YOUNGSTOWN, Ohio – Choosing the right health insurance plan during open enrollment season, Nov. 1 through Dec. 15, can be confusing.
Every year about this time, terms like deductible, co-pay and out-of-pocket start floating around your office. Employee benefits guides are dug out of desks, serious reminder emails are circulated, and suddenly you find yourself facing an intimidating screen full of health insurance plan charts – the meaning of which you must decipher before a fast-approaching deadline.
It’s open enrollment season. And for many people, it can be a time of stress, confusion, and anxiety. According to a 2016 survey by Policy Genius, “only 39% of respondents are very confident in their ability to choose the right [health insurance] plan for their needs, while 12% are not at all confident.”
If the thought of navigating open enrollment season fills you with dread (or if you’re not actually sure what open enrollment is), here are essential facts you’ll need to know and resources to help feel more confident and informed:
WHAT IS OPEN ENROLLMENT?
Open enrollment is a designated time period each year when eligible employees can enroll in or make changes to their health insurance benefits offered through their employer.
Eligible new employees have an open enrollment period when they first join a company, during which they can make their initial coverage selections (or choose not to enroll in coverage through their employer, if desired).
After that, open enrollment occurs once annually for eligible employees, giving them the opportunity to enroll in or change coverage for the upcoming year.
Open enrollment is the only time that an employee can enroll in health insurance benefits or change their coverage, unless they experience a qualifying life event.
A qualifying life event is defined as a change in your living situation that can make you eligible for a special enrollment period, allowing you to enroll in or update your health insurance outside the regular open enrollment timeframe.
A qualifying life event might include one of the following:
• Birth/adoption of a child.
• Death in the family.
• Move to a new location.
• Involuntary loss of previous coverage.
HOW DO I KNOW WHICH PLAN TO CHOOSE?
Once your employer has selected which plans they’ll be offering for the upcoming plan year (this selection period is known as the renewal process), you’ll be able to choose from the available options.
If you like the plan you’re currently on, that plan is still offered, and you don’t need to make any changes – like adding a dependent or spouse – you can simply re-enroll.
If you’re new to open enrollment, want to update your coverage, or wish to move to a different plan, you might need to do a bit more research to help you understand your options and select the plan that works best for you.
Here are a few questions to help you in your decision-making process:
• Did the plan I selected for the past year adequately meet my needs?
• Are my regular providers covered by my plan?
• What’s more important to me: a broader network of providers or lower monthly costs?
• Do I anticipate using more or less medical services in the year to come?
• How has my family changed in the past year? Do I have additional/fewer dependents?
• Did my family or I go through any big medical changes?
• Will anyone in my family be turning 26 and moving off of dependent coverage?
WHAT DO ALL THESE TERMS MEAN?
Choosing a health insurance plan can sometimes feel like reading something in a foreign language – it’s tough to make an educated decision if you don’t know what half the words mean.
Here are some of the most common health insurance terms and their definitions:
Deductible: The amount you must pay out-of-pocket for covered health services before your health insurance carrier begins to pay.
Copay: The fixed dollar amount you have to pay for a specific type of service. Copays count toward the out-of-pocket maximum but not the deductible.
Coinsurance: The percentage of the cost of a service or visit you pay after the deductible, if any, is met.
Out-of-pocket maximum payment limit: The most you would have to pay for qualifying services in a calendar year. The carrier covers 100% of the cost for qualifying claims after this maximum is met.
Preferred Provider Organization (PPO): A health care organization that has agreed to provide health care through a network. Care may also be provided by out-of-network providers but higher fees may apply.
CAN I CHANGE MY PLAN AFTER I’VE CHOSEN ONE?
If you’re still within your open enrollment period, yes, typically, you can. If your open enrollment period has ended, unfortunately, you’ll need to experience a qualifying life event or wait until next year’s open enrollment period to make any changes.
WHEN DO MY BENEFITS ACTUALLY START?
Usually, if you’re a new employee, your benefits will become effective on the first of the month after you complete enrollment (i.e. if you provided your enrollment information on July 15, your benefits would not be effective until August 1). However, exceptions may apply.
If you’re a current employee signing up during the annual open enrollment period, the date your benefits coverage becomes effective depends on your employer’s specific open enrollment dates and plan year.
SOURCE: Justworks. Founded in 2012, Justworks provides a software platform that gives small- and medium-sized businesses access to benefits, payroll, HR, and compliance support all in one place.