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  • Employee Open Enrollment: A Simple Plan for Employers

    Employee Open Enrollment: A Simple Plan for Employers

    Whenever your group health plan renews — January, April, July, or any other month — it is easy to feel the hard part is over once the renewal is settled. But the plan you chose only works if your employees actually enroll: in the right plan, with the right family members, on time. For the many groups renewing January 1, open enrollment also lands in the busiest weeks of the year, so a little planning now prevents a scramble in late December.

    Work Backward From the Carrier Deadline

    Your renewal date is when coverage starts, not when paperwork is due. Carriers typically need enrollment changes some time before the effective date to have ID cards and records ready, and the exact deadline varies by carrier and by whether you are with a carrier directly or through Covered California for Small Business (CCSB).

    Start with that deadline and work backward. Give employees enough time to decide, and leave yourself a buffer to chase missing forms. If you renew January 1, holiday schedules mean many employees will be out the last two weeks of December, so finishing before then is usually the safer plan.

    What Employees Need to See

    Employees make better choices when they can see the whole picture in one place:

    • The plan options available to them for the new plan year
    • What each option will cost them per paycheck, based on your contribution
    • The Summary of Benefits and Coverage (SBC) for each plan
    • A short note on what changed from the current plan year — new carrier, new network, new deductible

    Distribute the SBC with your enrollment materials. If a plan’s network changed, call it out plainly. The most common complaint after a renewal is an employee discovering their doctor is no longer in network.

    Don’t Skip the Waivers

    When an eligible employee declines coverage, collect a signed waiver that records the reason, such as coverage through a spouse. Carriers commonly use waivers to confirm participation requirements are met, and a waiver on file can matter if questions come up later. A missing waiver is easier to collect during enrollment than months later.

    Dependents and Life Changes

    Open enrollment is generally the one time each year employees can add or remove family members without a qualifying life event. Remind employees to check who is on their coverage. A new spouse, a child who has aged out, or a family member who now has their own coverage should all be addressed now — not discovered after the renewal date.

    A Simple Timeline

    Whatever your renewal date, a workable schedule often looks like this:

    • Week 1: Announce open enrollment and share plan materials and SBCs
    • Week 2: Hold a short meeting or video call to answer questions
    • Week 3: Collect enrollment forms and waivers
    • Week 4: Review for missing items and submit to the carrier before its deadline

    Adjust the weeks to your carrier’s deadline, not the calendar.

    A Familiar Scenario

    A small dental office in Burbank renewed with a new network for January. The owner waited until the week before Christmas to send enrollment forms, two employees were away, and one hygienist didn’t learn until January that her family’s pediatrician was out of network. Starting in November, with the network change called out in writing, would have given everyone time to plan.

    We’re Here To Help!

    We can help you build your enrollment timeline, prepare plan comparisons for employees, and answer employee questions in a short online group session. Reach out about six weeks before your renewal date — or now, if you renew January 1 — so enrollment is wrapped up in time. Call us at 818-253-1736 or use the contact form on our website.

    This article is general information about small group benefits enrollment. Enrollment deadlines, participation requirements, and plan details vary by carrier. It is not legal or tax advice; questions about your obligations as an employer should go to your ERISA vendor, counsel, or CPA.

  • Your January Group Health Renewal: What to Check Before You Accept

    Your January Group Health Renewal: What to Check Before You Accept

    When a group health renewal arrives, most business owners go straight to one number: how much the rate went up. It is a reasonable place to start. It is not a good place to stop.

    A renewal can change far more than price, and some of the most important changes are not on the first page.

    Look Past the Headline Rate

    Carriers periodically retire plans and move groups into a replacement plan, sometimes called plan mapping. The replacement may look similar and carry a similar name while having a different deductible, different copays, or a different network.

    When you review your renewal, compare the coming year’s plan to the current one line by line: deductible, out-of-pocket maximum, office visit and specialist copays, prescription tiers, and the provider network. A modest rate increase paired with a higher deductible can be a larger change for employees than the rate alone suggests.

    Also check the rating details. Small group rates are typically based on employee ages, so a renewal can shift as your workforce changes, even if the plan itself stays the same.

    Your Contribution Strategy

    How much you contribute toward employee and dependent coverage shapes what your employees actually pay each paycheck. A renewal is a natural point to revisit that decision.

    Some employers contribute a fixed percentage; others contribute a fixed dollar amount, which keeps the employer’s cost more predictable as rates change. Some offer a base plan with the option for employees to buy up. Each approach has trade-offs for budget and for how employees experience the increase.

    Participation and Contribution Requirements

    Carriers generally set minimum requirements for how many eligible employees must enroll and how much the employer must contribute. Falling below them can affect a group’s ability to keep or obtain coverage.

    There is one window worth knowing about. Under federal rules, small groups can generally obtain coverage during the annual Small Group Special Enrollment window, November 15 through December 15, without having to meet a carrier’s minimum participation or contribution requirements. For a business that has had trouble meeting those minimums, that window can matter.

    Alternatives Worth Seeing

    Accepting the renewal is often the right decision. It is a better decision when it is made after seeing the alternatives: a different plan design from the same carrier, comparable plans from other carriers, or options through Covered California for Small Business (CCSB).

    Seeing alternatives does not commit you to changing anything. It tells you whether the renewal is competitive.

    The Employer’s Timeline

    For a January 1 renewal, the working sequence is:

    • Review the renewal and alternatives as soon as it arrives.
    • Decide on plans and contributions with enough time to run employee open enrollment.
    • Hold employee open enrollment and collect elections and waivers.
    • Distribute required plan materials, including each plan’s Summary of Benefits and Coverage (SBC), to eligible employees at renewal.
    • Confirm enrollment is submitted to the carrier ahead of the effective date.

    Carriers set their own submission deadlines, and they come sooner than most owners expect.

    A Familiar Scenario

    A twelve-person company received a single-digit rate increase and accepted it the same week. In January, employees discovered their plan had been mapped to one with a much higher deductible. The owner fielded complaints for months over a change nobody had noticed.

    The details were in the renewal. There simply was not a comparison against the current plan.

    We’re Here To Help!

    If your group renews January 1, send us your renewal as soon as it arrives. We will compare it line by line against your current plan and show you the alternatives, so your decision is made with the full picture in time for open enrollment.

    This article is general information about small group health insurance renewals. Rates, plan designs, and participation and contribution requirements are set by each carrier and are subject to underwriting and approval. It is not legal or tax advice; questions about contribution arrangements, tax treatment, or employer compliance obligations should be directed to your CPA, counsel, or ERISA vendor.