What is Open Enrollment? A Comprehensive Guide for Employers

Open enrollment is a designated period each year during which employees have the opportunity to modify or select new insurance coverage. Every employer in Hawaii is impacted by the open enrollment period, as state regulations mandate that all businesses provide health insurance to their full-time staff. The process can be intricate for your workforce. Employers must be proactive, ready to address questions and guide their employees in evaluating and choosing the most suitable health insurance for themselves and their families.

This guide will help Hawaii businesses understand the basics behind open enrollment. We’ll also answer questions surrounding the open enrollment timeframe and what you can do to handle these deadlines effectively.

What is Open Enrollment?

As previously mentioned, open enrollment for businesses refers to an annual period when employees can change their benefits, such as health insurance, retirement plans, and more. Employees can review, select, and modify their benefits during this time according to their personal and family needs. While this process may not feel like a big deal for employees, if they miss the open enrollment deadline, they can only enroll in health insurance for the next year if there is a qualifying life event.

During healthcare open enrollment, employees can:

Enroll: New employees or those not signed up for benefits can sign up for the company's benefits programs.
Make Changes: Existing employees can change their benefits by switching plans, adjusting coverage, adding or removing dependents, or making adjustments to retirement contributions.
Opt-Out: Employees who do not want to participate in certain benefits, like health insurance, can decline coverage.
Learn About Changes: Employers often use open enrollment periods to inform employees about benefit changes, including adjustments to premiums, coverage levels, or policy terms.
Ask Questions: Employees can seek guidance from HR representatives or benefits administrators to clarify questions.
Choose Ancillary Benefits: Open enrollment might also cover other benefits like dental and vision coverage, life insurance, disability insurance, and more.

Employers must leverage their HR or benefits administrator to answer questions such as:

When is healthcare open enrollment?
What are my benefits options?
Have my benefits changed from last year?
How much do benefits cost?
Which plan is best?
Can I add or remove dependents from coverage?
What’s in versus out of network?
How does the deductible work?
Does the policy have wellness programs?
Is the prescription drug coverage changing?
How do I file a claim?
Can I switch plans mid-year?
How do flexible spending accounts (FSAs) and health savings accounts (HSAs) work?
What happens if I don’t choose a benefit?
Are there tax implications for choosing certain benefits?
Can I change my retirement contributions during open enrollment?

So, what does open enrollment mean for employees? Generally, it means reviewing their current policy and a few pieces of paperwork. But HR teams must work hard to address common questions regarding open enrollment and how it affects their workforce. It’s a big job for HR teams who must ensure compliance with all regulatory rules. Providing clear, accurate, and accessible information during the open enrollment process can help employees feel supported and well-informed as they select their benefits.

When is Open Enrollment?

The top two most common questions we hear from employers are:

What is open enrollment?
When is open enrollment?

Now that you understand what open enrollment is, we’ll tackle when it occurs each year.

The timeframe for open enrollment for health insurance can vary from one employer or insurance provider to another, so it's essential to check with your specific organization or insurance company to get accurate information about the open enrollment dates in Hawaii. However, some general trends might help you understand when open enrollment typically occurs.

For health insurance plans in the United States, including Hawaii, the open enrollment period for the Health Insurance Marketplace (established under the Affordable Care Act) usually takes place from November 1 to January 15 each year. This period is consistent across most states. However, there are some exceptions that we’ll cover in the next section.

Companies typically set open enrollment periods for employer-sponsored benefits, including health insurance, retirement plans, and other perks. These periods often occur in the fall, between September and December, to allow employees enough time to make informed decisions before the new plan year starts. However, the exact dates can vary based on the company's policies.

Exceptions to the Open Enrollment Deadline

Most rules have exceptions, and so does open enrollment. For example, the federal open enrollment period runs from November 1, 2022, to January 15, 2023. However, 14 states have their own health insurance exchanges, which may have different deadlines. Also, 10 states (not Hawaii) and the District of Columbia created permanent extended open enrollment periods, which means employees have more time to choose their policy coverage.

Specific exceptions to the open enrollment deadline allow individuals to change their benefits outside of the standard enrollment period. These exceptions are “qualifying life events” or “special enrollment periods.” Qualifying life events are specific life changes that can trigger a need for adjustments to benefits coverage. Examples of qualifying life events include:

Marriage or domestic partnership
Birth or adoption
Divorce or legal separation
Loss of other insurance coverage
Change in employment status
Relocation
Turning 26 and falling off a parent’s coverage
Significant coverage change to current employer benefits

The rules regarding qualifying life events and special enrollment periods vary based on the employer's benefits plan, the insurance carrier, and the applicable laws and regulations in your region. Employees typically have a limited window, usually around 30 to 60 days, to make changes following a qualifying life event.

Employers should communicate criteria for special enrollment periods to their employees and guide them on the documentation required to verify the qualifying event.

Open Enrollment: Understanding the Different Types

Every insurance provider has an open enrollment period, including government-run programs such as individual market insurance plans or Medicare. Understanding the different types of open enrollment can help individuals navigate this process effectively and ensure they have the coverage that best suits their circumstances.

Employer-Sponsored Benefits Open Enrollment

This coverage includes benefits employees receive through their employers, such as health insurance, dental coverage, retirement plans, and more. Employer-sponsored open enrollment typically occurs annually, and employees have a specific timeframe to change their benefits.

Health Insurance Marketplace Open Enrollment

The Health Insurance Marketplace, established under the Affordable Care Act, provides a platform for individuals and families to purchase health insurance plans. The federal open enrollment period for the Health Insurance Marketplace usually occurs from November 1 to December 15 each year. State-based marketplaces may have different open enrollment dates.

Medicare Open Enrollment

Medicare is a federal health insurance program for individuals aged 65 and older and people with disabilities. Medicare open enrollment occurs annually from October 15 to December 7. During this time, Medicare beneficiaries can change their Medicare Advantage (Part C) and Medicare prescription drug coverage (Part D) for the upcoming year. Beneficiaries can switch between Original Medicare and Medicare Advantage plans, change Part D plans, and explore options that better suit their healthcare and prescription medication needs.

Medicaid Open Enrollment

Medicaid is a state and federally-funded program that provides health coverage to eligible low-income individuals and families. While Medicaid enrollment is generally open year-round, there might be specific times when states conduct “redetermination” or “renewal” processes. During these periods, individuals enrolled in Medicaid must update their information to maintain coverage.

Additionally, states might have specific enrollment periods for certain Medicaid programs, such as Medicaid expansion programs.

Retirement Plan Open Enrollment

While less common than health insurance open enrollment, some retirement plans, such as 401(k) plans, may have specific times during the year when employees can change their contribution levels or investment choices. These enrollment periods allow individuals to adjust their retirement savings strategy based on their financial goals and risk tolerance.

Navigating the Open Enrollment Process

Open enrollment health insurance processes start well before notifying employees it’s time to renew their policies. Preparing for open enrollment in Hawaii is a multifaceted, complex process that may include:

Reviewing Benefits Plans: HR teams begin by reviewing the current benefits offerings, assessing their effectiveness, and considering employee feedback to determine what the company needs to change.
Communication: HR should develop a comprehensive communication plan to inform employees about the upcoming open enrollment period.
Educational Materials: HR creates clear and easy-to-understand educational materials that explain each benefit option in detail.
Employee Training: HR staff and benefits administrators often undergo training to familiarize themselves with the details of the benefits plans.
Employee Data Updates: HR must ensure accurate employee records by verifying personal information, dependents, and beneficiary designations.
Reviewing Compliance Rules: HR should collaborate with legal experts to ensure all benefit plans comply with relevant laws and regulations.
Cost Analysis: HR calculates the costs associated with each benefit plan and analyzes their impact on the company's budget.
Establishing Support Channels: HR sets up dedicated channels, such as a helpdesk or hotline, where employees can get questions answered promptly during the enrollment period.

Open Enrollment Dos and Don'ts

Employers can effectively navigate healthcare open enrollment by adhering to a few fundamental guidelines.

DOs:

Communicate Early: Provide clear, early communication about open enrollment dates, benefits changes, and resources.
Offer Education: Inform employees about benefit options through clear, concise materials and training sessions.
Simplify Choices: Offer a manageable number of benefit options to avoid overwhelming employees.
Provide Support: Offer guidance through HR representatives or online tools to help employees make informed choices.
Highlight Wellness: Highlight wellness programs and preventive services to underscore a comprehensive approach to well-being.

DON'Ts:

Assume One Size Fits All: Avoid assuming all employees have the same needs; offer diverse benefit choices.
Neglect Communication: Don't rely solely on emails; use multiple channels to ensure messages are received.
Lack Transparency: Avoid withholding critical details about costs, coverage, and limitations.
Miss Legal Compliance: Ensure all plans comply with relevant laws and regulations to prevent legal issues.
Overlook Feedback: Don't ignore employee feedback from previous enrollments; use it to improve the process.

Sail Through Open Enrollment with ProService Hawaii

Navigating compliance and paperwork with a looming open enrollment deadline is stressful for HR teams. Fortunately, you have the team at ProService Hawaii standing by to help. Since 1994, we’ve taken the stress out of Hawaii health insurance open enrollment for HR teams and employers. From benefits administration, payroll, and workers’ compensation to training and development, our team partners with Hawaii businesses to help you navigate the complexities of today’s HR requirements. Call on us to find out how we can help your business.