefits-focused testing confirms that the setup works for actual employee scenarios. Managing evidence of insurability closes the loop on pending coverage. Reconciliation confirms that the employer, payroll, and insurance carriers all have the same information.
When open enrollment goes wrong, it is easy to blame the configuration. But the more useful question is, “What process should have caught this before it affected employees?” Then document what happened and make the necessary changes so the same problem does not happen again.♦
_____________________________________________
Author bio:
Leah Joyner is the founder of HCM Tech Advisory and brings more than two decades of experience across HR leadership, benefits, and HR technology. Her career began at Deloitte Consulting as an Actuarial Analyst working on benefits design, budgeting, and delivery. She later moved into HR technology at Lifeworks (TELUS Health), leading large-scale implementations for clients with workforces of 50,000+ employees. Leah went on to serve as Director of HRIS at Revature, overseeing the global implementation of Workday HCM and the U.S. Health and Welfare program. Before starting HCM Tech Advisory, she contributed to implementation quality and process improvement at OneDigital. She holds a BBA in Actuarial Science and a CEBS designation.
_____________________________________________