Clocks are ticking! It’s that time of year, again. And, we’re not talking about the holidays. Employees have to enroll for group medical benefits – now under the influence of the Affordable Care Act (ACA). If your workforce benefits from your HRIS program, how much of the open enrollment can you leave to the system? It’s much harder than just keying into an HRIS terminal.
Tie up the loose ends
The best HRIS programs manage all the operational aspects of group medical benefits enrollment. In addition, HRIS pushes considerable responsibility to the employees who can manage their enrollment independently in the system.
Still, you have to communicate a lot of detail to educate employees regarding their decision and then direct that decision behavior before and during the enrollment period.
Here are six bases you have to cover and monitor:
1. Final deadline: Employees can sign up as late as January 16 to January 31, 2016. However, when they wait that long, their benefits coverage will not take effect until March 1, 2016.
• November 1, 2015 to December 15, 2015 enrollments take effect January 1, 2016.
• December 16, 2015 to January 15, 2016 sign ups take effect February 1, 2016.
You should begin now to communicate that open enrollment at the end of 2016 will occur between October 15 and December 7, 2015 without exception.
2. Mandatory enrollment: Employees must enroll in your offered medical insurance program when:
• The employee does not have government provided insurance, like Medicare or Veterans’ care.
• The employee is 26 and no longer enjoys protection under a parent’s health plan.
• The employee is not enrolled in a spouse’s medical benefit plan.
• The employee expects to secure tax credits to support payment of health insurance premium.
3. Change opportunity: Medical benefits renew automatically, but the specific benefits and the insurance carrier may change from year to year. For example, co-pays, provider networks, and prescription and hospitalization may change. Open enrollment presents the opportunity to:
• Select an alternative plan offered through the company.
• Seek insurance though the open marketplace or state sponsored exchange.
• Renew the current health insurance plan.
• Add family members previously not covered and/or drop members who are no longer eligible.
4. Missed opportunity: When employees fail to meet the enrollment deadlines, they cannot sign up for a year unless they qualify for special enrollment such as would follow a divorce, marriage, birth/adoption of a child, or death of a spouse or partner who had the included employee in their plan.
5. Increased penalty: In 2016, the penalty for lack of health insurance will be 2.5 percent of your income. That’s at least $695 plus $347.50 for each child. And, the plan must cover:
• Preventive, wellness, and rehabilitation services
• Outpatient care and lab tests
• Emergency care and hospitalization
• Pregnancy, newborn care, and dental and vision coverage for children
• Mental health and substance abuse expenses
• Prescription medications
You must provide Summary of Benefits and Coverage (SBC) for each plan option.
6. Tax credits: Tax credits are available to employees who find themselves between 100 and 400 percent of the Federal Poverty Level (FPL). So, an employee with a family of four will be eligible with an annual income as high as $97,000. That credit can be used to reduce the monthly insurance premium.
Much more than just a few keystrokes
Employees covered by Medicare and/or who have suffered a significant hardship in the current year may fall under special exceptions. However, it should be obvious that a large number of workers will find the process harder than just keying into an HRIS-enabled terminal.
Employees need advance communication, walk-throughs, and available advice. And, for those with an English language-limited workforce, your obligations multiply. You can negotiate with your HRIS provider to notch up their interface, but until ACA becomes an entitlement and while it goes through its start-up hiccups, you have to prepare to step up if only to hold hands.