What should employees see before open enrollment?
The essentials are five: each option’s summary of benefits and coverage, everyday-language definitions of the main terms, a premium-versus-probable-cost comparison across the choices, a quick way to confirm that favorite doctors are in the network, and the name of someone to contact with questions.
What is behind the short answer.
The headline answer is above; what follows covers the specifics that matter for a given plan.
The plan summary for every option
Every option’s summary follows one template, so the choices can be set next to each other.
The terms, defined once
Deductible, coinsurance, copay and out-of-pocket maximum in a few sentences each, with one worked example.
Total cost, not just the premium
A comparison of premium, a typical year and a worst-case year for each option.
Network check and a contact
A way to look up the providers they already use, and a name and number for questions.
What the rules say.
Numbers and rules in this section come from the federal sources listed at its end. Consider it general information rather than legal advice.
No more than four pages
Each SBC must use the prescribed uniform layout, stay within four pages, appear in type of 12 points or larger, and be written in terms the average enrollee can follow.
Defined terms and coverage examples
It carries uniform definitions of standard insurance terms and coverage examples for common scenarios such as having a baby or managing a chronic condition.
It is not the governing document
On the face of each summary is a note that the complete plan document or certificate is what governs, along with contact details (phone and web) for getting it.
Changes require advance notice
When a material change is missing from the latest summary, the plan has to notify enrollees no later than 60 days ahead of the effective date.
Sources: 42 U.S.C. 300gg-15
We assemble the packet.
We prepare the comparison, definitions and network guidance for your plans so employees see what they need before the window opens.
Related pages.
Explain Benefits Before Employees Enroll
Plan confusion is usually solved most simply by walking employees through the plan before enrollment opens, using one realistic example and the vocabulary they already know.
How to Use the Summary of Benefits and Coverage
Each group health plan is issued with a Summary of Benefits and Coverage.
Compare Total Cost, Not Just the Premium
The premium is only one part of what a plan costs an employee.
Avoiding Group Health Insurance Plan Confusion
Read our complete guide to helping employees understand their group health coverage.
Questions that come up next.
Brief answers to the follow-up questions employees raise. Each one has its own page.
Why do employees pick a plan that does not fit them?
Mostly because enrollment moves fast and the screen is a grid of numbers where the monthly premium carries the most weight. Rarely does anyone show employees what a bad year would cost, or help them check whether their own physicians are in network.
Does explaining the plan change what it covers?
They do not. Coverage is dictated by the plan documents, the carrier contract and the SBC; explaining a plan leaves it untouched. Explanation helps employees pick the plan that suits their situation and use it well.
Is a high-deductible plan always the cheaper choice?
No. A high-deductible plan usually has a lower premium, but it can cost more in a year with significant care. The right choice depends on how much care the employee expects to use and whether they can cover the deductible if they need to.
Ready? Send us your renewal, or talk it through with someone first. No cost, no obligation.
This is general background about group health plan terms, not legal or tax advice. For plan-specific questions, rely on the plan documents and the carrier.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents, two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
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