Open Enrollment To Do List

OPEN ENROLLMENT TO DO LIST

This is a list of tasks business need to do while working with staff and insurance brokers to ensure their Open Enrollment process goes off without a hitch.

The to-do list works like a workback schedule, starting 90 days before your open enrollment period and ending when coverage begins. Use the worksheet to count back your actual days and keep you on schedule. Here’s a quick chart to help:

When your open enrollment period starts 90 days out
October 1, 2019 July 1, 2019
November 1, 2019 August 1, 2019
December 1, 2019 September 1, 2019

80-90 days before

Create a plan and establish goals for open enrollment

This is when you look back at your year, and determine the changes you’d like to see as a company to your benefits.

  • Identify the number of employees eligible for benefits
  • Align company goals with broker and administrator for the renewal period, with the help of these questions:
    • Are you and your employees happy with the current carrier and their provider network?
    • Are you and your employees satisfied with your current benefits structure?
    • Do you anticipate business changes that may impact your financial situation with respect to Benefits allocation?
    • Have there been any major change in your workforce? (e.g., New out of state offices or employees, change of company name, merger, etc.)
  • Check benchmarking data for companies of similar size and in similar locations
  • Provide open enrollment schedule to staff

60-80 days before

Review broker package rates

This is when you shop plans, determine pricing, and finalize your company budget line items for benefits:

  • Review renewal packages with your broker
  • Follow up with your broker as they gather quotes from current and alternative carriers
  • Check with your broker to ensure plan options meet ACA requirements and are compliant with state and local ordinances
  • Review usage rates, costs, and availability of additional perks or programs you will offer throughout enrollment period, such as wellness programs, commuter benefits, FSA, HSA, etc.

50-60 days before

Finalize plan selections for the upcoming year

This is where the HR admin and other decision makers determine the company approved plans that will be rolled out for the following year’s coverage.

  • Coordinate time with decision makers to review plan options for the upcoming year, as prepared by your broker
  • Finalize and plan selections for the upcoming year and confirm with your broker

Coordinate with your broker to provide educational resources to employees during open enrollment including: FAQ, glossary, open enrollment booklet, etc.

­­­45-50 days before

Prepare for open enrollment

This is when an HR manager focuses on communication and education of the open enrollment dates and plan options with staff.

  • Update company calendar with important enrollment dates and deadlines
  • Work with broker to create and distribute summaries of various plans and options
  • Schedule open enrollment meetings to review dates for open enrollment, plan, and cost changes
  • Announce new perks or programs (i.e. wellness programs, commuter benefits, etc.)

30-45 days before

Open enrollment prep continues

This is when HR professionals must ensure employees have selected plans through email communications, reminders, and company updates.

  • Employees make their selections
  • Send reminder to staff that enrollment is starting

30 days before

Submit group and employee changes to insurance carriers

This is when, once you have all employee benefits selections, you work with your broker for final approval.

  • Submit the group application and employee plan selections to the insurance carrier

Coverage is effective!

Coverage begins

Congrats! This is when your new benefits coverage begins for employees. Changes to rates and plans will occur at this time.

  • Update employee handbook with most recent information and summaries
  • Check that all employees received ID cards
  • Verify deductions are confirmed in the payroll system for employees
  • Provide contact info for employees for questions and needs

Frequently Asked Employee Questions

Do employees need to go through open enrollment?

We recommend employees take their annual open enrollment period to make necessary adjustments to their employee benefits. Benefit information changes from year to year, and may require a change to your company’s benefit strategy. If your company admin has decided to "plan map" then you will automatically be enrolled in the same (or most similar) health plan as the one you originally selected. If your company does not have this automated process set up, you must re-select your health plan or you will be denied coverage.

Why would an employee’s insurance rates change?

This actually depends on how your specific company has chosen to set up its open enrollment process. If you have selected an option that's referred to as "plan mapping," then the company will make automatic selections for employees who fail to alter their health plans during the open enrollment period. Without alteration on the part of the employee, the company will keep the individual in the same health plan or in the most similar health plan to the individual's original selection. If that employee had previously declined coverage, the company will automatically decline coverage once again. 

However, if administrators at your company have not selected to "plan map," then any employee who does not actively make a selection during the open enrollment period will be declined coverage. This is even true for employees who had previously been enrolled in a health plan. These employees would need to re-select their health plan to continue using it. If the employee fails to do so during the open enrollment period, they can only enroll in health insurance if they experience a qualifying life event. It's possible that the employer could submit an "exception request" for an employee who missed open enrollment; this would be done through the employer's broker.

What happens if an employee misses the open enrollment window?

This actually depends on how your specific company has chosen to set up its open enrollment process. If you have selected an option that's referred to as "plan mapping," then the company will make automatic selections for employees who fail to alter their health plans during the open enrollment period. Without alteration on the part of the employee, the company will keep the individual in the same health plan or in the most similar health plan to the individual's original selection. If that employee had previously declined coverage, the company will automatically decline coverage once again. 

However, if administrators at your company have not selected to "plan map," then any employee who does not actively make a selection during the open enrollment period will be declined coverage. This is even true for employees who had previously been enrolled in a health plan. These employees would need to re-select their health plan to continue using it. If the employee fails to do so during the open enrollment period, they can only enroll in health insurance if they experience a qualifying life event. It's possible that the employer could submit an "exception request" for an employee who missed open enrollment; this would be done through the employer's broker.

When will employees receive new ID cards?

Carriers send ID cards about 7-14 days after the application has been approved. When a group is going through open enrollment, it is common to receive ID cards around 30 days after the effective date.

Are there any benefits employees can enroll in after the open enrollment period?

Employees can only make changes outside of their open enrollment period if they have a corresponding qualifying life event; all changes unrelated to a qualifying life event must be made during open enrollment

“I was hired recently and just enrolled. Do I still need to go through the open enrollment selection?”

Yes, if the company’s open enrollment effective date is after the new hire enrollment effective date, you will be required to enroll in coverage again.

If an employee makes a selection and then changes their mind, can they make a change?

Open enrollment is the only time of year that employees can make changes to their insurance coverage. Employees can make changes up until the renewal date, however, after the renewal date has passed, employees can only make changes if they experience a “Qualifying Life Event.”

What’s the difference between a co-pay and deductible?

A co-pay is the amount paid out-of-pocket at a doctor’s appointment or when purchasing a prescription. A deductible is the collective amount of money that is paid out-of-pocket before health insurance carriers begin to cover medical expenses. The deductible is typically calculated on an annual basis, either according to the calendar year or the plan year. It’s important to verify which time frame your deductible adheres to before making selections.

Can employees add or remove a dependent to their plan during the open enrollment period?

Yes, open enrollment gives you the freedom to make any changes to your coverage such as adding or removing dependents.

Does an employee need to make selections during open enrollment if they are on leave, such as maternity or paternity leave, or sabbatical?

Yes, it is recommended that all employees make their plan selection during open enrollment, even if the employee is on paid time off, vacations, or any kind of parental leave. If an employee is unable to make the selection at this time, the administrator should work with their broker or carrier to determine their options for enrollment.

What is a qualifying life event (aka special enrollment period)?

A qualifying life event (QLE) allows employees to enter into a special enrollment period, wherein they can reselect health insurance preferences. In the case of a QLE, employees are able to make changes to their insurance plans outside of the open enrollment cycle. Examples of QLEs are having a baby, getting married, getting divorced, and moving. Learn more.

What are some things employees can do to help save on health care costs?

Some actions you can provide to your staff to help mitigate the total cost of healthcare are encouraging preventative care and healthy lifestyles, or using tax-free health savings accounts such as an FSA or HSA. 

  • Preventive Care: to stay on the healthy track, be sure to take on a healthy habits and take advantage of preventive care
  • FSA plan: FSA plans lets you set aside money for health care expenses (deductibles, co-pays, prescriptions, eyeglasses, etc.) before taxes are calculated on your salary, and you are reimbursed tax-free. FSA accounts do not roll over if they are unused. This plan is the use-it-or-lose-it plan. Learn more about FSAs, how to use them, and FAQs.
  • HSA plan: you may use funds from HSAs to purchase eligible medical expenses (prescription costs, deductibles, copayments, and coinsurance) without paying taxes on those purchases. HSA accounts roll over year-to-year if they’re not used. Learn more about HSA plans, details.

If an employee expects to have a life event change after their open enrollment period ends, how will that affect their open enrollment elections?

If an employee has a qualified life event (marriage, birth, move, etc.) after the open enrollment period ends, they will need to access your benefits administrator and “Declare a Life Event.” Once they have submitted the qualified life event change, they will be required to elect and submit their benefits elections in an open enrollment event again.

When can I enroll in a 2020 Marketplace (healthcare.gov) plan?

  • The 2020 Open Enrollment Period runs from November 1, 2019 to December 15, 2019.
  • Plans sold during Open Enrollment start January 1, 2020.

Who is eligible to use the Healthcare.gov Marketplace?

To be eligible to enroll in health coverage through the Marketplace, you must:

  • Live in the United States.
  • Be a U.S. citizen or national (or be lawfully present). Learn about eligible immigration statuses.
  • Not be incarcerated.

If you have Medicare coverage, you are not eligible to use the Marketplace to buy a health or dental plan. 

Do part-time workers count towards the 50 employee threshold?

No. Full-time employees are defined as people who work 30 or more hours, on average, per week. 

Are companies reducing their sizes to fall under the 50 employee threshold? 

Potentially. There have been anecdotal accounts of small businesses  holding off hiring to stay under the 50-employee threshold, and the International Foundation of Employee Benefit Plans found that nearly 1 in 5 small businesses claimed to reduce hiring to try to stay under the threshold. But companies should be advised, there are other penalties that aim to prevent companies from averting the healthcare mandate. For example, business that overtly reduce the number of full-time employees to avoid ACA liability might violate the Employee Retirement Income Security Act (ERISA), as Dave & Buster’s’ $7.4 million proposed settlement demonstrated when a group of workers hours were cut.

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