Studies show that 50%* of employees don’t understand their health benefits. As a human resources or benefits manager, this may be especially apparent to you during open enrollment or after the first of the plan year. Employees usually begin asking questions after they receive an Explanation of Benefits (EOBs) statement or medical bill they don’t understand. And by this time, the employee and you, the employer, may have been impacted financially, maybe even unnecessarily so.
When diving deeper in trying to understand what, specifically, about their benefits employees don’t understand, we often find lack of understanding in:
- Employee responsibility of copay, deductible, out-of-pocket maximum, and co-insurance amounts
- In-network healthcare options
- Which facilities are covered (labs, outpatient facilities)
- When to seek care, and with what urgency
- How to make the best healthcare decisions based on medical condition
- Which prescriptions are covered
- Which pharmacies are covered, etc.
When viewing this list, it may be easy for benefits managers to wonder “Well, how do they still not understand their benefits when we have an extensive employee education program, we distribute a large booklet during open enrollment, provide information with every pay check, send them email reminders …” The answer to this is quite simple—until employees are actually faced with the financial impact of their healthcare decisions, all of the above may be information overload, and they may not take the time to prepare.
For example, imagine waking in the middle of the night to an inconsolable toddler who has a high fever and a rash, but they can’t tell you “what hurts.” As a parent, your first instinct might be to take them to the emergency department (ED) because you have no idea how sick they are. Upon arriving at the ED, you discover that your child has a virus, which needs to be remedied with plenty of fluids, fever reducers, and rest. While you’re relieved that your child is going to be okay, you may be wondering if there are ways to avoid such a scenario in the future, with finances and time in mind.
Rushing to the ED during times of after-hour sickness used to be a fairly common practice, but can be a costly option. With the advancement of technology, there are resources available, now more than ever, that can empower employees to take charge of their healthcare by making better, more cost efficient decisions that save both you, the employer, and them valuable resources. For example, calling a nurse advice line in the above scenario would have afforded the opportunity to speak with a trained medical professional who could better assess the need to report to the ED versus waiting to be seen at primary or urgent care the next day.
Costs vary depending upon the type of facility the patient visits. For comparison, here are the average costs per visit by setting:
Emergency Room $619
Urgent Care Center $132
Primary Care Doctor $78
“Virtual” Doctor Visit $35
One way employers can challenge employees to be prepared for any healthcare decision, whether emergent or not, is to pose questions that create a mock health scenario, such as the one listed above. Employees should be able to answer questions like:
- Where is the closest in-network urgent care facility? Where is the closest emergency department? (In relation to home, school, or work)
- What are the copays?
- Does the employee know where their insurance cards are?
- Are insurance cards available in a digital format on an app, for example, or stored on their phone as an image?
- Does the health plan or the employees’ primary doctor’s office offer a nurse advice line or care management services? These services are designed to alleviate some of the burden in determining how urgently a patient needs to be seen.
- Are telehealth services available?
- If a prescription is needed, does the employee know which drugs are covered or where to locate a list of covered drugs?
- Which pharmacies are in-network?
- What are the copays for each tier of medication prescribed?
- Is it more cost-effective to pay a cash price? (Paying for prescriptions out-of-pocket as opposed to using insurance coverage. See “Pharmacy Apps” below.)
- Is an Employee Assistance Program (EAP) available?
This is just a small sample of questions, but may be enough to get employees’ wheels turning so they are prepared in the event of a healthcare emergency or urgent care need.
Benefits managers can make employee education activities engaging and rewarding. Perhaps every employee who completes a mock healthcare scenario–and is able to answer pertinent healthcare questions, such as those above–is entered to win a giveaway. Or those who download the health insurance carrier’s mobile app get a coupon for free ice cream. The possibilities are endless, but the end goal should remain the same—to help employees understand their health benefits.
There are many tools and resources in the form of apps available to assist employees in taking control of their healthcare decisions. Keeping all of these resources together in one folder on a mobile phone is a great way to be prepared.
Health Insurance Apps
Does the health insurance carrier offer a mobile app? If so, the employee can easily access lists of in-network providers, copies of insurance cards, access customer help representatives, wellness incentives, etc. Encourage employees to download the app and take a look around. They might discover resources they didn’t know existed and may be left feeling empowered to handle whatever health incidents may come their way, even if they are traveling or need information on resources quickly.
GoodRx is a helpful pharmacy resource. On this free app, patients can look up specific drugs and then use the location search feature to determine which pharmacies nearest to them carry the drug at the lowest cost. In addition to a list of locations, the app reveals any current coupons or discount codes which can be applied to the cost of the drug. If the cash price of the drug (not using insurance) is cheaper than a patient’s pharmacy copay, the patient can simply show the coupon from their phone at the pharmacy counter and purchase the prescription at that price if they choose.
Improving healthcare requires moving beyond the bottom line and implementing the right mix of benefits, education and guidance. Presenting employees with real-world examples of the financial impact their decisions can have is a great way to build trust with employees as it shows that you, the employer, care about their overall wellbeing—financial wellbeing included.
*International Foundation of Employee Benefit Plans (IFEBP)