Health-care reform starts to be felt during open enrollment

Despite changes resulting from health-care reform, medical insurance open enrollment went smoothly for Lizette McNellis, an assistant vice president at Zurich North America in Schaumburg.

In fact, choosing a plan went faster this year because she made comparisons online. She also made her selection online to provide coverage for herself and her husband and baby daughter.

“It was very easy and faster than last year,” McNellis said. “Other than that, I didn't see any big changes.”

Workers throughout the suburbs, and nationwide, are in the midst of open enrollment, where they can select next year's health-care provider, medical plan and other coverage through their employer. It's the first signup period influenced by the rollout of health-care reform. and it's going fairly smoothly, local insurance brokers and human resource professionals said.

They have seen cost increases across the board, from a small amount to double-digits percentages.

Paul Bartman, senior vice president of Schaumburg-based Assurance, said he hasn't seen any increases higher than about 2 percent. He negotiates insurance coverage packages for about 3,000 companies, including about 1,000 in the Chicago and suburban area.

“It's not as bad as I expected,” Bartman said. “If there were any large increases, it's not due to health-care reform.”

But others saw much wider swings from premium reductions as great as 20 percent to increases as high as 55 percent, said M. Bernadette Patton, president and CEO of the Human Resources Management Association of Chicago.

“One broker told me the average increase in renewal premiums was 24 percent,” said Patton. “Most employees understand that health-care reform is impacting costs so they aren't blaming employers for any increases they are seeing in their shared portion of premiums.”

Premiums are influenced by many other factors, Bartman, Patton and others agreed. A rise in claims can raise rates. A shift in employees selecting various plans also affects rates.

You'll spot several changes in our health plan this year, including some health-care reform dictates that could reduce out-of-pocket expenses.

Co-pays for doctor visits and medical services have been dropped from some packages. A traditional PPO could have grandfathered-in a $25 co-pay, but an HMO or a PPO with a health savings account may not have any co-pays.

Some packages removed annual payments or limits on the number of visits for treatment by mental health or substance abuse specialists.

You also may notice that the lifetime maximum caps for individual or family payouts, often $2 million to $5 million, have been eliminated.

In addition, your dependent adult child up to age 26 can continue to be covered under your policy, according to the new federal laws.

“The greatest excitement from employees is around the ability to enroll adult dependent children under the age of 26 into their health plans,” said Patton. “Some companies extended this option to their dental and vision plans as well.”

But changes on over-the-counter medication coverage could cost you more. Most such products no longer will qualify for payment through your pre-tax flexible spending account, unless you have a doctor's prescription. That, coupled with the free preventive care, might reduce the amount you want to put in the account this year, experts say.

Many employees did not understand the change in over-the-counter medication coverage in 2011, so employers had to do more to educate them, Patton said.

Health-care reform continues to roll out through 2014, so more changes are in store, experts said.

“Now, that's the year where there could be some major financial impact on a company,” Bartman said.

That's when health-care reform is expected to offer insurance to all employees, regardless of their position, and companies will need to contribute more to make it more affordable to everyone.

“The major focus is on the more broad-reaching changes that will take effect in 2014,” said Patton. “Companies are exploring options, projecting impacts and seeking guidance for what employer-based health care coverage will look like then.”

How to pick the best health insurance options

<p>Experts offer these suggestions on how to deal with open enrollment: </p>

<p>• Understand your own needs and your family's needs. Study your options so you can choose the best plan. </p>

<p>• Seriously think about life events, including an upcoming birth, marriage or divorce. These often decide how many family members you'll likely include, or exclude, in the coming year's insurance plan and will affect your premiums and other health-care costs.</p>

<p>• Many wellness programs offer financial benefits, so participate in those that are offered.</p>

<p>• Read materials thoroughly. Don't be shy about asking questions regarding your financial situation.</p>

<p>• Take advantage of online educational materials, price and benefit comparisons, and even models that provide a more personal look in order to determine the best package for you.</p>

<p>Sources: Zurich, Daily Herald, Human Resources Management Association of Chicago</p>