Ask The Insurance Decoder
By Lynne Lucio
Q: I’ve worked for my employer for three years. I became eligible for health insurance when I was hired and at that time I enrolled in the medical plan but waived dental and vision coverage. Now it’s open enrollment time and I want to sign up for dental coverage. The HR people are telling me that it’s open enrollment for the medical but I can’t sign up for the dental because it’s a fully-funded plan. They’re telling me that this is only a dental renewal, not a totally new dental plan. Can you explain this to me? — Katrina M., Pasadena, CA
A: Depending on how your stand-alone dental/vision plans were set up, you may not be able to enroll in dental or vision after the initial eligibility period. Sometimes insurance companies that offer fully funded plans charge more if a group wants an annual open enrollment period. Although medical insurance carriers offer annual open enrollment changes and elections, separate dental and vision carriers are not necessarily bound by the same rules. The rational is that an employee could initially waive coverage then later find out they need costly dental work or vision care. If the employee was allowed to enroll at a later date, the carrier could be stuck with costs that had not been figured into the premium when the plan was originally written. When dental and vision plans are set up, the group is asked whether they want an annual open enrollment period and having an open enrollment comes with a higher premium. Given the economy today most employers are looking for ways to cut costs. Although an open enrollment option for dental and vision may be offered to the group, it may not be clear to employer groups that if they don’t choose the option their employees may be prevented from electing dental or vision coverage at a later date. But, if your employer chooses a new dental or vision carrier rather than renewing with the same carrier, you then have the opportunity to enroll in dental or vision coverage. So, it all depends on the plan design.
ASK The Insurance Decoder © Copyright 2012, Lynne Lucio. All rights reserved.
Lynne Lucio, the author of The Insurance Decoder: How to Maximize Your Health Insurance Benefits, Minimize Out-Of-Pocket Expenses and Stay One step Ahead of Your Insurance Company, has been a health insurance professional for over 20 years. As an insurance insider, Lynne learned how to decipher the medical claims labyrinth and developed the specific and practical knowledge of the claims process. Throughout her career, Lynne has shared her expertise with thousands of insured consumers, helping them resolve complicated health claims while showing them how to take full advantage of their health insurance benefits. The depth and breadth of Lynne’s knowledge of the topic encompasses not only the claims process but also the laws that influence and regulate health coverage, including ERISA, COBRA, FMLA, USERRA, HIPAA and others. Lynne provides consulting services to covered individuals and writes about health insurance issues on (www.ezine.com). For more information, or to submit your own health insurance related questions, contact Lynne at firstname.lastname@example.org.