Understanding Open Enrollment
It’s that time again…when members of your group health insurance plan have the opportunity to enroll in benefit programs. In a nutshell, this is “open enrollment” and insurance carriers are required to accept all applicants of the group without underwriting or evidence of insurability. Open enrollment is generally held once per year, with exceptions to the rule like new employees or changes of status such as the birth of a child or divorce.
You’ll want to be sure to check with your human resources department to see when your company’s open enrollment period begins and ends, and when your policy goes into effect. Then, follow these steps so you can make the best possible (and informed) decision.
First– Read and Understand the Materials
Before making a choice:
- Check to see if your current physicians and area hospitals are in the plan’s network. Using network providers generally will save money on your health care. (“In-network” vs “Out-of-network”)
- 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.
- If you take prescription medications, check them against the list of approved drugs in each plan booklet.
- If any part of a plan is unclear to you, ask for help from your human resources department or the insurance carrier.
Compare the Costs and Coverages of the Plans Offered
In this uncertain market, it’s important to carefully evaluate your healthcare costs when making your 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 for you until you do the figures.
To pick the best coverage, first calculate your healthcare costs from recent years and try to estimate what your costs might be for the coming year. Don’t forget to include the cost of doctor’s visits, daily medications and any procedures you might be planning.
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 you are responsible to pay. Remember, if you use a medical provider that is out-of-network, you will generally pay more out-of-pocket expenses. Include these fees in your calculations.
One of the obstacles to infertility treatment is determining how best to pay for the treatment itself. At Reproductive Resource Center we understand that a patient’s decision to pursue advanced infertility treatment can be stressful. Because many patients do not have insurance coverage for assisted reproductive technology (ART), financial anxiety can complicate the decision to pursue treatment. In response to these financial concerns, Reproductive Resource Center is pleased to offer our patients some unique financing options to help make paying for treatment more manageable.
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.
- If your dependents have health insurance coverage through their employer, school or the Veteran’s Administration, compare their costs and benefits to the family plans you are considering to ensure that you choose the best plan for every member of your family. Make the same type of comparisons for any dental or vision care plans that you are offered.
*Open Enrollment information courtesy of NAIC: National Association of Insurance Commissioners
*image courtesy of patrickcoe / creative commons
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RRC has over 200 years of combined experience. As a leading reproductive health, infertility, and in-vitro fertilization (or IVF) center based in Kansas City, we're proud to have the highest level of expertise available to our patients.