Department of Insurance gives tips for open enrollment

by Lesley Politi on November 8, 2008

Department of Insurance gives tips for open enrollment

It’s the time of year when many employers across the country hold open enrollment periods for their employees to select health insurance coverage. The Ohio Department of Insurance provides these tips to help employees make the best choice of the options available for them and their family.

What is Open Enrollment?

Open enrollment refers to the period of time during which all members of an employers group health insurance plan have the opportunity to enroll in certain benefit programs. During an open enrollment period, insurance carriers the employer chooses to use are required to accept all applicants of the group without underwriting or evidence of insurability. Open enrollment is generally only held once a year. For those who miss a company’s annual open enrollment, they likely will not be able to enroll in the employer-sponsored health insurance program until next year. Certain exceptions apply for new employees or employees with life changing events.
Make sure to check with human resources department to see when the company’s open enrollment period begins and ends, and when the policy goes into effect.
Read and Understand the Materials
There are many different types of major medical plans typically offered by employers. For help understanding the fundamental differences between preferred provider organizations, health maintenance organizations, point of service plans or indemnity plans, go to the National Association of Insurance Commissioners; of which the Department is a member, insurance education web site, and click on the life situation that most closely matches your own.
The health section includes basic information about each type of program.
Plan materials will detail which medical providers (physicians, hospitals, labs, pharmacies, etc.) are considered in-network and out-of-network.
They will also detail how much the insurance carrier will pay under each type of plan.
Before making a choice:
• Check to see if current physicians and area hospitals are in the plan’s network. Using network providers generally will save money on your health care.
• Check to see if spouses or dependents are covered. Some plans will cover spouses and other dependents, while other plans will not.
• Read all of the plan materials thoroughly. Doing so will tell you what your rights and responsibilities are under each plan.
• Review any pre-existing condition exclusions and prior authorization requirements in the plan materials.
• For those taking prescription medications, check them against the list of approved drugs in each plan booklet.
• If any part of a plan is unclear, ask for help from the human resources department or the insurance carrier.
• For those not satisfied with the answers to questions, call the Ohio Department of Insurance consumer hotline at 800-686-1526.
Compare the Costs and Coverages of the Plans Offered
In this uncertain market, it’s important to carefully evaluate healthcare costs when making annual enrollment decisions. While one option might have high monthly premiums and a low deductible, and another might have a low premium but more out-of-pocket expenses, it could be misleading which plan is best until a person does the figures.
To pick the best coverage, first calculate healthcare costs from recent years and try to estimate what costs might be for the coming year. Don’t forget to include the cost of doctor’s visits, daily medications and any procedures that might be planned.
Next, make a list of the premiums, out-of-pocket expenses and benefits under each plan. Co-payments, deductibles and additional charges for wellness care or specialists (e.g. chiropractic care, cosmetic surgery, etc.) are examples of out-of-pocket expenses that a person is responsible to pay.
Remember, for those who use a medical provider that is out-of-network, they will generally pay more out-of-pocket expenses. Include these fees in calculations.
Finally, a person needs to decide how much they can afford to pay.
Other things to keep in mind:
• Check for any annual limits and prior authorization requirements.
• Some prescription medications have higher co-payments than others and they might vary from plan to plan. Mail-order options might be available for maintenance drugs at a lower cost to you.
• For those with dependents that have health insurance coverage through their employer, school or the Veteran’s Administration, compare their costs and benefits to the family plans that are being considered to ensure that they choose the best plan for every member of a family. Make the same type of comparisons for any dental or vision care plans that are offered.
Double Check
Once enrolled in a health plan, a person will not be able to make changes until the next open enrollment period, unless there is a life changing event such as a divorce, job change, marriage, birth of a baby or adoption of a child.
For those who do not receive insurance cards and/or enrollment information, contact the HR administrator, or call the insurance company.


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