Open enrollment typically refers to the period when individuals can enroll and change their employee benefits.
As an employee, determining when your open enrollment period starts and ends is the first and most important thing. The 2nd is what platform will be used for completing the open enrollment for employees. Most companies will use a form of digital, but some may still use paper.
Open Enrollment Health Insurance/Plan Options for Employees
The employer may offer more than one plan selection. It is essential to understand some basic insurance terminology.
Network definition- PPO, HMO, POS.
Now that you have the basic terminology down, let’s assemble the information you may need to make an informed decision. Doctor’s names, prescription drug names and dosages, and last year’s medical
spending.
Doctors with correct spellings are ready to look up in the networks, especially if you are offered HMO or POS.
Last year’s health care spend- this can quickly be done by logging in or creating a login with a previous or current health insurance company.
Prescription names and dosages: Make sure you have the correct names if you are using generics. This info is ready and available in your carrier portal or pharmacy app.
Now you ready to start your open enrollment-
- Determine if the health plans being offered are on PPO, HMO, or POS. You now want to check if your physicians are all participating in the network. You can quickly search at the carrier sites but make sure you are searching for the correct network name.
- Look up prescription drugs- This can be done at the carrier’s site, but confirm the name of the drug formulary, aka Perscription Drug List (PDL). The drug formulary will have different tiers. For example, if your drug coverage has:
10/35/50/250
$10- Tier 1
$35- Tier 2
$50- Tier 3
$250- Tier 4
Some drugs may apply directly to the deductible.
Now look at the health plans– a good way to interpret the plan designs is to start with the out-of-pocket max and then determine how you will reach the out-of-pocket maximum.
Hopefully, you are using a platform that provides a side-by-side comparison. If not, you will want to look at the summary of benefits, which will act as a road map of how the plan works.
It’s important to understand that some plans (Health Savings Accounts) can have an all-upfront deductible that must be satisfied before the insurance kicks in. Still, the out-of-pocket may be much less than a traditional copay plan.
You should have enough information to decide, if not, then reach out to HR and ask specific questions. If you are still unsure, call the broker.
Dental
Some of the same principles apply to dental as they do to health. Look up your dentist. When reviewing the dental plan, look at what the maximum benefit is per year. The maximum benefit could be $1,000, $1,500, $2,000, and maybe even unlimited. If you have children, you will want to see if the plan covers orthodontia and the lifetime benefit. Some plans do offer adults. orthodontia benefit.
Vision
Look up your vision provider and determine if they are participating in the network. Key benefits to be aware of- max benefit for material and frequency. Does the plan allow for frames every year or every 24 months? Most plans cover an examination every 12 months.
Life Insurance
Most employer plans will provide some level of life insurance. It is very important to know the carrier’s name, and benefit amount and make sure you are a beneficiary on file. Keep a copy of this information with our important family documents. Most modern life insurance policies have a key component called accelerated death benefit.
Accelerated Death Benefit (ADB)
Allows the policyholder to receive a portion of their death benefit while they are still alive under certain specified circumstances. This benefit is designed to provide financial assistance to individuals who are terminally ill or facing specific medical conditions.
Voluntary Life Insurance
If the company offers a voluntary life benefit, take full advantage. Most plans will allow an employee to take out a set amount of coverage without any medical questions being answered. This is called a guaranteed issue. If you elect over the guaranteed issue amount, you must answer medical questions or
evidence of insurability. Most of these life plans also include an Accelerated Death Benefit (ADB). To have access to the ABD when a serious health condition occurs can have a considerable impact, offsetting a loss of income.
Disability
Some companies offer their employees disability insurance in short-term and long-term. Short-term provides income replacement to employees who cannot work due to a temporary illness, injury, medical condition, or pregnancy. A typical benefit could be 60% of the weekly income for a few months. Long-term provides financial support over an extended period.
The Key Components of Disability Insurance:
Coverage Duration
Medical Eligibility
Waiting Period
Benefit Amount
Duration of Benefits
Disability can be offered as an employer-paid or voluntary benefit. As with any insurance coverage, it’s crucial to review the terms of your disability policy thoroughly and understand the waiting periods, benefit amounts, duration of coverage, and any specific provisions. Do not hesitate to ask questions during your open enrollment period or after.
Supplemental Coverage, AKA Worksite
These policies are typically voluntary.
Accident
Provides coverage for medical expenses, hospital stays, and other costs associated with accidental injuries.
Critical Illness
This type of insurance provides a lump-sum payment if an employee is diagnosed with a serious illness, such as cancer, heart attack, or stroke. The payment can be used to cover medical costs, living expenses, or other needs.
Hospital Indemnity
Pays a set amount for each day an employee is hospitalized due to illness or injury. It helps cover the costs associated with hospital stays.
These types of policies can help offset costs toward your deductible and out-of-pocket expenses. The plan cost needs to be closely examined with what the benefit pays out.
