Top 5 Questions for HR and Business Owners about Employee Benefits

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Top 5 Questions for HR and Business Owners about Employee Benefits

During Open Enrollment and throughout the plan year, HR professionals and Business Owners must deal with a multitude of issues and questions about employee benefits. McKnight Advisory answers the Top 5 questions HR and Business Owners have.

What happens if at Open Enrollment your deductible and/or out-of-pocket changes?

This depends on if your deductible/out-of-pocket goes up or goes down. If you have met your out-of-pocket and it goes up, you will have to pay the difference to reach the new cost. If you have met your current deductible and out-of-pocket, and your new plan has a lower deductible/out-of-pocket you will not get money back, but you will not have to pay any additional costs. Please Note: Everything is based on date of service. If you go to the doctor the week before your plan changes you will have to pay the previous plans deductible/out-of-pocket, even if it is not filed until after the new plan is in place.

For Fully Insured plans, what happens if at Open Enrollment the number of employees enrolled in the Medical plan changes?

If your number of employees enrolled changes, your premium costs may change as well. With Small groups (2-50) a 15% change on the census could force the carrier to re-rate (adjust premium costs either higher or lower). In large group (51-150) a 25% change in the census could force the carrier to re-rate.

What if we do not have our cards by our effective date?

If you do not have your cards by your effective date you have a couple of different options:

  1. You can use your old card, if you are with the same carrier. You will show having the old plan until it updates and once it does so will your card

  2. You can ask your brokers office to call your doctor’s and explain to them you are on the plan and just haven’t received cards yet.

  3. You can wait until your cards come in to go to the doctor or pharmacy, if possible

  4. You can print a temporary ID card from the carrier website, or your broker can do this.

What if someone needs to make a plan change outside of Open Enrollment?

If you have a Section 125 pre-tax plan, then they must have a qualifying event:

  • Marriage

  • Divorce

  • Birth

  • Death

  • Loss of Coverage

What happens if there is an emergency day one of a new plan?

While we urge people not to make doctor’s appointments and/or go to the pharmacy the first week of coverage, sometimes life happens.

If you do not have your new cards or if the new plan is not in place, let your broker know what is happening. They can reach out to the carrier to try and expedite that individual’s coverage.

The broker can also try talking to the doctor’s office or hospital to get them to work with you on billing, until your plan is in place.

If the plan is not in place, you may have to pay out of pocket for your visit. Your broker should be able to work with the doctor and carrier to get everything filed correctly and you your money back.