Are You Prepared for Open Enrollment?

Open Enrollment is just around the corner. Please review this brief primer to learn about important dates, updates to the Affordable Care Act, and more information about employee-sponsored care and coverage from Canopy Health and our carrier partners.

Open Enrollment is one of the busiest and most critical times of the year for brokers and the companies they serve. As a healthcare thought leader, you have a unique perspective and level of influence during this time. This article outlines some of the critical changes you and your clients will face this year and offer suggestions about how to improve your Open Enrollment processes.

Candidly Review Your 2018 Open Enrollment Performance

Did 2018’s Open Enrollment go off without a hitch or was there room for improvement? Ideally, you should apply the lessons you learned during 2018 Open Enrollment and improve your processes and communications. As part of your performance evaluation, you should:

  • Review your clients’ 2018 participation data and identify pain points and factors that reduced enrollment numbers
  • Interview vital stakeholders about your Open Enrollment process and request honest feedback
  • Look for common trends in your performance data that highlight inefficiencies or systemic weaknesses
  • Identify and implement solutions that could eliminate or reduce past performance issues
  • Explain your improved processes to your clients and other stakeholders

When you offer a collaborative and transparent assessment that results in quantifiable improvements, you build trust with your clients and reaffirm your value as a partner and consultant.

Review Your Clients’ Plans and Assess Their Compliance with the ACA

The Affordable Care Act (ACA) and other healthcare regulations impose a series of requirements for employer-sponsored health plans. You’ll need to evaluate your clients’ health plans for compliance.

Grandfathered Plans

If your clients intend to make changes to grandfathered pre-ACA health plans, make sure they still qualify for grandfathered status. Employers are at risk of losing their grandfathered status if they change employee contribution or cost-sharing levels, eliminate benefits, or modify annual limits on care. If the plan no longer meets these criteria, it will have to comply with the ACA’s mandates. If it is still eligible as a grandfathered plan, you’ll need to provide employees with a “Notice of Grandfathered Status” during Open Enrollment.

Affordability and Large Employers

Certain large employers, called “applicable large employers” or ALEs, must offer their employees affordable healthcare coverage or pay additional penalties. For 2019 health plans, ALEs cannot require employee contributions exceeding 9.86% of a full-time employee’s household income or the federal poverty line. The 2019 affordability percentage is a significant increase over the historic 9.56% rate — giving your clients more flexibility when they select health plans and contribution models.

Preventive Care

Non-grandfathered plans must offer certain recommended preventive services without a deductible, co-pay, or other additional charges. This includes certain health screenings, routine immunizations, and well-child and well-woman visits. The newest U.S. Preventive Services Task Force recommendation, dated September 2018, recommends multicomponent behavioral interventions for obese adults.

Evaluate the Plans’ Out-of-Pocket and Other Maximums

Under the ACA, health plans must meet certain restrictions on employees’ out-of-pocket costs for essential health benefits (EHBs), flexible spending account (FSA) contributions, high-deductible health plan (HDHP) and healthcare spending account (HSA) limits.

For 2019 health plans, these requirements include:

  • Out-of-pocket maximum for EHBs: $7,900 for self-only and $15,800 for a family
  • HSA contribution limit: $3,500 for self-only and $7,000 for a family
  • Minimum HDHP deductible: $1,350 for self-only and $2,700 for families
  • HDHP maximum out-of-pocket expenses: $6,750 for self-only and $13,500 for families

Make sure your clients understand the implications if they do not exceed these thresholds and have alternative plans ready for them to consider.

Build Communication Plans That Encourage Educated Decision-making

Employers must relay information about their benefits programs to employees. This involves issuing a summary of benefits and coverage (SBC), summary plan description (SPD), and other notices — but this is only the beginning of your communication plan.

In addition to sending out formal health plan notices, your clients’ employees deserve understandable explanations of their benefit options. Today’s healthcare consumers expect personalized service but also tend to feel overwhelmed by the complexities of the healthcare system. As a broker, you can help them maximize their healthcare benefits.

Help your clients build communications strategies that outline their employees’ benefit options and educate them about important, but under-utilized, benefits they already have. Remind your clients they shouldn’t build their Open Enrollment communications plan in a vacuum. Instead, encourage them to focus on their workforce’s specific needs and personas. Depending on their workforce, they might need face-to-face, digital, and print communications that offer varying levels of complexity, including multilingual options.

Canopy Health: Your Partner in Bay Area Health and Wellness

Canopy Health delivers refreshingly clear, human care throughout the Bay Area. We’re committed to improving employer-funded healthcare, and our alliance provides members with coordinated, high-quality care that is convenient and cost-effective.


Final Update Summary: Weight Loss to Prevent Obesity-Related Morbidity and Mortality in Adults: Behavioral Interventions. (2018). U.S. Preventive Services Task Force. September 2018.

Miller, S. (2018, May 30). ACA’s affordability threshold rises in 2019. SHRM. Retrieved from

IRS sets new 2019 limits for group plans and HDHP/HSA plans. (2018, June 8). UnitedHealthcare. Retrieved from