Sep 14, 2023

Preparing Your Employees for Open Enrollment

girl holding papers that say open enrollment

    Preparing Your Employees for Open Enrollment

    For many, OE is just around the corner! If you’re preparing your employees for Open Enrollment, view this helpful guide from our advocates.


    It’s nearly time for Open Enrollment (OE). This is the period each year members can add, remove, or change elections in their employer-sponsored benefits plan. Use this plan to prepare your team for OE and understand what they need to know.

    Here are a few things to expect during OE this year:


    Benefits Portal Access

    Login links will be sent to members via email from the HR administrator to access their benefits portal. They may use this to log in and review their benefits plan and enrollment options, even if they don’t plan to make any changes to their elections.


    Review Plan Offerings

    Members should use this opportunity to refresh their understanding of the plan they currently have, see if anything has changed in the plan offerings, or see if they need or want to make changes.

    Ensure your employees understand:

    • Have the terms of the coverage changed?
    • Will they have a higher deductible or copay in the coming year?
    • Will their payroll deductions change in the coming year?
    • Are there additional group benefits being offered?


    Making Plan Changes Within the Same Carrier

    Members may decide to change to a different plan with the same carrier. This could be done for various reasons including:

    • Lowering out-of-pocket costs with a lower deductible by changing to a Gold or Platinum plan
    • Or lowering premium cost by choosing a Bronze or HMO plan

    Plan changes will produce new ID cards, so members should update their pharmacy and medical provider after a change.


    Employer-Sponsored Plan & Carrier Changes

    Your company may have decided to switch insurance providers and opt to go with a different health plan carrier (From Anthem to Blue Shield for example) for their sponsored benefits.

    If the provided health plan carrier is changing, employees should know:

    • Whether they have already met their deductible on their current carrier’s plan
    • Whether or not the deductible can be “carried over” to the new carrier’s plan
    • If they have any scheduled and pre-approved procedures or surgeries
    • How to talk to their doctor about ordering a new authorization with the new insurance carrier
    • Whether they need to stock up on prescription medications for the time between changes
    • How to get authorizations with the new carrier that will need to be requested by their doctor

    Employees should be reminded that their benefits portal is available for them to review plan coverage and make demographic changes at any time during the year.


    Comparing Plans: How is an HMO Different Than a PPO?

    If employees are considering switching to an HMO from a PPO, they should learn the difference between the two plans and what it means for their coverage.

    An HMO (or Health Maintenance Organization) plan can have lower premiums each year, but it comes with some limitations worth considering.

    • Medical coverage with an HMO is limited to a network of providers who are affiliated with a specific Medical Group or Hospital. In more rural areas, this could mean a limited pool of doctors and specialists participating in that Medical Group.
    • The Primary Care Physician (PCP) is the gatekeeper to specialist care. A PCP is affiliated with the HMO Medical Group and members should schedule an “establishing appointment” within 30 days of the effective date.
    • Special authorization is required from the PCP before seeing a specialist. This means if members need imaging or treatment beyond their annual preventative care, a referral from the PCP is required or the insurance claim will be denied, and members will be charged for the services.
    • Medical Groups have specific Urgent Care centers and may also require prior authorization or notification.
    • Medical Groups also have specific hospital affiliations. While HMO patients can go to any Emergency Room, not every hospital will be in-network. Members should familiarize themselves with their Medical Group’s affiliations before enrolling into an HMO plan.

    For members considering an HMO plan for the first time, we recommend watching our HMO vs. PPO Plans video before making the choice. HMO plans are cost-effective, but with the cost savings come strict rules about accessing specialty services. Members should understand the plan’s limitations and ensure an HMO will work for their needs before making the switch!


    Our Team is Here to Help!

    Remember, our Advocates are here to help! We are ready to answer all benefits questions such as what plans are available, how to enroll, and how any changes may affect your employees. Don’t hesitate to contact us for a direct connection to one of our team members. We’re available to provide helpful, personalized service both to you and your employees.

    Our team is available between 8am-5pm PST, Mon-Fri at: 855-662-1029 and

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