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Clear the Confusion: Top 5 Employee Questions for Open Enrollment

The healthcare insurance information you need to know during open enrollment, and all year long.
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It’s fall again. And as the crisp autumn air rolls in and pumpkin-spice everything appears on shelves, there’s one seasonal event that employers know all too well: open enrollment. It’s a time when employees have questions–lots of them–about their health benefits, plan options, and costs for the upcoming year. For many companies, this means an endless inbox of benefits questions. 

What if your lean, yet mighty benefits team didn’t have to be overwhelmed with open enrollment questions from employees? Imagine multiplying your benefits team during open enrollment without actually having to put anyone on payroll. That’s where a partner like Included Health comes in. We help you streamline open enrollment and make the process smoother for everyone.

We've put together a guide of the top five questions asked by employees' of benefits during open enrollment—so if you're answering these yourself here is your cheat sheet! And if you're looking for support beyond the five questions and want available 24/7 support for employee benefit questions, you should consider healthcare navigation. No pop quizzes, just valuable insights to help everyone navigate their health benefits with confidence.  

Top 5 questions asked by employees during (and even after) Open Enrollment

1. Copay, Coinsurance, Deductible, Premium...What do these words even mean?

Health insurance jargon can feel like a different language. 

Here’s what these terms mean in plain, simple language–and how they might impact your wallet: 

Premium: Think of this like rent for your health insurance. It’s the amount you pay every month, regardless of whether you go to the doctor or not. 

Copay: This is a fixed amount (like $20 for example) you pay out of pocket for covered healthcare service, such as doctor visits or prescriptions. 

Deductible: The amount you pay for healthcare services before your insurance kicks in. Once you “meet” your deductible, your plan starts covering a portion of your medical expenses.

Coinsurance: This is a percentage of the costs you share with your insurance after meeting your deductible. For instance, if your plan covers 80%, you’d pay the remaining 20%.

Coinsurance vs. Deductible–What’s the difference?

Let’s say you have a $3,000 medical bill, a deductible of $2,000, and coinsurance of 20%.

Here’s how it breaks down:

  1. You’ll pay the $2,000 deductible first, leaving a $1,000 balance

  2. For the remaining $1,000, you pay 20% ($200), and insurance covers the other 80% ($800)

  3. Total out-of-pocket you will pay: $2,200

2. How do I choose the most cost-effective plan?

It’s not just about the lowest premium or deductible. The right choice depends on your healthcare needs and financial situation. Here’s how to think it through:

  • Consider your anticipated medical needs for the next year. Are you managing ongoing treatments, prescriptions, or planning for major events like surgery, pregnancy, or a chronic condition?
  • If you expect your healthcare needs to be similar to last year’s, consider a plan that worked well for you in the past.
  • For moderate healthcare expenses, a Preferred Provider Organization (PPO) plan could be a good choice, as it provides a balance between flexibility and coverage.
  • If your costs were lower and you mostly used preventive care, you might want to explore a High Deductible Health Plan (HDHP) paired with a Health Savings Account (HSA) to save on premiums while still covering essential services.

Decision Tip: Use a flowchart to compare plan types (PPO, HMO, HDHP, EPO). It can help you weigh factors like monthly costs, network flexibility, and expected healthcare use.

3. If I switch plans or health insurance companies, will my doctors still be in-network?

It’s worth taking the time to confirm. The easiest way to check is by calling your doctor’s office and asking if they accept the new plan, or, you can also check the insurance company’s online directory. With Included Health, employees can just open the app to search for local or in-network options, or they can chat with one of our Member Care Advocates for help.

Tip: Call your doctor’s office again at the beginning of the year to make sure there haven’t been any last-minute changes to the insurance networks they accept. Virtual options are also growing, so consider using these convenient care services for more flexible access to healthcare.

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4. What are healthcare spending accounts and what kinds are there?

Healthcare spending accounts are a great way to save money on medical expenses. There are three types, explained below. In all three, the money in these accounts is not taxed, which means that if you pay for expenses using these accounts, you save around 30%.You can use this money to pay for copays, deductibles, and other medical expenses. You can also use it for vision expenses, sunscreen, bandaids, pain relievers and more. Many online-retailers have special HSA and FSA ‘stores’.

Here’s a breakdown of the three main types: 

  1. Health Savings Plan (HSA): A tax-free savings account that you own, available only if you’re enrolled in an HDHP. You decide how much to contribute, and any unused money rolls over year to year. The funds stay with you, even if you switch jobs.
  2. Flexible Spending Account (FSA): Owned by your employer, you decide how much to set aside each year. The money goes in tax-free, but doesn’t roll over indefinitely. You may get a grace period of 2.5 months to use leftover funds or carry over up to $640 into 2025.
  3. Health Reimbursement Account (HRA): Funded entirely by your employer, an HRA covers certain medical expenses. The employer sets the rules, and if you leave your job, you typically lose the funds.

FAQs:

  • Can I invest HSA funds? Yes, many HSA providers allow you to invest unused funds, potentially growing your savings tax-free.
  • What happens if I leave my job? HSAs are portable; FSAs and HRAs usually aren’t.

5. Once I make my healthcare plan decisions, can I change them during the year?

Open enrollment is your annual chance to make changes. Once the period closes, your choices are locked in for the year–unless you experience a Qualifying Life Event (QLE).

Common QLEs include:

  • Loss or gain of coverage: Such as losing coverage due to job loss or gaining it through a new employer.

  • Marriage or divorce: This can affect your need for individual versus family coverage.

  • New baby or adoption: You’ll want to add your child to your plan.

To make changes, you’ll need to provide documentation proving the QLE, like a marriage or birth certificate.

A checklist for employees: Preparing for Open Enrollment

  1. Review your current plan: Assess what worked and what didn’t in the past year.

  2. Consider anticipated health needs: Make note of any expected surgeries, pregnancies, or chronic condition treatments.

  3. Compare plans side-by-side: Use a plan comparison tool to see differences in costs and coverage.

  4. Verify in-network providers: Call doctors’ offices or check your insurance provider’s website (or your Included Health app!)

  5. Check for available HSA, FSA, or HRA accounts: And plan contributions based on anticipated medical expenses.

    We hope these five questions and answers can help you clearly communicate benefits with your employees and keep your inbox from overflowing this time of year. 

    Want next year's open enrollment to be simpler for employees and less hectic for your team? Learn more about healthcare navigation from Included Health.