The guessing game that is Open Enrollment

It's been a while since I’ve posted an article. Lots of great topics that I've encountered over the past months. I'm writing about health insurance plans because why else...It's Open Enrollment season!! Therefore, there are tons of questions about Employee Benefits and choosing the right plan for you and your family. When you make the decision to select a health plan, you always want to consider a couple things.

Do you know what you’re looking for? First off, know what you want in a plan. Do you know what your health situation currently is? Do you visit your doctor often? How often? Will you be having surgery during the plan year? What about medications? Are you on them daily? Will you be going to a Nutritionist this year? Are you planning to have kids? Do you have family members on your plan? Finally, how much are you willing to pay each pay period? Do you have a budget for it?

Are you even eligible for the plans? Once you’ve determined why you want a plan, find out which plans you are actually eligible for. Your company may have 1 plan, 4 plans, 7 plans available, different Tiers for different brackets of income, or maybe plans based on your status as an employee. Drum it down and figure out which one you are actually eligible for. No sense reviewing plans that you can’t even sign up for.

Life Happens! Once you’ve gotten that all figured out, start thinking of the services you may be using. This is not a perfect scenario because even if there is proper planning, Life Happens! (Of course, most company plans allow for such changes so that if there is a life changing event—marriage, loss of spouses plan, birth of a child, adoption, you are eligible to change your plan.) So what you planned for may not be what may happen during the course of the year. But it’s always good to have a great plan in place…just in case!

Bring out the colored highlighters. Most plans are done creatively by the Benefits department…some are written out in paragraph form or are communicated in a chart form having separate rows/sections for information on vision, health, dental, …….. What I like to do is get a highlighter and highlight the areas that I think pertain to me? For example, you might highlight the section on health, vision, dental, etc. Highlighting helps you focus on the specific sections that you anticipate using during the upcoming year.

Show me the money! Once you’ve determined what areas you’d like to focus on, everything else gets easier because it’s all about the money. More like SHOW ME THE MONEY! You now have to consider a couple things that pertain to you monetarily.

Premiums—simply put, a premium is the amount of money that is deducted from your paycheck every pay period. You will authorize your company to take this amount out during Open Enrollment (when you join the company and are eligible for Benefits or when you have a life changing experience). Once you choose your health plan, you should always check to see what the premiums are. There are usually different prices to choose from. Generally selecting a plan as “an employee” is different from selecting a plan as “a family”. The premiums as a family will be higher.

Deductible—The deductible is the amount that you will have to pay before the insurance company will begin to make (a portion of) payments to claims on your behalf. Most often than not, if you have a higher deductible, then you have lower premiums. If you have a lower deductible, then your premiums are higher.

Co-pay—A co-pay is the amount of “cash on hand” you need to take with you to pay for your visit to a health care provider. This is the amount that your company has negotiated with the insurance company, so make sure you know how much it is. The co-pay is determined by the type of plan that you choose. Depending on the plan, you might also have to pay a deductible before paying a co-pay.

Scenario 1. For example, let’s say that you select a plan that has a $40 co-pay to visit your health care provider along with a $250 deductible and you have to claims that are $125 each.
Co-pay: $40
Deductible: $250
Claim 1: $125
Claim 2: $125

You will first have to use up your deductible before you can start using the co-pay. Before the first visit, you have $250. After the first visit, you have $125 left to use in your “deductible bank”. After the second visit there is no more money that you have to pay out of pocket in your “deductible bank”. You can then begin paying $40 co-pay for your claims.

There are soooo many other items involved in Open Enrollment, such as adding dependents to your plans, Life Insurance policies, Long Term Disability, Flexible Spending Plans, etc. so each decision should be made following the items that I’ve outlined above. The plan documents for each of the plans offered by your company actually DO exist and can be located in your HR office. It has more of a detailed outline of all the items discussed but contains more information that you really care to know of.

Don’t forget to participate in Open Enrollment if you are eligible and good luck with choosing your plans. It may be a scary experience for some, but if you follow the outline above, it should be a little easier.

As always, prioritize, set boundaries, and Live!