Open Enrollment Questions Employees Ask and How Employers Can Answer Them 

Open enrollment allows employees to review their benefits, compare coverage options, and make decisions for the year ahead. But understanding health insurance, deductibles, premiums, and other benefits can be challenging, especially when employees are balancing multiple options and unfamiliar terminology. 

For employers, open enrollment is more than an annual administrative task. It is an opportunity to help employees understand their benefits, gain confidence in their choices, and feel supported by clear, accessible communication that reduces confusion for HR teams. 

So, what questions do employees commonly ask during open enrollment, and how can employers answer them? By anticipating common concerns, explaining benefits in plain language, and making support easy to access, employers can create a more effective enrollment experience. 

Key takeaways 

• Prepare for common questions before enrollment begins. Anticipating employee concerns helps HR teams develop clear answers and supporting materials in advance. 
• Explain health insurance terminology in plain language. Employees need to understand premiums, deductibles, copays, and out-of-pocket maximums before comparing plans. 
• Communicate deadlines and enrollment requirements clearly. Employees need to know what actions are required, when to complete them, and what happens if they miss the deadline. 
• Make benefits education an ongoing effort. Multiple communication channels and opportunities to ask questions can empower employees, helping them feel more confident and in control of understanding and using their benefits. 

What is open enrollment, and why does it matter? 

Open enrollment is a designated period when eligible employees can enroll in, change, or waive certain employer-sponsored benefits for an upcoming coverage period. 

For many organizations, open enrollment takes place once a year. Employees may select medical, dental, and vision coverage, review supplemental insurance options, adjust eligible account contributions, and update dependent information. 

The decisions employees make during this period can affect their health care access, household budgets, and financial protection throughout the year. Missing a deadline or choosing a plan without understanding its terms can lead to confusion and unexpected expenses later. 

Employers can help by explaining what is changing, outlining available options, and giving employees enough time to review their choices before enrollment closes. 

What are the most common open enrollment questions employees ask? 

Employees often have questions about plan costs, coverage, eligibility, and enrollment requirements. Preparing answers to these common questions can help employers communicate consistently and reduce confusion throughout the process. 

1. What is the difference between a premium, deductible, copay, and coinsurance? 

These terms describe different ways employees may pay for health care, and understanding them is essential when comparing insurance plans. 

Health insurance terminology can be confusing, particularly for employees choosing between multiple plan options. Employers should explain each term in straightforward language. 

• Premium: The amount paid for insurance coverage, typically deducted from an employee’s paycheck when the employer offers payroll-deducted coverage. 
• Deductible: The amount an employee typically pays for covered health care services before the deductible is met, after which the plan begins to share costs. Some services may be available before the deductible is fully met.
• Copay: A fixed amount an employee pays for a covered service, such as a doctor’s appointment or prescription, according to the plan’s terms. 
• Coinsurance: The percentage of the allowed cost an employee pays for a covered service, often after meeting the deductible. 
• Out-of-pocket maximum: The annual limit on what an employee pays for covered, in-network essential cost-sharing under the plan. Premiums, out-of-network care, and certain other expenses generally do not count toward this limit. 

How employers can answer: Provide a benefits glossary and a side-by-side comparison of plan features. Use simple examples to show how different costs might apply when an employee visits a doctor, fills a prescription, or receives more extensive medical care. 

2. How do I choose the right health insurance plan? 

The right plan depends on an employee’s health care needs, budget, preferred providers, and expected medical expenses. 

A plan with a lower paycheck deduction may not always be the least expensive option overall. A plan with a higher premium might offer lower deductibles or different cost-sharing arrangements, while a plan with a lower premium could cost more when care is needed. 

Employees should consider: 

• How often they typically visit doctors or specialists. 
• Whether their preferred health care providers are in the plan’s network. 
• Which prescription medications they take and how the plan covers them. 
• Whether they anticipate planned procedures or other significant health care needs. 
• How much they can comfortably afford in regular premiums and unexpected medical expenses. 
• Whether they are covering only themselves or enrolling eligible family members. 

How employers can answer: Provide a comparison chart that highlights premiums, deductibles, copays, coinsurance, out-of-pocket maximums, and provider networks. Encourage employees to evaluate total potential costs rather than choosing a plan based on a single number. 

HR teams should also make it clear that employees are responsible for reviewing plan documents and confirming provider and prescription coverage before making a selection. 

3. How much will my benefits cost me each paycheck? 

Employees should be able to identify their per-paycheck contributions for each available benefits option before submitting their elections. 

Benefits cost can be one of the most important considerations during open enrollment. Employees may want to know how much medical, dental, and vision coverage will reduce their take-home pay, particularly if premiums or employer contributions are changing. 

Employers should distinguish between the total cost of coverage and the portion employees pay. They should also explain whether contributions vary by coverage tier, such as employee-only, employee-plus-spouse, or family. 

For example, an employee may pay a different amount for individual medical coverage than for family coverage. Understanding these differences helps employees assess how benefits fit into their household budget. 

How employers can answer: Publish a clear rate sheet showing employee contributions by coverage tier and pay frequency. Explain any changes from the previous year and identify which costs are deducted from paychecks. 

If employees can contribute to a health savings account (HSA) or flexible spending account (FSA), explain those contributions separately so they understand how voluntary elections may affect their take-home pay. 

4. Can I keep my current doctor and prescription medications? 

Employees should verify that their preferred providers and medications are covered under the specific plan they select. 

A change in health insurance can affect which doctors, specialists, hospitals, and pharmacies employees can use at in-network rates. Prescription formularies, coverage restrictions, and cost-sharing arrangements may also differ between plans or plan years. 

Employees who regularly see specialists or take ongoing medications may need to pay particular attention to these details before changing coverage. 

How employers can answer: Direct employees to the insurance carrier’s provider directory and prescription drug formulary. Explain how to contact the carrier with questions about specific providers, medications, prior authorization requirements, or alternative treatments. 

Employers should avoid guaranteeing that a provider or medication is covered without verifying the applicable plan information. Employees should confirm coverage directly with the carrier before enrolling. 

5. What happens if I don’t make my elections before the deadline? 

The consequences of missing open enrollment depend on the employer’s plan rules and the employee’s current enrollment status. 

Employees may assume their existing benefits will continue automatically. However, some employers require employees to actively reelect certain benefits each year, while other elections may carry forward if the plan permits it. 

Missing the deadline could also mean an employee cannot make a new election or change coverage until the next open enrollment period, unless they qualify for a special enrollment opportunity or another permitted election change. 

How employers can answer: Communicate the enrollment deadline early and repeat it throughout the enrollment period. Clearly explain which benefits require active elections, which elections may carry forward, and what employees should do if they need assistance. 

Consider sending reminders before the deadline and providing a confirmation step so employees can verify that their elections were submitted successfully. 

6. Can I add my spouse or children to my benefits? 

Employees may be able to enroll eligible dependents, but eligibility requirements and documentation depend on the applicable plan. 

Many employer-sponsored plans allow employees to enroll eligible spouses and dependent children. However, employers should explain the plan’s specific eligibility rules, any documentation requirements, and the additional cost of dependent coverage. 

Employees may also ask about covering a spouse through another employer’s insurance or coordinating coverage when both spouses have employer-sponsored plans. 

How employers can answer: Provide a dependent eligibility guide that explains who qualifies, what documentation may be required, and how dependent coverage affects payroll deductions. Direct employees to the plan documents or benefits administrator for questions about special circumstances. 

Employers should also explain how employees can report qualifying life events, such as marriage, birth, or adoption, and identify the applicable deadlines for requesting changes. 

7. What’s the difference between an HSA and an FSA? 

An HSA and an FSA can both help employees pay eligible health care expenses with tax advantages, but they have different eligibility requirements and account rules. 

Employees may see these options during open enrollment without understanding how they work or which expenses they can cover. 

A health savings account is generally available to individuals enrolled in an HSA-eligible high-deductible health plan who meet the applicable eligibility requirements. HSA funds can generally roll over from year to year, and the account belongs to the individual. 

A health care flexible spending account is generally funded through employee salary reductions and may be available under different health plan arrangements. FSAs typically have plan-specific rules governing when funds must be used, including any permitted carryover or grace period. 

Employees should also understand that HSA and FSA eligibility can interact. For example, a general-purpose health care FSA can affect HSA contribution eligibility. 

How employers can answer: Provide a side-by-side comparison explaining eligibility, eligible expenses, contribution limits, tax advantages, and what happens to unused funds. Include links to official IRS guidance and the employer’s plan documents for current rules. 

Avoid assuming that every employee can contribute to both accounts or that every account follows the same rollover rules. 

8. What other benefits should I review during open enrollment? 

Employees should review all available benefits, not just medical insurance, to understand the full value of their employer’s benefits package. 

Medical coverage often receives the most attention, but other benefits may help employees manage health care expenses, protect their income, or plan for the future. 

Depending on what the employer offers, employees may want to review: 

• Dental and vision insurance: Coverage for routine care, exams, prescriptions, and other eligible services. 
• Life and disability insurance: Financial protection for employees and their families if a covered event occurs. 
• Supplemental insurance: Additional coverage that may help with certain expenses associated with covered illnesses, accidents, or hospital stays. 
• Retirement benefits: Employer-sponsored retirement savings plans and any available matching contributions. 
• Employee assistance programs: Resources that may provide support for personal, family, financial, or work-related challenges. 

Not every benefit requires an annual election, and some may have separate enrollment periods or eligibility rules. 

How employers can answer: Share a complete benefits overview that explains what is available, who is eligible, what each benefit does, and whether employees need to take action during open enrollment. Highlight underused benefits and provide instructions for accessing them throughout the year. 

How can GMS help employers manage benefits communication? 

Open enrollment requires coordination between benefits administration, employee communication, and HR operations. For small and midsize businesses in particular, managing those responsibilities alongside everyday HR demands can be challenging. 

Group Management Services (GMS) helps businesses navigate HR responsibilities, including employee benefits, so employers can better support their workforce and manage the complexities of administering benefits. 

With professional employer organization (PEO) services, GMS works with client businesses through a co-employment relationship. The arrangement lets GMS and the client business share certain employer responsibilities, as defined in their agreement, while the client continues to direct its employees’ day-to-day work. 

Contact us to learn more about available HR and employee benefits support.