An HR Pro’s Guide to 2019 Open Enrollment for 2020 Coverage

Wouldn’t it be great if your company’s benefits selection went off without a hitch? Use this HR checklist to ensure your smoothest open enrollment period yet.

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The HR Pro’s Guide to 2019 Open Enrollment for 2020 Coverage is an HR admin’s resource for simplifying the benefits open enrollment period. Whether this is your first time offering health insurance benefits to your workers, or you just want a cheat-sheet to make the process moves as efficiently as possible — welcome to your bookmarkable tool (bookmark, or download now).

Remember it’s smart to start thinking about open enrollment early.

Experts suggest an open enrollment process should begin 90 – 120 days before your company’s renewal date, while allowing at least 10 -15 days for employees to make their selections. In the open enrollment checklists below, we’ve used a standardized open enrollment time frame, but we realize your dates could be at any time.

You’ll learn:

  • Key dates and deadlines for OE
  • What to communicate to staff
  • What to expect from your broker partner
  • Answers to FAQ,
  • What’s new with the ACA

And More!

No time like the present, let’s get started.

 

Contents

Employer Checklist for a Smooth Open Enrollment Process

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ACA Facts and Updates - What You Need to Know

Skip Ahead

Open Enrollment FAQs

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Employer Checklists for a Smooth Open Enrollment Process

90-80 days before enrollment starts

Example date: October 1st–10th

Preparing your enrollment plans with your broker.

This is when you look back at your year, and determine the changes you’d like to see as a company to your benefits.

  • Identify the number of employees eligible for benefits
  • Align company goals with broker and administrator for the renewal period, with the help of these questions:
    • Are you and your employees happy with the current carrier and their provider network?
    • Are you and your employees satisfied with your current benefits structure?
    • Do you anticipate business changes that may impact your financial situation with respect to Benefits allocation?
    • Have there been any major change in your workforce? (e.g., New out of state offices or employees, change of company name, merger, etc.)
    • Check benchmarking data for companies of similar size and in similar locations
  • Provide open enrollment schedule to staff

Lost already? Maybe you need a refresher on what exactly open enrollment is. Definitions, and everything you need to know.

80-60 days before enrollment starts

Example date: October 10th–30th

Reviewing broker package rates

This is where you shop plans, determine pricing, and finalize your company budget line items for benefits.

  • After the administrator communicates the above information, the broker gathers rates from current carriers (and other carriers if desired) to prepare the most tailored proposals for the group. No action is required from the administrator at this time, but it is a notable step in the process.
  • Ensure brokers are responsible for insuring plans and are compliant with state and local ordinances, the ACA, etc.
  • Review usage rates, costs, and availability of additional perks or programs you will offer throughout enrollment period, such as wellness programs, commuter benefits, etc.

60-50 days before enrollment starts

Example date: November 1st–10th

Renewal selection period

This is where the HR admin and other decision makers determine the company-approved plans that will be rolled out for the following year’s coverage.

  • Broker gives a summary of the options and administrator can compare current plans to new plans. Once agreed upon, the broker will submit the chosen plans to the company, where the employees can view each one.
  • Admin drafts an FAQ and glossary to help staff clearly and firmly understand the nuances of each plan

Need help parsing health insurance jargon? Steal this cheat sheet to terminology and popular health plans.

­­­50-45 days before enrollment starts

Example date: November 10th–15th

Preparing for employees selection period

This is when an HR manager focuses on communication and education of the open enrollment dates and plan options with staff.

  • Update company calendar with important enrollment dates and deadlines
  • Create and distribute summaries of various plans and options
  • Communicate any changes in previous plans and costs. Hold one or multiple sessions to review updates, changes, and deadlines
  • Advise staff on updates or additions to additional perks (i.e. wellness programs, commuter benefits, etc.)

Pro Tip — Zenefits’ mobile solution clearly provides enrollment status for all employees.

45-30 days before enrollment starts

Example date: November 15th–30th

Employee selection period

This is when HR professionals must ensure employees have selected plans through email communications, reminders, and company updates.

  • Employees make their selections
  • Send last-day reminder prior to deadline

82% of workers feel prepared for open enrollment. Educate your employees.

30 days before enrollment starts

Example date: December 1st

Carrier application and acceptance

This is when, once you have all employee benefits selections, you work with your broker for final approval.

  • Submit the group application to company broker, who in turn sends the information to the insurance carrier for final approval.

With the Zenefits app your employees can enroll in their benefits from a mobile device and you can track their progress ensuring open enrollment is a success.

2020 Coverage Is Effective

Example date:

Coverage begins

This is when your staff’s new benefits coverage begins. Changes to rates and plans will occur at this time.

  • Update summary plan descriptions for employees to review
  • Update employee handbook with most recent information and summaries
  • Check that all employees received ID cards
  • Verify deductions are confirmed in the payroll system for employees
  • Provide contact info for employees for questions and needs

Pro Tip — It can be quite daunting to collect and store the above information in an organized and compliant fashion. Learn how Zenefits’ all-in-one HR platform collects, stores, and manages all HR related information to reliably save you time.

ACA Facts

 

 

 

ACA Facts and Updates – What You Need to Know

The American Care Act, aka Obamacare, has been a controversial, complex, and continuously evolving headliner since its inception. Most recently, current law is being reviewed on the basis of its constitutionality; the Trump Administration began work on an alternative, but then pushed the initiative until after the 2020 campaign cycle. A brief glimpse into internet archive headlines paint the picture.

Many have wondered: will the healthcare process in America change again? Will the ACA stay or go? What do I need to know as an HR administrator or employer?

The short answer is this: don’t expect much, if any, change in 2019.

The country’s healthcare laws and resulting employer requirements for health insurance will look much the same in 2019 as it did in 2018, with the ACA in full force.

With less change to worry about, HR admins can get to planning early, and employees can be better informed about their options and obligations for electing health coverage.

ALEs

Applicable Large Employers (ALEs)

US employers with 50 or more full-time employees are classified by the IRS as Applicable Large Employers, or ALEs. These businesses are required to provide full-time workers with “minimum essential” health coverage, or make an employer shared responsibility payments to the IRS. These same employers must also provide proof of that offer of coverage to the IRS with year-end forms 1095-C and 1094-C.

Important ACA Deadlines for ALEs:

  • 1095-Cs must be sent to employees by January 31, 2020 (This is an extended deadline)
  • Forms 1094-C & copies of the 1095-Cs need to be filed with the IRS:
    • Paper filing due February 28, 2020
    • Electronic filing (required for employers with more than 250 1095-Cs) due April 1, 2020.

Want a quick and easy way to remember all your compliance deadlines? Get the 2019 Compliance Calendar.

 

The federal government extended ACA filing deadlines on good faith relief two years in a row, both in 2017 and 2018 (the latter due to the government shutdown), though an extension for 2019 filings is unlikely.

Employers should expect to be fully compliant with the new laws.

The IRS has demonstrated they expect employers to be fully compliant with the ACA mandates, already sending a significant number of employers an “IRS Letter 226j,” an Employer Shared Responsibility Payment (ESRP), which informs companies of noncompliance and penalty fees.

Companies who submit late or incomplete forms can be subject to fees of $250 per form, or up to $3 million for the year. Failing to file at all can cost $500 per form.

Small Employers

 

Small Employers

US employers with fewer than 50 full-time employees are not impacted by the Affordable Care Act’s employer shared responsibility provision. Employers can choose to provide insurance to their workers, or they can purchase health insurance coverage for their employees through the Small Business Health Options Program (SHOP).

Even smaller companies could be incentivized to provide insurance with a tax credit. Employers with fewer than 25 full-time employees, and with less than $50,000 in annual wages, could qualify for the small business health care tax credit if they covered 50% or more of their full-time employees’ premium costs and if they purchased coverage through the SHOP.

Make sure all your ACA reporting is done accurately and timely – Zenefits’ all-in-one HR, payroll, and reporting can help.

Open Enrollment FAQs

Do employees need to go through open enrollment?

We recommend employees take their annual open enrollment period to make necessary adjustments to their employee benefits. Benefit information changes from year to year, and may require a change to your company’s benefit strategy. If your company admin has decided to “plan map” then you will automatically be enrolled in the same (or most similar) health plan as the one you originally selected. If your company does not have this automated process set up, you must re-select your health plan or you will be denied coverage.

What happens if an employee doesn’t take action during open enrollment?

There are many factors that contribute to rate changes, such as plan designs, legally mandated benefits, ACA taxes, and more. The normal trend for medical insurance rates is an increase between 10-12% while dental and vision rates trend around a 2-4% increase.

Why would an employee’s insurance rates change?

This actually depends on how your specific company has chosen to set up its open enrollment process. If you have selected an option that’s referred to as “plan mapping,” then the company will make automatic selections for employees who fail to alter their health plans during the open enrollment period. Without alteration on the part of the employee, the company will keep the individual in the same health plan or in the most similar health plan to the individual’s original selection. If that employee had previously declined coverage, the company will automatically decline coverage once again.

However, if administrators at your company have not selected to “plan map,” then any employee who does not actively make a selection during the open enrollment period will be declined coverage. This is even true for employees who had previously been enrolled in a health plan. These employees would need to re-select their health plan to continue using it. If the employee fails to do so during the open enrollment period, they can only enroll in health insurance if they experience a qualifying life event. It’s possible that the employer could submit an “exception request” for an employee who missed open enrollment; this would be done through the employer’s broker.

What happens if an employee misses the open enrollment window?

This actually depends on how your specific company has chosen to set up its open enrollment process. If you have selected an option that’s referred to as “plan mapping,” then the company will make automatic selections for employes who fail to alter their health plans during the open enrollment period. Without alteration on the part of the employee, the company will keep the individual in the same health plan or in the most similar health plan to the individual’s original selection. If that employee had previously declined coverage, the company will automatically decline coverage once again.

However, if administrators at your company have not selected to “plan map,” then any employee who does not actively make a selection during the open enrollment period will be declined coverage. This is even true for employees who had previously been enrolled in a health plan. These employees would need to re-select their health plan to continue using it. If the employee fails to do so during the open enrollment period, they can only enroll in health insurance if they experience a qualifying life event. It’s possible that the employer could submit an “exception request” for an employee who missed open enrollment; this would be done through the employer’s broker.

When will employees receive new ID cards?

Carriers send ID cards about 7-14 days after the application has been approved. When a group is going through open enrollment, it is common to receive ID cards around 30 days after the effective date.

Are there any benefits employees can enroll in after the open enrollment period?

No. All benefit changes should be made during open enrollment. Changes outside of this period can only be processed if an employee has experienced a qualifying life event.

“I was hired recently and just enrolled. Do I still need to go through the open enrollment selection?”

Yes, if the effective date of the company’s open enrollment is after the effective date of the new hire enrollment, you will be required to enroll in coverage again.

If an employee makes a selection and then changes his or her or their mind, can he or she or they make a change?

Yes, as long as the change is made before the last date of the open enrollment period, or during the period after a qualifying life event.

What's the difference between a co-pay and deductible?

A copay is the amount paid out-of-pocket at a doctor’s appointment or when purchasing a prescription. A deductible is the collective amount of money that is paid out-of-pocket before health insurance carriers begin to cover medical expenses. The deductible is typically calculated on an annual basis, either according to the calendar year or the plan year. It’s important to verify which time frame your deductible adheres to before making selections.

Can employees add or remove a dependent to their plan during the open enrollment period?

Yes, open enrollment gives you the freedom to make any changes to your coverage such as adding or removing dependents.

Does an employee need to make selections during open enrollment if he or she or they are on leave, such as maternity or paternity leave or sabbatical?

Yes, it is recommended that all employees make their plan selection during open enrollment, even if the employee is on paid time off, vacations, or any kind of parental leave. If an employee is unable to make the selection at this time, the administrator should work with their broker or carrier to determine their options for enrollment.

What is a qualifying life event?

A qualifying life event (QLE) is a significant lifestyle change that is either unexpected or unavoidable. In the case of a QLE, employees are able to make changes to their insurance plans outside of the open enrollment cycle. Examples of QLEs are having a baby or divorcing a spouse.

What are some things employees can do to help save on health care costs?

Some actions you can provide to your staff to help mitigate the total cost of healthcare are encouraging preventative care and healthy lifestyles, or using tax-free health savings accounts such as an FSA or HSA.

  • Preventive Care: to stay on the healthy track, be sure to take on a healthy habits and take advantage of preventive care
  • FSA plan: FSA plans lets you set aside money for health care expenses (deductibles, co-pays, prescriptions, eyeglasses, etc.) before taxes are calculated on your salary, and you are reimbursed tax-free. FSA accounts do not roll over if they are unused. This plan is the use-it-or-lose-it plan. Learn more about FSAs, how to use them, and FAQs.
  • HSA plan: you may use funds from HSAs to purchase eligible medical expenses (prescription costs, deductibles, copayments, and coinsurance) without paying taxes on those purchases. HSA accounts roll over year-to-year if they’re not used. Learn more about HSA plans, details.
If an employee expects to have a life event change after their open enrollment period ends, how will that affect their open enrollment elections?

If an employee has a qualified life event (marriage, birth, move, etc.) after the open enrollment period ends, they will need to access your benefits administrator and “Declare a Life Event.” Once they have submitted the qualified life event change, they will be required to elect and submit their benefits elections in an open enrollment event again.

When can I enroll in a 2020 Marketplace (healthcare.gov) plan?
  • The 2020 Open Enrollment Period runs from November 1, 2019 to December 15, 2019.
  • Plans sold during Open Enrollment start January 1, 2020.
Who is eligible to use the Healthcare.gov Marketplace?

To be eligible to enroll in health coverage through the Marketplace, you must:

If you have Medicare coverage, you are not eligible to use the Marketplace to buy a health or dental plan.

Do part-time workers count towards the 50 employee threshold?

No. Full-time employees are defined as people who work 30 or more hours, on average, per week.

Are companies reducing their sizes to fall under the 50 employee threshold?

Potentially. There have been anecdotal accounts of small businesses holding off hiring to stay under the 50-employee threshold, and the International Foundation of Employee Benefit Plans found that nearly 1 in 5 small businesses claimed to reduce hiring to try to stay under the threshold. But companies should be advised, there are other penalities that aim to prevent companies from averting the healthcare mandate. For example, business that overtly reduce the number of full-time employees to avoid ACA liability might violate the Employee Retirement Income Security Act (ERISA), as Dave & Buster’s’ $7.4 million proposed settlement demonstrated when a group of workers hours were cut.

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