Open Enrollment and Annual Benefits

This is the season of open enrollment. If your company, like most companies these days, does the annual health insurance dance, check with HR to find out when your open enrollment period is and make the necessary changes. You should also check to see if your plan operates on a calendar year or benefit year system, and plan your appointments and procedures accordingly.

Common Changes to Health Plans

During open enrollment, employers give employees the option to do several things. In some cases, the employer will also make changes to the plans that affect all employees. Some examples:

  • Adding insurance companies to the list of options
  • Changing insurance companies for everyone
  • Removing insurance companies from the list of options
  • Adding different plan types, such as HMOs and PPOs
  • Adding FSA or HSA options
  • Changing employee contributions
  • Adding or removing spouses or dependents

If you receive notice that your employer is changing the options, review that notice carefully and be sure to act by the deadline.

For example, this year my employer for the first time is adding an employee contribution for spousal and dependent insurance. The charge per month for my husband would be $87. He has free insurance through his employer, so we have to decide whether secondary insurance is worth $1044 a year. Last year, it would have been because the secondary policy saved us $4000 in medical bills from his surgery. This year, it may not be worth it. We have to run the numbers.

You may also have to choose your FSA election soon. The rules are changing for 2011, so review them carefully, then total up your expected costs and choose a limit accordingly.

Calendar Year vs. Benefit Year Benefits

Once you make the necessary changes to your plan, also note which benefits are on a calendar year and which are on a benefit year. For example, if your deductible is on a calendar year, it runs January 1 to December 31. If you’ve used it up, then plan as many appointments as you can before December 31 to avoid incurring more costs. On the other hand, if your deductible operates on a benefit year and your benefit year starts November 1, then you only have until November 1. However, if you haven’t used up your deductible, and need several appointments, you might be better off waiting until the start of your new deductible so you don’t have to double pay.

If you’re undergoing treatment, you should also confirm whether it falls under calendar year or benefit year coverage. If it’s benefit year and your benefit year ends shortly, your provider can start billing your insurance again once the next benefit year starts. If it’s calendar year, they can start billing your insurance again on 1/1.

If you’re not sure when your open enrollment period is, or where to find out what your benefits include, you should first check with your HR department or manager. Next, look at the back of your card for a toll free number. They can confirm benefits. Finally, visit the website for your plan. You can create an account that will detail your coverage and claims.

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