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Small Business Employee Benefits and HR Blog

Preparing to Enroll in an Individual Health Plan

It’s open enrollment season, but for many small businesses that don’t offer group Preparing to Enroll in an Individual Health Planhealth plans, this is the time of year when people at your company are trying to figure out how to get enrolled in the best individual health plan. If you plan to help your employees pay for their own individual health plans, here’s a checklist to help get the best coverage.

Learn About Plan Options

There are a lot of different plan types available in the individual insurance marketplace, and Obamacare stipulates that these must all offer at least a basic level of care, but they will differ in terms of your monthly costs (premiums), networks available, and how much you pay out of pocket for that care. Typically, plans fall into three categories:

  • HMO – Health Maintenance Organizations have set fees and co-pays and often no deductible, but you must have a primary care physician who manages your care from within a specified network.
  • PPO – Preferred Provider Organizations have an assigned network of physicians and facilities, but patients can go outside for care, and you pay co-pays and deductibles before receiving full benefit coverage.
  • POS – Point of Service plans are like a hybrid, where you choose a primary care physician, but you can choose providers outside the network and pay a higher portion of the costs.

Understand the Terminology

Healthcare can be confusing, but it’s critical that you learn key terminology such as co-pays, co-insurance, and deductibles. That makes it easier to compare options when shopping for a plan.

Ask Questions

If you already have a primary care physician and want to keep him or her, ask whether they are covered under each plan. Those with specific needs, such as pediatric care or maternity coverage, should ask about what is covered, the costs, and any limitations to the coverage under each plan.

Compare Costs

Each plan will have different costs that go beyond the monthly premium. Be sure to compare the potential out-of-pocket maximum costs, any co-pays, deductibles, or other things that could impact your care. While nobody wants to plan for a worst-case scenario, it’s important to think about total costs of each plan and make sure it’s still affordable. Also be sure to research what, if any, subsidies are available to help reduce your monthly premiums.

Prepare Your Financial and Personal Information

In order to apply for health insurance, you will need some basic information such as household income as well as social security numbers and birthdays for everyone who will be covered on the plan. If you come prepared with the following information, the application process for coverage will be quicker and easier:

  • Home and/or mailing addresses for everyone in your household who is applying for coverage.
  • Social Security Numbers for individuals in your household.
  • Documentation verifying legal immigration status, if applicable.
  • Employer and income information for every member of your household. This may come in the form of pay stubs or W-2 forms.
  • Your best estimate of your household income for 2016.
  • Policy numbers for any current health insurance plans covering household members.
  • A completed “Employer Coverage Tool” for every employer-sponsored health insurance plan you or your household members are eligible for.

Tip: The form should be filled out for every employer-sponsored health insurance plan you are eligible for -- not just the ones you are enrolled in.

  • If you have health coverage currently, notices from your current plan that include your plan ID.

Conclusion

Whether you’re a small business looking for ways to help your employees enroll in health insurance or an individual planning to shop the insurance marketplace, use this checklist to make sure you get the best possible coverage.

Do you have any questions about the enrollment process for individual health insurance plans? Ask us in the comments below.