Open enrollment comes at the same time every year, but just like the arrival of Christmas, it can catch us off guard if we are not careful. It often leads to last-minute scrambling and stress with the potential to impact employees and employers. A little preparation helps to smooth out those wrinkles while getting all the pieces into place.
To get ready for open enrollment, employer groups have several things to consider and should review the design of their health plan to make sure that any necessary updates can be addressed timely. In addition to making sure that their health plan design is compliant with regulations, employer groups also need to make sure that open enrollment materials contain certain required participant notices (such as the summary of benefits and coverage) and that summary plan descriptions (SPD) are up to date.
Some items to consider as you’re working through health plan renewals:
- Affordable Care Act (ACA) Affordability. Under the ACA, applicable large employers (ALEs), those with 50 or more full-time and full-time equivalent employees within the prior calendar year, may be subject to a penalty if “affordable coverage that provides minimum value” is not offered to full-time employees and their dependents.
- ACA Out of Pocket Limits. The ACA limits out-of-pocket costs on ‘essential health benefits’ such as deductibles, copayments, and coinsurance. ACA out-of-pocket limits are different for high deductible health plans (HDHPs).
- Health Flexible Spending Account (FSA) Contributions. While employers can create their dollar limit for a plan, it cannot exceed the ACA maximum.
- Open Enrollment Notices. Do your open enrollment notices contain, just to name a few, the summary of benefits and coverage, annual CHIP notices, or initial Cobra notices? Now is the time to review any requirements to make sure that your group is compliant.
- Establish a Timeline. Establishing a timeline for open enrollment plan options, dates, and deduction amounts.
- Update. Updating brochures and communications for employees about Open Enrollment.
- Host Meetings. Host meetings with employees to answer questions.
- Verify enrollments and deductions after open enrollment and with the first payroll.
Clients who utilize benefits through a benefits provider should have access to specialists who know open enrollment and serve as experts giving guidance. If you need step-by-step assistance, click here to review an open enrollment checklist ensuring best practices and compliance. It’s important to choose a provider who will also be your partner to drive your open enrollment success.
Autumn Stevens serves as the Insurance and Benefits Coordinator at ConceptHR, bringing over 15 years of specialized experience to her role. Autumn has guided countless businesses through the complexities of compliance and benefits optimization, with a special expertise in the Affordable Care Act. Her unwavering commitment to God and her goal-oriented approach has earned her a reputation for excellence and integrity in her field, establishing her not just as an authority in her domain, but as a trusted partner.
If you have questions about today’s article or any HR issue you are having, please email info@concepthr.com.
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