What is Open Enrollment?
Open enrollment refers to the specific period of time each year when you can enroll in or switch your medical plan without needing to qualify for a special enrollment period. You may also add other eligible members to an existing plan during this time. Open enrollment occurs once per year, so you’ll want to be aware of open enrollment dates so as to avoid a lapse in coverage.
When Does Open Enrollment Take Place?
Open enrollment runs November 1, 2015, through January 31, 2016. To receive coverage by January 1, 2016, you’ll need to apply by December 15, 2015.
What Are Mandated Benefits?
The Affordable Care act led to some major changes in the healthcare industry, with the goal of making sure that all policyholders have access to the same basic coverage. Some of the mandated benefits of the Affordable Care Act include preventative services, maternity coverage, and mental health services. Lifetime maximums and denial for pre-existing conditions have also been prohibited under this act.
What Do These Health Insurance Terms Mean?
- Coinsurance: Coinsurance is your share of the costs of a covered healthcare service calculated as a percent (for example, 20 percent) of the allowed amount for the service. You pay coinsurance plus any deductibles you still owe for a covered health service.
- Premium: A premium is the amount of money charged by an insurance company for coverage. The cost of premiums may be determined by several factors, including age, geographic area, tobacco use and number of dependents.
- Copayment: A copayment, or copay, is a fixed amount you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service.
- Deductible: A deductible is the amount you owe for health care services each year before the insurance company begins to pay. For example, if your annual deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services that are subject to the deductible. The deductible may not apply to all services, such as when a copay only applies or preventive care services. Deductibles are useful for keeping the cost of insurance low. The amount varies by plan, with lower deductibles generally associated with higher premiums. They are fairly standard on most types of health coverage.
- Out-of-pocket Maximum (OOPM): An out-of-pocket maximum is the most you should have to pay for your health care during a year, excluding the monthly premium. It protects you from very high medical expenses. After you reach the annual out-of-pocket maximum, your health insurance or plan begins to pay 100 percent of the allowed amount for covered health care services for the rest of the year. The deductible, coinsurance, copays, and prescription drug copays are included in the out-of-pocket maximum.
- Preventive Care: Rather than waiting for a patient to become sick, preventive care aims to keep people healthy, or at least catch illnesses at their earliest and most treatable stages. Preventive care includes preventive services performed by providers, such as annual physicals or mammograms. Under the provisions of the Affordable Care Act (ACA), policies must cover various preventive services for men, women, and children without sharing the cost for these services through coinsurance, deductibles or copayments. Certain Preventive care services are subject to frequency limitations.
- Annual Limit and Lifetime Limit: In the past, health insurance carriers imposed Annual and Lifetime limits on the benefits you receive. You are no longer subject to these limitations and there is no maximum to the benefits you may receive.
Who Can Be Covered Under My Plan?
Dependent children, same-sex or opposite-sex spouses, and domestic partners are eligible for enrollment under your plan. If you plan on enrolling a domestic partner, keep in mind that you may need to provide proof of your partnership in the form of a shared rental agreement/mortgage, shared utilities, and/or a joint banking account.
What Are the Different Network Types?
There are three main categories of network coverage: PPOs/POS, HMOs, and EPOs.
PPOs and POS plans tend to have higher premiums, but allow you to choose any doctor you want with no need for referral to receive specialty care. With PPOs and POS plans, you can also receive out-of-network care but may need to pay extra.
HMOs tend to be more affordable, but require referrals for specialty care and aren’t as flexible with your choice of physician. With an HMO, you’re also limited with your out-of-network coverage, except in the case of an emergency.
EPOs are hybrid networks that also have lower premiums in most cases, but often require referrals and have limited out-of-network coverage.
What Are Supplementary Benefits?
Supplementary benefits are additional coverage options that may be included as part of your plan. Options include dental, vision, life, and disability insurance.
What Information Do I Need to Enroll?
You’ll need some specific documentation and materials to enroll in your insurance plan. Have your first month’s payment ready, in addition to your current plan details and any dependent information including names, Social Security numbers, and birth dates. If you’re enrolling a domestic partner, you may need proof of residency as well.
Visit The CPA Insurance Marketplace to see all available plans.