Answering the 6 Most Common Employee Open Enrollment Questions

Employees consistently say that when they’re choosing where to work, health insurance can make or break their decision.

But once your employees have the offerings they want, do they know how to use them? Your workforce might not be taking full advantage of their benefits if they don’t understand the details.

The 6 Most Common Open Enrollment Questions

If you can pinpoint which parts of your benefits package are leaving your employees with questions, then you can do something about it. Be prepared to answer the following six questions about your offerings.

1. How Much Can I Contribute to a Flexible Spending Account (FSA) or Health Savings Account (HSA)?

In 2019, the IRS limited employee FSA contributions to $2,700 — however, employers can set lower limits. Look for the IRS to publish the coming year’s contribution limits in October.

Employees enrolled in an HSA-qualified high-deductible health plan (HDHP), on the other hand, can contribute up to $3,500 to an HSA if they have HDHP coverage for themselves, and up to $7,100 if their HDHP covers at least one other family member. Employers cannot place their own restrictions on these limits.

By the time your open enrollment period arrives, your employees should know:

  • How employer contributions to FSAs or HSAs work.

  • That outside of very limited exceptions, they can’t contribute to an FSA and an HSA at the same time.

  • The “use it or lose it” rule for FSAs. If you offer a carryover or grace period, be sure to clearly explain it.

  • That they can stop, start or change their HSA contributions at any time, but they have to make their FSA contribution decisions during open enrollment unless they experience a qualifying event.

2. Can I Buy My Own Health Insurance and Have You Reimburse the Premiums?

This question is more likely to arise now that the federal government has made headlines by expanding health reimbursement arrangements (HRAs) that can reimburse employees for individual market health insurance. A similar option became available in 2017, allowing small businesses to reimburse employees for the cost of individual health coverage. Your answer will depend on whether you’ve decided to offer one of these reimbursement arrangements.

3. What Do I Need to Do If I Want My Plan to Stay the Same?

This depends on whether you’re making any changes to your plan offerings. If not, employees should be able to continue their existing coverage without doing anything at all. However, encourage your workforce to research all available plans before enrolling, even if they’re certain they want to keep their existing coverage.

4. What Changes Can I Make to Save Money This Year?

A simple spreadsheet is a useful way to help employees see how their plan choice translates to total costs during the year, and how a different plan option — or using benefits like an FSA or HSA — could save them money.

The spreadsheet should outline monthly premiums and total out-of-pocket costs, which is a good way to compare plans based on total costs in a worst-case-scenario year. Since most employees don’t meet their out-of-pocket maximum in a given year, though, also include run-of-the-mill scenarios showing how each plan would cover smaller medical bills. This doesn’t need to get too complicated, and it’s something your broker can help you put together.

If you offer an FSA or HSA, provide concrete examples of how these accounts can help employees save money. Some employees assume that HSAs only work for young, healthy people, so this is an opportunity to examine the total cost analysis, including the triple tax advantages of HSAs — plus any HSA contributions that you make to employees’ accounts, if applicable. The Society for Human Resource Management has a helpful guide to explaining HDHPs to employees.

5. What’s the Difference Between a Deductible and an Out-of-Pocket Maximum?

If an employee doesn’t generally meet their health plan’s full out-of-pocket maximum, the difference might be unclear.

  • Deductible: the amount you must pay before your health plan starts to pay benefits. This doesn’t include services covered by a copay or covered in full before the deductible, such as preventive care on all nongrandfathered health plans.

  • Out-of-pocket maximum: the total amount you have to pay during the year for all in-network treatment covered by your plan, including the deductible, copays and coinsurance.

6. What’s the Difference Among Types of Health Plans?

The various plan types generally included in a benefits package — health maintenance organization (HMO), preferred provider organization (PPO), exclusive provider organization (EPO) and point of service (POS) plans — have different ways of structuring and using their networks.

A high-deductible health plan (HDHP) is a totally separate concept, although it often gets lumped in with the other plans. It’s not just any plan with a high deductible — the IRS has a strict definition for HDHPs, and an employee must have one to get an HSA. An HDHP is a type of plan design. An HDHP will also have a network design, generally an HMO, PPO, EPO or POS.

Visualize what employees can get out of every plan with a chart comparing whether each plan covers out-of-network care, and if so, how much more it’ll cost than in-network care. Make it easy for employees to determine whether their doctors are in each plan’s network.

Quick Tips for Answering Employee Questions

Responding to common health insurance questions typically goes smoothly when employers:

  • Avoid jargon as much as possible.

  • Use real-life examples to show how each plan covers various types of care.

  • Answer open enrollment questions in several ways — providing a visual explainer as well as a written list, for example.

  • Make side-by-side comparisons.

  • Remind employees to reconsider their coverage choices if their life circumstances have changed.

Remember that your part in the open enrollment process is to pick the available health plans and communicate their details to your employees. It’s not your role to advise employees on which plan they should select, but you can make sure your employees are as prepared as possible going into open enrollment.

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