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What Employees Need to Know Prior to Open Enrollment

Open enrollment is so embedded in American culture that we could make it a fifth season if not for meteorological and astronomical issues. It starts every year on or around November 1 and ends somewhere in mid-January. Unfortunately, that means it overlaps with Thanksgiving, Christmas, and New Year’s day.

Insurance brokers and employers typically begin preparing for open enrollment in August or September. They need to be ready to go by the middle of October or they will find themselves behind the eight ball. One of the most important preparations is getting information to employees prior to the official start of open enrollment.

What types of information do employees need? Here is what they need to know before November 1:

1. What They Can Do During Open Enrollment

Open enrollment is that time of year when people can sign up for health insurance, modify their existing insurance options, or cancel their plans. BenefitMall, a general agency based in Texas, says that most employers use health insurance open enrollment to facilitate enrolling in or modifying voluntary benefits as well.

2. Who Is Eligible to Participate

Although the Affordable Care Act (ACA) forces most businesses to offer complying health insurance plans to their employees, that doesn’t mean every employee is eligible. It is up to brokers and employers to inform employees exactly who is eligible and who is not. Those ineligible for employer-sponsored plans always have the option of enrolling in ACA Marketplace plans.

3. Changes to Existing Plans

Employees need to know exactly what they are purchasing before they make their annual selections. In light of that, they need to know about any changes to the plans they are already utilizing. Changes include everything from premium increases to new deductibles and additional out-of-pocket expenses.

4. Start and End Dates

Open enrollment is subject to predetermined start and end dates. For most private insurance carriers, open enrollment lasts no more than a few weeks. It lasts just over two months for Medicare, Medicaid, and Marketplace plans.

Regardless, employees need to know the start and end dates because they cannot make any modifications or sign up for new benefits outside of the open enrollment period. If they do not get it done during open enrollment, they need to wait until the following year.

5. Qualifying Life Changes

There are some exceptions to the open enrollment deadline restrictions. All are considered qualifying life changes. An individual who experiences a qualifying life change might be eligible to buy a new insurance policy or modify an existing one. Examples include:

  • employment termination.
  • the birth of a baby.
  • a divorce.
  • a death in the family.

Qualifying life events differ from one insurance carrier to the next. Employees need to know where they stand with their particular carriers.

6. Voluntary Benefits Options

Finally, employees need to be made aware of voluntary benefits options in advance of open enrollment. Even if employers choose to make voluntary benefits accessible throughout the year, an employee’s choices could impact health plan decisions as well. Therefore, they need to know all their options up front.

Voluntary benefits can be paid for entirely by employers or offered on a cost-sharing basis. Some employers elect to pass the entire cost of their voluntary benefits on to employees. One way or the other, employees need that information before open enrollment.

Whether we like open enrollment or not, it is part of the employee benefits landscape. Brokers and employers have an obligation to inform employees about everything they need to know prior to open enrollment starting. Not doing so is not cool.


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