What's the difference between a qualifying life event and a special enrollment period?

A qualifying life event is the triggering circumstance, such as marriage, birth, or job loss. A special enrollment period is the window of time that event opens up for making plan changes. Both group health plans and ACA marketplace plans use this framework, though deadlines and documentation requirements can differ.

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Q: What's the difference between a fully-insured and a self-funded health plan?

In a fully-insured plan, the business pays a fixed premium to a carrier, who assumes all financial risk for claims. In a self-funded plan, the business pays employee claims directly through a third-party administrator and buys stop-loss insurance to cap worst-case risk, gaining more control over plan design and potential cost savings. Most businesses under 50-100 employees do better with a fully-insured plan.

Q: When can an employee add a dependent outside of open enrollment?

Only with a qualifying life event such as marriage, divorce, birth or adoption of a child, loss of other coverage, or a change in employment status. The employee typically has 30 days from the event date to notify HR and submit documentation.

Q: What is HSA/HDHP compliance and why does it matter?

To contribute to a Health Savings Account, an employee must be enrolled in a qualified High-Deductible Health Plan that meets IRS minimum deductible and maximum out-of-pocket limits. A plan that doesn't meet these limits can disqualify HSA contributions retroactively, creating tax issues for employers and employees.

Q: Does my business need to file ACA reporting (Forms 1094-C/1095-C)?

ACA reporting is generally required for Applicable Large Employers with 50 or more full-time equivalent employees in the prior year. Businesses under that threshold usually aren't required to file, though other state-level reporting rules may still apply.

Employee Benefits for Metro-Denver Businesses

The professionals at Mountainside Insurance Management will help you analyze and control your existing Employee Benefits plan – from its structure to utilization. Our programs are designed to help you recruit and retain top employees in today’s ever-evolving and competitive business environment. Our goal is to help you reduce costs while maintaining the quality of benefits today’s workforce is looking for.

Our Group Benefit Plans

We offer key products to help you provide employees with a customized Employee Benefits program. This includes:

Group Health Insurance: Depending on employer’s need, we offer several solutions – from fully insured plans to alternative funding options (HSAs, FSAs) and non-traditional plan designs that include self-insurance.
Dental Plans: Plans are designed to meet the needs of employees, including covering basic services such as routine dental check-ups and cleaning as well as providing additional services such as fillings, root canal and other procedures; orthodontia; and oral surgery, endodontic and periodontics procedures.
Group Life Insurance: Provide security for employees with a group plan to protect their families in the event of an unexpected death. There are several plans available, including Term and Whole Life insurance. We can review each option with you, comparing pricing and benefits, to determine what’s right for your organization and employees.
Voluntary Benefits: These can be designed to offer Supplemental Life insurance, Vision coverage, Dental insurance, Short- and Long-term Disability, Cancer coverage, and Supplemental Hospitalization policies.

Virtual Care: Healthiest You

We work with a firm to deliver teleservices as part of your employer-sponsored plans. This enables your employees to receive convenient, high-quality care, 24/7. Care is delivered by board-certified physicians with an average of 20 years of experience. Employees can get care immediately and save money.
Mountainside can also assist businesses with ACA reporting to the IRS.

Frequently Asked Questions About Employer Health Benefits

What's the difference between a fully-insured and a self-funded health plan?

In a fully-insured plan, your business pays a fixed monthly premium to an insurance carrier, and the carrier takes on all financial risk for employee claims. Costs are predictable, but you can't recover savings even in a low-claims year.

In a self-funded plan, your business pays employee claims directly (typically through a third-party administrator), and only buys "stop-loss" insurance to cap your worst-case risk. This gives you more control over plan design and the potential to save money — but only makes sense once you have enough employees and financial stability to absorb claim variability.

Most businesses under 50–100 employees do better fully-insured. We help you run the numbers for your specific group before recommending either.

When can an employee add a dependent outside of open enrollment?

Only with a qualifying life event (QLE) — examples include marriage, divorce, birth or adoption of a child, loss of other coverage, or a change in employment status. The employee typically has 30 days from the event date to notify HR and submit documentation; miss that window, and the dependent generally has to wait until the next open enrollment period.

If a QLE is reported late due to an administrative error rather than employee delay, it may sometimes be handled as an administrative correction rather than a standard QLE — but this depends on plan documents and carrier rules, so it should be reviewed case-by-case with your broker.

What is HSA/HDHP compliance, and why does it matter?

To contribute to a Health Savings Account (HSA), an employee must be enrolled in a qualified High-Deductible Health Plan (HDHP) that meets IRS minimum deductible and maximum out-of-pocket limits, which change annually. A plan that doesn't meet these limits — even slightly — can disqualify HSA contributions retroactively, creating tax problems for both the employer and employees.

This gets more complicated with deductible reimbursement arrangements (where an employer reimburses part of the deductible) — these structures need to be reviewed carefully, since the wrong design can violate HSA eligibility rules even if the intent is to help employees.

Does my business need to file ACA reporting (Forms 1094-C/1095-C)?

Generally required if you're an Applicable Large Employer (ALE) — 50 or more full-time equivalent employees in the prior year. If you're under that threshold, ACA reporting usually isn't required, but other state-level reporting rules may still apply depending on where your employees are located.

What's a qualifying life event vs. a special enrollment period?

These terms are often used interchangeably, but technically: a qualifying life event is the triggering circumstance (marriage, birth, job loss, etc.), and the special enrollment period is the window of time it opens up for making plan changes. Both group health plans and ACA marketplace plans use this framework, though specific deadlines and documentation requirements can differ between the two.

How do I know if my group health plan is still compliant after a mid-year change?

Any time you change carriers, plan design, employee classes, or contribution structure mid-year, it's worth a compliance check — especially around ACA affordability rules, HSA/HDHP qualification, and nondiscrimination testing. Small changes that seem administrative can sometimes have downstream tax or compliance effects.

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