Supplemental health & financial wellness benefits: Providing value beyond a paycheck

The proliferation of State Paid Family and Medical Leave programs alongside the Federal FMLA has been an overdue and needed support structure for individuals struggling with medical crisis, family needs or behavioral health issues.

While the job protection and modest amount of financial support is there to help individuals through tough times, there are surprises (and not good ones) that leave employees with larger than expected medical bills, a lack of caregiver support, or just not enough money to make ends meet.

We’ve also seen a proliferation of supplemental health products that employees may purchase to counter the high deductibles that can come with medical plans. The lump sum benefits these provide are extremely helpful in the event of an accident, hospitalization, or even a long-term illness.

Premiums are paid through payroll deduction, which is simple and convenient. However, when the time comes to actually use these benefits, employees can forget they have the coverage, or they do not realize their situation may be covered. Carriers, brokers, and employers all play a role in educating employees on these benefits prior to purchase.

Why is this the case?

Insurance products can be complex, and a stressful health or family situation almost always compounds the issue. As an absence management provider, we see this every day: Employees missing work and still not filing for all the benefits or entitlements they deserve. Employees struggle to understand their benefit packages – just 55% know their financial benefits, with similar rates for emotional and supplemental benefits, according to the Employee Benefit Research Institute.

What can be done to make sure employees access their benefits? In the current environment, the responsibility for recognizing which benefits are in play most often falls to the employee, not the employer or insurance company. Ideally, carriers can help flip this script, with employers and claims examiners helping recognize when claims are not filed and then connecting with insureds to proactively communicate that an event will likely qualify for a benefit.

As for employers, they can be heroes when carriers deliver this value, driving better utilization among the workforce, along with an overall improved employee experience. The legacy challenge lies in multiple, often disjointed, departments at insurance carriers – disability vs. supplemental/life insurance vs. absence. Products and services are managed in silos and integrating systems to talk to each other is difficult and expensive. There is an answer, and it begins with commitment.

The industry must fully embrace training all claim examiners to understand the big picture, working together to benefit the customer when they need it most.

So, where do we go from here?

When crises strike, employees are understandably caught up in the chaos of their situations, often without the time or energy to remember or check which benefits they purchased. This is when carriers can and should do the work to help ensure applicable benefits are identified and paid.

In these situations, claims integration can significantly benefit the employee, with both the employer and insurance company using data to notify the employee that a claim was set up on the employee’s behalf.

With an “auto intake” process, a carrier removes the step requiring the employee to start the process themselves.

Consider these other scenarios, in which a carrier can rely on claims integration to ensure employees receive all their benefits when they need them most.

• Often FMLA will run concurrent with employer-sponsored disability insurance. At Reliance Matrix, we manage both. With access to the employee’s data, we can look at other, supplemental benefits – not to mention local and state paid leave programs – to help ensure every applicable benefit and entitlement is considered. If, for example, someone with pregnancy complication files for FMLA and does not realize that they can file based on their hospital insurance, we can surface this benefit and file on their behalf.
• FMLA also offers 12 weeks of unpaid job protection leave to deal with a serious health condition of a loved one. When our data shows an employee takes intermittent time to travel with their spouse to chemotherapy, our claim examiners are absolutely going to check if they are enrolled in Critical Illness Family Coverage. I believe this is one of the most often forgotten supplemental health benefits worth thousands to employees.

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These advancements fall into the broader category of inclusive benefits design and delivery. It is the carrier’s role to design benefits to be flexible, giving each employer the opportunity to craft programs that are specific to the makeup of their workforce. And while identifying and paying every benefit is likely impossible, artificial intelligence and machine learning now offer superior ability to match people, products, and situations – and help get benefits paid.

In the end, we all have a responsibility to ensure employees are getting the benefits and entitlements they deserve, which we all know will only result in higher employee engagement, satisfaction, and value. It is a win-win-win, and the right thing to do.

Patrick Trinsey is the Chief Marketing Officer for RelianceMatrix, a leader in absence and employee benefits solutions including financial protection, absence management and supplemental health and insurance benefits.