What Health Insurance Questions Are My Employees Likely to Ask Me?

Gusto Editors

If it’s about health insurance, the questions your employees have will multiply faster than multiplication tables. While the questions fire, you should be ready to block and tackle everything they’re wondering about. To give you a head start, here’s a script for you to turn to whenever someone on your team is curious about all the wonders brewing inside their benefits package.

Your team’s questions, answered

When can I sign up for health insurance?

You can enroll during something that’s called (quite fittingly), an open enrollment period. It happens once a year, but if you miss it you can either: 1) wait for next year, or 2) sign up during a special period for qualifying life events, or QLEs. A QLE is a period that lasts for the 30 days after a big occasion, like a marriage or a birth. If you just joined the team, it kicks a special enrollment period into gear, which then enables you to sign up.

Should I get an HMO or PPO?

Even though the two types sound similar, they’re on different ends of the plan spectrum. The main difference between HMOs and PPOs boil down to cost and flexibility. HMOs generally have lower out-of-pocket costs than PPOs do. HMOs are also more restrictive, because you need to get a referral to see any specialists, while PPOs let you go to any specialist without a referral, regardless if they’re out- or in-network. With a PPO, you also don’t need a primary care doctor, but with HMOs you not only need one, but they need to be within your network.

If you’re still curious about which one to go with, consider talking to our broker. They’ll be happy to help you nail down a final decision.

What exactly is in- and out-of-network?

In-network means that our insurance carrier and provider have secured an agreement that enables you to pay less. On the flip side, out-of-network means that you’ll have to spend more because our carrier and provider don’t have this pact in place.

What’s the difference between my deductible and premium?

Your premium is the monthly amount you fork over to get health insurance. Your deductible is how much you pay for medical care before your insurance is activated. Let’s say your deductible is $500. That means you need to spend $500 on health-related expenses recognized by the plan before your insurance starts covering the cost of care. Generally, if your plan has a lower deductible, your premium will be higher. The opposite is true, too. If you have a higher deductible, your premium could be considerably smaller.

Plan on helping your team find answers to these plan-specific questions

Your employees will also pose questions that depend on the type of plan they have. For some of these, they can simply flip over their insurance cards and dial the number on the back. For others, they can search around their carrier’s website:

  • What happens if I have to go to the emergency room?
  • Is there a monthly premium? How much?
  • How much is my deductible and out-of-pocket maximum?
  • Is my doctor in network?

Plan on answering these plan-specific questions

For these questions, reach out to your broker to get their expert guidance:

  • How much do I have to contribute to my premium each pay period?
  • What’s included in my deductible?
  • Will the plan work for my current situation? What happens if I get married or have a kid?
  • How will the plan work if I have a pre-existing medical condition?

Hopefully this list provides a good refresher on the top questions employees ask. If your team stumps you with any other questions, feel free to email us at [email protected] and we’ll help you sort it all out.

Gusto Editors Gusto Editors, contributing authors on Gusto, provide actionable tips and expert advice on HR and payroll for successful business management.
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