Things You’ll Wish You Knew Now About Open Enrollment

How many times do you think to yourself, “I wish I’d known that sooner?”

It happens to the best of us. Sometimes we feel very prepared, only to have something surprise us.

That can especially happen with the complicated process of open enrollment. Add the fact your employees are making very important decisions for themselves, and perhaps their dependents, and it can be an overwhelming time for everyone.

That’s why Apex’s open enrollment subject matter experts are bringing you information you may wish you’d known before going through the process with your employees.

Make sure employees are aware of their options

This may be surprising, but it’s common for employees to be clueless about what is available to them in a benefits package. Sometimes, even HR pros might not fully know because of how of complicated it can get.

This includes any lines of coverage, not just medical, dental and vision plans. Make sure your employees are aware of what coverages are available and give them time to make decisions before open enrollment begins.

However, too much time can be counterproductive. If employees know they have lots of time before open enrollment they may put it off until the last second.

Difference between HSA and FSA

A Health Spending Account (HSA) and a Flexible Spending Account (FSA) both offer pre-tax dollars for enrollees to use toward health-related purchases, but there are differences between the two. Knowing the specifics of these accounts ahead of time can help employees choose if they want to enroll in one, both or neither.

HSA

• Requires a high-deductible health plan (HDHP)
• Not eligible for Medicare
• Owned by individual and carries over with employment change
• Unused funds roll over every year
• Can change contribution amounts at any time

FSA

• Set up by employer
• Owned by employer and lost with job change (unless eligible for continuation through COBRA)
• Employer chooses whether funds expire at end of year, and employees get a 2 ½ month grace period, or roll over $500 into the next year
• Can only change contribution amounts at open enrollment or during a qualifying event

Embedded vs. Non-embedded deductible

Family health insurance plans have one of two types of deductibles. If an employee is planning to bring family members on to the health plan, it’s important for them to know if the deductible is either embedded or non-embedded.

An embedded deductible includes an individual and family deductible. On the other hand, a non-embedded deductible includes only a family deductible.

Why does this matter? In an embedded deductible, if the individual limit is $3,500 and the family limit is $7,000, a spouse who has medical expenses costing $4,000 will have met their deductible, but the employee will still need to pay out of pocket until the family deductible has been met.

Coverage is for the full year

When an employee chooses their lines of coverage, those remain in place until the next open enrollment season.

There are a few exceptions to this, and the most notable is a qualifying life event. To name a few qualifying life events:

• Changes in household (marriage, divorce, childbirth, death in family)
• Change in residence
• Turning 26 and losing coverage through parent’s plan

Carriers must be notified of all plan changes

It is important to notify insurance carriers of any plan changes. This usually needs to be done by the last day of the month prior to the renewal date.

Some carriers will allow changes throughout the renewal month, but after the cut-off date, employees will have to wait until next year’s open enrollment to make changes unless they have a qualifying event.