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Tag: open enrollment

  • 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.

  • Covered California Open Enrollment: Get Ready Before November 1

    Covered California Open Enrollment: Get Ready Before November 1

    If you have coverage through Covered California, your plan will most likely renew on its own for next year. That is convenient. It is also the reason many households start the year in a plan that no longer fits, paying a premium based on information that is out of date.

    Open enrollment is the one time each year you can take a fresh look without needing a qualifying life event.

    The Dates

    Covered California open enrollment begins November 1. Covered California begins sending renewal notices in October, and you can review and update your information then. To have new coverage start January 1, you generally need to enroll or make changes by December 31. Open enrollment runs through January 31, but if you enroll or make changes after December 31, your coverage generally will not start January 1.

    Outside of open enrollment, you can generally only change plans if you have a qualifying life event, such as losing other coverage, moving, marrying, or having a baby.

    Your Income Estimate Drives Your Premium

    Financial help through Covered California is based on your household’s estimated income for the coming year — not last year’s tax return and not what you earned when you first enrolled.

    That estimate matters in both directions. If your income is estimated too low, you may receive more financial help than you qualify for, which can mean paying some of it back at tax time. If your income is estimated too high, you may be paying more each month than you need to.

    Anyone who changed jobs, started a business, retired, or saw their hours change this year should update their estimate before renewing. The amount of financial help available can also change from one year to the next, so last year’s figure is not a reliable guide.

    Auto-Renewal Is a Convenience, Not a Review

    When your coverage auto-renews, Covered California generally keeps you in the same plan, or the closest available plan if yours is discontinued. What auto-renewal does not do is check whether that plan still suits you.

    It also may not keep your financial help in place. Covered California generally needs you to confirm or update your household and income information before financial help is applied for the coming year. If you do nothing, your coverage could renew without it, and the first bill of the year could reflect the full, unsubsidized premium.

    Premiums change every year. Carrier networks change. A doctor you rely on may leave a network, or a plan in your area may now offer a better match for how you actually use care. None of that is reflected automatically.

    A few minutes confirming your information and comparing next year’s options is usually enough to keep your financial help in place and confirm your plan still makes sense — or to catch that it does not.

    What to Gather Now

    Before November 1, pull together:

    • A realistic income estimate for next year for everyone in your tax household
    • Your current plan name and the premium you pay after financial help
    • A list of the doctors, specialists, and hospitals you use
    • A list of your regular prescriptions
    • Any household changes this year — a new dependent, a move, someone gaining or losing job-based coverage
    • Any notice from Covered California asking you to confirm or update your information

    With those in hand, a review takes very little time.

    A Familiar Scenario

    A household’s income dropped when one spouse moved to part-time work in the spring. Nobody updated Covered California, and the plan auto-renewed on the old estimate. The household spent another year paying more each month than necessary.

    A change of a few minutes in November would have caught it.

    We’re Here To Help!

    As a certified Covered California agent, we can review your renewal, update your information, and compare next year’s plans with you. Our help is available at no additional cost to you. Reach out before December 31 so any changes are in place for January 1.

    This article is general information about Covered California open enrollment. Eligibility for financial help, premiums, and plan availability depend on your individual circumstances and are determined by Covered California. It is not tax advice; questions about reconciling financial help on your tax return should be directed to your tax advisor.