How to make wise choices during open enrollment

As fall quickly approaches, millions of Americans face one of the most important decisions for themselves and their families. The annual ritual called open enrollment is often the only time each year businesses allow their work force to make changes to their health benefits plans.

Smart Business spoke to Barry Arbuckle, Ph.D., president and CEO of MemorialCare Health System and the past chair of the California Hospital Association, to learn how employers and employees can make smarter choices about their health.

Why do employers and employees give so little attention to open enrollment?

Open enrollment is like putting together a complex puzzle. The more you try to make sense of the insurance options offered, the more you end up confused in the process, resulting in an average of just 16 minutes spent choosing a health plan. But without careful selection, people may lack the choices needed later on.

Why is open enrollment so important?

During this period — typically about 30 days — employees select benefits for themselves and their families. Choices determine cost, access and quality of your health care for the following year. Whether it is adding dependents, enrolling in a different plan, selecting a new primary care physician, increasing or decreasing out-of-pocket expenses or other options, consumers should understand all their options before making decisions.

What many may not realized is that by selecting a doctor, you are determining the entire course of your health care — including the hospital you’ll go to for care.

What’s the best approach?

Shop for health care benefits like you would any major purchase. A wrong decision can be costly in terms of health and financial results. Instead of signing up for the same plan, examine benefit options for your current needs. Watch for hidden costs and surcharges and determine if there are incentives for healthy behavior.

With HMOs, the doctor (or network) selection determines specialists one can see. Therefore, it’s important to have a big-picture perspective before signing on with a health plan. Are you satisfied with your medical, dental, vision and drug plans? Are you comfortable with your current primary care physician acting as your gatekeeper or do you desire increased flexibility? Review these and other issues before making a change.

Where do I start?

Ensure your chosen physician is part of a hospital and larger system of care like MemorialCare. A health care system with multiple locations and thousands of physicians and employees offers comprehensive care for everyone in the family. Selecting the best hospital for your care when you’re healthy makes good sense. A health system is more likely to have access to the latest equipment and procedures. Most hospital admissions involve people who never expected to get sick. By planning ahead, you’ll have access to the health services you consider important — and hospitalization in a facility that meets your standards. Inquire about a hospital’s clinical outcomes, reputation and patient care philosophy before making a decision.

What’s the next step?

After you’ve selected your hospital and physician, check the details. Are you able to understand benefits covered by your health plan? Are you comfortable with the medical group your physician belongs to? Can you continue to see your favorite specialists? Don’t just select the plan with the best price. Examine your medical needs. Do you need regular prescriptions or doctor visits? What are the out-of-pocket costs? These questions play a part in how much coverage is adequate without paying too much. Price out the unpredictable — emergencies do occur and payment varies from plan to plan.

How can employers improve open enrollment?

Selection of the right health plans and medical groups is critical. Health plans with limited offerings of physicians, for example, may impact recruitment and retention efforts.

Improve the process and educational tools available. Spend more time in person and online helping employees understand their options and the complicated terms and rules surrounding their benefits. Try to ensure that employees are clear on how deductibles, co-payments, co-insurance, in and out of network and denials work and how to easily access answers to their ongoing questions and concerns.

Where can we go for help?

MemorialCare offers business outreach services to help employers reduce their health benefits burden and improve employee health. Benefits audits identify savings and can lower workers’ compensation claims. Executive and employee physicals spot health issues before they become serious and provide wellness regimens to stay fit. Programs in the community and at your business ensure a healthier and more productive work force. Memorialcare.org also offers free online tools, calculators, guides and physician referrals to help achieve a healthier life.

BARRY ARBUCKLE, Ph.D., is president and CEO of MemorialCare Medical Centers (www.memorialcare.org) and past chair of the California Hospital Association. Reach him at [email protected] or (562) 933-9708. The not-for-profit MemorialCare Health System includes Long Beach Memorial Medical Center, Miller Children’s Hospital Long Beach, Orange Coast Memorial Medical Center in Fountain Valley and Saddleback Memorial Medical Center in Laguna Hills and San Clemente. For additional information on excellence in health care, please visit memorialcare.org.

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