HEALTH INSURANCE OPEN ENROLLMENT
Choosing the Best Option for You and Your Family
It's the time of year when many companies across the country hold open enrollment periods for their group
health insurance plans. The Mississippi Insurance Department (MID) provides these tips to help you make the
best choice of the options available for you and your family.
What is Open Enrollment?
Open enrollment refers to the period of time during which all members of your group health insurance
plan have the opportunity to enroll in certain benefit programs. During an open enrollment period,
insurance carriers are required to accept all applicants of the group without underwriting or evidence of
insurability. Open enrollment is generally only held once a year. If you miss your company's annual open
enrollment, you likely will not be able to enroll in your employer-sponsored health insurance program until
next year. Certain exceptions apply for new employees or employees with life changing events.
Make sure to check with your human resources department to see when your company's open enrollment period
begins and ends, and when your policy goes into effect.
Read and Understand the Materials
There are many different types of major medical plans typically offered by employers. For help understanding
the fundamental differences between preferred provider organizations (PPO), health maintenance organizations
(HMO), point of service plans (POS) or indemnity plans, go to the NAIC insurance education Web site,
www.InsureUonline.org and click on the life situation that most closely matches your own. The health
section includes basic information about each type of program. Plan materials will detail which medical
providers (physicians, hospitals, labs, pharmacies, etc.) are considered in-network and out-of-network.
They will also detail how much the insurance carrier will pay under each type of plan.
Before making a choice:
- Check to see if your current physicians and area hospitals are in the plan's network. Using network
providers generally will save money on your health care.
- Check to see if spouses or dependents are covered. Some plans will cover spouses and other dependents,
while other plans will not.
- Read all of the plan materials thoroughly. Doing so will tell you what your rights and responsibilities
are under each plan.
- Review any pre-existing condition exclusions and prior authorization requirements in the plan materials.
- If you take prescription medications, check them against the list of approved drugs in each plan booklet.
- If any part of a plan is unclear to you, ask for help from your human resources department or the insurance carrier.
- If you are not satisfied with the answers to your questions, contact the MID.
Compare the Costs and Coverages of the Plans Offered
In this uncertain market, it's important to carefully evaluate your healthcare costs when making your annual
enrollment decisions. While one option might have high monthly premiums and a low deductible, and another
might have a low premium but more out-of-pocket expenses, it could be misleading which plan is best for you
until you do the figures. To pick the best coverage, first calculate your healthcare costs from recent years
and try to estimate what your costs might be for the coming year. Don't forget to include the cost of
doctor's visits, daily medications and any procedures you might be planning. Next, make a list of the
premiums, out-of-pocket expenses and benefits under each plan. Co-payments, deductibles and additional
charges for wellness care or specialists (e.g. chiropractic care, cosmetic surgery, etc.) are examples of
out-of-pocket expenses that you are responsible to pay. Remember, if you use a medical provider that is
out-of-network, you will generally pay more out-of-pocket expenses. Include these fees in your calculations.
Finally, decide how much you can afford to pay. Other things to keep in mind:
- Check for any annual limits and prior authorization requirements.
- Some prescription medications have higher co-payments than others and they might vary from plan to plan.
Mail-order options might be available for maintenance drugs at a lower cost to you.
- If your dependents have health insurance coverage through their employer, school or the Veteran's
Administration, compare their costs and benefits to the family plans you are considering to ensure that
you choose the best plan for every member of your family. Make the same type of comparisons for any
dental or vision care plans that you are offered.
Once enrolled in a health plan, you will not be able to make changes until the next open enrollment
period, unless there is a life changing event such as divorce, a job change, marriage or the birth or
adoption of a baby. If you do not receive insurance cards and/or enrollment information, contact your HR
administrator, or call the insurance company. If you have questions about the insurance company or the
information you should receive from them following your enrollment, contact the MID at
www.mid.ms.gov or call 800 562 2957. For more information about your changing insurance needs and tips for choosing the
coverage that is best for you and your family, visit