Eight Tips For Participants Of Employer Sponsored Health Insurance During Open Enrollment


HighRoads[1], the industry leader in employer health care regulation compliance[2] and benefits management, today shared eight tips for employees as they navigate their annual employer benefits open enrollment period. Following these simple steps may save employees hundreds of dollars on their health care costs while ensuring that they make the most of their benefit plan programs.

Employers are making more changes than ever to their benefits plan designs and as a result employees need to take extra precautions to assure that they have the benefits coverage they expect, for a price they can afford, during this years open enrollment period, said Cynthia Weidner, vice president H&W consulting, HighRoads. This is the time for employees, retirees and their families to consider all of their options, including health savings accounts and wellness programs, to make the most of their benefits while minimizing out of pocket costs for the year to come.

Now that the Supreme Court has upheld the Affordable Care Act (ACA), employees will see some changes in their annual open enrollment benefits materials. For many employees this will include the addition of a Summary of Benefits and Coverage (SBC) document. SBCs are benefit plan summaries that are intended to benefit employees by creating clear, understandable and straightforward information on what health plans will cover, what limitations or conditions will apply, and what they will pay for, according to the U.S. Department of Health and Human Services.

However, reading the SBC alone may not provide employees with everything they need to make informed decisions during open enrollment. Following these eight tips can help to eliminate an employees risk of unexpected plan changes or cost increases:

1. Get your plan materials Pay attention to how your employer is making your SBCs and the traditional Summary Plan Descriptions (SPDs) available to you. Many are making them more accessible online, via mobile apps as well as on paper. Its good to know how you can access this information during open enrollment and throughout the year, in case you want to review it again when you are in need of a particular medical service.

2. Do your homework Take the time during open enrollment to truly read through your plan materials, including the SBCs and SPDs, to make yourself familiar with each of your plan options. Reading each of these materials will give you the detailed plan descriptions you need to decide on the best plan for you and your family in the coming year.

3. Calculate your costs Many employers provide cost calculators to help project your total cost for the coming plan year. The total cost includes the premium you pay as well as your share of the deductible and coinsurance. Take the time during open enrollment to think through your potential medical needs and calculate your anticipated expenses before selecting a plan. It may save you hundreds in the long run.

4. Consider an account If your employer offers you the option of a healthcare account, whether it is a flexible spending account (FSA), a health reimbursement account (HRA) or a health savings account (HSA), take a good look at it. These accounts can help you save money on qualified medical expenses that arent covered by your health care plan, such as deductibles and coinsurance. Each account has a different set of rules about how and when you can spend the money, but each are worth considering because the savings youll see can add up quickly.

5. Ask if you have a grandfathered plan. One of the benefits of health care reform is an extended list of preventive care benefits that must be offered by new health care plans for free. Preventive services such as colonoscopy screenings for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults must be offered without out-of-pocket costs. However, these benefits are only for new health plans and dont apply to grandfathered plans that havent significantly changed in a few years. Find out if your plan is considered to be grandfathered and identify exactly what preventive services are covered for free.

6. Prepare for the unexpected Everyone needs to be prepared for the unexpected, including job loss, separation, or other life-changing events. Be sure you know what the benefits plan costs might be if you need to pay for it under COBRA. COBRA requires that most employers with group health plans must offer employees the opportunity to continue temporarily their group health care coverage under their employer’s plan if their coverage otherwise would cease due to termination, layoff, or other change in employment status (referred to as “qualifying events”). However, COBRA insurance must be paid entirely by the former employee. Be certain that if you need to continue your companys health coverage that you are comfortable with the full premium cost should you need to pay for it on your own.

7. Use wellness incentives More employers than ever before are offering incentives to employees and their family members for health improvement. These incentives may come in the form of medical premium discounts, access to certain low deductible plans or even incentives and prizes. Some employers even offer to put money in an employee’s medical account as an incentive. Take the time to learn everything your employer offers. You may find that you are already leaving money on the table because you have a gym membership or participate in a weight loss program that qualifies for an incentive from your employer.

8. Know your deadlines. No matter what changes you may make, if any, during this years open enrollment period, dont let your selection deadlines slip by without action. Doing nothing could end up costing you hundreds in 2013 in higher premium costs, lower coverage, or missed opportunities to optimize your health care dollars. Missing your open enrollment deadline will mean that you have to wait it out a full year before making changes that can help pad your bank account.

About HighRoads

The worlds leading employers choose HighRoads to gain control over their health care costs and compliance. HighRoads SaaS-based solutions provide employers with complete benefits management capability, including benefits plan information and pricing, competitive benefits benchmarks and complete benefits compliance. The privately-held company is headquartered in Woburn, MA. For more information, visit www.HighRoads.com[3]. Follow us at @HighRoadsHR


  1. ^ HighRoads (cts.businesswire.com)
  2. ^ compliance (cts.businesswire.com)
  3. ^ www.HighRoads.com (cts.businesswire.com)

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  1. Reply

    Health Tips? Is it bad for the health when after eating, I immediately lie to sleep?

      • HealthNut
      • September 19, 2012

      Yes it is you should wait at least 2 hours after eating before going to sleep or else the food you just ate won’t burn up! you shouldn’t eat after like 6pm

  2. Reply

    Health Diet Tips To Keep Myself Skinny And Healthy? I am 115lbs and I am 13. I was wondering if anyone had any health tips to keep myself healthy.

    I was looking into this diet where I would start with eating protein and gradually work my way into eating my fruits and vegetables. Does anyone know what this diet is called?

    (Please, No comments with additude. Any other comments will be appreciated. Thanks so much!)
    Also, I don’t want to be on a diet plan (Such as Weight Watchers). Thanks!

      • HealthNut
      • September 19, 2012


  3. Reply

    Health Tips And Vitamins I Should Take Being A Growing Teen? Anyone recommend any daily vitamins i should take? please provide the store i can get em at and the price. what it does and all the details please. also any random health tips would be appreciated. thanks.

      • HealthNut
      • September 19, 2012

      A multi vitamin suh as centrum is good. Flaxseed oil capsules are great as well.

  4. Reply

    How Can I Get Healthy? -Health Tips? This year, I made it a point to become healthy. I have lost some weight and got rid of some acne.

    I really want to be healthy, and make sure that I look healthy.

    Can you give me some all over health tips?
    Im a teen girl by the way.

      • HealthNut
      • September 19, 2012


      The best advice I can give you is exercise daily and eat well. Eat at least 5 portions of fruit or vegetables a day. Try to cut out as much sugar and snacks as you can manage. Drink plenty of water. Exercise for about 30 minutes a day, remember this does not have to be running a million miles and lifting 10 ton weights. Walking is an excellent form of exercise and is great because you can walk briskly around shops whilst looking at really cute outfits!

      I hope this helps!

  5. Reply

    I’m Trying To Loose Weight, What Are Some Health Tips? I’m making a modeling portfolio, and I know I need to be slimmer. What are some health tips, such as eating veggies, and colors to dress in the make you look slimmer? What is skinny for height 5’8″? I am Indian (India) & German and I have blue eyes.

      • HealthNut
      • September 19, 2012

      Unfortunately there are no easy ways to permanently lose weight and most people who lose weight regain it all.

      A vegetarian or vegan diet for the rest of your life might perhaps be a good option as very few vegetarians or vegans are overweight.

      If you want a life changing permanent weight loss you need to follow a maintenance diet for the rest of your life after you reach your target weight with one of the many diets you can choose from.

      You can see further details in a web search for “how to lose weight and keep it off”.

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