Gearing up for Open Enrollment

Are you ready for Open Enrollment Season? Every year, companies talk with their employees about their insurance coverage for the new health plan year. For most employers, that takes place in the fall as a traditional method of enrolling in insurance plans, and some organizations use another time frame for their plan year. Either way, employees must decide what type of coverage they want or can afford. This period is called open enrollment because that is when you can elect certain changes to be made for benefits offered to everyone at their respective companies.

According to the National Association of Insurance Commissioners (NAIC), during an open enrollment period, insurance carriers are required to accept all applicants of the group without underwriting or evidence of insurability. Open enrollment is generally only held once a year. If you miss your company’s annual open enrollment, you likely will not be able to enroll in your employer-sponsored health insurance program until next year. Certain exceptions apply for new employees or employees with life changing events. Before making a choice:

• Check to see if your current physicians and area hospitals are in the plan’s network. Using network providers generally will save money on your health care.
• Check to see if spouses or dependents are covered. Some plans will cover spouses and other dependents, while other plans will not. Clarify coverage for step children.
• Read all of the plan materials thoroughly. Doing so will tell you what your rights and responsibilities are under each plan.
• If you take prescription medications, check them against the list of approved drugs in each plan booklet. Also, if you take an expensive brand-name medication, check the copayment that each plan requires.
• If you or any family member needs ongoing physical therapy or has a mental health problem that requires therapy, review what your health plan will and will not cover.
• Check to make sure that you and your family have adequate coverage for emergencies if you are traveling either in the U.S. or in a foreign country.
• If any part of a plan is unclear to you, ask for help from your human resources department or the insurance carrier.
• If you are not satisfied with the answers to your questions, contact your state insurance department.

Employers are trying to save money. One way to do this is to reduce health insurance benefits and shift more of the premium costs to employees. Employees should make sure to carefully read their health plan materials, they may find that their benefits and costs will change for the coming year. Costs are definitely going up for 2017.

Health insurance premiums are going to increase by 5 to 6 percent in 2017 for employees, based on a new study from the National Business Group on Health, a Washington, D.C.-based organization that represents large employers. Specialty pharmacy costs, high-cost claimants and overall medical inflation are among the top drivers for rising health insurance premiums. Individual policies are going to go up on the Public Exchange by as much as 27% for a Silver Plan, according to the Kaiser Family Foundation.

In this uncertain market, as an employee it’s important to carefully evaluate your healthcare costs when making your annual enrollment decisions. While one option might have high monthly premiums and a low deductible, and another might have a low premium but more out-of-pocket expenses, it could be misleading which plan is best for you until you do the figures.

To pick the best coverage, first calculate your healthcare costs from recent years and try to estimate what your costs might be for the coming year. Don’t forget to include the cost of doctor’s visits, daily medications and any procedures you might be planning. Next, make a list of the premiums, out-of-pocket expenses and benefits under each plan. Co-payments, deductibles and additional charges for wellness care or specialists (e.g. chiropractic care, cosmetic surgery, etc.) are examples of out-of-pocket expenses that you are responsible to pay.

Remember, if you use a medical provider that is out-of-network, you will generally pay more out-of-pocket expenses. Include these fees in your calculations. Once enrolled in a health plan, you will not be able to make changes until the next open enrollment period, unless there is a life changing event such as a divorce, job change, marriage, birth of a baby or adoption of a child.

According to Healthcare.gov, Open Enrollment for 2017 health plans starts November 1, 2016. Important dates to note:

• November 1, 2016: Open Enrollment starts — first day you can enroll, re-enroll, or change a 2017 insurance plan through the Health Insurance Marketplace. Coverage can start as soon as January 1, 2017.
• December 15, 2016: Last day to enroll in or change plans for coverage to start January 1, 2017.
• January 1, 2017: 2017 coverage starts for those who enroll or change plans by December 15.
• January 31, 2017: Last day to enroll in or change a 2017 health plan. After this date, you can enroll or change plans only if you qualify for a special enrollment period.

The concept of open enrollment can be confusing, but the opportunity provides employers options to provide employees various ways to choose their health care and insurance costs. Although the choices may be limited in some cases, this time frame serves as the current best method of allowing changes to be made in employee health care.

For some great additional tips on open enrollment, the folks at Insure.com have put together some great information that provides insights into the do’s and don’t’s of this annual healthcare event: https://www.insure.com/health-insurance/open-enrollment-for-individual-health-insurance.html .

Keeping certain restrictions in place, like not allowing employees to change their plan design whenever they want, helps the insurance companies and employers to maintain a certain relative consistency to control costs and limit adverse selection, but it limits the scope of available options to employees if they have a change in their status due to income shift or ability to work. Overall, open enrollment currently is the accepted practice for employers to develop a workable solution to offer insurance coverage and not cause mass confusion among the ranks. As an employer or employee, make sure to ask all the right questions, then pick the option that works best for you.