Open enrollment season is when employees—and their families—make critical decisions about medical coverage for the year ahead. Yet despite its importance, many plan selections are driven by habit, incomplete information, or a focus on premiums alone. As HR professionals, you can play a pivotal role in helping your workforce avoid common missteps and secure the right coverage for their unique needs.

Here are the top 10 mistakes employees often make when choosing family health plans, along with strategies HR can use to steer them toward smarter decisions.

1. Prioritizing Premiums Over Total Cost of Care

• The Mistake: Opting for the lowest monthly premium without considering deductibles, copays, coinsurance, and out-of-pocket maximums.
• Why It Matters: A low-premium plan may carry high deductibles or coinsurance, resulting in steep medical bills if care is needed.
• HR Tip: Provide total cost comparisons. Use side-by-side examples showing “No claims” versus “Moderate claims” scenarios. Encourage employees to calculate estimated annual costs, not just premiums.

2. Ignoring Provider Network Restrictions

• The Mistake: Failing to check whether preferred doctors, specialists, and hospitals participate in the plan’s network.
• Why It Matters: Out-of-network care can lead to balance bills and higher out-of-pocket expenses, even if employees pay their deductible.
• HR Tip: Offer a searchable network directory or vendor-provided tool. Host a “Find Your Provider” workshop where employees map their family’s doctors and confirm network status.

3. Overlooking Prescription Drug Coverage

• The Mistake: Assuming all plans cover medications equally and neglecting to review formularies and tiered copays.
• Why It Matters: Specialty and maintenance drugs can vary wildly in cost between plans, potentially costing thousands extra annually.
• HR Tip: Provide a side-by-side formulary comparison for common or high-cost medications. Encourage employees with regular prescriptions to estimate their drug costs under each plan.

4. Underestimating Family Healthcare Utilization

• The Mistake: Selecting a plan based solely on an individual’s needs and forgetting to account for spouses or dependents who may have chronic conditions, planned procedures, or pediatric needs.
• Why It Matters: A plan that works for one person may be inadequate for a family. Unexpected pediatric or maternal care can quickly exhaust deductibles and out-of-pocket limits.
• HR Tip: Remind employees to project their family’s care needs. For example, anticipated dental work, maternity care, or specialist visits – and choose plans that accommodate those services.

5. Misunderstanding HSA and FSA Trade-Offs

• The Mistake: Assuming a Health Savings Account (HSA) or Flexible Spending Account (FSA) provides free money, without recognizing eligibility requirements and use-it-or-lose-it rules.
• Why It Matters: Employees who elect an HSA-eligible High Deductible Health Plan (HDHP) must meet minimum deductibles; FSAs often forfeit unspent balances at year-end per the “use-it-or-lose-it” rule.
• HR Tip: Educate employees on the differences: most HSA funds roll-over and earn interest, while FSA funds almost always expire. Provide calculators to model contributions based on anticipated out-of-pocket expenses.

6. Disregarding Preventive Care Benefits

• The Mistake: Focusing on major medical costs and forgetting that many preventive services such as vaccines, screenings, well-child visits are covered 100% in-network under the Affordable Care Act.
• Why It Matters: Skipping preventive care can lead to late-stage diagnoses and far higher treatment costs.
• HR Tip: Highlight no-cost preventive services in plan materials and communications. Use reminders to schedule annual checkups and age-appropriate screenings and vaccinations.

7. Neglecting Telehealth and Virtual Care Options

• The Mistake: Overlooking whether a plan includes telemedicine or virtual behavioral health visits at reduced or no copay.
• Why It Matters: Virtual care reduces costs, increases convenience, and can catch issues early, especially valuable for remote or busy families.
• HR Tip: Showcase telehealth benefits in emails and webinars. Provide login instructions or demo sessions for your plan’s telemedicine platform.

8. Failing to Account for Specialty Programs

• The Mistake: Not exploring value-added programs such as maternity coaching, chronic condition management, smoking cessation, or mental wellness programs, all of which can improve outcomes and lower costs.
• Why It Matters: These programs can reduce hospitalizations and long-term claims, but employees often don’t know they exist or how to enroll.
• HR Tip: Partner with carriers to offer educational sessions on specialty programs. Include program highlights in benefits newsletters and office posters.

9. Delaying Enrollment Decisions

• The Mistake: Procrastinating until the last minute, then rushing through elections without fully understanding plan features.
• Why It Matters: Quick decisions increase the chances of errors, such as missing deadlines, forgetting to add dependents, or leaving money on the table.
• HR Tip: Launch a structured enrollment calendar with interim deadlines (“evaluate networks by Week 1,” “compare costs by Week 2”) and send countdown reminders at regular intervals.

10. Overlooking Annual Plan Updates

• The Mistake: Assuming plan terms remain static year to year and failing to review revised benefits, networks, or costs.
• Why It Matters: Carriers frequently update provider networks, formularies, copays, and premiums. Renewing last year’s elections without review may lead to coverage gaps or unexpected price hikes.
• HR Tip: Create a side-by-side “Last Year vs. This Year” summary for each plan. Highlight any significant changes such as network shifts, new deductibles, or altered benefits, all in an effort to prompt re-evaluation.

Bringing It All Together: HR’s Role

HR leaders can transform benefits enrollment from a source of confusion into a guided, high-value experience by:

• Offering Decision-Support Tools: Interactive plan comparison wizards, calculators for total cost analysis, and in-depth webinars.
• Personalizing Communications: Segment employees by family size, age, or health needs and send targeted messages.
• Facilitating One-on-One Consultations: Schedule virtual or in-person benefit-advisor sessions for employees with complex needs.
• Creating a Benefits Resource Hub: An intranet page with FAQs, plan documents, explainer videos, and quick-reference checklists.
• Measuring Impact: Track enrollment patterns, participation in educational sessions, and plan-switch behaviors to refine your strategy year after year.

Conclusion

Employees face a dizzying array of medical plan choices each enrollment season, and common decision-making pitfalls can leave families underinsured or overpaying for coverage they don’t need.

By recognizing the top 10 mistakes – overemphasizing premiums, ignoring networks, underestimating family utilization, and more – HR professionals can proactively guide employees toward smarter selections. Through education, decision-support tools, and targeted communications, you’ll empower your workforce to choose plans that deliver optimal coverage, predictable costs, and peace of mind for the year ahead.

Ready to elevate your benefits enrollment process? Contact a benefit advisor at HUB Southwest for expert support in designing enrollment strategies, implementing digital tools, and coaching your team to success.