Making Open Enrollment Simple for Members

Now is the time for plan sponsors to identify the best tools to guide their members through the benefit selection process. During open enrollment, which typically falls in the third quarter of the year, members seek to identify the best health care plan for their needs and determine how much (or whether) to contribute to supplemental coverage, such as health savings accounts (HSAs) and flexible spending accounts (FSAs).

In recent years, high-deductible health plans (HDHPs) have made the open enrollment period more complex. Many individuals struggle to understand common insurance terms like co-insurance, deductible, and out-of-pocket maximums and their effect on total cost of care.

Every member’s unique circumstances and challenges should guide them as they choose the best coverage options for them. In-person benefit fairs are a classic way to educate members, but – as we all learned in 2020 – virtual support is also vital.

We recommend offering members a customized, enhanced experience with specific information describing all of their options. This would include costs and coverage, and provide web-based as well as live support.   

Plan sponsors should include tools that:

• Allow members to identify pharmacies included in their network so they can understand where they will fill prescriptions.

• Provide the formulary that lists covered medications for the upcoming plan year so members can determine whether their medication is covered or if they will need to change to another medication, based on the plan that they choose.

• Show members the price of their medications, including detailed information on deductibles and out-of-pocket costs for better financial planning.

These capabilities are particularly important for members enrolled in HDHPs, who are responsible for the total cost of their healthcare during the deductible phase of their benefit. Providing these functionalities during open enrollment helps them be better informed consumers who can budget for their overall prescription expenditures and out-of-pockets costs, which can be substantial.  

For plan sponsors who are interested to learn more about open enrollment support from Express Scripts, please contact your account management team for further information and see how you can utilize these benefits in the future.