Enrollment Support

Giving employees access to individual health coverage can increase choice, but it can also shift more decision-making to the employee.

Some employees may be comfortable comparing plans independently. Others may need help understanding premiums, deductibles, provider networks, prescriptions, household coverage, and enrollment steps.

Before choosing an ICHRA approach, employers should consider how much support their workforce is likely to need during enrollment.

Consider how familiar employees are with individual coverage

Employees who have only used traditional group health plans may not be familiar with shopping for individual coverage.

They may need to understand concepts such as:

• Comparing multiple carrier options.

• Reviewing different metal levels.

• Evaluating deductibles and other out-of-pocket costs.

• Checking provider and hospital networks.

• Reviewing prescription coverage.

• Selecting coverage for spouses or dependents.

• Understanding plan effective dates.

A workforce with little experience in the individual market may require more guidance than one that already includes employees who regularly purchase their own coverage.

Review the complexity of available plan choices

The number of available plans is not the only measure of complexity.

Employees may need to compare differences in premiums, networks, cost-sharing structures, formularies, plan types, and carrier rules.

More choice can be valuable, but too many options without clear guidance can make enrollment harder rather than easier.

Employers should consider whether employees will be able to identify meaningful differences between plans and understand which factors matter most for their own situations.

For more information about evaluating individual plan options, see Plan Selection.

Consider household and healthcare needs

Enrollment decisions can become more complicated when employees are selecting coverage for a spouse or dependents.

Household members may have different physicians, prescription needs, expected medical use, or preferred hospitals.

Employees with ongoing care needs may also spend more time evaluating network and formulary details than employees who primarily compare monthly premiums.

For more information about these differences, see Employee Coverage Needs.

Evaluate language and communication needs

Enrollment support is not only about insurance knowledge.

Employers should also consider how employees receive and understand benefits information.

Relevant factors may include:

• Preferred language.

• Comfort with online enrollment.

• Access to email or mobile devices.

• Work schedules that make enrollment meetings difficult.

• Different levels of familiarity with insurance terminology.

• Whether employees are located remotely or across multiple locations.

Clear communication can reduce confusion and help employees understand what actions they are responsible for completing.

Consider how much one-on-one support may be needed

Not every employee needs the same level of assistance.

Some employees may only need instructions and access to plan-comparison resources. Others may want help understanding how different options relate to their providers, prescriptions, household needs, or budget.

Employers should decide whether the enrollment experience they are planning provides enough support for employees who need additional guidance without making the process unnecessarily complicated for those who prefer to enroll independently.

Plan for enrollment deadlines and incomplete actions

Even when employees understand their options, enrollment can involve multiple steps and deadlines.

Employers should think about how they will handle employees who:

• Have not started enrollment.

• Begin but do not complete enrollment.

• Need additional information before choosing a plan.

• Miss an initial communication.

• Have questions close to an enrollment deadline.

• Experience a change that affects enrollment timing.

A clear follow-up process can help reduce last-minute confusion and incomplete enrollment activity.

Consider geographically distributed teams

A multi-state or remote workforce may require a different enrollment-support approach from a workforce concentrated at one location.

Employees in different markets may see different carriers, plan options, networks, and premiums. In-person enrollment meetings may also be impractical.

Employers should consider whether their support model can work consistently across locations while still allowing employees to receive help with market-specific questions.

For more information, see Multi-State Workforce.

Decide what level of support fits your workforce

The goal is not necessarily to provide the maximum amount of assistance to every employee.

The better question is what level of support allows employees to make informed choices without creating unnecessary complexity.

Consider:

• How familiar employees are with individual health coverage.

• How complicated the available plan choices are.

• Whether household and healthcare needs vary significantly.

• Whether employees have language or technology barriers.

• How many employees may need individual assistance.

• Whether the workforce is remote or geographically dispersed.

• How the organization will follow up on incomplete enrollment activity.

An enrollment strategy should reflect the workforce that will actually use it.

Questions to answer before choosing your approach

Before moving forward, consider:

• Have most employees previously selected individual health coverage?

• Will employees understand how to compare premiums, deductibles, networks, and prescriptions?

• Are household coverage decisions likely to make enrollment more complex?

• Do employees have different language, technology, or communication needs?

• How much one-on-one assistance is likely to be required?

• Can employees receive support regardless of where they are located?

• How will the organization identify and follow up with employees who have not completed enrollment?

• Will the enrollment experience give employees enough help without overwhelming them with unnecessary information?

Answering these questions can help determine how much enrollment support your workforce may need for an ICHRA to work effectively.

Important: This article provides general information about ICHRA and employee enrollment planning and does not constitute legal, tax, or accounting advice.

Consult your legal, tax, benefits, or other qualified professional regarding enrollment and employee communication requirements applicable to your organization.