A recent survey of individual consumers, employers, benefits brokers and consultants quantified this phenomenon as a "confidence disconnect," or gap, between employers and their employees when it comes to health care benefits. The survey showed that 88% of employers believe their workers are confident in understanding their health care benefits. However, only 52% – barely half – of individuals surveyed say they feel confident. Meanwhile, only 45% find it easy to use their health benefits, and only 35% find it easy to navigate the health care system.

Why do gaps matter?

Consumer knowledge gaps can negatively influence utilization of benefits, patient engagement and compliance with care plans. In addition, surveys continue to show that health care literacy is lacking, which has been shown to contribute to poor health outcomes and higher health care costs caused by inappropriate use of health care services and benefits.

As benefits professionals, we can reduce or eliminate the benefits confidence gap and deliver a better health care experience for employees by helping them understand the following five things about their benefits, which, according to recent research, represent the most common challenges that employees face when accessing health care.

1. Finding coverage details

Help employees understand their coverage details and where to look when they need to verify if specific needs or clinical services are covered by their plan. Understanding their coverage also includes making them aware of their plan type (HMO, PPO or high-deductible health plan, for example), the amount of their copay or coinsurance, and how their deductible works.

Spend time communicating early and often, taking time to guide employees to key coverage details within their Summary Plan Description or within your online benefits portal. Doing so can help them avoid surprise expenses down the road. Find ways to make this information easily accessible in the workplace or employee portal and be creative in finding ways to reference it throughout the year.

2. Finding doctors and accessing care

While this step may seem like the easiest part of health care, it's an area employees find challenging. Take time during open enrollment to teach employees how to use your find-a-doctor app, cost and quality tools, and provider search for their chosen plan and network.

Having health care navigation that includes care coordination services can provide personalized support and ensure employees get the care they need at the right time, thereby avoiding missteps that can generate unnecessary costs or delay their care plan. And because COVID has made telehealth a primary option for many patients and providers, it's important that benefits teams clearly communicate to employees the virtual care options available to them and how using them may or may not affect employer-employee cost sharing.

3. Deciphering EOBs and bills

The health plan Explanation of Benefits (EOB) can generate concern among employees if they don't understand what it means and how that relates to the actual invoices they will receive from their care providers. Consider creating a mock EOB as part of your open enrollment communications and use graphic callouts to explain the various sections of the document and the actions employees should take, if any.

Teach employees how to reconcile their EOB with the bill they receive from their provider, so they understand how much they owe or contest a charge. It's important that employees understand never to pay for services until reconciling their bill and EOB. You can also help by providing proactive information about what to do if met with high health care bills and whom to contact.

4. Securing prior authorizations and referrals

Employees who have had limited experiences with health care likely won't know they need prior authorizations or referrals for certain types of care and for certain levels of prescription drugs or medical equipment. Failure to secure a prior authorization can impact their coverage, which makes this information essential. Consider including a section in your benefits communications about prior authorizations, or ask your health plan to provide language you can use in your open enrollment communications. You can eliminate this burden for employees by leveraging the expert knowledge and experience of your health care navigation partner in facilitating authorizations on behalf of your employees.

 5. Test results and treatment options

Accessing and understanding test results and treatment options feels both scary and foreign to most employees. Take time during open enrollment to educate employees about how a patient portal works and the kinds of information a patient portal will provide. This is another good opportunity to inform employees about supportive services, either through the health plan or a navigation partner, that are available to them.

Even if you think you've overcommunicated these details already, communicate some more, because one thing I've learned working as a benefits leader with a background in health care navigation is that the gaps are real between what we think our employees understand and how they actually engage with their health care benefits. Open enrollment is the time to bring attention to the fine details and help employees understand how to use their benefits. While those details can seem overwhelming, continuing to educate and communicate even after open enrollment will keep the information and lessons fresh, which can increase utilization.

For human resources professionals, demystifying health care benefits should be part of annual planning and team goals. To fully understand the impact of health care benefits complexity on employees, consider the following research findings from a recent Quantum Health survey:

• Among individuals who experienced challenges with health care (79% overall), 57% suffered a resulting negative impact, including: a significant decline in mental well-being (19%), a significant decline in physical health (17%), or interference with a prescribed treatment plan (16%).
• For people with complex or chronic conditions, 76% said they had suffered a negative health impact because of health care complexity, including a decline in mental well-being (28%), a decline in their physical health (37%) and interference with a prescribed treatment plan (28%).
• Meanwhile, 60% of respondents in a recent survey said they have had to spend time during their workday on health care-related tasks for themselves or a loved one in the past two years. When that occurred, the average time spent was 27 minutes.

It's not too late to take advantage of open enrollment and the opportunity it provides to educate employees and close the benefits confidence gap. By creating an enrollment experience that supports all employees, wherever they are situated across the spectrum of health care needs, you can improve benefits understanding for employees, which in turn can influence utilization, and maximize enrollment in the benefits options you offer.

Read more: 

• Employers not confident in employees' health plan understanding
• The benefits help people need right now
• Only half of employees feel they understand their benefits