When a person turns 16 years old, they get to drive. When 21 comes around, they can drink legally. Additionally, when they turn 26 years old, their reward is moving off their parents’ health plan. It’s not exactly the most welcome birthday present, but before the Affordable Care Act was enacted, they would have been on their own much earlier. So as employees (or children of employees) approach 26 years of age, it’s important they be prepared. Here’s what to tell them.
Explain the Open Enrollment Windows
Once a year, usually in October or November, there’s an open enrollment period in which employees select their health care plans for the next year. Picking the right health plan is crucial because unless the employee experiences a qualifying event, they’re stuck with the plan for a year. Qualifying events are things that would be considered major life occasions — think marriage, divorce, having a baby or changing jobs.
Here’s What’s Covered
Health insurance doesn’t cover everything. Cost sharing takes the form of a co-pay or coinsurance, which is the portion the employee is responsible for. It may be $20 for a regular doctor visit, for instance, or $500 for an emergency room visit.
Ensure employees also know the deductible on the company plan. This is the portion that employees must pay before the plan begins to pay. Encourage them to think carefully about how frequently they expect to visit the doctor and plan accordingly. There are a lot of ins and outs with coverage, so going over the plan in person is always a good idea.
No Charge for Most Preventive Care
Under the Affordable Care Act, employees are entitled to preventive care visits. Likewise, an annual physical is covered and so are many immunizations and certain screenings.
Encourage the Selection of an In-network Doctor
Some employees may have had the same physician forever, especially if they’re on their parents’ health plan. When it comes time for them to move off of their parents’ health plan, it’s important that they double-check to see if their physician is in-network. Doctors, laboratories and hospitals make individual contracts with insurance companies. If an employee’s doctor has a contract with the employer’s chosen insurance provider, then the employee’s cost to see the doctor will be lower than if there’s no contract. The out-of-network fees can be extremely high, so look on the insurance company’s website and confirm with the doctor’s office when making the appointment.
Becoming an independent adult can be daunting for many employees. A business owner can be an invaluable resource to help explain to employees how moving off their parents’ health plan doesn’t have to be scary.
Suzanne Lucas spent 10 years in corporate human resources, where she interviewed and hired employees, managed the numbers and double-checked with the lawyers. Her writings have appeared in Inc. Magazine, CBS MoneyWatch, US News, Readers Digest and other publications. She focuses on helping businesses nurture great employees and helping employees enjoy great careers.