In this article published Nov. 6, 2017 in the Sacramento Business Journal, Sutter Health Plus Vice President of Sales Rob Carnaroli shares his insight on how HR professionals and executives can prepare for open enrollment.
Open enrollment is a busy time for HR teams serving as the frontline to help employees understand their options and make important benefit decisions for themselves and their families. HR professionals and executives can prepare for open enrollment with answers to some of the most frequently asked questions.
Here are answers to the top six questions employees may ask this open enrollment.
1. Why do premiums typically increase each year?
Health insurance premiums typically go up because the cost to deliver care increases. Higher utilization of health care services, the cost to administer benefits, and state and federal regulatory mandates—and in some cases taxes—are included in premiums.
An employee’s share of cost includes a percentage of the premium not covered by the employer. It also includes the amount they must pay for covered services, such as deductibles and any copay or coinsurance amounts.
2. I have a preexisting health condition. Will I continue to have coverage in 2018?
You can breathe easy. At this point, there is no change to the preexisting condition clause. Under current law, health insurance companies cannot refuse to cover you or charge you more just because you have a “preexisting condition”—that is, a health problem you had before your new health coverage starts, such as asthma, diabetes or cancer.
3. What should I consider when looking at benefits packages if I am planning to start a family within the year?
When looking at plan options, compare the total costs for health care. To understand what is covered in a plan, look at two very important documents: the Summary of Benefits and Coverage and the Evidence of Coverage (EOC). These summarize key features of the plan, such as covered benefits, cost-sharing provisions, and coverage limitations and exceptions.
In addition, take a close look at the provider network to ensure your primary care physicians, specialists and hospitals are included.
4. How should I plan for my children in college?
If a parent’s health insurance plan covers dependents, a child can stay on the parent’s plan until age 26. Many major colleges offer basic coverage through a student health clinic as part of the tuition, but if a student needs to seek additional care, most HMO plans cover out-of-area urgent and emergency care. However, all other covered care must be received within the HMO’s service area. If the child is living far from the service area and more comprehensive coverage is desired, a PPO option may provide more flexibility in accessing care locally.
5. How can I save money on pharmacy costs?
It’s no secret that pharmacy costs nationwide continue to climb. Using a mail order pharmacy program, where available, may save time and money. It can also be helpful to use a drug price-checking tool online to compare costs and seek alternatives, including generic medications. With an average copay of $10, generic drugs offer one of the greatest values in the market today.
6. What do I need to consider when planning an international trip?
If you’re leaving the country, talk to your doctor about vaccinations or drugs you may need specific to the region you’re visiting. For travel abroad, find and save the local emergency telephone number as not every country uses 911 as its emergency number.
Make sure you understand what services are covered by your health plan while you’re away from home. Check your EOC for specifics on what to do in case of an emergency. Sutter Health Plus plans cover emergency services and urgent care worldwide. If your health plan offers an online portal, you’ll have access to this information regardless of where you’re traveling—just make sure you register and have access before you go on vacation.
