Open Enrollment Begins November 15th.
Are You Ready?
Big decisions, like selecting a health insurance plan, require advanced preparation. With only 2 months until open enrollment, now is the perfect time to get ready. Whether you’re an experienced benefits professional or an open enrollment rookie, we’ve got a few things that will help you navigate the chaos and come out on top.
Step 3: FIND HELP
Open Enrollment Terms & Definitions
- ACA (or PPACA): The Patient Protection and Affordable Care Act, also known as the Affordable Care Act or Obamacare, is a United States federal statute signed into law by President Barack Obama in 2010. Primary components include subsidies, mandates for participation and insurance exchanges, read more HERE or HERE.
- Broker: In the U.S., insurance brokers are regulated by the states. Most states require anyone who sells, solicits, or negotiates insurance in that state to obtain an insurance broker license. The premiums you pay for individual health insurance will be the same with or without the help of a broker. (So why not use a broker like HIG who can help you get the exact coverage you need!)
- Carrier: Generally this is the insurance company or a company that ‘carries’ insurance policies (e.g. Aetna, Humana, Cigna, Coventry, BlueCross BlueShield, United Healthcare, etc.).
- Coinsurance: Your share of the costs of a covered health care service, calculated as a percent. For example, if the health insurance plan’s allowed amount for an office visit is $100 and you’ve met your deductible, a coinsurance payment of 20% would be $20. The health insurance plan pays the rest of the allowed amount, or $80.
- Deductible: The amount you owe for health care services before your health insurance plan begins to pay.
- Guaranteed Issue: A health insurance term meaning that coverage is offered to everyone regardless of health status or pre-existing conditions.
- Open Enrollment: The annual period during which individuals may buy individual health insurance plans through the online, federal and state-based health insurance exchanges established by the Affordable Care Act. The term also applies to the period of time, usually once per year, when employees of companies may make changes to their benefits, such as health insurance.
- Out-Of-Pocket Maximum: The most you pay during a policy period (usually one year) before your health insurance plan starts to pay 100% for covered health benefits. This limit includes: deductibles, coinsurance, copayments or similar charges for qualified medical expenses. This limit does NOT usually include premiums, out-of-network cost-sharing, or spending for non-essential health benefits.
- Premium: The amount that must be paid for your health insurance plan. You and/or your employer usually pay it monthly, quarterly or yearly.
- Provider: Generally refers to health care providers, such as doctors or even institutions like a doctor’s office or hospital system.