Open enrollment season isn’t just about handing out benefits packets—it’s about having real conversations. For most employees, choosing a health plan is one of the most important (and confusing) decisions they’ll make all year. And as an employer, HR leader, or trusted insurance broker, you’ll need to be ready with clear, confident answers.
If you’re updating employee health plans, reviewing group benefits, or comparing group plan providers before renewal, your team will likely have the same recurring concerns. In this blog, we’ll explore five of the most common questions employees ask and how to answer each one in a way that builds trust and supports informed decision-making.
1. “How Do I Know Which Plan Is Right for Me?”
This is by far the most common and most important question employees ask during open enrollment. And it’s no wonder: most employee health plans include multiple options (HMO, PPO, EPO) with different premiums, deductibles, and networks. What seems like a simple choice can quickly become overwhelming.
To help your team make informed decisions:
- Encourage them to consider their healthcare habits—do they visit the doctor frequently or rarely?
- Point out provider networks—are their doctors in-network?
- Compare monthly premiums vs. out-of-pocket costs—a lower monthly cost may mean higher expenses later.
Sample Plan Comparison Snapshot
| Plan Type | Monthly Premium | Deductible | Out-of-Pocket Max | In-Network Access |
| HMO Basic | $100 | $1,500 | $6,000 | Local only |
| PPO Standard | $175 | $750 | $4,000 | Nationwide |
| EPO Flex | $150 | $1,000 | $5,500 | Statewide |
Let your employees know there’s no one-size-fits-all. What works for a healthy 25-year-old might not fit a family of four with ongoing medical needs.
2. “Will This Plan Cover My Doctor or Medication?”
Network and formulary coverage questions are huge concerns—especially for employees with established care routines or chronic health conditions.
Here’s how to respond:
- Direct employees to the provider directory or drug formulary tools on the insurer’s website.
- Offer to help them check whether their doctors or specialists are in-network under each employee health plan.
- Clarify the difference between generic vs. brand-name drug coverage, especially if a certain medication requires prior authorization.
Let employees know that insurance brokers and HR are there to help decode the fine print—especially when switching providers or plans. Failing to guide your team through this could result in surprise bills or delayed treatment.
Tip: Partner with your group plan provider before renewal to ensure your employee population’s most-used medications and healthcare networks are still well covered.
3. “Can I Add My Spouse or Dependents?”
Questions about dependent eligibility often surface during open enrollment. And rightly so—families want peace of mind.
Most group benefits allow employees to add:
- Spouses (including same-sex spouses)
- Domestic partners (varies by plan)
- Children under age 26
- Disabled dependents beyond age 26
However, premium costs can increase significantly when dependents are added, and not every plan includes vision or dental for them.
Dependent Eligibility Overview
| Dependent Type | Eligible? | Coverage Type | Notes |
| Legal spouse | Yes | Medical, dental, vision | May require marriage certificate |
| Domestic partner | Varies | Depends on carrier | May require affidavit or registration |
| Child (under 26) | Yes | Full coverage | Biological, adopted, or stepchildren |
| Disabled adult child | Yes | If disabled before age 26 | Documentation may be required |
Remind employees that coverage elections can’t typically be changed until the next open enrollment period—unless they experience a qualifying life event (like marriage or birth of a child).
4. “Is My Health Information Safe?”
In a world of increasing data breaches, employees are (rightfully) concerned about how their personal health information is handled. During open enrollment, it’s easy to accidentally cross lines—especially if paper forms or shared spreadsheets are involved.
Make sure to address HIPAA compliance openly:
- Never email or store forms with personal health info unencrypted.
- Educate HR staff and managers on what qualifies as a HIPAA violation—even mentioning someone’s prescription in a shared Slack message can be risky.
- Offer a secure digital enrollment portal if possible.
Pro Tip: Let employees know that their info will never be shared with coworkers, managers, or third parties without consent. Transparency builds trust.
5. “What Happens If I Don’t Enroll or Miss the Deadline?”
Deadlines matter. If an employee misses the open enrollment window and doesn’t have a qualifying event, they may have to wait until the next enrollment period—potentially leaving them uninsured.
Key talking points:
- Most employee health plans require active enrollment—even if the employee wants to keep the same plan.
- Missing the deadline can mean losing coverage or defaulting to the least comprehensive option.
- Employees may still enroll in state-sponsored coverage through Covered California during open enrollment if they’re ineligible for group plans.
Let employees know you (and your insurance broker or benefits provider) are available to help guide them through the process well before the final cutoff.
Additional Concerns to Consider
While most employees stick to the common open enrollment questions—like which plan to pick or how to add dependents—there are several overlooked yet important considerations that can impact how they experience their benefits year-round. Proactively addressing these can boost engagement and reduce confusion later in the year.
“Does the plan include mental health services?”
Mental health coverage is now a standard part of employee health plans under the ACA and California law. But employees may not know where to find these benefits, or that services like therapy, counseling, and substance abuse treatment are included under most group benefits packages.
Encourage employees to check:
- If mental health providers are in-network
- Whether telehealth options are available for therapy
- If sessions require referrals or preauthorization
According to the Department of Labor, mental health benefits must be equal to medical/surgical benefits under federal parity laws. Be sure your benefits guide includes this information clearly.
“Are there any wellness programs or incentives?”
Today’s employee health plans often go beyond basic coverage by offering wellness programs that reward employees for living healthier lifestyles. These might include:
- Gym reimbursements
- Smoking cessation support
- Weight-loss coaching
- On-site health screenings or flu shots
- HSA contributions for participating in wellness challenges
Wellness benefits are sometimes underutilized simply because employees aren’t aware of them. Promoting these perks early and often helps improve employee well-being and reduce long-term claims costs for the employer.
Tip: Include a wellness calendar or program summary in your open enrollment packet to increase participation.
“Can I contribute to an HSA or FSA—and what’s the difference?”
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are powerful tools to help employees pay for out-of-pocket medical expenses with pre-tax dollars—but many don’t understand how they work.
| Account Type | Who’s Eligible? | Use It or Lose It? | Portable After Job Change? |
| HSA | Only with HDHPs | No | Yes |
| FSA | Most employees | Yes (annual limit) | No |
Clarify that:
- HSAs require enrollment in a High Deductible Health Plan (HDHP).
- FSAs have an annual use-it-or-lose-it rule (with a short grace period in some cases).
- HSA funds roll over year to year and follow employees even if they leave the company.
Many insurance brokers help employers set up these accounts, often partnering with payroll providers or banks.
“What should I do if I have a life change mid-year?”
Life happens outside of open enrollment, and it’s important that employees know when they can make changes to their employee health plans. Qualifying Life Events (QLEs) include:
- Marriage or divorce
- Birth or adoption of a child
- Death of a covered family member
- Loss of other coverage (such as a spouse losing a job)
Employees usually have 30 days from the event to notify HR and update their coverage. If they miss this window, they’ll need to wait until the next open enrollment unless another QLE occurs.
Helping Employees by Empowering Them
Open enrollment is an opportunity to educate, engage, and support your team. By anticipating these five questions and preparing thoughtful answers, you show your team that you value their well-being and want them to make the most of their employee health plans.
At Regency West Insurance, we specialize in making benefits simple and human. From comparing group benefits to answering HIPAA questions, we’re here to help California businesses provide clear answers and compliant coverage. We’ll help you build smarter employee health plans backed by experience and care.
Schedule a benefits consultation with Regency West Insurance today.