Do you find open enrollment season to be a stressful time for your employees and the HR team?
It doesn’t need to be that way.
To ease the stress and confusion, here are some questions that HR professionals and employers should be ready to answer. By simplifying the information and focusing on the most impactful points, we can make this process less daunting for everyone.
HR and employers play a key role in helping employees navigate this process successfully.
Let’s aim to inspire positive action and make our employees feel empowered and informed during Open Enrollment.
What is open enrollment?
The term “open enrollment” is often used interchangeably with “open enrollment period,” but they really mean the same thing. Both phrases signal the annual enrollment period offered by employers during which employees can add to or change their health insurance benefits.
Outside of this period, changes to plans are generally only allowed under special circumstances, like major life events (e.g., marriage, the birth of a child, or loss of other coverage). Open enrollment offers everyone a fair and predictable opportunity to access and modify their health insurance on a yearly basis.
In addition to employer-sponsored plans, government-operated health exchanges at both federal and state levels also offer open enrollment periods. Our goal is to simplify this complex process and empower employees to make informed choices regarding their health insurance coverage. By providing straightforward and clear information, we can guide our audience through these difficult decisions with confidence and ease.
When is open enrollment?
Open Enrollment for health insurance can be a stressful and confusing time for employees. It’s important to ensure that they are well-informed and prepared before the enrollment period begins.
To facilitate this process, employers should clearly communicate important deadlines, provide updated benefits guides, and assign a benefits resource person to answer employee questions. If there are significant changes compared to previous years, like the enrollment process, it’s even more crucial to offer employees extra support during this time.
The open enrollment period for the health insurance exchange operated by the United States federal government runs from November 1, 2024, to January 15, 2025.
How does open enrollment work, and how can I make changes during open enrollment?
Making changes during open enrollment involves several important steps to ensure you can modify or switch your health insurance coverage effectively.
Open enrollment offers a structured opportunity to evaluate health insurance needs and make necessary adjustments annually.
Here’s a guide on how an employee would make changes, though this will vary based on your company’s open enrollment plan:
- Review Your Current Plan: Start by examining your current health insurance coverage. Assess what has worked well and what hasn’t. Note any changes in your health needs or those of your dependents that might require different coverage.
- Compare New Plans: During open enrollment, look at the different health insurance plans available. Compare their benefits, coverage options, premiums, deductibles, out-of-pocket costs, and network of healthcare providers. Many providers offer online tools to help you compare plans side by side.
- Gather Information: Collect necessary information such as personal details, Social Security numbers, and any relevant medical information. If you’re applying for financial assistance or subsidies, have income documentation ready.
- Make Your Decision: Based on your review and comparison, decide whether to stick with your current plan or switch to a new one. Ensure the new plan meets your healthcare needs and budget.
- Enroll or Change Plan:
- Online: Most health insurance providers offer online portals where you can make changes or enroll in a new plan. Log in to your account, follow the prompts to make changes, and submit your selections.
- Phone: You can make changes over the phone by calling your health insurance provider or the marketplace. Have all your information ready before you call.
- In-Person: Some providers offer in-person assistance through your employer’s HR department, a local insurance agent, or a healthcare navigator.
- Submit Necessary Documentation: If your changes require additional documentation, such as proof of income or qualifying life events, submit these as instructed. Make sure to follow up to ensure all documents are received and processed.
- Confirm Changes: After submitting your changes, you should receive a confirmation notice. Review this notice carefully to ensure all changes are correct. Keep this documentation for your records.
- Understand Your New Coverage: Once your new plan is in place, familiarize yourself with the coverage details, including how to access services, copayments, and any other relevant information.
Is Open Enrollment only about medical insurance?
While medical coverage often takes the spotlight in the benefits conversation, open enrollment offers so much more. There are numerous voluntary or ancillary benefits that you could enroll in during this period.
Your employer should make you aware of the additional benefits available to you and provide information on any requirements or differences in the enrollment process for these benefits. Open enrollment is an excellent opportunity to highlight company perks that directly benefit employees, even if they don’t require enrollment.
Empowered employees make informed choices during open enrollment.
It’s important employees grasp the range of benefits available to them, beyond just medical coverage. Open enrollment is an opportunity to discover the additional benefits that may enhance their overall well-being and work-life balance.
There’s a whole world of ancillary benefits to explore. These additional benefits can include dental, vision, life, disability, accident, critical illness, and hospital indemnity insurance, along with wellness programs, telehealth services, employee assistance programs (EAPs), long-term care, and even pet insurance.
The beauty of ancillary benefits is that they complement primary health insurance coverage, creating a robust safety net that addresses various aspects of health and well-being.
Open enrollment is an opportunity to delve into these options. Consider how they can integrate with your overall healthcare and financial planning needs. By reviewing and understanding these benefits, you can make informed decisions that enhance your well-being and provide peace of mind for the future.
What can I change during open enrollment?
During open enrollment, you’re able to make meaningful adjustments to your health insurance so it can align more perfectly with your needs. Here are some things that could be covered by your open enrollment based on your plan:
- Switch Health Plans: Switch to a new health insurance plan to explore different coverage options, provider networks, or cost structures.
- Enroll in a New Plan: If you’re without coverage, now’s your chance to get on board with a new health plan during the open enrollment window.
- Change Coverage Levels: Whether you need more coverage or are looking to streamline, explore plans with low to high coverage to see what your out-of-pocket may be in each.
- Add or Remove Dependents
- Update Personal Information
- Adjust Premium Payment Methods: You can change how you pay by switching payment frequencies or updating your methods.
- Select or Modify Additional Benefits: Customize your plan with extra perks like dental, vision, life insurance, a Flexible Spending Account (FSA), or wellness programs, and make changes as needed.
- Opt Into or Out of Employer-Sponsored Plans: If your employer offers health insurance, take the wheel on selecting the right coverage or choosing different tiers that suit you best.
- Change Health Savings Account (HSA), FSA, or Dependent Care FSA Contributions: These accounts allow you to contribute pre-tax dollars to pay medical claims, purchase approved items, or pay for dependent care. Fine-tune your contributions to your HSA or FSA for the upcoming year.
These changes empower you to craft a health insurance plan that fits you and addresses your current health needs and financial goals.
What if I miss open enrollment?
If you miss the boat on open enrollment, there are still ways to secure the coverage you need. Here are your options:
- Special Enrollment Period (SEP): Life happens, and when it does (think marriage, divorce, welcoming a new family member, job loss), you may qualify for a SEP. This means you have 60 days from the event to tweak your coverage—like a personalized health insurance pit-stop.
- Medicaid or CHIP: Medicaid and CHIP are open year-round for those who meet the criteria. They’re like the year-round safety nets of the healthcare world.
- Short-Term Health Insurance: While not a permanent fix, short-term plans offer temporary coverage outside open enrollment.
- Employer-Sponsored Coverage: Landing a new job with health benefits? You can snag employer-sponsored coverage even outside of the usual enrollment window.
- Catastrophic Coverage: If you’re under 30 or qualify for a hardship exemption, a catastrophic health insurance plan could be your lifeline. It’s there for the unexpected bumps in the road.
- Paying Out-of-Pocket: While doable, paying out-of-pocket for medical expenses can be draining on your wallet. It’s a short-term fix, not a long-term game plan.
Missing open enrollment isn’t the end of the world, but it can lead to limited choices and financial risks down the road.
So circle those enrollment dates on your calendar, do an annual check-in on your coverage needs, and keep your health protection game strong.
What are qualifying life events for special enrollment?
Experiencing significant life events can sometimes lead to a need for adjustments in health insurance coverage, and that’s where the Special Enrollment Period (SEP) comes in.
During these times, you have the opportunity to enroll in or change your health insurance outside the usual open enrollment period.
Here’s a rundown of the main qualifying life events:
- Changes in household – marriage, divorce or legal separation, birth or adoption, death
- Changes in residence – moving to a new zip code or county, moving to the U.S. from a foreign country or U.S. Territory, students moving to or from the place they attend school, seasonal workers moving to or from the place they live and work, moving to or from a shelter or other transitional housing
- Loss of health coverage – losing job-based coverage, losing individual health coverage, losing eligibility for Medicaid or CHIP, losing coverage through a family member
- Changes in eligibility for coverage – becoming eligible for marketplace coverage, gaining or losing eligibility for premium tax credits or other assistance
- Other qualifying events – changes in employment status, release from incarceration, becoming a U.S. citizen
These events offer you the chance to enroll in or change your health insurance coverage outside the standard open enrollment period, helping you maintain appropriate coverage when significant life changes occur.