Open Enrollment Without an HR Department: Explaining Benefits With AI

Turning Carrier Documents Into Plain-Language Explainers

Start with the documents you already have, because they are the source of truth for everything you will write. The most important is the Summary of Benefits and Coverage, or SBC. Federal rules require group health plans and insurers to provide an SBC in a standardized format, along with access to a uniform glossary of terms such as deductible and copayment, so that people can compare plans on a like-for-like basis. As CMS explains, each SBC also includes coverage examples showing roughly what the plan would pay in common situations such as having a baby or managing a chronic condition. SBCs must be provided at enrollment and renewal, so your carrier or broker should already be supplying them.

The SBC's standard format is both its strength and its weakness. It makes plans comparable, but it is still eight pages of grids that most people skim. This is where AI does its first useful job. Upload or paste the SBC for each plan into an approved AI tool, since these documents describe the plan and contain no personal information, and ask for a one-page explainer written at a general audience reading level. A good prompt specifies the audience ("staff at a small nonprofit, many of whom have never chosen a health plan"), the format ("a short intro, then sections for monthly cost, what you pay when you get care, and what to watch for"), and the constraint ("use only information in the attached document, and mark anything you are unsure about with [CHECK]"). That last instruction matters, because it makes the model's uncertainty visible rather than smoothing it over.

The renewal letter is the second document worth translating, though mostly for leadership and the board rather than staff. Renewal letters often bury the important facts in a table: the percentage increase, any plan design changes the carrier is making (a higher deductible, a new prescription tier, a narrower network), and the deadline for deciding. Ask the AI to extract every change from last year to this year into a simple list, with the dollar impact where the letter states it. Then ask it to draft a short memo to the executive director or finance committee summarizing the renewal, the options the broker presented, and the questions still open. A finance lead who already uses AI for payroll and benefits deductions will find this a natural extension of the same workflow.

The plan comparison sheet from your broker is the third. These are usually dense grids comparing two to four plans across dozens of rows. AI can turn them into a table with only the rows staff care about, add a plain-language column explaining each term, and flag where plans differ in ways that matter, such as whether specialist visits require a referral or whether a plan's network excludes the hospital most staff use. It can also produce a glossary sheet tailored to your plans, defining premium, deductible, copay, coinsurance, out-of-pocket maximum, in-network, and formulary using your actual numbers as examples.

Throughout, keep one rule in mind: the plan documents control. If an explainer says the deductible is $1,500 and the SBC says $1,750, the SBC wins, and the explainer is wrong. Models occasionally mix up columns, merge in-network and out-of-network figures, or carry over details from similar plans they saw in training. The fix is a line-by-line check of every number in the final draft against the source document before anything goes to staff. It takes twenty minutes and it is not optional.

The 403(b), HSA, and FSA Questions Staff Ask Every Year

Open enrollment is also when staff ask about the accounts that sit around the health plan. The same handful of questions come up every year, which makes them ideal for an AI-drafted FAQ that you verify once and reuse. The goal is to explain how each account works in general terms, using current IRS limits from primary sources, and to direct individual questions about what someone should contribute to a qualified tax or financial professional or to the plan's recordkeeper.

The 403(b). Most nonprofits that offer a retirement plan use a 403(b), the tax-exempt sector's counterpart to the 401(k). Employees can defer part of their pay, pre-tax or as Roth contributions if the plan allows, and the employer may add a match or a fixed contribution. For 2026, the IRS sets the elective deferral limit at $24,500, with an $8,000 catch-up for those 50 and older and a higher catch-up for those aged 60 through 63 under SECURE 2.0. Some 403(b) plans also allow a special catch-up for employees with 15 or more years of service at the same eligible employer. Starting in 2026, catch-up contributions for employees whose prior-year wages from the employer exceeded the IRS threshold must be made as Roth contributions. The 2027 limits are typically announced in the fall, so if they are not out when you write your materials, say so and update them when the IRS publishes them. Staff also commonly ask about vesting schedules for employer contributions and about changing their deferral percentage, which in most 403(b) plans can be done at any time, not only during open enrollment. That is worth stating plainly, since many people assume otherwise.

HSAs. A Health Savings Account is available only to people enrolled in a qualifying high-deductible health plan who have no other disqualifying coverage. Contributions are tax-advantaged, the money rolls over year to year, and the account belongs to the employee even if they leave. For 2027, the IRS has set HSA contribution limits at $4,500 for self-only coverage and $9,000 for family coverage, with the qualifying HDHP minimum deductible at $1,750 self-only and $3,500 family, as summarized by Navia Benefits. The $1,000 catch-up for those 55 and older is unchanged. Employer contributions count toward the annual limit, which is a detail staff frequently miss.

Health FSAs. A health Flexible Spending Account lets employees set aside pre-tax money for eligible medical expenses, but unlike an HSA it is generally use-it-or-lose-it, subject to any carryover or grace period the plan offers. For 2026, the health FSA salary reduction limit is $3,400, as noted in Mercer's summary of the 2026 limits, and the 2027 figure is expected in the IRS's fall inflation adjustments. A crucial interaction: enrolling in a general-purpose health FSA generally makes someone ineligible to contribute to an HSA, while a limited-purpose FSA restricted to dental and vision is compatible. If you offer both an HDHP and an FSA, your materials must explain this clearly, because getting it wrong can create a tax problem for the employee.

One reason to cite primary or authoritative sources for every limit is that AI models are often confidently out of date. A model trained before this year's announcements may state last year's HSA limit, or blend figures from different years. Before any FAQ goes out, check every dollar amount against the IRS or a current summary from your benefits vendor, and add a line telling staff which year the figures apply to.

COBRA, State Continuation, and the Required Notices Calendar

Continuation coverage is the topic small employers most often get wrong, partly because the rules depend on size and state. Federal COBRA generally applies to group health plans of private employers, including nonprofits, that had 20 or more employees on more than half of their typical business days in the prior year, as the U.S. Department of Labor explains. It lets employees and dependents who lose coverage because of job loss, reduced hours, divorce, or similar events keep the same group coverage for a limited time, usually at full cost plus a small administrative fee. It also brings specific notices: a general notice when coverage begins and an election notice after a qualifying event, with strict timelines.

Employers below 20 employees are not off the hook in many states. A large number of states have their own continuation laws, commonly called mini-COBRA, that apply to fully insured small group plans. The durations and rules vary considerably. Some states provide only a few months of continuation, while California's Cal-COBRA can extend to 36 months, and the details of who administers it, the employer or the carrier, also differ. Because these laws are state specific and change, the right approach is to ask your carrier or broker which continuation rules apply to your plan and who sends the notices. AI can help you prepare that question and summarize the answer for your files, but it should not be your source for what your state requires.

Beyond continuation coverage, group health plans carry a set of recurring notices. Some are delivered at enrollment and annually, some only when something changes, and responsibility is split among the employer, carrier, broker, and any PEO or third-party administrator in ways that are rarely written down. The Medicare Part D creditable coverage notice is a good example of a deadline small employers miss. It must go to Medicare-eligible individuals covered by the plan, including active employees and dependents, before October 15 each year, regardless of employer size, according to Newfront's compliance guidance. If your organization did not send it this year, talk with your broker now and put it on next year's calendar for September.

This is where AI earns a second role: building and maintaining a notices calendar. Give it your plan year, your headcount category, whether your plan is fully insured or self-funded, and the list of benefits you offer, and ask it to draft a calendar of notices that commonly apply, with a column for who is responsible and a column marked "confirm with broker." Then send the draft to your broker or PEO and ask them to correct it. The result is a document you did not have before, validated by someone accountable for the answer. The same calendar can carry your internal deadlines: when the renewal decision is due, when materials go to staff, when elections close, and when payroll deductions must change.

The Firm Boundaries: Advice, Health Data, and Verification

Everything above depends on four boundaries holding. They are worth stating to staff as well as observing yourself, because once people see how helpful an AI explainer is, they will naturally want to ask it about their own situation.

No individual benefits or tax advice. Your materials should describe how plans and accounts work and show general scenarios. They should never tell a specific person which plan to choose, how much to put in an HSA, whether to make Roth or pre-tax 403(b) contributions, or how a choice affects their taxes. Those questions depend on a person's health, family, income, and other coverage, and they belong with a qualified tax professional, financial planner, or the plan's own resources. This applies to you as much as to the AI. An executive director who tells an employee "you should take the HDHP" is giving advice they are not positioned to give, and doing it with AI's help does not change that. If you deploy any AI assistant that staff can query about benefits, its instructions should limit it to general explanations drawn from your verified materials and direct personal questions elsewhere.

No staff health or enrollment data in consumer AI tools. Group health plans are covered entities under HIPAA, and the information they hold about participants is protected health information. For a small employer with a fully insured plan, the practical structure is that the insurer carries most HIPAA privacy obligations, and the employer, as plan sponsor, can generally receive enrollment and disenrollment information and summary health information without becoming responsible for most of the Privacy Rule's administrative requirements. As a Maynard Nexsen compliance primer explains, that lighter position depends on the employer not taking in more health information than that. Pasting an employee's claims questions, diagnoses, dependent details, or enrollment elections into a consumer chatbot is exactly the wrong direction. Separately from HIPAA, many state privacy laws and basic employment trust argue for the same rule. Self-funded and level-funded plans carry heavier HIPAA obligations for the employer, which is another reason to know how your plan is funded. Our article on HIPAA and AI data protection covers the broader framework, and your AI acceptable use policy should name staff health and benefits data as a prohibited input for unapproved tools.

Always check outputs against the plan documents. The SBC, the summary plan description, the carrier's certificate of coverage, and the 403(b) plan document are the authorities. AI summaries are convenience copies, and every number, rule, and date in them must be verified before distribution. A practical habit is to keep a short verification log: what was checked, against which document, by whom, and when. It takes minutes and it protects both staff and the organization if a question arises later.

Lean on the broker or PEO. Most small group plans come with a broker whose compensation is built into the premium, and many brokers will provide enrollment materials, run employee meetings, answer staff questions confidentially, and track compliance notices if asked. If your organization uses a PEO, it likely handles enrollment administration, many notices, and COBRA or state continuation. Using AI does not replace these relationships. It makes you a better-prepared client: you arrive with a clear summary of the renewal, specific questions, a draft notices calendar for them to correct, and staff materials for them to review. Escalate to the broker, PEO, or benefits counsel whenever a question involves eligibility, a qualifying event, ACA status, continuation coverage, a staff member's individual claim, or anything where getting it wrong carries a penalty.