With open enrollment around the corner for many, now’s the ideal time to prepare for employee questions that may arise. As an employer or HR professional, you’re likely well-versed in plan options, but to many employees, insurance benefits seem like a foreign language.
The good news is that you can demystify open enrollment and help your employees get the most out of your benefits by having answers to their questions. To help you prepare, here are some questions you'll likely hear from employees — and information on how to respond.
1. What is open enrollment?
Under the healthcare reform laws, families and individuals can only make changes to their health insurance plans during a specific period, unless they experience a life-changing event such as a marriage or the birth of a child (but we’ll explain more on that below). This time period is known as open enrollment.
Admittedly, employees might not actually ask this first question, but you should explain it upfront so they don’t have to. Some of your employees may not understand the significance of open enrollment, but feel like they should, so they avoid the topic altogether. Start them off on the right foot by making sure they’re clear on what open enrollment means.
2. What are the dates of open enrollment?
This is up to the employer. Whatever your open enrollment dates are, make them clear to your employees. Whether you communicate the dates through your company newsletter, include a note on payment statements, or display them on break room TVs or signs throughout the office, share them early so your employees have time to decide whether they need to make adjustments to their plan. Too often, employees automatically re-enroll in their previous year’s plan and don’t realize the open enrollment dates until it’s too late.
3. What is a qualifying life event (QLE)?
A qualifying life event (QLE) is a change in an employee's personal situation, like getting married, getting a divorce, having a baby or losing healthcare coverage (see a complete list of QLEs here). A qualifying life event is a circumstance that allows employees to make changes to their benefit elections outside of the open enrollment window. That said, employees are required to make these changes within a set period of time — usually within 30 or 31 days of the qualifying life event.
4. Does a spouse's open enrollment allow an employee to change their benefit elections midyear?
If permitted by the employer’s cafeteria plan, an employee may make a midyear election change during a spouse’s open enrollment period under IRS Section 125 rules. Any change must be consistent with the election made under the spouse’s plan. For example, a spouse who drops coverage under their own plan may be enrolled in the employee’s plan, or an employee may drop coverage for enrollment in a spouse’s plan.
This election-change opportunity generally applies only to medical, dental and vision coverage and does not extend to unrelated benefits such as life insurance, disability insurance or health flexible spending account (HFSA) elections. Employers should confirm that their cafeteria plan document allows this type of midyear change and obtain documentation of the spouse’s open enrollment period and corresponding election change.
5. Can I cancel my health insurance at any time and get a new policy?
Employees can only change their plan during the designated open enrollment period or if they experience a qualifying life event.
6. How do I know if my doctor is covered by a health insurance plan?
Understandably, this is a major factor in healthcare decisions. Employees should check the insurance company’s website to see if their doctor is listed under the plan’s covered providers. To be extra sure, they can also call the insurance carrier and their physician’s office to confirm coverage.
7. What is a high deductible health plan (HDHP) and how does it work?
For 2027, a high deductible health plan (HDHP) is a health insurance plan with a deductible of at least $1,750 for an individual plan, and a deductible of $3,500 for a family plan. The deductible is the amount employees must pay out-of-pocket for covered healthcare services before the insurance company starts to pay. So, if an employee's deductible is $1,750, they pay the first $1,750 of the covered services (unless it’s a covered preventive service under the Affordable Care Act). After an employee meets their deductible, they usually pay only 10% or 20% of the covered healthcare service, which is known as coinsurance. For 2027, the maximum out of pocket amount is $8,750 for an individual plan and $17,400 for a family plan.
HDHPs usually have lower monthly premiums. If employees don’t anticipate many medical expenses in the upcoming year, these plans can be a good option to help them save money each month. That said, employees who choose an HDHP should budget for the out-of-pocket maximum in case an unexpected medical issue arises.
8. How do non-HDHPs work?
Health insurance plans with lower deductibles offer employees more predictable costs, and in many cases, more generous coverage. At the same time, their monthly premiums may be higher, so your employees need to budget accordingly.
If an employee is not enrolled in a high deductible health plan (HDHP), they may have copays for doctor visits. These copays do not count toward their deductible, and the employee would only be responsible for the copay amount for the office visit — nothing more.
9. Is it possible to backdate my insurance?
Typically, no, but there are some exceptions. For example, if an employee has proven insurance, known as “Proof of Insurability,” the new health insurance provider cannot deny claims for a certain period of time. There are other instances as well. If an employee has a new baby or adopts a child, their coverage will be effective the day of the birth or adoption. Or if an employee qualifies for Medicaid, the coverage is effective on the date the application is submitted — even if approval is not received right away. Exceptions like these can be somewhat nuanced, so employees should discuss their situation with the insurance provider or employer.
10. How much can I contribute to my Health Savings Account (HSA)?
In 2027, the maximum HSA contribution amounts for employees with HDHPs are $4,500 for individual coverage and $9,000 for family coverage. Employees who are 55 and older can make an additional $1,000 “catch up” contribution in 2027.
Keep in mind, if an employer is contributing toward employee HSAs, the employer contribution will go toward maximums. Have more HSA-related questions? Check out our HSA FAQs here.
11. What if I miss the open enrollment period for benefits?
Despite your efforts to guide employees through the open enrollment process, there’s always a chance that they’ll miss the open enrollment deadline. Unfortunately, if they do, they’ll have to wait until the next open enrollment period — unless they experience a qualifying life event.
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Editor's Note: This article was originally published Oct. 23, 2019, and has been updated to reflect the most recent information.