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Preparing For Health Insurance Open Enrollment: Employer Checklist for Open Enrollment

Open Enrollment for health insurance has begun. This period gives employers and employees the opportunity to change their benefit options, and many companies use this time to review their employees’ health insurance plans to see if they can find ways to save money or improve coverage. The opportunity for business owners to save money during Open Enrollment is especially important this year because the coronavirus has hit many companies hard financially. Now is the time to speak to an EZ agent to see if you should renew your current plan or switch to a more affordable plan that offers just as many benefits.

As you review your options, you also have to be aware of any legal changes affecting the design and administration of your current plan or any other plan you choose. Go through the following checklist, share it with your employees, and use it to help you choose your plan for the coming year.

change written on many freen arrow signs pointing in different directions. — *Healthcare plans change every year, including the price and coverage, so you need to be aware to be better prepared.*

Plan Design Changes

Healthcare plans and the rules surrounding them change every year. The cost of your plan may go up, so you need to be aware of changes to your costs. But you also need to be aware of changes to certain limits in your plan. Some changes to know for 2021 include:

Affordable Care Act (ACA) affordability standard– The affordability percentage for 2021 is 9.83%. Employer-sponsored coverage for next year’s plan will be considered affordable under the employer shared responsibility rule if the employee’s required contribution for self-only coverage does not exceed 9.83% of the employee’s household income for the tax year.
Out-of-pocket maximum– The annual out-of-pocket maximum limit for 2021 is $8,550 for self-only coverage and $17,100 for family coverage.
FSA contribution limit: This has not been announced yet, so watch for IRS guidance on the FSA contribution limit for the 2021 plan year.
High deductible health plan (HDHP) and health savings account (HSA) rules for 2021:
- HSA contribution limits: $3,600 for individuals and $7,200 for families
- HDHP minimum deductible: $1,400 for individuals and $2,800 for families
- HDHP out-of-pocket-maximum: $7,000 for individuals and $14,000 for families

Make sure to confirm that your plan’s out-of-pocket maximum complies with the ACA’s limits for next year. If you offer a HDHP, make sure that the plan’s deductible and out-of-pocket maximum are also in compliance with next year’s rules. Remember to communicate these changes to your employees.

Notices To Pass On To Employees

You should provide certain benefits notices to your employees during the Open Enrollment Period. Benefit notices that you should review and provide to your employees include:

Summary of Benefits and Coverage– The ACA requires healthcare plans and health insurance issuers to provide a summary of benefits and coverage to enrollees. This has to be given to your employees who enroll or re-enroll during Open Enrollment.
Summary Plan Description (SPD)– Plan administrators have to provide a SPD to new participants within 90 days after plan coverage begins. In addition, any changes that are made to the plan should be communicated to employees in an updated SPD booklet.
COBRA General Notice– Group health plan administrators have to provide an initial COBRA notice to new participants and certain dependents within 90 days after plan coverage begins. It can be included in the SPD.
Grandfathered Plan Notice– If you have a grandfathered plan, then make sure that you provide any information about the plan’s status and any changes to the plan.
Children’s Health Insurance Program (CHIP) Notice– Group health plans that cover residents in a state that provides assistance subsidies under a Medicaid plan or CHIP have to send an annual notice about the available assistance to all employees residing in that state.
Notice of Patient Protections– This notice needs to be provided if you are offering non-grandfathered group health plans that require designation of a participating primary care provider. If a non-grandfathered plan requires participants to designate a participating primary care provider, the plan or issuer must provide a notice.
Individual coverage HRA (ICHRA)– This applies to employers who sponsor ICHRAs for specific classes of employees, or all employees. You must provide the written notice to each participant at least 90 days before the beginning of each plan year.
HIPAA Privacy Notice– Employers with self-insured health plans are required to maintain and provide their own Privacy Notices. Special rules apply for fully insured plans. Under these rules, the health insurance issuer, and not the health plan itself, is primarily responsible for the Privacy Notice.
Wellness Program Notices- There are 2 notices that you will need to provide employees if you offer a workplace wellness program:
- HIPAA Wellness Program Notice– HIPAA imposes a notice requirement on health-contingent wellness programs that are offered under group health plans. Health-contingent wellness plans require individuals to satisfy standards related to health factors (for example, not smoking) in order to obtain rewards.
- Americans with Disabilities Act (ADA) Wellness Program Notice– Employers with 15 or more employees are subject to the ADA. Wellness programs that include health-related questions or medical exams must comply with the ADA’s requirements, including an employee notice requirement.

shopping cart with money held in a paperclip inside of it. — *Comparing plans with an EZ agent can help you save hundreds of dollars a year!*

Finding An Affordable Plan

Whether you are considering renewing your current group plan, or finding a new plan or insurance company to work with, you will have to do some researching and comparing. There are hundreds of group insurance plans to compare in order to find the one that best suits you and your employees. By combing through these plans, you will be able to save hundreds, and maybe even thousands of dollars a year! The first step in figuring out what kind of plan to look for is to conduct an employee health survey.

Next, you should speak to an EZ agent. It can be time consuming to sit down and compare plans, and with Open Enrollment coming to an end soon, the whole process can become overwhelming. Running a business means that you have a lot on your plate, so let EZ.Insure do all the work for you. You can speak to one of our agents free of charge. They will ask you questions regarding your budget and employees, and will then begin comparing quotes. EZ will present you with the best option that will offer the most benefits and savings. To get instant quotes, simply enter your zip code in the bar above, or to speak directly to a licensed agent, call 888-998-2027.

Tips To Avoid Surprise Medical Bills

Getting hit with an unexpected medical bill can be scary. It can happen to anyone; in fact, surprise medical bills have affected more than half of all Americans. Even if you have health insurance, there’s no guarantee that you will not get an unexpected bill from your healthcare provider. This is usually because your health insurance policy does not cover as much as you thought it did. There are ways that you can avoid receiving a surprise medical bill in the mail, and EZ has provided some helpful tips to keep you from being blindsided.

network of people connected to each other — *Call ahead and make sure a doctor is in network before going to the appointment.*

Stay In Network

If your primary care physician refers you to a specialist, check to see if they are in your policy’s network before making an appointment. Seeing a specialist who is not in your network will mean having to pay a hefty bill for any services you receive from them. To avoid a surprise medical bill from a specialist that is not covered under your plan, call your insurance company and ask them to find a provider that is in your network. Or you can ask how much you’ll have to pay for the services so you can be financially prepared.

Ask Questions

Recent surveys show that people most often receive surprise medical bills after a visit to the emergency room. The next most common unexpected charges came from diagnostic tests and appointments with specialists. Why? Because these visits usually involve medical care that is more advanced than what is covered by your plan. While all ACA-approved health insurance plans cover 100% of preventive care, some services and tests are considered above and beyond preventive, and you could end up being billed for them. If possible, try to ask questions about any care and tests you are receiving at an emergency room or from a specialist.

For example, if you are scheduled for a mammogram, which should be covered by your plan, call your health insurance company and ask for the billing code that they use for mammograms. Then when you go to the doctor’s office for the test, make sure that they are using that billing code. If they use more advanced reading methods such as a 3D mammography, which you might have to pay for out-of-pocket.

Keep Records

When you plan to have any kind of tests or procedures done, such as lab work or surgery, see if you can get a cost estimate from the hospital or healthcare provider beforehand. It is important to keep records so that if you get a surprise bill later, you can use that paperwork to justify your appeal.

Beware Facility Fees

Large healthcare facilities, including hospitals, add a charge for the use of their space and equipment, called facility fees. You could be charged a facility fee, which could be a few hundred dollars, just for visiting a doctor that is in a hospital complex or an urgent care office. Ask your provider ahead of time if there will be a facility fee, especially if it’s not an emergency situation and you do not need to visit a hospital.

Be Prepared In Case Of Emergency

In the event of an emergency, you could need an ambulance ride to the hospital. These rides are very pricey, costing several thousand dollars for just a few miles. Be prepared for emergencies by calling the ambulance providers in your area and making sure they are in-network. In the worst case scenario, if you need an ambulance ride and receive a large bill because they were not in-network, you can try to negotiate with the ambulance service or your health insurance company to reduce the price. You can even ask them to create a monthly payment plan for you.

Avoid Balance Billing

Balance billing is when a provider bills you for the difference between the amount they charge and the amount that your insurance pays. For example, if the provider’s charge is $200 and your plan’s allowed amount is $150, the provider may bill you for the remaining $50. Balance billing often happens when people go to a hospital or emergency room that is in their network, but see an out-of-network provider while there. If this happens to you, you can negotiate with the hospital billing manager or the doctor who billed you, and ask them to either pay the cost themselves or lower the bill for you. You can also call your health insurance company and ask them to waive the fees because you were in a hospital that was in your network.

two hands shaking with a red heart in the background — *An EZ agent will provide you with the most affordable plan that offers the most coverage, at no cost.*

Finally, and most importantly, if your medical needs have changed due to an addition to your family or a new chronic condition that you are managing, for example, then it might be time to look for a better health insurance plan. EZ will compare all available plans in your area, and find you the plan that best fits your financial and medical needs. Instead of settling for a health insurance plan with surprise medical bills, allow us to find you a plan with more coverage and a lower price tag.

To compare plans for free in minutes, enter your zip code in the bar above, or to speak to a trained licensed agent in your area, call 888-350-1890.

Preparing For Health Insurance Open Enrollment: 2021 ACA Premium Rates

Open Enrollment begins on November 1, and the 2021 premium rates for ACA plans have now been announced. Rates will be increasing slightly, because insurance companies have had to shoulder the costs of the free coronavirus testing and treatments mandated by Congress. This no-cost testing and treatment has left insurers with a $103 billion dollar bill. The rate increase may not be very large for some, though, because of the medical loss ratio rebate that will be incorporated into their premiums next year. If you’re looking for a new plan, or want to change plans, we’ve broken down what your costs could look like, and how you can still find affordable health insurance that fits your budget and coverage needs.

The ACA Premium Increase

black chalkboard with two white lines forming a line graph, with a red line going upwards in the graph. — *ACA premium rates are increasing slightly for some, while others might see a 20-50% increase.*

The average cost of ACA premiums is increasing by only a few percentage points, with very few states experiencing a decrease. The increase will vary depending on the state, and will also be affected by whether each individual insurer has met the legal standard of spending 80% of revenue on direct medical care. If they have not met the standard over the last three years, then they must issue medical loss ratio rebates back to the policyholders. Many are doing this by putting the rebates towards premiums for next year to help keep them from spiking too much.

Despite projections of slight increases, some policyholders have been posting letters from their insurance carriers on Twitter that say their premiums will increase anywhere from 20 to 48%! In addition, according to one study, commercial insurers like Blue Cross Blue Shield, Aetna, Cigna, and Oscar Health could increase premiums anywhere from 4% to 40%.

So far, the highest increase for individual health plans has been proposed by Oscar Health in New York at 19.1%. For small group plans (employer-sponsored plans), Oscar Health also has the highest proposed increase of 29.1%, followed by Emblem at 20.9%.

More Affordable Options

Now that Open Enrollment is approaching, you should reassess your current insurance plan, if you have one (and if you don’t, now is the time to start looking!) It’s possible that different insurers have expanded into your state or county, and you might have more options available to you than you did before. Take advantage of this time and consider all of your options!

Because premiums vary by state or region, it is important to get some help determining what the increases to your premiums could look like. You should also get help finding the best plans available in your area. The best way to do this is by speaking with an EZ agent. Our agents are trained in your region and work with the top-rated companies in the country, so they have quick and easy access to all plans in your area. They will go over your medical and financial needs, and then compare all plans, including their coverage, premiums, deductibles, and other costs of each plan. We will help find an affordable plan, and maybe even lower your health insurance cost!

To compare plans in your area for free, enter your zip code in the bar above, or to speak to one of our highly trained, licensed agents, call 888-350-1890.

Renewing Your Health Insurance? Here Are Some Helpful Tips

It’s easy to simply purchase a health insurance plan, get comfortable with it, and not review it at the end of your year-long policy period. But if you automatically renew your plan and don’t look at other options, you could be missing out on savings, or a plan that provides more coverage. When you receive a “renewal notice” from your health insurance company, you should read through it carefully in order to decide if your current plan is still right for you.

It can be stressful to research and compare plans, which is why EZ.Insure was created. We want the best for our customers, so we provide you with a dedicated EZ.Insure agent who will go over your current plan, its price, and its coverage. We’ll then compare it to all other plans in your area so you can decide whether you should sign up for a better plan or renew your current one.

november 1st on a calendar in red with a red thumbtack on it — *You can renew your health insurance plan, or change it, during open enrollment Nov 1-Dec 15.*

When Can You Renew?

In general, you can only renew your health insurance plan during Open Enrollment. But if you have employer-based insurance, then your enrollment period might be at a different time, so make sure to check with your employer. Open Enrollment is November 1st through December 15th.

There are two ways that you can renew a plan:

Active renewal – you personally cancel the policy that you had and pick a new one.
Passive renewal – your health insurance company automatically re-enrolls you into the same plan for the coming year.

What You Need To Review

When you receive a renewal notice, you should go over the following things to make sure that your plan still suits your needs:

Premium– Your monthly payment for your health insurance plan.
Deductible– The amount you pay before your health insurance company starts paying for services.
Copay- how much you pay for each doctor visit, hospital visit, prescription medication, and specialist visit.
Coinsurance– the percentage of costs you have to pay after meeting your deductible.
Out-of-pocket maximum– The maximum amount of money you will have to pay out-of-pocket for covered healthcare services in a given year.
Your Current Network- the doctors, pharmacies, and specialists that are covered by your plan
Some health plans will offer a gym membership stipend.

Other Benefits To Review

Check to see if other benefits have been added to your plan, if benefits that you want are not covered, or if other plans might have benefits that you want included for free. Some of the benefits to look for include:

Gym discounts
Covered annual physical exam
Weight loss programs
Discounts on glasses and contact lenses

Change In Status

When deciding whether to renew your plan or find a new one, you should also consider whether you’ve had a change in income, or if your family has grown or has become smaller. Adding or removing dependents can change the cost of your plan and its coverage, so you might find that your current plan is more expensive, or that it is going to provide less coverage.

Although it is easy to sit back and let your health insurance plan renew, you should take a closer look at your plan and how it will change in the coming year. You don’t want any surprises, like to find out that your doctor is no longer in your network, you have less coverage, or your deductible went up, etc. Any of those things could end up costing you a lot of money.

If it feels like a lot of work to go over your current plan and research new ones, don’t worry: EZ will help you. We will compare all of the plans available to you, as well as go over all of your financial and medical needs. We’ll make sure that your current plan has the coverage you need, and if it doesn’t, we’ll find you a great new one! If you allow us to help you, you could end up saving hundreds of dollars a year. And remember, our services are always provided at no cost to you. To start comparing quotes, simply enter your zip code in the bar above or to speak directly to one of our agents call 888-350-1890.

How You Can Save Thousands On Health Insurance & How EZ Can Help

If you feel like healthcare costs are out of control, you’re not alone. It seems like costs are constantly rising, making it hard for many to afford a health insurance plan or their medications. Because of this, many people end up going without health insurance and avoiding doctor visits, which can mean missed diagnoses and delays in treating major health conditions. But health insurance doesn’t have to be unaffordable or unattainable. EZ knows how to save you thousands on health insurance without sacrificing coverage, so you can remain insured and healthy, while saving money at the same time.

Opt For A Higher Deductible Plan

Your first option for saving money? Cut your monthly premium by switching to a high deductible health plan. One of these plans could work for you if you don’t go to the doctor often, or if you don’t need any ongoing treatments, because if this is the case, you probably won’t ever need to meet your deductible. High deductible plans can be risky, though: if something ends up happening to you, you’ll have to pay a lot out-of-pocket to meet your deductible.

Go With A Lower Drug Formulary Tier

pill bottle sitting on top of a dollar bill with pills on the bill too — *Save money on your prescription medication by opting for a different drug tier.*

Another way to lower your healthcare costs is by taking a look at your prescription drugs, and at your plan’s drug formulary. If your doctor is prescribing you a name-brand medication that has a high copay, check to see if there are any less expensive generic drugs available – you could end up saving 30-50%.

Check your plan’s drug formulary (the list of medications included in your plan, and their costs), as well, and see how your insurance company classifies your medications. Every plan’s formulary has four different pricing tiers, and each insurance company – and every plan! – has a different formulary, so comparing them all can get quite confusing. EZ’s agents are here to help, though – our agent will go over your medical needs, and compare plans and their drug formulary tiers to help you find a plan with affordable drug costs.

Enroll In A Wellness Incentive

If you are enrolled in your employer’s health insurance plan, find out if they offer any wellness programs or incentives. Some companies will offer a lower premium to employees who participate in wellness challenges or other incentivized programs. This could end up saving you a lot of money, or could even get you free coverage!

Use A Health Savings Account (HSA)

If you decide to opt for a high deductible health plan, or if you already have one, then start contributing to a health savings account (HSA). HSAs are only available to those with a qualified high deductible health plan, and they allow you to put money aside tax-free to pay for qualified healthcare expenses. You will accrue tax-free interest, and you will also be able to withdraw money from the account tax-free. Not only are these accounts triple tax-advantaged, but the funds in your account rollover automatically each year and continue to grow until you use them!

white question mark in a blue circle — *Before getting any lab work or tests done, make sure to ask it it is covered!*

Make Sure Tests Are Covered

Avoid surprise medical bills – before you agree to any tests ordered by your doctor, make sure that they are covered under your plan. Be aware that, even if your doctor prescribes a test, such as blood work to confirm a diagnosis or rule out health conditions, it may not be covered. If it isn’t, ask your doctor for other options.

Not knowing what’s covered in your plan can end up costing you thousands of dollars. If you find that you are often being sent for tests that are not covered, consider finding a different plan that offers more coverage. Our agent can compare plans for you and find a plan that offers the coverage you need to get any necessary tests done, so you can avoid surprise bills – and save money.

Negotiate

If you receive a high bill from your doctor’s office or hospital, don’t automatically assume that it is correct – as many as 8 out of 10 times, higher than expected medical bills have some type of error. If a bill seems off to you, then contact your provider and ask them to go over it with you and explain why it is so much. If your high bill is not due to a billing error and you are having trouble paying it, then negotiate with your provider – ask if they can lower the bill, or if they can offer you a monthly payment plan.

african american man with his daughter on his lap checking her temperature while sitting in front of a laptop with a doctor on the screen. — *Telehealth can save you hundreds of dollars by avoiding a doctor visit copay or emergency room visit.*

Utilize Telemedicine

Going to the ER should be your last resort. When you are not feeling well or need immediate care then you should consider more affordable options like urgent care or telemedicine. Telemedicine is a great option, because it allows you the convenience of speaking to your doctor over the phone and getting prescription medication sent over to your pharmacy. This eliminates having to pay a doctor visit copay, or a huge hospital bill. If your plan doesn’t offer telemedicine, EZ can help you find an affordable plan that does offer this option.

Health insurance is not cheap, but that doesn’t mean that you can’t find an affordable plan. EZ understands the need for affordable health insurance, especially in times of uncertainty. Don’t stick with the plan that you already have if it’s too pricey, or doesn’t offer the coverage you need. One of our agents can find you a more affordable plan with just as much coverage, or more. We can easily compare all available plans in your area within minutes, at no cost to you. Taking advantage of our free services is just another way you can save money with EZ. To get started, enter your zip code in the bar above, or to speak to an agent directly, call 888-350-1890.

Preparing For Health Insurance Open Enrollment: 2021 Health Insurance Enrollment CheckList

Open Enrollment is less than 2 weeks away (November 1- December 15), so make sure you’re prepared! Whether you are enrolling in an individual health insurance plan for the first time, renewing your current plan, or seeking to change your current plan, follow the checklist below. Going through these steps will help you better understand what coverage you need, how much you can afford, how you can save money, and how you can make the process go more smoothly.

Step 1- Review

man writing in a notebook while a laptop is in front of him on a table. — *Review your medical needs, income, and what you must have before searching for a plan.*

Getting better coverage for next year begins with taking some time to go over your medical and financial situation. Before Open Enrollment begins, review:

Your medical needs – review your medical expenses from 2020 and decide if you will need more comprehensive coverage for next year, or if a basic plan would be more cost-effective.
Your household income – estimate how much you are going to make in 2021. This will allow you to have a better understanding of what your budget is, as well as if you will qualify for any discounts (one of our agents can help you to determine that)
Plan members – Think about whether you will be adding or removing anyone from your health insurance plan next year.
Your must-haves – Make a list of doctors and medications that you definitely want to be included in your plan. You might have a specific primary care physician you want to be able to see, or regular prescriptions that you need coverage for.

Step 2- Research

There are many different companies in the U.S. that offer health insurance. Some companies do not offer plans in certain states, and others have a limited number of plans. Each plan offered will be different, so in order to be better prepared, you will need to do some research on:

What you can expect to pay (especially if this is your first time signing up) including: copays, deductibles, monthly premiums, coinsurance, and out-of-pocket maximums.
The drug formularies in different plans. This will allow you to find cheaper options for your medications.

The different types of plans available- PPO, POS, EPO, HMO, and more.
The different metal tiers- Platinum, Gold, Silver, and Bronze.
Catastrophic plans, which are limited to preventive care and come with low monthly premiums and a high deductible. These plans are only available for certain people (those who are under 30 or experiencing financial hardship).

Step 3- Sign Up With An Agent

man in a suit pointing at a laptop screen with a woman next to him lookin at it — *Using an EZ agent is the most important step to getting the vest affordable plan for your needs.*

This is the most important step, because it will allow you to get a great plan, while saving you time and money. Use an EZ agent so that:

You know you are getting the best coverage. EZ.Insure agents are experts at finding quality, affordable plans that meet all of your financial and medical needs. Our agents are highly trained and work with the top carriers in the country. They can help you review all your information and research and compare all the plans in your area for free.
You are aware of how your plan works, including any extra perks it has to offer.
You have a go-to person whenever you have any questions or need help with claims. EZ’s agents are there for you 24/7, and will resolve any issues immediately.
You get the most savings. Researching and comparing plans with an agent will automatically save you 10% on your plan, because they have direct access to all the carriers in your area and know what each plan has to offer, including any discounts you might qualify for.

Step 4- Payment

After you purchase a plan through one of our agents, they will give you a timeline for when to pay and when you will get your insurance card. You will need to:

Pay for your plan by December 15 so that you have your insurance card in hand by early January.
Pay your first premium bill on time so that your plan will be activated.

Coverage for your plan, whether you renew your current plan, switch plans, or are buying a plan for the first time, will begin January 1st.

By following these 4 steps, you will be better prepared for Open Enrollment. With the help of one of EZ’s agents, you will have better knowledge of how health insurance works, the different plans you have access to, and which plan will work best for your specific needs. Save time researching all the different plans by having our agent do it all for you, at no cost to you. To be prepared for Open Enrollment and get better coverage, enter your zip code in the bar above, or to speak directly to an agent, call 888-350-1890.

Tag: health insurance help