Open enrollment can be an intimidating process – especially if you’re doing it on your own. We want to help you feel more prepared and confident during open enrollment this year, so we’ve created a “toolkit” to define some of the common insurance terms, provide key steps to expect during the enrollment process and share helpful resources.
Before you begin your research, let’s define some of the common insurance-related terms you may come across during enrollment.
Helpful Terms to Know
- Open enrollment period: A limited period of time for you to select and enroll in an individual health insurance plan. In Kansas, the open enrollment period is from November 1 through December 15. If you need health insurance coverage on January 1 of the following year, you must enroll during that window
- Qualified life event: Life happens, and sometimes that means big changes to your health coverage. That’s why there are additional windows of time called special enrollment periods; during this time, you can make the changes you need to reflect your situation. Qualifying life events include: changes in marital status, having a baby, adopting a child or being placed with a child through foster care. It’s also a qualifying event if someone on your plan dies and as a result you’re no longer eligible for your current plan. Just a note: divorce or legal separation without losing coverage does not qualify you for a special enrollment period.
- Health Insurance Exchange or Marketplace: The exchange or marketplace is where individuals, families, and small businesses can shop for and enroll in individual health insurance. Kansas participates in the Federal exchange, which is accessible through websites, call centers, and in-person assistance.
- Premium: The monthly payment for your insurance coverage.
- Copay: A fixed amount you pay for a service, usually when you receive the service. The amount can change depending on the type of service, but may be needed for things like doctor’s visits.
- Deductible: This is the amount you pay to your provider (also referred to as out-of-pocket costs) before your insurance will cover any expenses.
- Co-insurance: This is a set percentage that you pay for a service, with the rest paid by your health insurance plan. For example, if you have a 10% co-insurance, you pay 10% of each medical bill, and your health insurance will cover 90%.
- Network: In-network means that your doctor (or other provider) has a negotiated rate with your health insurance company. Out of network means that the doctor or facility providing your care does not have a contract and you may be responsible for up to the full cost of care.
Now that you know some of the most common terms, let’s talk about what to expect during open enrollment.
Key Steps to Prepare for Open Enrollment
- Step 1
Get prepared. You will need the following information to enroll: Social Security numbers (or document numbers for any documented immigrants who need insurance), address, birth dates for all family members enrolling, income information, employer information, any existing health insurance policy numbers and information from your employer about any health insurance they make available to you. And, be ready to share any tobacco use for anyone being enrolled.
- Step 2
Check for financial assistance. Before you begin the enrollment process, check to see if you qualify for a federal subsidy. This subsidy could make purchasing quality individual health insurance a reality for many by helping to lower their premium cost. You can use our marketplace calculator to see if you qualify for financial assistance.
- Step 3
On or off exchange. Individual health insurance is available to you for purchasing both on and off the exchange. If you do qualify for a federal subsidy, you now have financial assistance to lower your monthly premiums when purchasing a plan offered through the exchange. If you’re not anticipating a federal subsidy, other individual health insurance plans, not on the exchange, should also be considered. Your best option might not be on the exchange, so it is worth exploring all your options. For example, we currently offer health insurance plans that could save you 20% or more than what is currently offered on the exchange – a significant cost savings.
- Step 4
Pick your plan and more. We recently gave helpful tips on what to consider when selecting a plan, including coverage needs, budget considerations and more. Don’t forget to consider other insurance offerings available, such as dental coverage. You can find this coverage on the exchange, but it also sold directly through health insurance companies (off of the exchange). Just a note that if you do enroll in dental coverage while on the exchange it is then tied to your health insurance meaning if you cancel your health insurance at any time then your dental coverage automatically ends as well. This can be avoided by purchasing dental coverage directly from a health insurance company. Once the open enrollment period begins, you can start your enrollment process here or you can contact customer service for help in navigating the process.
Finding and selecting a high-quality individual health insurance plan for yourself and your family takes some consideration, but utilizing this toolkit along with reviewing plan descriptions and checking on financial assistance can help you feel confident in your plan choice. Learn more about our individual and family health insurance plans on our website or call us directly for help figuring it all out at 1(800)438-1565.