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What Questions Should You Ask About Employee Benefits?

Vicky Warren · December 13, 2018 · 7 min read


When open enrollment arrives, usually towards the end of the calendar year, it's an opportunity to review your benefits and ensure they are still a good fit for you. It's also an opportunity to understand exactly what your health plan covers and It's good to review your benefits annually to make sure they are still working for you. Here are a few questions many ask during open enrollment.

What's changed?

Even if plan names are the same, the providers, what is and is not covered, and deductibles may have changed. It's good to ask your benefits adminsitrator or representative what is different this year. If you have specific providers you want to continue to see, you want to make sure they are still covered by your plan. You can also ask if there are new plans or benefits offerings that might serve your needs better.

What other benefits am I eligible for?

Be sure to find out if your employer has added new benefit options or if there are benefits you may be eligible for you might not have known about. For example, if you have a high-deductible health plan you are eligble to sign up for a health savings account (HSA). For employer may also offer benefits like tuition reimbursement, emgency savings accounts, or 401(K) matching that you may not be aware of. Open enrollment is a great time to learn about the full range of benefits your employer offers that you can take advatnage of.

What are the important dates and deadlines?

It sounds basic, but knowing when open enrollment starts and what the deadline is to sign up is important. Employers and benefits providers restrict signs ups for health insurance to a specific period (referred to as "open enrollment") to help cut down on "adverse selection" and help offer health insurance at more reasonable prices. Knowing the deadline for enrolling in insurance is important because if you miss it, you may have to go a whole year without coverage or with the wrong type of coverage for your needs.

How can I prepare?

Open enrollment may feel overwhelming and, because of that, many Americans spend very little time actually evaluating and selecting health insurance plans. Taking time to prepare for open enrollment will make sure you get the most out of your benefits. It's important to know not only what has changed on your employer side, but for you as well. Have you had a major life change? Are you moving? Have you had a change in your health needs? Understanding what you need will help you select the benefits that are right for you.

What is the difference between a Preferred Provider Organization (PPO) and a Health Maintenance Organization (HMO)?

When it comes to insurance, it's nice to have choices. PPOs and HMOs are both types of  insurance plans. In general, the differences between PPOs and HMOs have to do with:

  • Plan size network

  • Ability to see specialists

  • Plan costs

  • Out-of-network service coverage

PPO plans give you greater flexibility when picking a doctor or hospital. PPOs have a network of doctors, but there are fewer restrictions if you want to see a non-network provider. Many PPO insurance plans will pay for you to see a non-network provider but keep in mind, it may be a lower rate.

HMO plans give you access to doctors and hospitals within the network. Providers who have agreed to lower their rates for plan members and meet certain quality standards make up a network. Under an HMO, you don’t have much choice in seeing a provider outside the network, unless you want to pick up the entire tab. In addition, HMO plans typically have more restrictions on things such as the number of visits, tests, and treatments you can utilize.

What is an embedded deductible?

You’re likely familiar with deductibles. A deductible is the amount of money you have to pay out-of-pocket before the insurance company pays any bills on your behalf.

You may not be as familiar with an Embedded Deductible. This term simply means that a person, covered under a family plan, doesn’t have to wait for the family deductible to be met before the coinsurance kicks in for that individual. For example, if John is covered under the family plan and meets his annual deductible before the entire family deductible is met, the co-insurance will begin paying for John.

In addition, when another individual or combination of individuals meets the remaining portion of the family deductible, it would be considered satisfied.

What is an embedded out-of-pocket maximum?

You’re probably also familiar with the term out-of-pocket maximum, but may be wondering what an embedded out-of-pocket-maximum is. Similar to an embedded deductible, once a covered person under a family plan reaches the individual out-of-pocket maximum that individual's remaining expenses will be paid at 100 percent, even if the family out-of-pocket has not been satisfied.

Also, once an individual or combination of individuals meets the remaining portion of the family out-of-pocket maximum, it would be considered satisfied.

How much money can I contribute to a Health Savings Account?

You are eligible for a health savings account if you are enrolled in a high deductible health plan. The IRS sets contribution limits for Health Savings Account contribution for those enrolled in individual and family plans.

What happens to the money in my HSA after I turn 55 and 65?

When you turn 55, you can continue using your account tax-free to pay for out-of-pocket health expenses and you are eligible to make an additional "catch up contribution" to put more money into your HSA.

When you enroll in Medicare, you can utilize your HSA to pay for Medicare premiums, deductibles, coinsurance and copays under any Medicare plan. Be advised, you cannot use your account to purchase Medicare supplemental insurance.

If you have retirement health benefits, you can use your HSA to pay for the premiums.

Once you turn 65, you can use your account for items other than medical expenses. Keep in mind, if you use the money for non-medical expenses, the money used will be taxed as income, but not subject to any other penalties.

If your under 65 and use your account for non-medical expenses, you’ll have to pay income tax as well as a 20% penalty on the amount you withdraw.

How to make the most of open enrollment

Taking time to prepare for open enrollment will ensure that you get the most out of it and sign up for the health coverage that works best for you. Make time in your schedule to attend an information session offered by your employer or insurance provider, talk with your HR or benefits administrator about about any questions or concerns, and meet with your financial advisor about the impact of any benefit changes. You can also review our comprehensive open enrollment guide to make sure you're not missing any important details.

Learn more with Lively

As you navigate the open enrollment process, you can rely on Lively's resources to help you get the most out of your health and financial benefits. If you are looking to add a top-rated HSA with unparalled customer support that will be there for you during open enrollment and beyond, don't hesitate to reach out to us today.

Hope this helps as you prepare to make the most of open enrollment this year.

Vicky Warren

Vicky Warren

Vicky Warren, once a nurse, now a freelance healthcare writer and social media coach.

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Disclaimer: the content presented in this article are for informational purposes only, and is not, and must not be considered tax, investment, legal, accounting or financial planning advice, nor a recommendation as to a specific course of action. Investors should consult all available information, including fund prospectuses, and consult with appropriate tax, investment, accounting, legal, and accounting professionals, as appropriate, before making any investment or utilizing any financial planning strategy.



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