Open Enrollment Is Live: Your 2026 Action Plan
Open enrollment has started, and small businesses across Pennsylvania, New Jersey, and Delaware are making choices that will shape their 2026 budgets. Industry tracking shows employer health benefit costs are likely to climb again. Mercer’s national employer survey points to an average increase of about 6.5% for 2026, with higher outcomes if no cost controls are applied. Mercer employer survey (2025). The question now is not if costs will rise, but how to act during open enrollment to protect your plan and your people.
At Health & Benefits Partners, we focus on small business health insurance strategy for PA, NJ, and DE, and we can evaluate other states by request. Use the action steps below to make the most of the open enrollment window.
Week-by-Week Guide for Small Employers
Week 1: Confirm Your Goals and Budget
- Set a target increase you can live with. Decide if you want to hold the line on premiums or adjust plan design.
- List must-have benefits for your team, such as key hospitals or specialists.
- Start here if you need a fast overview: Small Business Health Insurance in PA, NJ, and DE.
Week 2: Choose Your Pathway
Pick one of three routes based on your workforce and cost control needs.
- Stay Group, Tune Design: Consider a good-better-best lineup, an HSA-compatible plan with employer HSA seed, or level-funded options. See: HMO vs. PPO.
- Switch to ICHRA: Set a fixed employer contribution while employees choose individual-market plans. This approach works well for hybrid, part-time, or remote teams. Learn how to implement it here: Set up an ICHRA for your company. For a plain-language explainer, read: Guide: ICHRA for small businesses.
- Blend Solutions: Keep a core group plan and use ICHRA for hard-to-cover groups such as variable-hour or remote employees.
Week 3: Validate Networks and Medications
- Confirm that the hospitals and doctors your team uses most are in network.
- Check high-cost medications on each plan’s formulary to avoid pharmacy surprises.
- Share our practical guide: How to Educate Employees on Their Health Plans.
Week 4: Communicate Choices to Employees
- Explain what changed, why it changed, and how to choose.
- Show simple ways to save: stay in network, use preventive care, and consider telehealth or urgent care for non-emergencies.
- Provide side-by-side comparisons and a one-page checklist for selecting a plan.
Week 5 and 6: Enroll, Verify, and Close Gaps
- Make sure elections match payroll deductions and carrier submissions.
- Confirm dependents, PCP selections when required, and any referrals.
- Schedule a post-OE review to prepare for business health plan renewal 2026 and set your education calendar for Q1.
Decision Helpers for 2026
Use this quick comparison to decide whether a traditional group plan, an ICHRA, or a blended approach fits your team and budget.
| Criteria | Traditional Group | ICHRA | Blended |
|---|---|---|---|
| Best fit | A traditional group plan fits best when you have a stable full-time team with similar coverage needs. | An ICHRA fits best when your workforce is hybrid, part-time, seasonal, or spread across multiple locations. | A blended approach fits best when your core team stays on group coverage and hard-to-cover roles move to ICHRA. |
| Employer cost control | Cost control is moderate and depends on renewal results and claims experience. | Cost control is high because the employer sets a fixed monthly allowance. | Cost control is high for the ICHRA segment and moderate for the group segment. |
| Employee choice | Employees choose from the plans you select and sponsor. | Employees choose from a broad range of marketplace plans that fit their needs. | Core employees choose from group options while ICHRA participants have broader individual-market choices. |
| Administrative effort | Administration is centralized with a single plan and consolidated billing. | Administration includes an allowance policy, reimbursements, and substantiation rules. | Administration combines standard group tasks with light ICHRA policy management. |
Learn more about each path: Small Business Health Insurance · Set up an ICHRA for your company · Guide: ICHRA for small businesses
Who We Help in the Region
We focus on PA, NJ, and DE, and we can review other states by request. See tailored options for your industry:
Additional services that can strengthen your program: Benefits Administration, HR Solutions, Individual Insurance, Medicare, IBX Plans.
Compliance Quick-Check During OE
These are the items most small employers review during open enrollment. Timing can vary by plan design and employer size, so confirm with your advisor or legal counsel.
- Summary of Benefits and Coverage (SBC): Provide a standardized summary for each option so employees can compare coverage and costs. Provide at open enrollment, at enrollment, and when plans change.
- ICHRA Notice (if using ICHRA): Explain allowance amounts, how reimbursements work, opt-out rights, and Marketplace coordination. Generally due 90 days before the ICHRA plan year or by the date an employee becomes eligible.
- Medicare Part D Creditable Coverage Notice: Tell Medicare-eligible employees and dependents whether your prescription coverage is creditable. Send annually before October 15 and at certain events such as hire, enrollment, or plan changes.
- WHCRA (Women’s Health and Cancer Rights Act): Provide an annual notice if your plan includes mastectomy-related medical/surgical benefits. Provide at enrollment and annually thereafter.
- CHIP/Medicaid Premium Assistance: Share the model notice if any employees live in states offering premium assistance. Provide annually and upon request.
- HIPAA Special Enrollment Rights: Explain rights to enroll midyear after marriage, birth, adoption, or loss of other coverage. Provide at or before the first day of eligibility and include in open enrollment materials.
- COBRA Initial Notice (if COBRA applies): Explain continuation rights to covered employees and spouses. Send within 90 days of coverage start; separate election notices go out after qualifying events.
Tip: Keep a simple log of what was sent, to whom, when, and by what method. It helps with audits and employee questions.
Plan Ahead for 2026
- Set a Q1 calendar for employee education to improve utilization and employee benefits cost control.
- Review HMO, PPO, and level-funded options to align cost and access. Helpful explainer: HMO vs. PPO.
- Track costs now so you can budget early for the next renewal cycle.
You might also find these helpful: Rising Health Insurance Costs · How to Re-evaluate Your Plan Mid-Year.
Talk With a Local Advisor
Open enrollment moves fast. Whether you are renewing a group plan, setting up an ICHRA, or combining both, our team can help you evaluate options and communicate changes clearly.
