Who needs to participate in open enrollment?
EVERYONE needs to participate in Open Enrollment, regardless of status.
(New employees, very part-time employees, no insurance, with insurance, Everyone!)
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What & when exactly is "Insurance Open Enrollment"?
Open enrollment is the one time of the year when eligible employees are allowed to make changes to their benefits or to enroll for the first time. This includes switching plans, adding new or uncovered dependents, or choosing new plans. Remember that Insurance Open Enrollment is only offered one time each year.
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What changes can I actually make?
A variety of moves can be made! You can change medical plans, add or delete dependent coverage; just remember you must keep the package intact (medical, dental & vision must remain together)
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I need more info - where can I go to compare plans? Are there books?
Unfortunately, insurance companies don’t even provide physician listings because they would be out of date by the time they went to print. We strongly suggest the insurers’ web sites to compare plans. If you don’t have Internet access in the office or at home – try the public library, it’s usually free. Contact info for all plans is on the bottom of the next page. Summary sheets of the medical plans that we offer are also available at www.judymadrigal.com, click on 2008 Insurance Rates.
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If I don't change Plans, will my coverage be the same?
Your coverage will remain the same. There are minimal mandatory plan changes, some of which are a benefit to you. Updated plan design summaries are available at www.judymadrigal.com, click on 2008 Insurance Rates. Summaries are located at the bottom.
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I am currently enrolled in Blue Shield HMO and am not changing anything. What do I have to do?
All you have to do is return the employee questionnaire indicating that you wish to make no changes, then check the appropriate box indicating the option you currently have. Please make sure the form is returned no later than Wednesday, April 16th.
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I’m currently enrolled in Blue Shield PPO or Kaiser and would like to stay on that plan, what do I need to do?
Since there are now 2 different Blue Shield PPO and Kaiser plans, you must check the box of the plan you wish to choose so that we may internally transfer your coverage.
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What happens to the deductible I have already contributed towards this year?
If you decide to change to the Blue Shield PPO 250-90/60 “Elite" plan and have met the deductible under the current Blue Shield PPO plan in the 2008 calendar year, you will be given credit towards the higher deductible.
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If I’m on Blue Shield HMO... What’s the difference between that and the PPO?
There’s a significant difference between an HMO and a PPO. HMOs require copays and there are little or no out-of-pocket costs. However, you must follow all of the rules for seeing specialists and getting referrals. PPO claims are subject to either a copay or an annual deductible, depending on the service provided. With the PPO, employees can go to any specialist without the pre-approval of a primary care physician. There are higher out of pocket costs if non-participating providers are seen.
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Why would I choose the Blue Shield PPO 250-90/60 “Elite” or Kaiser Traditional “Elite” plans?
Choosing a health plan for you and your family is an important decision. You know your family best. You want to balance your treatment needs with the cost of purchasing the coverage. If you know you and your family have ongoing medical issues, and you want to keep your out-of-pocket costs to a minimum, then you may want to consider the Blue Shield PPO 250-90/60 “Elite” or Kaiser Traditional “Elite” plans. Elite plans cost more in payroll deduction, but when you receive medical services, the plan pays a larger share of the total bill.
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Why would I choose the Blue Shield PPO 1000-80/50 “$aver” or Kaiser Deductible “$aver” plan?
As with the Elite plans, you need to balance your treatment needs with the cost of purchasing the coverage. If you and your family are healthy, do not have a lot of ongoing medical costs, and are primarily interested in protecting yourselves against catastrophic medical issues, then the Blue Shield PPO 1000-80/50 “$aver” or Kaiser Deductible “$aver” plans may be right for you. A $aver plan will require you to pay a larger share of the medical bill when you need services, but will cost less in payroll deduction. $aver plans are good for employees who wish to keep the payroll deduction to a minimum.
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How does the deductible under the Kaiser Deductible “Saver” Plan work?
Instead of copays for all services under this plan, certain services require you to pay a deductible (the first $500 per calendar year) plus 10% coinsurance when you require services for in-patient hospital care, outpatient surgery, certain procedures, and emergency room visits during the calendar year.
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I am changing some of my options - When do I have to get forms back to you?
As soon as you decide to make a change, please let us know. We will provide you with the appropriate forms. No change can be made without the appropriate enrollment/change form
April 16th: Due date for all employee's questionnaires, whether making changes or not.
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Can I enroll in only the dental plan?
Our health benefits are bundled together in a package -- medical, dental and vision. It is not an option to enroll only in the dental plan.
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Can I put my children on the dental only?
Again, this is not a benefit that JMA offers, as our benefits are provided as a package.
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My hours just increased. What do I have to do to qualify for benefits?
The following qualifications must be met to be eligible for benefits:
- You must work 30+ hours per week on a regular basis.
- You must have completed your 90-day eligibility period.
- You must be regular status and not classified as a Temp or Per Diem employee.
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Why do the premiums go up every year?
Rising health care costs are a fact of life. It has been the subject of countless news features on television, articles in the local newspaper, and speeches by politicians. While this situation is commonly known, the resulting increases in the insurance premium often come as an unpleasant surprise to companies and their employees.
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What are the reasons behind increasing healthcare costs?
Healthcare costs go up due to increases in utilization. Some of the reasons claims costs increase include new and expensive medical technologies and drug therapies, including biotech drugs, increases in prescription drug costs, an aging workforce, and malpractice lawsuits and Government mandated benefits. Overall medical plan costs are projected to increase by more than 11%. Prescription drug costs alone are anticipated to increase by 12%.
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My office has decided not to raise their current allocation. When will the new charges come out of my check?
You will see the new payroll deductions in May for June coverage. Premiums are paid one month in advance. You will be automatically enrolled in our cafeteria plan, which allows you to pay your premium in pre-tax dollars. This plan will prevent your premium from being a taxable item on your paycheck.
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Can I put my spouse/domestic partner/child on now?
Yes. This is one of the few times each year when you can make these changes.
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If I am on Blue Shield, can I enroll my child/children on Kaiser?
It is not an option to enroll yourself on one medical plan and your family on another plan. All family members must be enrolled on the same medical plan.
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I am unhappy with my current plan. Can I drop out all together?
Yes, you can cancel your insurance at the beginning of any month.
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Can I still go to the same medical group/doctor if I switch to the HMO or PPO?
There is a good chance that your doctor is on both the HMO & PPO; however, we recommend that you call their office to confirm that.
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I don’t want the insurance at all anymore; do I get a pay increase?
While some offices do offer pay in lieu of benefits, this is not typically an option. Benefits are offered to all employees who qualify. If you choose not to participate because you have other group coverage, this may be taken into consideration. You would need to discuss this further with your site supervisor.
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Contact info for the different medical plans:
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I am responsible for collecting all of the completed questionnaires, should I wait and fax them all at the same time? Or send them as soon as they are complete?
Please send the completed questionnaires back via fax as soon as you get them back from each individual employee. Do not send via mail. Please call to confirm your fax was received. Questionnaires can be lost in the mail and you’ll have to repeat the entire process.
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