Kick off Open Enrollment on the right foot

Oct. 11, 2010


By Wendy Arnone, CEO, UnitedHealthcare of Wisconsin

It’s football season in Wisconsin, but the most important kick-off is not just the one happening on the field. Let’s not forget that “open enrollment” season for your health insurance benefits is also right around the corner.

Most large employers who provide health coverage to their employees hold an open enrollment season each fall to give workers a chance to review and change their benefits coverage for the following year.

Just like football – with its intricacies and nuances on the game’s strategies – fully understanding your health care benefits also can be daunting. But don’t be discouraged. You can start by expanding your basic health insurance vocabulary to ensure you are making the most informed choices this open enrollment. Here are a few “Insurance 101” primers to get you started:

•Preferred Provider Organization (PPO) – this is the most common type of health plan offered by employers today. A PPO allows you to receive treatment from physicians and hospitals that are within an insurer’s care provider network, as well as from those who are out of network (although going out of network will cost more). With a PPO plan, you may pay a small copay with each doctor’s visit and will often need to satisfy a deductible before the benefits are paid.

•Health Maintenance Organization (HMO) – the biggest difference with an HMO is that you must stay within the insurer’s care provider network and may need a referral to some specialists. Generally, there are no deductibles, but most plans require a copay per office visit. You must choose a primary care physician from the plan’s list of providers, and your primary care doctor will refer you to a specialist or other providers as needed within the HMO network. With most HMOs you will not receive benefits if you go out-of-network, except for emergency care.

•Point of Service (POS) – this is a hybrid of the HMO and PPO. Like a standard HMO, your primary care doctors make referrals to other providers within the plan. But if you want to go to a physician outside the network without consulting your primary care doctor, the POS plan will pay a certain amount of the bill, but your share of the bill will be higher than it would be if you stayed in-network. These plans usually cost more in monthly premiums than traditional HMOs, but they give you the flexibility to call any doctor.

•High Deductible Health Plan (HDHP) – these have been rapidly growing in popularity in both the employer-sponsored and individual markets. An HDHP is a plan that features higher deductibles than traditional insurance plans, but that generally translates to lower monthly premiums coming out of your paycheck. HDHPs can be combined with a health savings account (see below) or a health reimbursement arrangement that allows you to pay for qualified medical expenses with pre-tax dollars.

•Health Savings Account (HSA) – this is an actual bank account that can be paired with a high-deductible health plan that has a minimum annual deductible of $1,200 for individuals and $2,400 for families in 2011. HSAs offer triple tax advantages: money is deposited into the account tax-free; any interest that accrues is not taxed; and withdrawals can be made tax free as long as the money is used to pay for qualified medical expenses. Another advantage of an HSA is that you own the account. If you change jobs, the dollars saved in your account go with you.

Beyond the basics, the more you’re willing to learn, the better health care consumer you’ll be. One fun way to learn how health benefits work is to explore UnitedHealthcare’s Health Care LaneSM at It is an interactive website where “townspeople” explain and teach health insurance topics in easy-to-understand terms. Anyone can visit the online town to interact with fictitious businesses and their employees, each representing a different health care topic.

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