Navigating health care jargon: ensure benefits don’t get lost in translation
If deductibles, copayments, coinsurance, in-network, out-of-network, preventive care, SBC, and prior authorization leave your employer clients and their employees scratching your heads, they're not alone.
If deductibles, copayments, coinsurance, in-network, out-of-network, preventive care, SBC, and prior authorization leave your employer clients and their employees scratching your heads, they’re not alone.
Survey says: health insurance is confusing
A recent survey found that 39% of insured Americans say they do not understand what their health insurance covers. Research shows individuals struggle to identify the difference between deductibles, copayments and coinsurance. The definitions of in-network and out-of-network benefits might seem obvious on the surface, but when you dig into the fine print, some plans offer cost-savings for out-of-network claims and others do not. These details can dramatically affect costs that trickle down to your employees.
Even though preventive care and screenings are required to be included at no charge to members under the Affordable Care Act (ACA), the definitions of what’s included are outlined by the U.S. Preventive Services Task Force (USPSTF). While the average consumer is not researching USPSTF’s recommendations, it is crucial to understand that preventive care and screenings are not carte blanche. There are narrowly defined requirements and specifics for the health care services and treatments included in benefit plans that should be considered.
While these are just two examples, not understanding health insurance can lead to underutilizing benefits, delaying or avoiding necessary care, higher costs for employees and your organization, inefficient use of HR resources, low morale, and even turnover.
So how can employers and their benefits advisors empower health plan members to choose, understand and maximize the benefit plans organizations invest in/?
Communicate and educate
Providing an overview of benefit plans at open enrollment is always the first step to opening up the lines of communication with employees. In-person or remote sessions are helpful, but not everyone wants to raise their hand in a large group setting to ask for clarification. One way around this is to host follow-up sessions that allow employees to ask questions one-on-one.
Provide regular updates, reminders, and tips on how to use the benefits throughout the year, such as navigating preventive care, understanding claims, or choosing between in-network and out-of-network providers. Outside of open enrollment, employees should have access to resources on demand. Employers don’t need to build these tools from the ground up. Health benefits administrators offer online tools, including health care and insurance glossaries, educational videos, podcasts and numerous other educational tools to help them to get more value out of their plans.
Offer employees simple and convenient access to benefit plan information so they can reference plan benefits whenever they need. Internal communications should match the needs and demographics of employees. Different approaches resonate with different audiences. For example, email may work well for office-based employees who are frequently at their computers, but for less tech-savvy staff, it may not be as effective. You want to ensure employees receive regular communications about their benefits leveraging multiple formats, including email, text messages, intranet updates, and printed materials. Adjust communication methods based on the needs and preferences of the workforce. Regardless, an internal hub to access information and resources on demand serves all audiences.
Partner with the professionals
The right employee benefits professional can offer tremendous value to HR teams — and when they work together, the best results can be achieved. That’s because HR understands their workforce’s demographics, the dynamics of their workplace, and the communication platforms available to reach their employees. On the other hand, benefits professionals know the market and can make recommendations based on their expertise. By collaborating, they can bring the best of both worlds together and develop strategies tailored to the health plan’s population. This might include tying health insurance education with wellness initiatives, showing employees how their plans can support preventive care, mental health resources, or fitness programs, offering incentives for completing preventive screenings or participating in wellness challenges.
Health insurance is notoriously complex. Partnering with an experienced employee benefits professional can cut through the confusion, and clarify the endless acronyms, legal and insurance lingo. The true value of health benefits lies in understanding them, and with the right partner, maximizing an organization’s plans becomes much easier
Sara Fluskey is Chief Marketing & Communication Officer at Nova Healthcare Administrators, Inc.