Open Enrollment − What This Year Revealed and Why It Matters

Another open enrollment period has just concluded, and for many organizations, this marks the beginning of reconciliation, analysis and reflection. While open enrollment is always a demanding time, this year brought a notable increase in vendor and account structure changes as our clients focused on improving the benefit experience for their employees through plan redesigns or carrier moves.

These shifts added layers of complexity to an already intense enrollment season—one that is routinely fraught with tight timelines, high volumes and heightened expectations from employers and members alike.

Reflecting on Open Enrollment Challenges

Open enrollment consistently tests the operational and strategic capabilities of HR and IT within organizations, especially when change is involved. The challenges encountered this year are likely to resurface in future cycles, underscoring the need for deliberate planning and mitigation strategies.

• Plan and carrier transitions
  Employer decisions to switch carriers or modify plan offerings affected account structure, often with limited lead time for the required rapid configuration, testing and validation. Two specific examples we saw were:
  
  • When there are existing file share requirements, open enrollment files that include the changes could confuse both the organization and the vendor.
  • Mapping updates to include or exclude certain plans, products and/or set limits on new rates could be needed. This is most important for spending accounts that can change from year to year.
• Movement between vendors
  
  • New vendor relationships introduced additional data flows and integration requirements during peak volume. This meant key decisions regarding management of existing files for the remainder of the plan year, plus determining when and how the new vendor would become active to receive the open enrollment and ongoing new plan year file.
• Compressed timelines and downstream risk
  Late benefit decisions left little margin for error, increasing the risk of eligibility issues, incorrect elections or post-enrollment corrections.

• Implementation of new vendors
  Plans that decided for a new vendor also had to determine whether to onboard during open enrollment, beginning the census load with new open enrollment elections, or defer implementation until the new plan year. A key consideration was whether the new vendor could successfully support implementation amid peak enrollment volume.

Analysis of Outsourcing

In an environment defined by change and complexity, outsourcing plays a critical role in stabilizing and strengthening open enrollment execution. A strong vendor can not only facilitate or remove burdens but will also get the data where it needs to be in the time, order and accuracy that is expected.

• Absorb operational complexity by managing account structure changes, configuration updates and data validation efficiently.
• Ensure accuracy and continuity during plan or carrier transitions, reducing downstream reconciliation issues.
• Scale during peak enrollment periods with proven processes and dedicated support.
• Support employer and member experience by minimizing disruptions and ensuring elections are processed correctly the first time.

The right vendor acts as an extension of the HR and IT teams, bringing expertise, flexibility and consistency during the busiest time of year.

Turning Reflection into Readiness

Open enrollment can be challenging because important decisions must be made during one of the busiest times of the year. Now those lessons learned can be incorporated into planning for the next enrollment cycle. Understanding what worked, what created friction and where vendor support made a measurable difference helps organizations prepare for future change, because open enrollment is rarely static.

Organizations that invest in a strong vendor are better positioned to deliver a smoother open enrollment experience year after year. Download our BenefiX® brochure to see how we help reduce risk, manage change and execute with confidence.