What should employees see before open enrollment?
At minimum: the summary of benefits and coverage for each option, a plain definition of the key terms, a side-by-side of premium and likely cost, a way to check their doctors against the network, and a named person to ask.
What is behind the short answer.
The short answer is above. These are the details that decide it for a specific plan.
The plan summary for every option
The summary of benefits and coverage is built so options can be compared on the same footing.
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.
The figures and requirements below come from the federal sources cited at the end of this section. General information, not legal advice.
No more than four pages
The summary of benefits and coverage must be in a uniform format, no more than four pages, in at least 12-point type, written so the average enrollee can follow it.
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
The summary says on its face that the full plan document or certificate controls, and gives a phone number and web address for it.
Changes require advance notice
A material change that is not reflected in the latest summary requires notice to enrollees at least 60 days before it takes effect.
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
The most effective fix for plan confusion is also the simplest: explain the plan before the enrollment window opens, with a real example, in words employees already use.
How to Use the Summary of Benefits and Coverage
Every group health plan has 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
The full guide to helping employees understand their group health plan.
Questions that come up next.
Short answers to the questions employees ask after this one. Each links to its own page.
Why do employees pick a plan that does not fit them?
Usually because the choice is made fast, from a table of numbers, with the premium doing most of the persuading. Few employees see a worked example of what the plan costs in a hard year, or check whether their doctors are in the network.
Does explaining the plan change what it covers?
No. Explanation does not change coverage. The plan documents, the carrier contract and the summary of benefits and coverage decide what is covered. What explanation changes is whether employees choose the plan that fits them and know how to use it.
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.
General information about group health plan terms, not legal or tax advice. Plan-specific questions belong with 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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