By Kara Cerrone, Kindbody Director of Channel Partnerships
As someone who used to work in health insurance, I’m used to fielding my friends’ questions about their health plans and confusing medical bills all year every year. But the most confusing time of year is “Open Enrollment,” around November of each year. Since Kindbody is in-network with many major insurance providers, we get a lot of questions from our patients about how to use their insurance to cover their fertility and gynecology services. Let me break it down for you.
What’s Open Enrollment?
It’s the one time each year where you are able to proactively manage your healthcare costs by choosing a health insurance plan that works best for you. If you work for a mid-sized or larger company, your employer is required to offer a health insurance program for you to participate in, usually with a few different plan options. If you are self-employed or work for an employer that doesn’t offer health insurance, you can purchase your own plan off via Healthcare.gov or via independent health insurance companies, like Oscar.
First, let’s review some common insurance vocab.
- Deductible: The dollar amount you contribute before your insurance plan kicks in. If your deductible is $1000 and your first medical bill is $100, you will pay that $100 yourself.
- Co-Pay: The fixed dollar amount you pay for a covered expense once you’ve hit your deductible that year. Your insurance plan will pay for the rest of the bill.
- Co-Insurance: An alternative to a Co-Pay, this is a fixed percentage of the bill that you are responsible for once you’ve already hit your deductible.
- Health Savings Accounts (HSA)/Flexible Spending Account (FSA): these allow you to put away pre-tax dollars from your paycheck that you can use on any out-of-pocket medical costs that your insurance isn’t paying for (i.e. egg freezing or supplements!)
Now, let’s talk about open enrollment deadlines.
Typically, open enrollment for the new year is from November 1st to December 15th, with the majority of plans covering the calendar year. If you haven’t seen any emails flooding your inbox about open enrollment, there’s a chance you have an “off-cycle” plan that occurs during other times throughout the year. If you are unsure, ask your HR team for more information.
Next, let’s think about health and wellness goals for the year.
Map out your year. What medical expenses do you anticipate during the next year – are you planning a major life event like trying to start a family or taking care of a surgery you’ve been putting off? If so, you may want to select a plan with a lower deductible so your out-of-pocket expenses so your insurance coverage will kick in quicker. No planned expenses next year? How did your past few years look? If you don’t typically use your insurance throughout the year, it may make sense for you to enroll in a high-deductible plan, which has a lower monthly fee, but will only give you coverage once you’ve self-payed a higher amount.
Finally, let’s take note of what’s new.
Increasingly, employers are offering new solutions that increase the quality of life for their employees by providing access to new and innovative options from a wide variety of categories – think gym memberships, pharmacy perks and — you guessed it — fertility services! In fact, if you live in NY, read more about the recent mandate that may require your employer to offer fertility coverage.
Have questions about whether your plan covers services like Kindbody’s Fertility Assessment? Our team is very familiar with helping you navigate insurance. Reach out at navigator@kindbody.com and we’re happy to help.
By the way, did you know Kindbody works directly with employers to offer fertility benefits, including for egg freezing? Reach out to solutions@kindbody.com to learn more!
