First things first, for those not in the benefits administration space, what is Open Enrollment? Open Enrollment (OE) is defined as the period of time in which employees can freely add, remove or edit their benefit packages without needing to provide proof of a qualifying life event or change reason (think marriage, babies, loss of other coverage, etc). After their plan selection is made, the employee can make any changes they please during the remainder of the Open Enrollment window. Once this window of time closes, they must wait until the following year’s annual enrollment or enroll through the use of a qualifying event.
Each fall (for the many employer groups renewing around first of the calendar year), benefit administrators are faced with a heavy burden of decisions relating to employee benefits. What benefit design will they offer? How will they educate their employees on new and existing benefits? How do they increase employee participation during Open Enrollment? And, perhaps most importantly, when on earth will they find time to sleep?
Keeping in mind employees only have access to plan changes once a year during Open Enrollment, unless they have a qualifying life event, one of the key questions benefit administrators ask is: What timeframe will we allow members to make new benefit decisions for the upcoming plan year?
When it comes to selecting an Open Enrollment window, timing is key. While there are several months worth of dates to choose from, there are generally two areas of timing, both with their own unique pros and cons for everyone involved.
Opening up enrollment to employees early (think crunchy leaves, pumpkin everything, flannel) brings both challenges and opportunities. On one hand, Benefit Administrators may find themselves with online enrollment system issues if adequate testing hasn't been performed. They might also face inadequate education time, leaving employees less prepared to make informed benefit decisions. With this period also comes a lengthy window of time for employees to change their minds after signing up for a plan. For administrators, this might mean they could receive requests to add/remove the same dependent for John Doe six times or more after the enrollment window has closed. This means more time and energy from the ben admin team to go in and make necessary corrections, whether it be online or via updated paper forms. On the other hand, the early window comes complete with more time for HR teams to focus on payroll and other areas that also see changes at this time of year. Further, employers have more time to ensure that all of their employees’ benefit elections have been properly updated with the correct Trading Partners, meaning enrolled employees will receive both identification cards and coverage in a timely manner. This option also offers more time to wrap up any outstanding eligibility issues prior to the holiday, which in turn, allows for a much more relaxing year end for everyone.
Giving employees access to a later Open Enrollment window (think Christmas shopping, hot cocoa, snow) presents its own unique pros and cons. It certainly benefits employers to have the most time possible to spend researching Trading Partners (think Aetna, Anthem, Cigna, etc) and plan offerings that are right for their teams. This also means potential cost savings for the employer and better choices for their employees. Employers will also have much more time to implement communication plans (think email blasts, mailers, benefit fairs, etc.) to their teams, thereby doing their best to educate the users of these health plans. The challenges of a later Open Enrollment window however, are often related to the timing of data interchange, whether that be via paper or Electronic Data Interchange (EDI) powered online tools. Due to the high volume of transactions being processed at Trading Partners during this time of year, there are often delays. This means if data is not entered into the Trading Partner systems in a timely manner (rule of thumb: 7-10 business days to ship id cards), employees run the risk of not receiving their id cards by the time their insurance goes into effect on 1/1.
At the end of the day, it is up to each organization to choose their Open Enrollment window based on what resources they have available to plan, educate their teams and execute the legwork required to get everyone enrolled. As we’ve all learned at one point or another, if you fail to plan, you plan to fail.
Tags: Healthcare consumerism, Providers