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8607 Roberts Drive, Suite 150 Sandy Springs, GA 30350-2237


Open Enrollment for Medical Insurance

Published October 10, 2011


Horizons in Hemophilia, October 2011 

By Michelle Fitzwater, Managed Care Contract Specialist

Open enrollment is the time period when you may enroll in or transfer insurance plans offered by your employer.  It happens once a year, typically in the fall, and is the best time to review your health care needs.  This is a really important decision and you may have to put in a lot of work to get a good result.  After all, once you choose a plan it will be your insurance for the next year. 

Here are some of the essential things you should know before selecting a plan:

  • Determine if factor is covered on your drug card or the major medical plan
    Factor products are increasingly being moved to the drug benefit portion of medical insurance. While this typically means you don’t have to pay a deductible, there are some plans that have a co-pay as percentage of cost.  Also, if factor is covered on your drug benefit you could have a limited network of pharmacies to choose from.  Many plans are selecting only one specialty pharmacy for their drug plan.  This means that you will not have a choice in where your factor comes from or be able to control the costs.

  • Determine the out-of-pocket costs.
    Most people initially look at the premium and think that is what the plan will cost them.  Actually, there are a lot of other costs to consider.  Once you see all of the costs together you will have a better picture of the whole cost of the insurance plan.  For example, the premium (the amount you pay per month or per pay check) on a high deductible health plan may be significantly lower than an HMO premium but the deductible may be much higher.  If you have a High Deductible Health Plan with a $7000 deductible, you will have to pay the entire $7000 out of pocket before the plan will cover any other expenses. However, if you choose an HMO with a higher monthly premium, your deductible might be just $1500.  

  • Explore Flexible Spending or Health Savings Accounts. 
    If you can estimate your potential out of pocket costs, you will be better prepared to take advantage of the tax savings available in a flexible spending account.  For example, if you know you will have surgery this year you can elect to contribute the amount of your deductible to your Flexible Spending Account.  This amount will be divided between your pay checks and taken out pre-tax.  It is then available for you to pay the provider as soon as you are enrolled.  This means that if your plan starts January 1st, you can use the funds before you have fully contributed to it.

If you don’t already know the answers to the above questions, direct them to your employer’s benefit manager.  They should have or be able to get all the answers you need about the plans they offer.