Healthcare benefits are complicated for most people. Even for seasoned business owners, choosing a healthcare benefits package, that meets all the needs of the employees is always the challenge.  You think you made the right decision after reviewing your options.   What happens with you are not happy with what you picked?  Buyers’ remorse is real, and the team at AUI can help.

What Options Do Employees Have to Change Your Government Healthcare Plan?

Under the Affordable Care Act, there are specific times that allow you to change your healthcare coverage.  Understandably, life changes, and when those changes happen there are stipulations in your plan that let you change your coverage. Once open enrollment ends you can only change your personal health plans if you qualify for a special enrollment period.

Things included that qualify include:

  • Marriage
  • Birth
  • Changes to household income levels
  • Death of a family member
  • Change of jobs or loss of job

You have under the government guidelines up to 60 days to report on the changes.   You can see the instructions here: (

What Options do Employers Have for Changing Healthcare Coverage After Open Enrollment Ends?

Let’s say you just rolled your old coverage over because you did not have time to review your plan for your business health benefits.  What options do you have as an employer to make changes to your plans?

Once open enrollment ends, employers can only m. minimum changes to their employment benefits without the consent of their employees. Our goal at AUI is to find the right packages for you to start with, but it is sometimes difficult to anticipate all the changes.

Example of Coverage Changes Employers Cannot Anticipate:

For instance, one of your employees goes to their annual eye exam.  They have used the same eye doctor their entire life and the doctor no longer accepts the insurance you provided in your benefits package. This is called being in an “out of network.” It may mean that that the trusted doctor your employee has built a relationship with will now be more expensive with fees that may be too steep to pay out-of-pocket.   The employee goes to the employer for help.

 What happens next?

The employee can ask for an appeal, sometime the insurance company will go to bat for you and try to create a plan with your doctor. You can also sometimes appeal to keep your doctor with temporary in-network coverage under health insurance rights and protections unless it is part of a grandfathered health insurance plan.

Here are some instances where your coverage may be worth an appeal:

The Old Healthcare Plan is Not Working for My Business. Now What?

The plan fit the need last year, but not this year.  When this happens the team at AUI can work with you to see if offering alternative benefits can contribute to a solution under your current plan.  Our team can also take this into account during open enrollment to ensure that your employees have the broadest coverage with most providers possible going forward.

There may be additional options you can offer your employees in the interim; the key is that you need to know what they are and have a team of experts to help you navigate them.

Quote " On average, primary care and mulispecialty practices experienced slightly more than 10% turnover in 2021 survey, according to the Medical Group Management Association, which consists of 15000 group medial practices representing more than 350000 physicians." Medical Group Manage

The Key is Communication

The world of healthcare coverage is a moving target. Not only do plans change over time, but as an employer it is impossible to navigate changes from individual doctors or medical groups.  Insurance companies negotiate rates with them independently of any coverage you may have selected during open enrollment.

The best thing you can do is have an open-door policy with your employees to address concerns they may have about your medical needs.  How the plan works for your employees will help you determine if you make changes going forward. Things can look great on paper, but they don’t always work great in the real world.

Our team at AUI can also help you create surveys to get quality feedback from your employees about their benefits packages.

Work with a Health Benefits Team Like AUI

The team at AUI is here for you with knowledgeable agents who work with lots of different carriers for employers like you. We know the ins and outs of different plans and can work with your entire team to help determine the best fit for you.  Our team is an extension of your team, and we want everyone to have the best possible care.   Call us today to get started.

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