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Navigating the Open Enrollment Maze


When you are running a business, you need to get an early start on your small group health plan Open Enrollment preparation—and now more so than ever with all the confusion around the state of health insurance in the country.

With recent new regulations, options have changed for employers, and you need to stay focused on maximizing your outcomes within your budget. You also want to drive participation as that too can reduce overall rates for you.

Here are some tips to help you sort through Open Enrollment:

Understand your options.
Familiarize yourself with the various options that you have:

  • Health maintenance organizations – HMOs are typically the least expensive plans because they require enrollees to visit their personal physicians and tightly controlled in-network doctors. Going out-of-network is discouraged with high out-of-pocket costs. An HMO will usually only pay for care outside of the plan network when it’s an emergency or another unusual situation.
  • Preferred provider organizations – PPOs contract with hospital and provider networks to help control costs. While they will cover services outside of the network, the cost is higher than going in-network. PPOs are more flexible than HMOs, but premiums are often higher – as are some out-of-pocket costs. One key difference from an HMO: PPO enrollees don’t need a referral from their primary care physician if they are going to a specialist.
  • Point of service – A POS health plan is a mix between an HMO and a PPO-style health insurance policy. With a POS health plan, your staff has more choices than with an HMO, but they will usually need to select a primary care provider and need a referral to see a specialist.
  • Exclusive provider organizations – The EPO is also a PPO-HMO hybrid. Enrollees need to receive covered services inside of the network, except in a few instances, but they can also see a specialist without a referral from their primary care doctor.

Check your budget.
In 2018, group health insurance premiums averaged $575 a month ($6,896 annually) for single coverage, and $1,635 per month – or $19,616 per year – for a family, according to a survey of employers by the Kaiser Family Foundation.

Make sure your employee premium cost-savings stay within the guidelines of the Affordable Care Act, which requires that plans be “affordable,” meaning they cannot cost more than 9.78% of an employee’s household income. Also keep in mind, if you try to unload too much of the premium on employees, you may see people leave your plan and, if too many decide not to participate, you may not be able to offer the policy. Try to offer plans that will be valuable to your staff as well as affordable.

Maximize enrollment.
If you want to find out what your employees expect from their benefits, you can run an employee survey. It can cover the basic elements of the plans you are going to choose from, and ask them which ones they would find most valuable. Then, move forward with plans based on their responses.

Remember, your goal is maximum participation. Your broker will give you materials to disseminate to those who may need plans explained to them. Give them some time to look the plans over. Employees want and need to know what changes are being made to their benefits packages in advance, so make sure you give them time to look through the offerings.

Next, hold a meeting a month before Open Enrollment starts in order to go over the plans and options with your staff, as well as any significant changes you’ve made. During the meeting, highlight the value of each of the plans you are offering. Unfortunately, there may be those among your staff that haven’t really paid attention to the plan documents you gave them earlier, so plan your meeting accordingly.

Health insurance is complicated, and there are a lot of choices to make; choosing the right broker can help simplify the process. The right broker will be a partner, helping to guide you through the insurance maze. And the best broker will understand your business and offer you more value.

Visual Media Alliance has been helping businesses in the graphic industry since 1935. And during Open Enrollment, VMA can get you the right insurance for yourself, your family, and your work family. VMA also includes lots of free added perks with enrollment such as complimentary Human Resource tools. Contact VMA at 800-659-3363 to talk to someone today!

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