Questions About Open Enrollment Answered

HARTFORD — Open enrollment for health benefits can be an overwhelming time for employees. What kind of coverage do I need? Which plan should I choose? The Connecticut Insurance Department offers many resources to assist consumers in understanding insurance and finding the types of coverage that best meets their needs.

Commissioner Thomas R. Sullivan offers consumers seven tips for getting the most out of this open enrollment season:

*Understand your insurance needs. Life situations can vary with each household; the coverage that was adequate last year may not be adequate this year. Review your insurance needs; identify areas that may have changed (new baby, child in college, recently married, etc).

*Understand the benefits; not all health plans are alike. Take the time to understand your co-payment and deductible requirements. Assess the out-of-pocket cost differences between the in- and out-of-network benefits. Often times the out-of-network benefits maintain larger deductions and have the added expense of “excess billing” (you are billed the amount above the usual and reasonable charge). Familiarize yourself with any preexisting condition exclusions and prior authorization requirements. If there are any questions about coverage for procedures or visits, be sure to ask your plan’s coordinator or human resources representative. If questions remain, contact the Connecticut Insurance Department at 800-203-3447 or online at www.ct.gov/cid, for more information.

*Review all your options. Health benefit plans vary by employer. Some employers offer more than one plan, and a dual-income household may have options between many plans; take the time to review the benefits, the cost, the deductibles, and co-pays for each plan. Consider the differences between policy types (i.e., health maintenance organization (HMO), preferred provider organization (PPO), point of service (POS), etc; more information can be found at www.ct.gov/cid/cwp/view.asp?q=390270.

*Research the network. Check to see if your physician and area hospitals are in the plan’s network; staying in network can translate to big savings on your health care.

*Understand prescription coverage. Understand the rules around prescription coverage. Carriers may use formularies with preferred drugs and there may be different levels of cost sharing for different classes of drugs. Check for any annual limits, prior authorization requirements, and pharmacies in the network. Mail order options may be available for maintenance drugs at a lower cost to you.

*Double check. Once enrolled, you will not be able to make plan changes until the next open enrollment period unless there is a life changing event such as job change, getting married, having a baby, or adopting a child.

*Check with your Human Resources Department for more information about your plan.

If questions remain, contact the Connecticut Insurance Department at 800-203-3447 or visit www.ct.gov/cid for more information.