December 2011 Issue
November 23, 2011

Health Advocate: Open enrollment

Author: Sue Klug
Source: NYSUT United

For many NYSUT members or their spouses, fall is the annual open enrollment period when changes can be made to health benefit plans. Many people don't bother to review their choices, but this could prove to be a costly mistake. According to the Kaiser Family Foundation, average costs increased about 9 percent nationally in 2010, and workers are paying an increased share of the premium.

NYSUT members are encouraged to review open enrollment materials including out-of-pocket co-pays and deductibles to predict expenses for the new plan year in addition to payroll deductions. Often the formulary, or list of covered drugs, changes as new drugs enter the market. After reviewing the formulary, participants may wish to contact their physician to determine if they can change to a less costly generic prescription drug or obtain prescriptions through the mail order plan. The cost for a 30-day supply of a brand-name drug in upstate New York increased from $100.57 in 2004 to $194.03 in 2010, a 93 percent increase in six years. In comparison, a 30-day supply for a generic drug increased 3.4 percent for the same period, from $19.44 to $20.11.

Open enrollment is generally the only time to add family members without a qualifying event (marriage, loss of health insurance, birth of child, divorce, etc.). All health and prescription drug plans can cover adult children to age 26 under the new Affordable Care Act, but members need to complete application materials. If you have questions concerning open enrollment, please contact your employer's Human Resources Department.