Open Enrollment may also refer to Medicare or Schools and Education .
Open Enrollment (sometimes called open season or annual enrollment) is a period of time when employees of companies may make changes to their employee benefits package.
All employees should take extra care in order to select choices that provide the best results for themselves and their families. Too often, the lowest cost choice is not the best.
When Does Open Enrollment Take Place?
Open Enrollment usually happens near the end of a calendar year.
Your employer will notify you of the specific time. Usually, the time period is for one or two months, occasionally, it may be much less, only one or two weeks. The penalty for not acting during this crucial time is having to wait another full year in order to make changes. Be careful not to miss your chance.
At this time of year, employers will usually make each employee aware of their current benefits, as well as present all available options for the New Year. Sometimes, benefit vendors and insurance providers may be present to make group presentations or provide one-on-one counseling.
Choose Carefully
Learn the difference between a PPO (Preferred Provider Organization) and a HMO (Health Maintenance Organization
If you enroll in an HMO, you’ll need to receive all or most of your care from a single source. You will select a primary care doctor who then will provide the bulk of your basic care. If you should need a specialist, or outside service such as a lab test, your primary care doctor will need to provide you with a referral. If you do not have a referral, or seek help outside your network, you will probably need to pay the entire bill on your own.
With an HMO, all the doctors file their own claims in order to get paid.
If you enroll in a PPO, you may choose from a selection of doctors called “preferred providers”. You won’t need referrals as long as you stay within the list of network providers.
With a PPO, all the doctors also file their own claims in order to get paid. However, if you go outside the network, you may need to pay the service provider first and then file a claim. Usually, the full amount of the claim will not be paid and you will be responsible for the balance.
Questions You Should Ask
What is an annual deductible ?
What is a copayment ?
What is coinsurance ?
Are you planning on having a child?
Has someone in your family been recently diagnosed with a chronic illness?
Are prescription medications covered?
Does coverage apply to your spouse and children?
Be Cautious. Do Your Homework.
Be sure to carefully read your materials and make sure all your questions are answered thoroughly.
If you want to learn more about your options, contact your state’s insurance department. They are very helpful and can also outline any complaints about the health plans licensed in your state.