Navigating Open Enrollment: Terminology and Employee Outreach

As the end of the year approaches, benefits administrators are gearing up for the much-anticipated open enrollment period. This crucial time of the year requires meticulous planning and clear communication to drive adoption of consumer-directed health plan (CDHP) options. Administrators can play a big role in helping employers and their employees understand the often-complex terminology used in describing these plans, so everyone is speaking the same language.

Below is a high-level guide for open enrollment preparation, with a glossary of common and not-so-common CDH terms. Feel free to share these definitions with your employer groups and encourage them to use in conversations with employees. And to access an array of open enrollment materials, visit our OE Resources page.

Open Enrollment Preparation: Key Steps to Consider

• Review Current Plans: The first step in open enrollment preparation is to assess the effectiveness of the current benefit plans. Analyze the usage data from the previous year to identify trends and understand employees’ needs better.
• Educate Employees: Develop educational materials, webinars, and workshops to help employees understand their benefit options. Clearly explain the changes in plans, if any, and emphasize the importance of active participation.
• Communication Strategy: Plan a robust communication strategy to disseminate information effectively. Utilize various mediums such as emails, newsletters, and intranet portals to ensure that every employee receives vital information regarding open enrollment.
• Assistive Tools: Implement user-friendly online tools and calculators that allow employees to estimate costs based on their healthcare needs. Interactive tools can empower employees to make informed decisions.
• Q&A Sessions: Organize question-and-answer sessions where employees can clarify doubts and concerns about their benefits. A well-informed employee is more likely to choose the best benefits to support their whole health – physical, emotional and financial.
• Compliance Check: Ensure that all benefit offerings comply with the latest healthcare regulations and guidelines. Regularly updating plans in line with legal requirements is crucial to avoid complications later.

Check out our recent webinar for a deeper dive into OE preparedness: Never Too Soon: Planning & Best Practices for Your Best Open Enrollment Ever

Consumer-Driven Health (CDH) Glossary

• Co-insurance: A percentage of a healthcare cost, such as 25 percent, that covered individuals pay after meeting their deductible.
• Co-payment (Co-pay): A fixed amount that insured individuals pay for covered healthcare services, such as a doctor’s visit, usually at the time of the service.
• Deductible: The amount an employee must pay for covered health care services before the insurance plan starts to pay.
• Dependent: An individual (typically a child) for whom a parent, relative or other person provides healthcare.
• Flexible Spending Account (FSA): A pre-tax account that employees can use to pay for eligible medical expenses, often with a ‘use it or lose it’ policy.
• Formulary: A list of prescription drugs covered by the health plan, often structured into tiers that cover a higher percentage of low-cost generic drugs than more expensive brand-name or specialty drugs.
• Health Reimbursement Arrangement (HRA): an employer-funded plan that reimburses employees for qualified medical expenses and, in some cases, insurance premiums.
• Health Savings Account (HSA): A tax-advantaged savings account that allows employees to contribute pre-tax funds for qualified medical expenses.
• High Deductible Health Plan (HDHP): A health insurance plan with higher deductibles and lower premiums, often paired with HSAs.
• Network: The facilities, providers, and suppliers your health insurer has contracted with to provide healthcare services.
• Out-of-Pocket Maximum (OOPM): The maximum amount an employee has to pay for covered medical services in a plan year, after which the insurance covers 100% of the costs.
• Wellness Program: Employer-sponsored initiatives designed to improve employees’ health and well-being, often offering incentives for healthy behaviors.

Open enrollment can be a daunting task, but with the right preparation and communication, benefits administrators can ensure a smooth and informed process. By empowering employees with knowledge and resources, administrators play a vital role in fostering a healthier and more engaged workforce.

Remember, a well-informed workforce is a happy and productive workforce, and open enrollment is the perfect opportunity to achieve this harmony between employee well-being and organizational success.