Blog 9/9/2019

Married & Domestic Couples: Ten Items for Your Open Enrollment Checklist

For many employers, open enrollment is just around the corner. If you’re married or in a domestic partnership and your spouse/partner also works, you have some decisions to make—not just around your needs, but also around whose company’s health plan you will choose.

To ensure that you’re both prepared to choose the right health plan, here’s a checklist with items to review before your spouse and you make your benefits decision:

1.Review changes to lifestyle and needs

Before doing anything else, discuss whether your needs have changed over the last year. For example, were you recently married or is your partnership a new one? Was one of you prescribed a new maintenance medication? Were you or your children diagnosed with a chronic illness? Have you moved? Don’t forget to look ahead, too: are you planning on a baby next year? Is your child about to start playing organized sports? Taking the time to understand your needs will lead to a better decision when enrollment time comes around.

2.Double-check your enrollment windows

Not every employer holds open enrollment in the fall. If your spouse/partner’s employer schedules enrollment for April, July or some other time during the year, you may want to take that into consideration when making your choices. Under Internal Revenue Service (IRS) regulations, some employers allow midyear election changes (or “permitted change in election events”) if there is a change in a spouse or dependent’s coverage under another employer plan (e.g., spouse’s employer had no insurance coverage before but now offers a plan). Take a look at your plan’s (and your spouse/partner’s plan’s) summary plan description to see if this applies to you; you may be able to make a change if another plan better suits your needs.

3.Review your current elections and any new plans being offered by either employer

Whether you’re each covered through your own employers or you’re both covered under one plan, think about your coverage and how you’ve used it. Did it meet your needs? Does it still work despite recent lifestyle changes and new circumstances? Be sure to review both employers’ offerings, since new plans can be offered in a new plan year or changes might be made to already existing plans.

4.Make sure you’re familiar with basic health care terminology

While you may feel like you have a strong understanding of health insurance terms, it’s important to make sure you understand the difference between copays and coinsurance, in-network and out-of-network care, and other key terms. If you’re unsure about certain terms, consult a health care glossary (such as this one) or the company’s HR or Benefits teams for clarification.

5.Research your plans

Request SPDs/SBCs from both of your companies. Summary Plan Descriptions (SPDs) describe everything you need to know about your health plan, such as deductibles, copays and out-of-pocket limits; what’s covered—and what isn’t—and any other limitations or requirements. Summaries of Benefits and Coverage (SBCs) provide a high level summary of how a plan covers certain common services, and are designed to make comparing plans easier.

Review these with your spouse to get an understanding of how much you would be “on the hook” for when you undergo various procedures and exams under each plan, and don’t forget to consider any specific needs you have. For example, if your spouse needs specialty prescription drugs, check out which plans offer the best coverage in that area.

6.Figure out the costs

Yes, it’s tedious, but choosing a plan purely based on how much it costs per paycheck may cost you more money in the long run. Often, the plans with the lowest premiums require the most “upfront” payment when you receive services. As a first step, list out all your family’s medical costs for the previous year, including doctor’s visits and prescription drug copays, coinsurance, your deductible and your premiums. Look at how each option available to you and your spouse covers those same expenses. You both may find yourself surprised at which plan will cost you less.

Make sure you take into consideration any accounts your employer(s) may offer to help cover your out-of-pocket costs (see #7 below).

Also, don’t forget to check if there’s a spousal surcharge associated with your employers’ plans. This is normally an increase in premium costs to cover a working spouse who has the option to elect health care coverage from their employer, but declines the coverage to join their spouse’s plan. Keep in mind that some employers completely prohibit spousal coverage if the spouse has other coverage available, so read your plan materials carefully.

7.Look into tax-advantaged reimbursement programs (TARPs)

As noted above, many employers offer programs to help offset employee out-of-pocket health costs. These programs typically enable employees to set aside funds on a pretax basis (thus reducing their taxable income and, in turn, their taxes) to pay for health care during the year. These funds are not taxed when they are used to pay for covered expenses. The most common type is a health care flexible spending account (FSA), which can be used for medical, dental and/or vision care expenses. Participants in a high deductible health plan (HDHP) may have access to a health savings account (HSA); which your employer may contribute to on your behalf. Other employers may offer a health reimbursement account (HRAs). To understand the difference between these three common health care expense accounts, check out this HSA vs FSA vs HRA comparison sheet.

8.Ask about voluntary benefits

To meet the increasingly varying needs and interests of their workforce, more and more employers are offering voluntary benefits to round out the support they can provide to employees. With voluntary benefits, you pay the full cost, but rates are far less than if you purchased coverage on your own. Ask and see what’s available at both your and your spouse’s workplace. Some examples of voluntary benefits employers offer include:

  • Buy-up long-term disability insurance
  • Critical illness coverage
  • Accident insurance
  • Financial and/or legal counseling
  • Home and auto insurance
  • Pet insurance

9.Look into wellness programs

Employer-sponsored wellness programs are a great way to stay healthy and save some money, as 86 percent of employers offer financial incentives in their wellness programs. These incentives often include premium credits or health care reimbursement program contributions (such as contributions to an HSA) for certain activities, such as completing a biometric screening and health risk assessment or participating in a weight loss program. Check with both of your employers to see if any kind of incentives are offered that can reduce the cost of whichever health plan you two choose.

10.Seek help

Don’t try to be heroes and figure out everything about your benefits on your own. If your employers offers enrollment support, such as one-on-one in person or telephonic meetings with a benefits expert, take advantage of it. You may learn about benefits you didn’t know about, and you’ll be able to ask questions about your own situation.

Once you check off these items, both your spouse and you should be ready to make successful benefits decisions together!

(Kim Buckey, vice president of client services, DirectPath)

The Vitamin Shoppe Uses DirectPath’s Transparency Services to Empower Health Enthusiasts to Make Informed Health Care Decisions
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The Vitamin Shoppe Uses DirectPath’s Transparency Services to Empower Health Enthusiasts to Make Informed Health Care Decisions
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