Navigating open enrollment

Ashley Milne-Tyte Jun 9, 2006


KAI RYSSDAL: We had a meeting with Human Resources last week. Talked about benefits, insurance policies, dental plans, all that really interesting stuff.

It is that time of year at many companies: open enrollment. That always delightful period when you get to opt out of one healthcare plan and into another or change the way you use your current plan.

But with healthcare getting more expensive — and complicated — every year. We wondered, hoped really, whether there might be some foolproof way to navigate the process of open enrollment. We sent Ashley Milne-Tyte to find out.

ASHLEY MILNE-TYTE: During open enrollment last year, Susanna Tully filed into her company’s conference room along with her colleagues. A rep from the health insurance company started to drone on about healthcare options in the lingo of HMOs, PPOs and FSAs.

SUSANNA TULLY: “It got to the point where it was kind of laughable, because people kept raising their hands and asking a lot of questions and trying to find out exactly what he was talking about.”

Explaining this stuff can be daunting. Usually, the task falls to the HR department. Craig Johnson is with Mercer Human Resource Consulting. He trains HR staff to explain healthcare options to employees the way they would to a parent or spouse.

CRAIG JOHNSON: “They’re not necessarily professional communicators. Inherently they know that this information is complex, and might not be easy to understand, so they have a level of anxiety about standing in front of their fellow employees.”

After her open enrollment Susanna Tully finally opted for what seemed like a fairly affordable, convenient plan.

TULLY “But then when you actually get into the program and you try to do something within it you find out there are a lot of limitations.”

Karen Pollitz of Georgetown University’s Health Policy Institute says unwelcome discoveries are common. She says open enrollment is tough because health insurance plans have so many strings attached. And companies are economizing and passing on more healthcare costs to employees.

Which means employees have to be vigilant about what their plan does and does not include. For instance, do you need to get permission from the health insurance company before you can obtain certain treatments or medication? Or will you be stuck with the bill? And it’s worth inquiring about the plan’s past performance.

KAREN POLLITZ: “What’s its track record? How often do claims get denied or turned back and not paid because there’s something else that went wrong that’s hard to understand? How many complaints have there been about this particular plan or this plan option?”

She says many people focus on having the least amount of money come out of their paycheck each month…so they pick a plan with a high deductible. But buyer beware. Pollitz says you should also find out how much more you have to pay toward your care after that deductible has been met. She says most people choose a plan when they’re healthy, without investigating how much of their care it would pay for if they did get sick or injured. But that’s a mistake, as she found out when she was diagnosed with cancer.

POLLITZ: “Because once you’re sick, once you’re lying in a hospital bed or you’re home throwing up from the chemotherapy, that is not the time that you want to try to start figuring all this out.”

Dig deep, she says, and you’ll get fewer surprises. That’s what Trudy Steinfeld did. Steinfeld works at New York University. She says the company conducted open enrollment by putting the information online, as well as sending brochures home.

TRUDY STEINFELD: “What was so great about it, besides providing a lot of detail it also gave you a chart that really compared them side by side, and then they provided a worksheet, basically how you can estimate what you would spend in a calendar year.”

She says the information made it easy to decide which plan offered the most comprehensive, affordable coverage for her family of four. Clearly her open enrollment experience was better than most people’s.

Karen Pollitz of the Health Policy Institute says for many, understanding how a plan really works might mean going beyond HR. She says you might want to ask your doctor about their experience with the plan. Or you could approach a friend or colleague…

POLLITZ: “…who you know has been sick or someone in their family has really kinda taken that card out and used it before, that would be another good person. How did it work out, how difficult was it to get to the care I need?”

For those who worry they’ve picked a dud plan, she says, there is a silver lining: another open enrollment next year.

I’m Ashley Milne-Tyte for Marketplace Money.

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