According to the Kaiser Family Foundation’s 2014 Employer Health Benefits survey, the enormous increase in healthcare cost has led many employers to consumer-driven health plans, which allow employees to make financial decisions on their health insurance. WorkForce.com offers the following advice for employers handling healthcare-related inquiries from their personnel:
Employees used to be able to choose between an HMO and a PPO and they
were pretty much done with their health insurance decision-making for
the year. “Decisions, decisions” could be summed up as “decision; done.”
Not anymore. Thanks to tremendous health care cost increases — average
health insurance premiums for families jumped to $16,834 in 2014 from
$9,950 in 2004, according to the Kaiser Family Foundation’s
2014 Employer Health Benefits survey — more employers are turning to consumer-driven health plans to help offset the costs.
The days of Door No. 1 or Door No. 2 are out the door.
In other words, employees are being asked to make financial decisions
about their health care that they’re not accustomed to so they’ll have
questions, and it’s up to benefits managers to have the answers.
For instance, what if your company offered a new high-deductible health
plan? And say employees took up the new plan (or plans) at a truly
impressive rate, which has you excited for the new era of health care
consumerism. Good for you! Now you can just sit back and wait as all the
changing behaviors and health care savings begin.
Well, maybe that’s a stretch. Sitting back is what happens on gigantic
human resources teams. You work on a benefits team. There are only a
handful of you, and while you all might collectively exhale and
celebrate your triumph, you can’t really take the time to relax because a
wicked number of first-quarter benefits questions this way comes, and
you’re maybe a little bit anxious about what’s going to happen once
employees start using those shiny new plans.
Don’t fret. That kind of concern is totally natural. Unfortunately, I
can’t say it’s unwarranted. Thousands of your employees have just made
decisions that will affect the way they’ve been brought up to understand
managed care, and some might find the process frustrating and
confusing.
You might not hear about these frustrations at first because employees
frequently turn to their providers when health insurance questions pop
up. But there’s a very good chance they’ll find their way to you
eventually, so it’s a good idea to brace yourself for the challenges
employees will seek guidance on in the coming weeks.
I’ll walk you through what you can expect, but first, let’s go back a
few months and look at what happened during open enrollment.
What Happened?
You thought your people understood their plans. Sure, there were a few
hiccups, education-wise, in the period leading up to enrollment, but
that’s to be expected. Health insurance is confusing (I’m looking at
you, deductibles and maximum out-of-pocket limits), and explaining the
differences between health savings accounts, or HSAs; health
reimbursement arrangements, or HRAs; and the limited and original-recipe
versions of health care flexible spending accounts, or FSAs, can test
even the most patient and beneficent of benefits professionals.
But you did it.
You and your provider spent weeks or even months lovingly pummeling
employees and their families with useful HDHP resources, decision
support and education, and with the help of your third-party
administrator, you were able to get everybody’s accounts set up
properly.
Everybody should be HDHP experts now, right?
Not so much. Here’s the thing — the biggest employee concern leading up
to enrollment involves their plan decisions, their “What should I
do’s?” and their “How should I feel about it’s?" It’s a tough row to hoe
(for more on what’s going through your employees’ minds during this
stage, see “Can’t Retain, so You Must Explain”), and exotic concepts
like explanation of benefits forms and limited FSAs only make things
harder.
What employees don’t want at this time is HDHP
education. That
doesn’t mean you shouldn’t make education resources available. It just
means that employees aren’t interested in becoming HDHP experts. At the
point of enrollment, they’re worried about knowing enough to make a
decision, and when they start using their plans, they just want to know
enough to feel comfortable and taken care of.
Now you’ll never be able to get an employee to want to learn about
HDHPs for his or her own enjoyment, but you can help them with the
things they need to know when they come to you for help. Like when
there’s ...
Point of Service Perplexity
The first you’ll hear from employees after the business of choosing
plans and setting up accounts is taken care of is when they start
actually using their plans, and the questions you’re most likely to
encounter are going to be about what happens at the point of service,
especially with pharmaceuticals.
Expect some sticker shock. Like when your employees head to the
pharmacy in the middle of flu season and discover their prescription for
Tamiflu is going to cost $130 instead of the $20 they would have paid
with last year’s prescription drug benefit.
Another source of frustration employees encounter happens at the
doctor’s office. If they haven’t done any research ahead of time, they
don’t know what they are going to have to pay at the time of service,
and the doctor’s office staff can’t give them a straight answer because
they don’t know the details of the plan.
Here are some steps to combat point of service perplexity:
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Remind employees that spending for prescription drugs applies to their deductible.
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Make sure to use a price transparency tool or service. Promote your
transparency solution to employees as a “health care shopping service,”
and show employees how it can make shopping easier while taking the
mystery out of what they’ll pay.
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Promote free prescription drug price comparison tools like goodrx.com,
which show the costs of drugs at local pharmacies and provide coupons
for discounts.
HSA Funds Befuddlement
HSA confusion comes in all shapes and sizes. You’ve no doubt witnessed
this at open enrollment, but once the plan year starts, you’ll get new
and different types of questions.
One of the first points of confusion to pop up, HSA-wise, happens at
the start of the year when employees realize that they don’t have any
money in their accounts yet. If you don’t load HSA accounts with funds
available for immediate use, employees accustomed to how their health
care FSAs worked could come knocking on your door wondering where their
$600 contribution went.
Another common HSA issue involves the amount of money employees have
chosen to contribute to their accounts. It’s important for them to
understand that they’re not locked into what they thought they needed
last year during open enrollment. They might have underestimated their
health care needs or need to trim back the level of their contributions.
Here’s how you can help reduce HSA funds befuddlement
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Remember all those resources you made to help employees understand HSAs during open enrollment? Start promoting them.
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Convert your HSA education resources into small messages that you can
promote via email or social media. Nobody’s going to sit down and read
the benefits guide over again, but a tweet-length email can certainly
catch someone’s attention and jog that person’s memory.
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Think about the issues your employees might face and when they might
face them. For example, January might be a good time to explain that
employees can use HSA funds to reimburse themselves, so if they don’t
have any money in their account for services today, they can pay
themselves back later once their contributions start adding up.
Preventive Care Coverage Confusion
Imagine this: Your employees are starting to get the hang of their
HDHPs and start becoming good health care consumers by taking advantage
of their 100 percent covered preventive care. Great, right?
Of course it’s great. Preventive care helps keep people from getting
sick, and helps detect diseases and medical issues before they become
more serious. What’s not-so-great is the reactions some employees get
when they receive unexpected bills for services they thought were
supposed to be free.
Suppose an employee goes to a primary-care physician to get a physical.
While there, the employee presents to the doctor allergy symptoms, so
the doctor writes a prescription, and then a few weeks later the worker
gets a bill and comes knocking on your door for an explanation.
Here’s how you can help clear up preventive-care coverage confusion
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Encourage preventive-care use, but be sure to let employees know that
when they start talking to a doctor about new or ongoing medical issues,
they may be charged for the doctor’s efforts to treat those issues.
These are not considered “preventive.” In other words, the diabetes
screening will be free, but the cost of treating diabetes won’t be.
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Make sure your preventive-care-coverage communication drives home the
value of covered care in terms of real dollar values. For example, “Go
see your doctor, and your plan will pick up the cost of your preventive
care: Your physical is valued at $90, your standard lab tests are valued
at $73, and your doctor’s evaluation of that pain in your back (or
whatever else that ails you) is $38, but you’ll pay nothing for visit.”
EOB Ennui
The last HDHP challenge you’ll face is helping employees with the sense
of tedium, weariness, and malaise caused by their explanation of
benefits, or EOB, forms.
EOBs are confusing, rage-inducing, fonts of frustration. Anybody who
considers themselves a fully functioning adult will recognize the layout
of these things and reasonably think, “This looks like it’s a bill,”
yet somewhere on the page is a line that says, “Not a bill.”
What gives?
Employees new to HDHPs, when they get their first explanation of
benefits, don’t understand what they’re supposed to be about. What are
they supposed to do with them? File them? Throw them away? Process a
payment somewhere despite the “Not a bill” announcement?
They’re also very likely going to suffer a bit of sticker shock. After
all, they’re not reading the average, run-of-the-mill explanation of
benefits one might get for getting coverage out of network. What they’re
getting is an EOB for an HDHP, which is a delightful way of seeing in
black and white how none of your services are covered by insurance.
Now since the logo on the top of the EOB page is going to belong to
your provider, you may not hear anything about explanation of benefits
at all, but if you do, you’ll probably find yourself talking to
employees who want some sort of validation that everything was processed
correctly.
Here’s how you can treat EOB Ennui:
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If there ever was time to talk about the value of having lower monthly premiums, this is it.
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Check with your provider to see if they’ve prepared any “how to read
our EOB” resources, which can walk employees through their EOBs on a
line-by-line basis.
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Be ready to explain how deductibles and maximum out of pocket limits
are met, how the provider pays the medical provider (remember—not a
bill), and what kinds of things will be covered and at what levels (like
preventive care) before the deductible and MOOP are met.
Founded by Larry J. Wedekind in 1996, IntegraNet is an independent physician association that works closely with various healthcare plan providers to ensure the delivery of quality and affordable medical care. Subscribe to this blog for more healthcare-related discussions.
