Prepping for Open Enrollment as an Employee

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Open enrollment is right around the corner for many of us – you know, that time of year where you try to review and compare complicated insurance policies and make a decision that protects you and your dependents from unforeseen or crippling expenses.  Employers take pride in the benefits they offer, recognizing that these benefits play a critical role in both giving their employees peace of mind but also coverage that is extensive, easy to use, and that minimizes your out of pocket costs.  Keep in mind, your benefits are a form of compensation and your employer is well aware that much of why you are working for them is to take advantage of the benefits they offer.  This is why they typically offer you so many varieties of insurance and coverage levels.

However, knowing how difficult these decisions can be to sort through, we wanted to take the opportunity to remind you of the following tools, resources and items to keep in mind as you approach your employer’s next open enrollment campaign.

Understand Your Options

Many of you have the choice of selecting an insurance plan from your employer or the insurance plan of a spouse or parent employed elsewhere, potentially.  Even if their open enrollment window doesn’t coincide with yours, you should be requesting plan benefit and cost overviews now for these other coverage sources to compare with what your employer offers you.  With this information in hand, grab a cup of coffee or tea and work through the following checklist!

Compare Benefit Options

  • Copays: These are a flat dollar amount per service.  Usually, higher for more expensive things like inpatient hospital or emergency room visits, and cheaper for things like a doctor’s visit or prescription drug.  If you don’t see any copays listed, no worries, that means you are looking at a consumer driven health plan based on deductibles instead of copays.  If that’s the case, be sure to check out our prior article on how to navigate a high deductible health plan like a pro.
  • Deductibles: Think of this as the amount you are responsible for prior to insurance coverage “kicking in”. Thankfully, deductibles don’t typically apply on a per case basis (like in auto insurance) but on a per year basis.  Once you satisfy the plan deductible for your contract type (i.e. single vs family coverage), your insurance plan is covering the majority of future costs in that same plan year.
  • Co-Insurance: This is the amount you pay after the deductible is reached.  Usually, this is expressed as a percentage.  For instance, you pay 20% while the insurance plan covers 80%.
  • Out of Pocket Maximum: Every plan has a maximum out of pocket cost, your “worse case scenario” for the year after which you would not have to pay a portion of any future eligible medical or Rx services that plan year.   These are typically high numbers, but for the vast majority, you will not typically come close to reaching the out of pocket maximum.  If you do find yourself with steep healthcare costs, keep in mind these tips to saving money.
  • Premiums: Everything just mentioned impacts what your costs will be when you go to access health care services and solutions.  The premium component, however, is the fixed amount that comes out of your (or your parent’s or spouse’s) paycheck to have access to that insurance policy.  This is an important piece to evaluate.  For instance, if you are offered two health plans, with one costing $100 more than the other each month, you need to factor in the fact that you would need to spend on average $100 or more each month in terms of copays, deductibles and coinsurance for the cheaper plan to not be worth it, potentially.
  • HSA or HRA Contributions: Finally, you need to take into account if the insurance policy comes with any employer contribution toward a health reimbursement or a health savings account.  These are accounts that employers will sometimes put funds into to help employees save up for future medical expenses.  What’s more, if it’s a health savings account, you can even contribute your own money into it on a pre-tax basis for future healthcare expenses which is like having a 25% coupon when you use those funds to cover eligible health-related costs!

Utilize Decision Support Technology

Recognizing that there are a lot of moving parts to try to work through the comparison exercise above, some employers offer decision support technology to help employees determine which plan would best meet their specific needs.  These tools, such as Consiliarium’s Decision Doc®, typically ask you basic information about your current health status, how many people would be on the health plan with you (your spouse and/or dependents), and uses the information gathered to make a personalized recommendation.

Decision support tools can often make recommendations as well for whether you would be better off putting money into your HSA or into your 401-K retirement account for instance, taking into account any employer match that might be in place.  We find this technology helps individuals avoid situations where they are over or under insured, not to mention lessens much of the stress associated with open enrollment!

Explore Alternate Insurance Options for Children

Did you know that it may be cheaper for you to obtain insurance for your dependents under the age of 19 separately through state sponsored Child Health Plus (CHIP)?  CHIP is not only affordable, but the coverage is very generous – there is very little to no costs at all when you utilize medical services or access prescription drugs for your dependents at in-network locations.  If you don’t cover your children on the same plan you are selecting for yourself, then you would only need to consider a single or an employee/spouse policy which likely cost less than purchasing a family policy through your employer.

Eligibility and cost for CHIP is dependent on your household size and income.  For those who live in NYS, you can check eligibility and cost information here.  Further, to apply for CHIP, you need to complete an application here or you can find someone to guide you through the application process here.

Don’t Stress the Decision

Rest assured, you are not alone if you dread open enrollment.  Evaluating all the options, math and scenarios to work through is a daunting task to undertake just to try and make a good decision.  Keep in mind that selecting a plan is really just making an educated guess as to which plan will best serve you over the course of the following year.  Regardless the plan you choose, keep in mind there are numerous resources to help you navigate your health care journey confidently that we have covered in previous posts.  Finally, know that your HR team and we at Consiliarium Group are here for you! Here’s to a positive Fall open enrollment for us all!

About the Author

Ben Lewis resides with his wife and four kids in Rochester, NY where he has lived since coming to Rochester for college in 2001.  After completing his Bachelors of Science in Mathematics at Rochester Institute of Technology in 2005, Ben went on to work at Excellus BlueCross BlueShield where he developed insurance rates for large fully insured and self funded employers.  During these years Ben also obtained his MBA in Finance from RIT.   With industry experience coming from a variety of rolls in finance, benefits consulting, marketing and even a brief stint as an HR Benefits Manager, Ben joined Consiliarium Group as a partner in April, 2019.  Brought on as the Strategic Healthcare Practice Leader, Ben’s responsibilities include heading up the Self Funded business unit, vetting emerging healthcare technology or vendor solutions, and championing the marketing efforts at Consiliarium.  

Ben’s ambition is to help employers empower individuals to pursue personal well-being by working with HR and Finance teams to employ smart, sustainable benefit solutions that meet individuals where they are at and simplify the journey for where they want to go.  When individuals are informed and empowered to become better consumers of healthcare, the results make it a win for everyone.