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Sunday, October 22, 2006

Open Enrollment - Making the Right Decision is a Matter of Life and Health

It never fails. The dreaded once a year email comes to all employees and is from Human Resources: "Open Enrollment is Here!" screams the subject line. You remember last year as you wearily tried to make sense of the never ending choices between plans. Health insurance doesn't have to be a dirty word! Employers realize that these benefits are of great importance to employees and offer them at a very affordable rate. Presented below are basic concepts of plans and what it ultimately means to you.

HEALTH PLANS -

HMO vs PPO: In an age of acronyms, insurance plans seem to have cornered the market on these catchy abbreviations! Simply speaking, HMO is shortened for "Health Maintenance Organization" plan and PPO stands for "Preferred Provider Organization.

Characterizations of HMO: Typically offers a very low, flat dollar rate for seeing a doctor or having a medical procedure done.

Qualifications for using HMOs: You must choose a doctor from a designated pool of physicians to be your primary care doctor. Your designated doctor must coordinate all care on your behalf such as referring you to designated specialists or scheduling x-rays at a facility, etc.

Pros and Cons OF HMO's: They are very affordable and do not require filing of claim forms. The downside is that you must choose a doctor in a designated pool of other doctors. Your current physician may or may not be offered in this health plan.

Characterizations of PPO: Typically costs more than HMO plans, also usually offers a higher dollar rate for seeing a doctor or having a medical procedure done.

Qualifications for using PPO's: You may use any doctor you wish, although discounts on medical care are offered if you decide to use a doctor within the HMO physician pool.

Pros and Cons of PPO's: You may have to file your own claim forms for each doctor that you see. You may use any doctor or specialist that you wish, but the cost is usually significantly higher than the HMO.

There, that wasn't so bad, was it? We shall continue on looking at the various other types of plans that have gained popularity in recent years.

FLEXIBLE SPENDING ACCOUNTS OR FSA'S/HSA'S (Health Savings Accounts)- FSA's: Your employer may offer these type of "savings accounts" designated solely for the purpose of health care or other IRS approved expenses on a tax free basis.

Characterizations for using FSA/HSA's: Employees may begin contributing a specific dollar amount to these accounts for designated health care expenses. The dollar amounts contributed are deducted from your gross payroll so that taxes are not calculated on that amount. Therefore, you are taxed at a lower rate.

Qualifications for FSA/HSA's: You must calculate your projected health care expenses carefully as an annual figure. Then, a set dollar amount is deducted from your pay in equal increments over the course of the year.

Pros and Cons of FSA/HSA's: Typically, if you fail to use all of the monies that are set aside for healthcare expenses for the year, the employee LOSES that money! According to the IRS, it cannot rollover from year to year. So estimate your expenses very carefully!