How to Help Employees Understand Their Benefits and Choose the Right Plans

It’s no secret that employees value their health benefits. However, many workers find insurance plans confusing. So they often put off enrolling in benefits programs. About 73% of employees spend less than an hour, and 41% spend less than 30 minutes, reviewing plan information. Because employee benefits can change each year, workers need to know their coverage options. Here’s how employers can help employees understand their benefits and choose the right plans. Educate workers on these six things:

Costs

Before reviewing new benefits packages, employees should make a list of their current plans, including the monthly premium, copayment and deductible amounts. They should compare this information with the new benefits offered for the next year. Seeing these numbers side-by-side will help workers know if they need to budget more to cover out-of-pocket costs. If there are several plan options, workers may need to select another plan to save money. It pays to understand how much all of the benefits cost.

Coverage levels and features

Review current services and coverages offered by benefit plans. Which options do employees and their family members use most? Will they have new health needs in the next 12 months that they’ll need to cover? Are there waiting periods on any services? Is there a pharmacy benefit that covers critical medications? Workers should carefully read over the new benefit plans to gain an understanding of any changes. Then verify plan features and coverage levels to determine if the benefits will meet their needs.

Network providers

Most employer-sponsored health plans have preferred providers and hospitals that are listed as in-network. These providers agree to accept a set payment amount from the insurance company for each covered service. Employees should find out if their health providers are in-network. If they are not in-network, workers will either need to find new providers in the network, or settle for out-of-network benefits. Employees should review these frequently used insurance terms to understand their benefits better.

Frequency limitations

Many employees and their family members need care from specialized health professionals. When reviewing benefit choices, workers should check if new benefit plans limit the number of visits for specialty care, such as mental health, physical therapy or chiropractic care. Understanding these benefits can mean the difference between getting the coverage needed to continue care or not.

Plan options

Encourage workers to compare their benefits alongside those available through their spouse’s employer. This is especially important when selecting coverage for kids. Working parents will want to choose the benefits that best fit their family’s needs. If employees anticipate family changes, such as marriage, divorce, or the addition of new dependents, they need to know the cost of adjusting coverage. When changing plans, it also helps to know when existing carriers need to be notified.

Insurance carrier reputation

When plan options involve different carriers, employees should review each carrier’s history. They will want to know the coverage specifics and about the carrier’s customer service and claims processing record. It’s also vital to check a carrier’s insurance ratings, financial stability, and how long they’ve been in business. Visit their websites and review their news releases, too. This way, employers and employees can avoid selecting an insurance carrier with financial difficulties or problems paying claims.

Many employer-sponsored health benefits feature plans with a Participating Provider Organization (PPO) network. Find out the benefits of a PPO provider network design, such as the savings associated with in-network providers.

Sources and References:
SHRM