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Benefits Review: Top 3 Tips for a Successful Plan Year

Posted on January 15, 2016
Connie ManiscalcoWritten by Connie Maniscalco | Email author

Laughter is the best medicineSo here we are in mid-January and most likely your new benefits plan year began January 1st.  This cartoon conjures up memories of the myriad of phone calls an HR department receives as soon as the new plan year begins.  Questions such as “what is my co-pay?” and “do I need a referral for services other than preventive care?”  And how about the dreaded call from an employee at the doctor’s office telling you that the carrier says he is not covered!  Ugh! While these questions are not uncommon, there are things you can do (and must do in some instances) to ensure all bases are covered.

Tip #1: Provide the Summary of Benefits and Coverage

  • Provide the Summary of Benefits and Coverage (SBC) during Open Enrollment to all benefits eligible employees. The SBC’s purpose is to accurately describe the benefits and coverage under the group plan. The format standards were created to ensure that benefits and coverage information is consistently presented in clear language and in a standard format to help consumers better understand their coverage and easily compare coverage options. SBC’s must be provided upon request to benefit eligible, newly hired employees and to current employees for annual enrollment or when the plan changes. The SBC was developed under section 2715 of the Public Health Service Act (PHSA) as added by the Patient Protection and Affordable Care Act and must include a uniform glossary of terms commonly used in health insurance coverage, such as the words “deductible” and “co-payment” for example. In addition, the requirements of the Affordable Care Act include that the SBC must indicate if the plan meets MEC (minimum essential coverage) requirements.

Tip #2: Conduct an Enrollee Audit

  • Conduct an audit of the enrollees by cross referencing your benefits enrollee roster with the carriers’ rosters. Be sure to verify the plan in which the employees intended to enroll is correct; the coverage tier is correct; and all dependents are enrolled as requested. In addition, verify that the benefits deductions have been entered correctly in the payroll system for the first pay cycle of the new plan year.

Tip #3: Consider Technology

  • Many of our clients are currently in the midst of collecting the information for reporting their ACA required information to the IRS for plan year 2015.  For those whose process is manual, now is the time to think about the use of technology for 2016 to help ease the burden of data collection for the reporting of your 2016 plan year data.

Right now you are in the driver seat!  Be proactive and begin to make changes to your current processes and procedures to ensure a successful enrollment session for the next time around.  Decide now that this is the last time you are going to go through the chaos!

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