🏥 Do I have to enroll every year?

Yes — you must actively enroll during Open Enrollment (Nov 1–22, 2026) even if you want to keep the same coverage. HSA and FSA elections do not carry over automatically. Medical, dental, and vision elections will carry over if you take no action, but we strongly recommend reviewing your options each year.

💰 What's the difference between an HSA and an FSA?

Both let you save pre-tax money for healthcare costs. The key differences: HSAs roll over forever and are only available with HDHP plans. FSAs have a "use it or lose it" rule (with a $660 rollover) and are available with the PPO Classic. You cannot have both at the same time.

👨‍👩‍👧 Can I add my family mid-year?

Generally, you can only change your benefits during Open Enrollment. However, certain qualifying life events allow you to make changes within 30 days of the event. These include: marriage, divorce, birth or adoption of a child, loss of other coverage, or a dependent aging off your plan. Contact HR immediately after a qualifying event.

🔍 Do I need a referral to see a specialist?

No. All three medical plans are PPO-style plans, which means you can see any in-network specialist without a referral. You'll pay less when you stay in-network, but out-of-network care is also covered at a higher cost-share.

💊 How do I know if my medication is covered?

Check the Prescription Drug Formulary in the Documents section. You can also call the number on the back of your insurance card or use the carrier's online drug lookup tool. If your medication isn't on the formulary, your doctor may be able to request an exception.

🏥 What counts toward my deductible?

Most medical services count toward your deductible — doctor visits, specialist visits, lab work, imaging, surgery, and hospital stays. Preventive care (annual physicals, screenings, vaccines) is covered at 100% and does NOT count toward your deductible. Telehealth visits are also $0 on all plans.

🦷 Is teeth whitening covered by dental?

No. Cosmetic dental procedures like teeth whitening, veneers, and elective implants are not covered. The dental plan covers preventive, basic restorative, major restorative, and orthodontia services.

🧠 Does the plan cover mental health?

Yes. All three medical plans cover mental health and substance use disorder services at the same level as physical health care (this is required by law). Telehealth mental health visits are $0 on all plans. In-person visits are covered at the same rate as primary care. The EAP also provides free, confidential counseling sessions.

📋 What if I miss the enrollment deadline?

If you miss the November 22 deadline, you will be enrolled in the same coverage as last year (or no coverage if you were not previously enrolled). You will not be able to make changes until the next Open Enrollment period unless you have a qualifying life event. Please don't miss the deadline!

📞 Who do I call if I have a billing problem?

First, call the member services number on the back of your insurance card. If you're still having trouble, contact HR at benefits@tenkeyinc.com or (508) 555-0100. We're here to help you navigate any billing issues.