Insurance Open Enrollment FAQs

Q: When is the open enrollment period for the 2018 plan year?

A: Open enrollment will be Oct. 30 - Nov. 10th. The Enrollment window will close at 5:00 PM on Friday, November 10.  All employees who want have health, dental, vision or flexible spending coverage in the 2018 plan year will need to go through the enrollment process. Health, dental, vision and flexible spending benefits will not automatically transfer to the new year. Voluntary plans that are not changing will require participants to confirm their elections.

Q: Will I need to do anything during open enrollment?

A: Yes. Open enrollment for the 2018 plan year is mandatory. All employees who are eligible for insurance in the 2018 plan year, which is Jan. 1-Dec. 31, 2018, must log in and confirm their election, even if you want to decline benefits. This online enrollment must be completed by 5 pm on Nov 10, 2017.

Q: Why do I have to participate in the enrollment process? Why can't I just be enrolled automatically?

A: The selection of a health plan is a personal decision and depends largely on the employee's personal circumstances. Needs and circumstances change from time to time, we encourage employees to examine their benefit needs annually to determine if any changes need to be made. We require that employees confirm their elections annually through the enrollment process.

Q: How do I choose a health plan: Step 1 – Traditional vs Qualified High deductible health plan?

A: The choice between the Traditional plan and the Qualified High Deductible Health Plan is a choice that rests on your personal feeling about security vs control. The traditional plan is more about security, you pay a higher monthly premium but you pay less for the deductibles and out of pocket maximum, but conversely you also pay a higher monthly premium even if you don’t require any medical care during the year. The High Deductible plan is more about having control over your health care dollars. You pay substantially less in premium and in exchange you will be expected to cover more of your upfront costs based on the deductible. To help manage the insecurities associated with this plan, the IRS allows you to set money aside in Health Savings Account (HSA); the funds in this account can be used to cover the costs you may incur. A very risk averse person would likely lean toward the Traditional plan, and person who wants to have more control over how their health care dollars are spent will likely lean toward the High Deductible plan.

Q: How do I choose a health plan: Step 2 – Advantage vs Summit

A:  This choice rests on which network you are more comfortable with. The advantage network is mainly the Intermountain Health Care (IHC) network, whereas the Summit network is essentially the Non – IHC affiliated hospitals and clinics.   This would include Mountain Star, Iasis, and University of Utah Health Care clinics and hospitals. Some individuals might have strong opinions toward one network or the other, while others don’t really care at all. The plan designs are equivalent and you should receive excellent care through both networks.  If you don’t have strong feelings toward one or the other you may want to look at the list of covered hospitals, on page 7 & 8 of the benefit guide, and select the network with the hospital closest to your home.

Q: How do I choose a Health plan: Step 3 – Base vs Buy Up?

A: This is question largely about out-of-network coverage. While the base option has regional network agreements that allow participants to receive emergency services out of the Utah region, they don’t provide any kind of out-of-network benefit. The Buy Up option allows you to have out-of-network coverage. There are two advantages to the buy up:  first, some participants who travel might have concerns about finding a doctor to treat a medical need while traveling, this option allows them to get services almost anywhere.  Second, some people have a specialist that they like to visit that may not be in their preferred network; the buy up allows them to have coverage for this out-of-network specialist. The additional cost is substantial, so you will want to consider your projected out-of-network costs carefully before you select this option.

Q: I don’t understand the HSA tax dependent rules. Who can I use my HSA dollars for?

A: Because the HSA is governed by the IRS, the HSA regulations follow tax law for dependency. This means that the funds can only be used for medical expenses for either you and your tax dependents. In short if you claim them on your taxes, as a dependent, you can use your HSA dollars for their approved expenses.  If you don’t claim them as a tax dependent, you can’t use your HSA to pay for their expenses. The confusion comes because the Affordable Care Act allows children to stay on a parents health plan until they reach age 26, but dependents who are in there 20’s may, or may not be a tax dependent. Let me give you an example, I have two children one age 22 and one age 24. The 22 year old is a student and living at home, I claim him as a dependent for taxes. The 24 year old has graduated from college, is married and has started a career; I don’t claim her on my taxes. I am however, covering both children on my health insurance. I can use my HSA to cover the medical expenses of the 22 year old because they are still my tax dependent; however, I can’t use my HSA to cover the expenses of the 24 year old because I no longer claim her as a dependent on my taxes.

Q: I am seeing APA benefits as the administrator for the Flex spending and HSA accounts; is this a new Carrier?

A: We have been working with APA benefits for some time now. APA benefits acquired Custom Benefit Solutions our previous flexible spending and COBRA administrator. We transitioned to the APA benefit structure on January 1, 2016. We expanded our contract with APA benefits for them to also administer the HSA.  All participants who elect to participate in the Flex Plan or the HSA and request a debit card will receive two cards in the participant’s name. An annual $18 debit card fee will be assessed to your account if you elect for the card.

Q: Will my premiums change?

A: UNfortunately health care cost continue to increase which has required us to increase premiums.   As agreeed upon in the annual negotiations premiums will increase in the 2018 benefit year.    The District absorbed the larger portion of the increase.   

Q: Will my benefits change?

A: Aside from the rate increase on the total Premium that was divided equally between employees and the District, we needed to make changes to the Traditioanl Plan.  Those Changes are as follows:

 -Change In deductible from $750/$2,250 to $850/2550
 -Change in out‐of‐pocket max from $3,000/$6,000 to $3500/$7000
 -Office Visit Copay will move $20/$35 to $30/$50
There were not any plan design changes to the High deductible plan, other than the rate increase.

Q: Why are Socials Security numbers required for my dependents?

A: The Social Security Number is the unique identifier used by insurance companies to reconcile claims data when more than one carrier is involved. Starting January 2015, the Affordable Care Act requires that pharmacy claims and health insurance claims both count toward the annual out-of-pocket maximum. While this is a small change to the plan design it requires a major change to the administrative process. In order to accumulate claims data toward the annual out-of-pocket maximum, the carriers must communicate and reconcile claims between the pharmacy and health administrators. If dependent Social Security Numbers are not recorded in the enrollment system then the claims incurred may not accumulate toward your out-of-pocket maximum correctly. If you do not have Social Security Numbers for your Dependents, please contact the Insurance Department as soon as possible at 801-826-5428 or send an email to This email address is being protected from spambots. You need JavaScript enabled to view it. and we will assess your situation to determine your options.

Q: Some of the benefits are indicating “Plan Disabled.”

A: When there is an indicator showing “Plan Disable,” this signifies that another step must be completed before the plan is activated.   The enrollment system is designed around a specific procedure.  Some benefits are contingent on other benefits being selected or waived.   For instance, the HSA benefit might show as “disabled” because the health plan election has not been finalized.  If an employee doesn’t enroll in a Qualified High Deductible Plan, they would not be eligible to enroll in the HSA and it consequently would not be an option for them.   When you select the “Next” button, the system will take you to the section of the enrollment tool that is next in the process.