Helping Clients Understand Open Enrollment Options

Open Enrollment

There is no “standard” open enrollment period for Group Health Insurance – in contrast to the open enrollment period for the Affordable Care Act (ACA) federal and state exchanges. California’s open enrollment for Individual & Family Plan (IFP) coverage on the Covered California public exchange is November 1, 2023, through January 31, 1024. The Nevada Health Link open enrollment period for IFP coverage through the Silver State Health Insurance Exchange is November 1, 2023, through January 15, 2024.

Group Health Open Enrollment

Employers seeking Group Health Insurance coverage for the first time may choose whatever dates they want for their open enrollment (OE) period. For those looking to replace existing Group Health coverage, the OE period is generally 30-60 days in advance of the scheduled end of the group’s current contract. For example, a group that enrolled in 2022 for coverage effective January 1, 2023, the open enrollment dates for new coverage (effective in 2024) are likely to be as early as October 1 or as late December 15, 2023.

Many employers have calendar year benefits, with their open enrollment period happening during fourth quarter (October through December). Others may have near-calendar-year benefits, which start on November 1, December 1, or February 1. The groups’ coverage effective dates may be selected by the employer or may be a result of expiring prior coverage (under a different health insurer or exchange program). Ask your clients about their OE period preferences.

Qualifying for Group Insurance

Different states and carriers have varying rules and forms that need to be completed to apply for Group Insurance coverage. In most situations, your clients will be asked to complete an Employer Application that asks for some essential information including business officers, HR/benefits or other designated contact person, existing benefits/coverage information such as plan specifics and insurers, employee count, threshold for benefits qualification, waiting period, and other information.

Employer Mandate and Penalty Impact

Of course, the decision to offer Group Health Insurance may be influenced by the Affordable Care Act (ACA) Employer Mandate. If your client has at least 50 full-time employees, including full-time equivalents, on average during the year, the employer is an Applicable Large Employer (ALE). That means the business is subject to the employer shared responsibility provisions of the ACA. The ACA guidelines say that employers with 50 or more full-time equivalent employees must provide health insurance coverage to at least 95% of full-time employees. The ACA and IRS set a baseline for affordability. (If you and your client want more information, you can find it on the Internal Revenue Service website.) Failure to offer “affordable” coverage could result in employer penalties: a penalty for failing to offer minimum essential coverage (Penalty A) or failure to offer coverage that is deemed affordable to employees (Penalty B). An ACA FAQs page is available on the IRS website with more guidance. Several “safe harbors” are available to employers when it comes to determining any applicable penalty, as discussed in a reference distributed by Equifax Workforce Solutions.

Diverse Coverage Options

Working with Word & Brown as your general agent ensures you’re able to offer a diverse roster of products and services to your clients. Word & Brown’s portfolio includes Health Insurance for small and large businesses from more than two dozen carriers plus Ancillary coverage like Dental, Vision, Disability, Life, and more from 30+ sources.

Whatever your clients and their employees are interested in, we have solutions and the industry-leading software to help you match their needs and budget to available plans. Our Integrated Provider Search also ensures your clients get access to the doctors, medical groups, and hospitals affiliated with the each of the plans being considered. Ask your Word & Brown representative for details. If you’re not working with Word & Brown as your general agency, call 800-869-6989 or complete our online form to get started.

Choice of Enrollment Method

In your discussions with clients, be sure to ask what they might prefer when it comes to their employees’ open enrollment. Depending on the number of employees and their geographic distribution, you and your client can choose online or electronic enrollment, a “paper” enrollment, or a combination electronic and paper enrollment.

Our enrollment team works as an extension of your agency. We will provide personalized employee worksheets and kits, customized with the employer’s name and logo. Additionally, in California, we can support your groups in six languages.

We work directly with carriers to get your cases approved quickly. And we’ll deliver answers to all your – and your clients’ – questions.

Importance of Open Enrollment

Open enrollment is a critical time of year for employers and employees. It gives employers the opportunity to revisit their sponsorship of employee benefits – and their contribution to employees’ coverage. As cost projections for Group Health for 2024 range from five to nine percent premium increases, employers are likely to be open to plan, carrier, and even broker changes in 2024. Working with Word & Brown, you can be ready. We have the tools to help you easily compare plans and zero in on the ones that address your clients’ needs. We also deliver value-added extras that can help you retain clients and build a stronger, long-term bond with them.

For employees, open enrollment is also important. It’s their annual opportunity to revisit their coverage and consider changes. As premiums edge up, many employees may find they can switch plans and still visit their preferred doctors and hospitals. Again, our Integrated Provider Search can ensure they get access to the doctors, specialists, hospitals, and prescription drugs they want and need. Learn more on our website.

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