Your Guide to Open Enrollment. Don’t miss out

To ensure your open enrollment is smooth and error-free, we created a quick checklist to go through before you submit your elections. 

⚠️ Pyn note to HR: Please update this message to include information specific to your organization and its policies.

We’ve got you covered! We’re pleased to offer health insurance for all full-time employees, covering [XX%] of coverage costs. 

The Open Enrollment period is [DATE - DATE]. 

Don’t be late! Missing the deadline impacts your coverage for the entire year and can’t be changed mid-way. 

What is Open Enrollment?

Open enrollment is the time when you get to evaluate if your health benefits have worked for you over the last year. Ask yourself: Was I able to see the doctor I wanted to see? Was I happy with the network of doctors? Did I use my benefits?

And, it’s time to think about the year ahead. Ask yourself: Is there a procedure I need to get done this year? Will I be adding a family member to my plan? Is there a prescription we need to get?

The selections you make stick with you and your family for the whole year. So it’s good to really think about if you have the plan that best meets your needs and what life events you might have in the year to come. 

Understanding health insurance terminology 

Premium: The monthly fee for your insurance. 

Deductible: A fixed dollar amount you must pay before your insurance will begin paying for anything. 

For example: If you have a $1,000 deductible and undergo three $500 procedures in one year, you will be responsible for paying for the first two procedures only. The third procedure will be covered by your insurance.

Co-pay: A fixed dollar amount that you are responsible for paying for each doctor visit. This amount is fixed by your plan. 

For example, a plan may have a $20 co-pay for a routine doctor’s appointment and a co-pay of $100 for emergency room visits.

Coinsurance: The percentage you are responsible for paying once you’ve met your deductible. 

For example: If your plan has a $100 deductible and 30% coinsurance and you use $500 in services, you are responsible for paying the $100 deductible plus 30% of the remaining $400 up to your out-of-pocket maximum. 

Out-of-Pocket Maximum: The most you will have to pay out-of-pocket annually. This is an important part of your plan because it limits the total amount you pay each calendar year. Your deductible goes towards your out-of-pocket maximum. 

For example: If your plan has an out-of-pocket maximum of $2,500 per year and you get sick, which requires more healthcare services, the most you will pay in a year out-of-pocket is $2,500.

In-Network vs Out-of-Network: An in-network doctor is a doctor that is part of a group of doctors that have a pre-negotiated rate with your insurance company. When you visit an in-network doctor, you will receive the “in-network rate.”

An out-of-network doctor is a doctor that does not have a pre-negotiated with an insurance company. You might be charged more when visiting an out-of-network doctor and your plan will likely cover a smaller portion of the visit.  

Understanding different plan options (PPO, HMO, POS, EPO)  

Health insurance plans are categorized by how they work, and people choose plans for different reasons. Below you will see how each type of plan is structured.

• Preferred Provider Organization (PPO) plans give you flexibility when it comes to selecting a provider. A referral from your primary doctor is not required if you wish to see a specialist. You do not have to stay in-network; however, in-network doctors will be less expensive. 
• Health Maintenance Organization (HMO) plans tend to be more affordable with lower premiums and a lower (or no) deductible. If you need to see a specialist, your primary care doctor will refer you to one. Typically, HMOs do not cover any out-of-network doctors. 
• Point of Service Plan (POS) plans will let your primary doctor coordinate your care and refer you to any specialists. In-network doctors will be less expensive. You also have the option to go out-of-network at a higher out-of-pocket cost. This plan might be for you if you want more provider options and a primary doctor that oversees your care. 
• Exclusive Provider Organization (EPO) plans mean you do not need a primary care doctor. You have to stay in-network for coverage (unless it is an emergency). This plan is for you if you want lower out-of-pocket costs and does not require a primary doctor for referrals. 

Review health plan doctor networks 

When you visit in-network doctors, costs will be lower compared to out-of-network doctors. You will want to determine whether the doctor(s) you plan to visit are in-network. 

• If you already have a preferred doctor and want to continue to see them, make sure they are in-network with the plan you are considering. You can even call the doctor’s office to confirm whether they are in-network or out-of-network. Doctors can also change the insurance they accept so it is best to call and confirm with them.
• If you don’t have a preferred doctor, you will probably want to select a plan with a large network so that you have more choices. You can always call a local doctor to see which network they fall into. 
• Most HMOs and PPOS are region-specific and only cover smaller geographic areas. Be sure to select a plan that has a network near you. 

Choosing between a high or low deductible plan

General guidance is that if you are young, healthy, and have some money saved up, your most cost-efficient option would be to opt for a higher deductible plan. If you are older, have any pre-existing or chronic health conditions, or go to the doctor frequently, your best bet would be to opt for the low (or no) deductible plan. More detail follows. 

A high deductible plan means you will pay more for each visit while having a lower monthly premium. You might consider an HDHP if: 

• You’re healthy and rarely get sick or injured and are only anticipating preventive care (which is covered under most plans when you stay in-network).
• You rarely go to the doctor beyond your annual preventative care appointments.
• If you are looking to save money by lowering your monthly premium. 
• You are interested in contributing to a Health Savings Account (HSA) account each month. The funds in an HSA account can help pay for eligible medical expenses.  
• You are comfortable playing a higher deductible. This means you are required to pay for your medical care out-of-pocket up to that amount before the health plan begins to help pay.  For example, if your deductible is $10,000 and you get sick, you will be responsible for up to $10,000 in medical bills.  

Low deductible plans are a little more predictable so that you don’t have to worry about a large out-of-pocket expense if you ever get sick. The downside is that monthly premiums are higher.  

A low (or no) deductible plan might be for you if: 

• You frequent the doctor's office regularly or plan to this coming year.  
• You are pregnant or planning to become pregnant or currently have small children.
• You and/or your children are prone to injury. 
• You have a chronic condition and frequently see a doctor. 
• You’re considering a larger surgery such as a knee or hip replacement.
• You take a prescription drug or an expensive name-brand drug.

Other questions to consider when making your selection

Another way to determine what you need out of your insurance is to dive into your current health and financial situation. Review the plans for services that are important to you.  

Ask yourself the following questions:   

• Are you continuing any medical expenses or expecting a new medical expense? Determine which plan is going to support these medical needs. 
• Do you need your plan to cover any existing prescriptions? 
• Are you planning to get married this upcoming year? Review the plans and compare the cost of adding a partner as well as making sure the coverage meets the needs of your partner. Which plan will allow you and your partner to see the doctors you want to see? Or are you open to a new network of doctors? 
• Are you expecting to add a new member to your family? Review the plans and compare the cost of adding a dependent and review the care for a dependent. Which plan will allow you to see the doctors you want to see? Or are you open to a new network of doctors? 
• What happens if I get sick while traveling abroad while on vacation or for work?

NOTE: A qualifying life event is a major life change that may affect your health insurance needs. This includes a change in job, family status, location, and income. Typically once a qualifying life event occurs you have 60 days to notify your insurance provider with legal documentation and to make any necessary changes.

When to consider a Flexible Spending Account (FSA) 

An FSA is a great way to save money on things you likely have to pay for while using tax-free money. FSAs are best used for predictable, maintenance, or anticipated costs. This program is “use it or lose it” which means that any remaining balance in your FSA at the end of the year will be forfeited. 

You might consider an FSA account if: 

• You have predictable medical, dental, or vision expenses that accept FSAs. 
• You can determine your annual expenses so money is not forfeited at the end of the year. 
• You like to use tax-free money to pay for additional savings.
• You understand that if you don’t use the money in the FSA account, you will lose it at the end of the year. 

How much to contribute: 

• If your medical expenses are generally low, consider contributing to the total amount of your copays for medical, dental, and vision expenses for the year ahead.