Each year, on the anniversary date of your health insurance plan's start date, your medical, dental, and vision plans are subject to change. Typically, we see only minor changes in coverage, and some increase in premium costs.
This anniversary date is the normal time of year for you to consider your existing benefits and make changes to them. It's also the time of year that the insurance company allows your employees to make changes to their enrollment (this is typically called "Open Enrollment").
We'll cover many topics and potential questions, click the links below to jump to a specific topic.
- Renewal Process Overview and Timing
- Will My Benefits Change?
- How Much Will My Rates Change?
- What Changes Can I Make at Renewal?
- How Should I Decide on a Renewal Plan?
- Can I Make Changes Outside of My Renewal?
- Employee Open Enrollment Process
- Employee Changes Outside of Open Enrollment
- How Do I Use SimplyInsured to Make Renewal Changes?
- What Is an "Eligibility Verification" or "Audit"?
- How Does Renewal Affect My Deductible?
- Why Did I Get a Letter Saying My Plan Was Ending?
- Why Do I Need to Wait Until Open Enrollment to Make Changes?
- How Long Will It Take for Changes to Process?
- Why Is My Bill Not Updated after Renewal?
- When Will I Get My New ID Card after Renewal?
- Does the Government's "Open Enrollment Period" Affect Me?
The SimplyInsured Guide to Your Annual Health Insurance Renewal
Renewal Process Overview and Timing
Your health insurance renewal happens each year at the anniversary date of the plan. For many companies, this is January 1, but it does not have to be. If you originally signed up for a group plan with coverage starting on May 1, your renewal will be on May 1 each year.
When you sign up for a plan, the insurance company is legally required to maintain the same rates and plan terms for 12 months. After 12 months, the rates and coverage are subject to change. The carrier will propose a "default" renewal plan, and if you don't make any changes, your employees will be automatically transferred to the new plan. Typically, this plan is the most similar plan to the one you had the previous year, so the changes are not significant.
Our recommendation is that you review your new plan and rates 45-60 days before the renewal date, with a goal of choosing a new plan at least 30 days before renewal, so that your employees have time to review the new plans and make changes.
Will My Benefits Change?
Typically, you will see some changes to your medical benefits, but these are usually minor. You may see a slight change in certain copays and deductibles. In some rare cases you will see significant changes, in which case you can use SimplyInsured to shop the available options.
Typically, you will not see changes to your dental and/or vision plans.
How Much Will My Rates Change?
A typical change in rates at renewal is 5-10%. Sometimes you may see higher or lower fluctuations, depending on changes in the marketplace, new laws and regulations, or a change in the insurance carrier's strategy in your geographical area.
Should your change exceed 10%, or if you're interested in re-evaluating to ensure you're getting the best price, you should certainly explore new available options, and potentially even consider choosing a different insurance carrier using the SimplyInsured platform.
What Changes Can I Make at Renewal?
You can make a variety of changes at your insurance renewal, including:
- Changing medical plans
- Adding additional medical options for your employees- many carriers will allow you to offer 3-4 options for your employees
- Changing your dental or vision plans, or offering dental and vision when you previously did not
- Adding coverage for employees who previously declined coverage
- Making changes to the new employee waiting period
- Increasing or decreasing the amount you contribute towards your employees' coverage
How Should I Decide on a Renewal Plan?
You may consider several factors when choosing a new renewal plan.
If your business needs have changed and you need to reduce your costs - You may consider reducing your plan coverage, either by increasing your deductible and copays, or by choosing a plan on a narrower doctor network, such as an HMO or EPO plan type. You might also consider reducing your % contribution to your employees.
If your employees are asking for better coverage - You can consider spending more on a plan with lower deductibles and copayments. If your budget doesn't allow for spending more, you may consider staying with your existing plan, and adding a higher coverage option, allowing your employees to upgrade to the higher coverage plan, with the increased cost coming out of their paycheck as a pre-tax deduction. You might also consider adding ancillary coverage, like Dental and Vision insurance, as a way to make your employees feel like they have better coverage, with a more manageable increase in monthly cost.
If you're having trouble accessing certain in-network doctors or hospitals - You may consider looking at wider network plans such as PPO or POS plans, which also provide some out-of-network coverage.
To specifically check on the status of particular doctors, you may want to use the insurance carrier's doctor search tools:
Find an In-Network Doctor
Can I Make Changes Outside of My Renewal?
Your insurance carrier technically only allows you to change plans on your anniversary date. Sometimes, however, for whatever reason, your current plan might not be working for you and you may need to change plans.
If you'd like to make a plan change within the same insurance carrier (for example, you want to change from one UnitedHealthcare plan to another UnitedHealthcare plan), speak to a SimplyInsured representative and they will help you request a change on an exception basis. These requests are not guaranteed to succeed, as the insurance company will consider the request and then either grant or deny the exception.
If you'd like to change insurance carriers, this can be can done any time during the year according to the new insurance carrier's submission deadlines, just reach out to a SimplyInsured representative and we'll be glad to help you explore options.
Employee Open Enrollment Process
Once you've chosen a new set of plans, you'll be able to give your employees the opportunity to make changes to their coverage. This is called "Open Enrollment", and typically runs 14-30 days. During this period, your employees can make a number of changes, including:
- Adding coverage if they previously declined
- Adding or changing their dental and vision elections
- Adding or changing coverage for their dependents
- Changing plans if your company offers multiple plan options
Once you trigger an open enrollment during your renewal on the SimplyInsured dashboard, your employees will receive an email with instructions to complete the open enrollment on their SimplyInsured employee dashboard.
Employee Changes Outside of Open Enrollment
Outside of open enrollment, an employee can only make a plan to their plan coverage with a "Qualifying Event", a major life change that allows for changes to their enrollment status.
Qualifying Events include:
- Losing other coverage
- Getting married
- Having a child
- Moving in or out of the coverage area
You can find full list of qualifying events here:
How Do I Use SimplyInsured to Make Renewal Changes?
You can find full instruction on using your SimplyInsured dashboard to perform your renewal here:
Renewing Your Plan on Your SimplyInsured Dashboard
What Is an "Eligibility Verification" or "Audit"?
For groups that are smaller (less than 5 employees), some insurance carriers will require that you re-establish your eligibility as a small group employer. In order to establish eligibility, the insurance company will request documents establishing:
- Each enrollee is still currently employed by the company
- There is at least one person enrolled on the policy who is not the owner of the company (or the owner's spouse)?
The insurance company will require your most recent quarterly wage report (a state filing that shows all of your employees on payroll and their wages), and possibly certain tax documents from the owners of the company.
Should it be necessary for you to perform this kind of audit, a SimplyInsured representative will reach out to you in advance of your renewal.
How Does Renewal Affect My Deductible?
Depending on your plan, most insurance plans either use a "Calendar Year" deductible period (Jan 1 - Jan 1), though some allow a "Contract Year" deductible period (from annual renewal date to annual renewal date).
If you have Contract Year deductible, whatever plan you choose will have a new deductible, and run for the full year until your next renewal.
If you have a Calendar Year deductible, and your renewal occurs in the middle of the year, then any progress you have made toward the deductible will be transferred to the deductible on the new plan, assuming you stay with the same insurance carrier.
If you are moving to a new insurance carrier to another plan with Calendar Year deductible, then SimplyInsured can help you apply for a credit toward your new deductible.
Why Did I Get a Letter Saying My Plan Was Ending?
Often, when a renewal is approaching, the insurance carrier will send you mail intimating that your plan is being canceled, or that it will no longer be offered.
While this is technically true, in reality a new plan is taking it place, and your coverage will continue seamlessly. You can can ignore this mail, but if you do have questions, don't be afraid to reach out to the SimplyInsured support team.
Why Do I Need to Wait Until Open Enrollment to Make Changes?
Many customers ask us why they can't make changes to their plan outside of open enrollment. Basically, the insurance company wants to be sure that you pay for the plan that makes sense for your health condition for the entire year. Otherwise, if you could increase and decrease your benefits as needed, it would lead to a situation where you pay low premiums when you don't need the coverage, and then increase the benefits when you are about to incur expensive medical bills.
For example, if you were pregnant, the insurance company doesn't want you to be on a Bronze plan for most of the year, and then switch to a Platinum plan near the time of delivery. Or, they don't want you to decline coverage while you're healthy, only to purchase insurance once you are diagnosed with a serious illness. This is an insurance concept called adverse selection.
Don't forget, however, you can make changes to your coverage mid-year if you have a qualifying event.
Read more about qualifying events here:
Learn More About Qualifying Events
How Long Will It Take for Changes to Process?
If you make changes within the same insurance carrier, it can take up to 5 business days for the insurance company to make the changes, but often we see these changes processed in 1-3 business days.
If you're switching to a new insurance carrier, it can take up to 10 days for the insurance company to approve the new policy, though SimplyInsured typically strives to obtain your approval in under a week.
Why Is My Bill Not Updated after Renewal?
Insurance billing cycles can be a little bit confusing. Let's say that in renewal, you decide to switch from a UnitedHealthcare Silver plan to a UnitedHealthcare Bronze plan, effective May 1. Let's also say that you complete these changes on your SimplyInsured dashboard on April 25.
Changes will be submitted to the insurance carrier with a guaranteed effective date of May 1, however during the 3-7 days of processing time, UnitedHealthcare may generate your May invoice, before changes are processed. So, you would see a bill that is too high (still on the Silver plan instead of the new Bronze plan). In cases like this, your next bill (June) would show the new Bronze plan, plus a credit for the overpayment made in May, so you would be made whole.
In situations like this, our recommendation is to pay your bill in full in order to avoid an interruption in coverage. But if for any reason that is problematic (financial hardship, etc.), just reach out to a SimplyInsured representative, and we'll help you resolve the issue. Often, if you pay only the amount you actually owe for the cheaper plan, the insurance company will not cancel your coverage, and then things will balance out once the credit is applied on the next bill.
Conversely, if you have upgraded your plan, added new employees or dependents, anything that increases your bill, you could see an invoice that is below what you would expect, and the following months, you would see additional charges to make up for the under-payment.
When Will I Get My New ID Card after Renewal?
If you are changing to a new insurance carrier - You and your employees should expect to receive ID cards 7-14 days after the new plan is approved, and your electronic ID should be available via SimplyInsured 2-5 days after the new plan is approved.
If you need to access care before receiving your ID card, read more about that topic here:
Visiting a Doctor Without Your Member ID Card
If you are making changes within the same insurance carrier - The insurance company will usually send you a new ID card 7-14 days after changes are processed, but the ID number will remain the same, so you can continue to use your existing ID card, even if it shows the wrong plan name. If for whatever reason you pay a higher or lower copay than you were supposed to because of unprocessed plan changes, the insurance company will reimburse/bill you for the difference.
Does the Government's "Open Enrollment Period" Affect Me?
Typically, no. You may hear about the individual "Open Enrollment Period" around the end of the calendar year (November-December). This is the time of year that individuals can sign up for individual health insurance plans, either privately with the insurance carrier, or through a public exchange (like Healthcare.gov or a state-specific exchange). Sometimes this is referred to as the "ACA Open Enrollment Period" or the "Obamacare Open Enrollment Period".
Your plan through SimplyInsured is a private small group plan, so it is not subject to this open enrollment period. Your Open Enrollment period is the time leading up to your annual renewal, which may or may not happen to fall on January 1.
If you have employees who are trying to decide between signing up for an individual plan (because they qualify for ACA/Obamacare subsidies, for example) then the government's Open Enrollment period might apply to them, but as a general rule, you and your employees do not need to take action during this time.