Enrolling for benefits is required in order to get the health coverage you need for the upcoming year. It’s also crucial to get it done in the correct time frame, typically during open enrollment. Failing to do so will leave you stuck without your current benefits unless a significant life event happens that changes your eligibility. We will walk through some of the critical steps you need to take to ensure proper benefits enrollment for 2021.
What is Health Insurance Open Enrollment?
Open enrollment is any period of time in which you can enroll in something; in this case, health insurance. It happens once a year, and the benefits you enroll for will apply for the entire year. Few exceptions allow for special enrollment periods outside of open enrollment, which we will discuss below.
The health insurance open enrollment period is your opportunity to apply for health coverage through your employer, a family member’s employer, the government plans through your state (like MNSure), Medicare for 65+ individuals, or Medicaid for low-income or other circumstantial eligibility.
Open enrollment is the one time where you can make changes to or remove your insurance benefits. Again, outside of SEPs (special enrollment periods), this is your opportunity to make those adjustments.
When is Health Insurance Open Enrollment?
Your job-based insurance plan can occur at any time of the year, depending on when they re-apply. But in general, open enrollment happens at the end of the year between October and December for plans effective in January or February. They can also occur mid-year, but most fall in line with the federal dates of November 1st through December 15th, when insurance under the Affordable Care Act (ACA) goes into effect each new year.
However, some states have a state marketplace that runs under a federally mandated exchange where people can choose their plan out of several options. These states include Kansas, Montana, Nebraska, Ohio, South Dakota, and Virginia. They have a bit more control over their enrollment deadlines, and it’s important to pay attention to those if you live in those states or apply for insurance outside of your job-based insurance plan.
Special enrollment periods can be any time of year, but depending on who your insurance carrier is, they will offer a different range of time to apply. If a life event like marriage or having a baby happens, your job-based insurance plan must give you at least 30 days to make the changes to your insurance plan. If you receive insurance through a federal or state-based health plan, you will get a window of up to 60 days for your special enrollment period.
Guide to Open Enrollment for Employers.
If you are an employer offering benefit plans to your employees, there are a few key things you need to ensure you are prepared for open enrollment and that it goes smoothly.
You will want to have proper benefit enrollment software, such as BeneQuick. Benefit enrollment portals allow your employees to safely and securely apply for their plans, or deny coverage, via a user-friendly portal. They gain more autonomy and access to their plans, and it can be much more convenient than out-dated paper enrollment forms. Plus, it saves your human resources department a lot of time and money spent towards processing those enrollment forms. It can all be safely done in secure software where employees and members can re-access their benefits at any point for review.
Choosing a benefits enrollment portal can be a great tool to manage it on your own, which is excellent for small to mid-sized teams that want the basics covered.
You may also want to hire a broker or insurance agent to handle any more granular details to the enrollment process. Brokers can ensure you have up to date information regarding rules and regulations, plan offerings, negotiable rates, and finding you the right plans for your team. You will want to determine if you need to offer health savings plans, life insurance, short-term disability, and/or other benefits. A robust portal like BeneQuick can offer more customization for your business based on the needs of you and your employees. We’ve detailed a few tips to ensure a seamless open enrollment period for employer-based insurance plans.
Guide to Open Enrollment for Employees.
As an employee, your job is relatively easy—you just need to choose the right plan for you and your family. With the proper support from your employer, broker, the insurance company, and your benefits portal, it should be a simple process for you.
If you are a single individual, choosing a plan through your employer is relatively straight forward. If you are over the age of 26, where you can be on your parents’ insurance, you can choose a simple plan that gets you coverage as a young, healthy individual.
Things can get more complicated if you require specific medical treatments or medications, but those details can be sorted out during the open enrollment period with your employer.
If you are married or have children, you have the choice to go on your plan with your family or you could go on to your spouse’s job-based plan. Sometimes it will make sense to stay on your current plan. Again, it all depends on what is covered, the cost of premiums, and what you think is the best coverage for you and your family. Healthcare.gov is a useful resource for information on healthcare in general, and it’s good to be aware of your options.
What Circumstances Make me Eligible for Special Enrollment?
Earlier, we mentioned special enrollment periods(SEP), which are times when certain life events change your eligibility for health insurance and allow you to make changes to your coverage outside of the regular open enrollment. Life events that can change your eligibility for insurance and allow for a SEP include, but are not limited to:
- Having a baby
- Adopting a baby or child
- Fostering children
- Losing insurance coverage (job-loss, losing a spouse, etc.)
- Moving to another state
- Gaining U.S. Citizenship
- Becoming a permanent resident of the U.S.
- Job-based plans are renewing or changing
- Losing a job or gaining a new job
- Insurance company error during enrollment
What if My Job Doesn’t Offer Benefits?
If your job does not offer benefits, you still have a few options. If you are married, you can potentially get on your spouse’s plan through their employer. Single individuals, under the age of 26, can receive benefits through their parent or guardian’s plan. Under the Affordable Care Act, coined Obamacare, you can apply to federal or state-mandated programs that offer you basic coverage at an affordable rate. Pay special attention to important dates regarding open enrollment for these plans.
Common Questions Enrollees May Ask During Open Enrollment
Has there been a change to my prescription drug coverage?
Year by year, prescription drugs may change depending on suppliers or big pharma, making manufacturing changes. Also, some prescription coverage changes drastically depending on whether there is a generic version or not. Employers should supply any updated approved drug lists and generic options to their employees. Most insurance websites will have a section where people can search for drug coverage based on their plan. Make sure your employees know where and how to use this feature.
Are my preferred physicians or clinics still covered?
If the health plans have changed this open enrollment period compared to last year, it’s critical to determine if any physicians or clinics have dropped off as in-network. Switching providers can make detrimental changes to who members can or cannot see. If you can access your exact plan options before open enrollment, employees can use that information to find out if their preferred physicians are still covered and in-network online.
Have premiums changed?
The cost of an insurance premium could potentially change the minds of enrollees. A more expensive plan may not be as attractive if the benefits are subpar. For example, if an employee was on one plan last year, and now a new, less expensive one is an option, they may turn to that, despite losing some coverages. Cost is a significant factor, and any raise in premium could scare off employees. Get them a detailed price plan as soon as you can to discuss it with their family and determine the best fit.
Are there any new wellness plan benefits?
Additions to wellness plans like gym memberships and step trackers can be a driving force towards employee retention and who is likely to choose a plan through you or go outside to a state marketplace. Wellness plans are essential to help motivate and nurture employees in your company. They want to have those benefits just as much as they want basic health coverage.
How will adding my spouse and children affect my premium or coverage?
Adding a working spouse to a plan can induce fees around $100 extra a month in premiums. It’s important to both support and inform your employees how adding their spouse or family to the plan could or could not affect their premiums. Each year insurance providers negotiate new and different coverages for these instances, and often it makes more sense for husbands and wives to be on separate plans, just for cost alone. So have that information readily available so you can support your team in these difficult decisions during open enrollment.
Health Insurance Resources for Critical Information
Your employees will want to do their research and seek out more information about their options. You can share with them these helpful resources that can answer any question they may have. These resources are also incredibly useful to your HR departments.
Benefits Enrollment Platforms
Employers have pretty heavily moved away from filling out paper forms to an insurance provider during open enrollment. Most of it is done online now, which makes the entire process super easy for most people. To do this, they must work within a benefits enrollment portal that houses all of the plan information and can be referenced even after open enrollment.
Some common benefits enrollment portals are Gusto, Zenefits, BambooHR, and our very own Benequick. Benequick has simplified the process and works with you and for you to ensure a seamless open enrollment period. Whether you are an HR representative, an insurance broker, or a third party administrator, we have the platform that can work for you. For more information on preparing for the upcoming plan year and open enrollment, please don’t hesitate to call us and get your questions answered. We offer fully comprehensive open enrollment portal services for TPAs, Brokers, and Employers and want to ensure a pain-free enrollment for all. Contact Benequick and request a FREE demo here.